Utility of Social Cognition and Insight in the Prediction of Inpatient Violence Among Individuals With a Severe Mental Illness

Abstract

The purpose of this study was to assess the utility of social cognition and insight in the prediction of violence in a psychiatric inpatient sample. Violence history, demographic information, symptomatology, neuropsychological functioning, social cognition (i.e., attributional style), and insight were assessed in 29 inpatients with severe mental illness. Greater posttest violence was associated with greater pretest violence, less education, greater psychiatric distress, neuropsychological impairment, and hostile attributional and personalizing biases. Hierarchical multiple regression analyses showed that history of violence contributed the most variance to posttest violence. Hostile attributional and personalizing biases were also uniquely associated with posttest violence. Overall, this study supported the modest utility of attributional style measures in the prediction of inpatient violence. The predictive value of insight in this context appears limited.

Neurocognition, social cognition and functional outcome in schizophrenia

“…For example, a review published by Couture et al 15 established an association between community functioning and different domains of social cognition (social perception, emotion perception and Theory of Mind). It has been even suggested that social cognition may be more relevant for functional outcome than neurocognition 28,34,42 . Thus, the Fett et al 28 meta-analysis studying the relationship of neurocognition and social cognition with different functional outcome domains in schizophrenia found that social cognition was more related to community functioning than neurocognition.…”

“…Many studies in the last years have also associated social cognition with functioning, so that social cognitive performance would explain an additional proportion of the variance of functioning that is not explained by neurocognition 16, [34][35][36][37][38][39][40][41][42] . Some studies have even found that social cognition could be a better predictor of functioning than neurocognition itself 29, 43 .…”

Subjective perceptions of cognitive deficits and their influences on quality of life among patients with schizophrenia

“…Studies of social cognition in schizophrenia have shown the following: Social cognition predicts functional outcomes independently from, and perhaps more strongly than, neurocognition [15][16][17][18][19][20][21]; social cognition is related to the severity of the disorder and rates of relapse [22][23][24]; negative and disorganized symptoms are related to low social competence, difficulty in social representations, and poor social and vocational adjustment [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]; there is a significant association between social cognition and quality of life (QoL) [26,27]; and social cognitive skills play an important role in patients' subjective evaluation of their own QoL [28]. Finally, as Tas et al [27] recently reported, ''the association between mental state reasoning and the more internal aspect of QoL in schizophrenia may reflect a specific role for social cognition in introspective and subjective judgments of one's own QoL, whereas neurocognition and negative symptomatology may be more predictive of the external or extrinsic aspect of QoL.…”

Characteristics of Assaultive Psychiatric Patients: 20-Year Analysis of the Assaultive Staff Action Program (ASAP)

“…This was true at 10-, 15-, and 20-year periods. Specific clinical findings with regard to forensic patients, the violence triad, and victimization of women as well as methodological issues were discussed and the implications noted.Psychiatric patient assaults on health care staff are a serious and continuing occupational hazard [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In 1995, Bjorkley and his colleagues estimated that 15-30% of hospitalized patients engaged in assaults and that the prevalence of aggressive behavior ranged from 0.15 assaults per bed year to as high as 88.8 incidents per bed year in some high security units [2].…”