Categorization of Aggressive Acts Committed by Chronically Assaultive State Hospital Patients

This study examines the relationship between psychiatric symptoms and violent/disruptive behavior among 192 inmates who participated in prison-based substance abuse treatment. Participants came from two sites able to provide narrative reports of disciplinary actions in the Criminal Justice Drug Abuse Treatment Studies' Co-Occurring Disorders Screening Instrument study. In multivariate logistic models, a lifetime history of thought insertion/control ideation (OR, 11.6; 95% CI, 1.8-75.2), antisocial personality disorder (OR, 3.3; 95% CI, 1.2-8.9), and disciplinary action related to possession of controlled substances or contraband (OR, 4.9; 95% CI, 1.9-12.3) were associated with increased risk for violent or disruptive behavior while in prison, whereas lifetime phobic symptoms (OR, 0.2; 95% CI, 0.1-0.54) and high school graduation (OR, 0.4; 95% CI, 0.2-1.0) were associated with a decreased risk of violence and disruptive behavior in general. We conclude that, among inmates in substance abuse treatment, symptoms that increase risk for violence or disruptive behavior include thought control/insertion ideation and disciplinary infractions related to controlled substances, contraband, or failure to participate in assigned programs, as well a history of antisocial personality disorder.

Section: Discussionmentioning

confidence: 99%

Violent and disruptive behavior among drug‐involved prisoners: Relationship with psychiatric symptoms

Friedmann

Melnick

Jiang

et al. 2008

“…A recent study of aggressive acts among civilly committed inpatients showed that the most common type of aggression was impulsive (54%), even though most patients suffered from a psychotic disorder (Quanbeck et al, 2007). Using the method developed by Stanford and Barratt (1992), the investigators systematically described and then categorized aggressive acts as impulsive, organized (corresponding to Barratt's premeditated aggression), and psychotic (secondary aggression due to psychotic symptoms).…”

Section: Inpatients Who Assault While In the Hospitalmentioning

confidence: 99%

Schizophrenia and impulsive aggression: A heuristic inquiry with forensic and clinical implications

Felthous

2008

Assessment of a violent act committed by an offender with schizophrenia typically focuses on whether the act was due to distortions in thought or perception, i.e., delusions or hallucination. An important but less appreciated feature is the impulsivity of the act, which can have forensic and therapeutic implications. Here a modification of Barratt's classification of aggressive behavior is presented that includes premeditated (instrumental), medical (secondary), impulsive (expressive), and compulsive (instrumental and expressive) aggression. Violence due to a mental condition such as schizophrenia is considered medical, but even aggression motivated by delusions or hallucinations can also be characterized as impulsive, premeditated, or compulsive.Although research on aggression and schizophrenia is limited with regard to the impulsivity-premeditation dimension and difficult to compare, current evidence suggests this to be an important consideration in the assessment of aggression in individuals with schizophrenia, important both forensically and therapeutically. Future research on the impulsive-premeditated quality of aggressive acts by offenders with schizophrenia--research wherein aggressive behavior is defined, situational context is clarified, and diagnostic criteria are explicitly followed--should further refine our understanding of the nature of aggressive acts associated with schizophrenia. Findings from such research will undoubtedly inform assessment, treatment, and forensic relevance of schizophrenia-related physical aggression.

“…Three primary motivations for assault were described: impulsive-an assault committed in response to an immediate provocation and associated with agitation and loss of emotional control; planned-a controlled assault committed for a specific goal; and psychotic-assaults committed as a consequence of delusions, hallucinations, and/or disordered thinking. In recent work using the same categorization scheme, impulsive/reactive assaults comprised the largest number of observed incidents of aggression (46%; Quanbeck et al, 2007). As such, it should not be surprising that the PCL-R is not as strongly related to this type of aggression.…”

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confidence: 97%

“…Because previous research has indicated that impulsive aggression is the type of misconduct most often observed in psychiatric settings (Quanbeck et al, 2007), it may be that only certain aspects of the measures of psychopathy are associated with this type of aggression, such as factors measuring impulsive lifestyle. Additionally, measures of psychopathy may be most associated with aggressive incidents over a longer time period, whereas psychiatric symptoms may be more associated with imminent aggression; that is, aggression exhibited in the days or weeks after an assessment, rather than years.…”

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confidence: 99%

The accuracy of risk assessment instruments in the prediction of impulsive versus predatory aggression

McDermott

Quanbeck

Busse

et al. 2008

Actuarial violence risk assessments, many of which include the construct of psychopathy, have been shown to be superior to clinical judgment in the prediction of long-term risk of community violence and recidivism. While these instruments initially appeared to provide similarly accurate judgments of risk of institutional aggression, recent research has indicated that such assessments may be less robust in this setting. One explanation may lie in the types of aggression most frequently observed in each setting. Impulsive (or reactive/affective) is the type of physical aggression most commonly exhibited in psychiatric facilities. This research examines the relationship between risk assessments and aggression in an inpatient forensic setting, with such aggression categorized as impulsive, predatory or psychotic aggression. Consistent with previous research, impulsive aggression was the most frequent type observed (58%). Anger (as measured by the Novaco Anger Scale) and clinical issues (as measured by the HCR-20) were most associated with impulsive aggression, with AUC values of .73 and .71 respectively. In contrast, anger and psychopathy (as measured by the PCL-R) were more associated with predatory aggression, with AUC values of .95 and .84 respectively. Psychotic symptoms were highly associated with psychotically motivated aggression (AUC=.90). These results suggest that traditional violence risk assessments may have limited utility in predicting aggression in an institutional setting and that psychiatric symptoms and heightened affect are more relevant.