Evaluating the Relationship Between Childhood Abuse and Neglect,Interpersonal Hostile-Dominance,and Aggression in Psychiatric Hospitals

This study examined whether interpersonal hostile-dominance (HD) mediated the relationship between childhood trauma and aggression in 200 psychiatric inpatients (M age = 38.32 years, 66% male). Childhood emotional (50.5%), physical (42.0%), and sexual (42.0%) abuse, and emotional (46.5%) and physical (41.0%) neglect of moderate to extreme severity was reported. More severe emotional, physical, and sexual abuse, and physical neglect in childhood were associated with higher HD. Higher levels of HD and all forms of childhood abuse and neglect were associated with aggression; HD mediated the relationship between childhood emotional abuse, sexual abuse, and physical neglect and aggression. Findings highlight the high prevalence of childhood trauma in adult psychiatric inpatients. Further, childhood trauma contributes to HD, which increases the risk of aggression.     

Childhood Characteristics of Adolescent Inpatients with Early-Onset and Adolescent-Onset Disruptive Behavior

Childhood characteristics are associated with life-course-persistent antisocial behavior in epidemiological studies in general population samples. The present study examines this association in an inpatient sample. The purpose is to identify easily measurable childhood characteristics that may guide choice of treatment for adolescent psychiatric inpatients with severe disruptive behavior. Patients (N?=?203) were divided into two groups with either early-onset (EO) or adolescent-onset (AO) disruptive behavior, based on ages at which professional care was used for disruptive behavior, referral to special education, and criminal offences. Both groups differed on several childhood characteristics. No gender differences in these characteristics were found. Logistic regression analysis indicated that individuals with grade retention in primary school, childhood impulsive behavior, and a history of physical abuse, had the highest probability of being member of the EO group. These characteristics are reasonably easy to identify, likely apply to other clinical samples as well, and may help clinicians to target their treatment.     

Application of the Modelof Human Occupation

The model of human occupation is proposed to be an effective basis for occupational therapy assessment in child and adolescent psychiatry. The theoretical tenets of this model are reviewed with emphasis on the development of human occupation during childhood and adolescence. Application of themodel is demonstrated through the presentation of human occupation assessment batteries currently in use on short-term, diagnostic and research units for child and adolescent psychiatric inpatients. In addition, two case studies demonstrate the model's effectiveness in conceptualizing the occupational functioning of this population.     

Subtyping female adolescent psychiatric inpatients with features of eating disorders along dietary restraint and negative affect dimensions

Cluster-analytic studies of eating disorders in adult patients have yielded two subtypes (pure dietary and mixed dietary-negative affect). This study aimed to replicate the subtyping in female adolescent psychiatric inpatients with features of eating disorders. Cluster analyses of 137 patients with eating-disordered features revealed a dietary-negative affect subtype (43%) and a pure dietary subtype (57%). The dietary-negative affect subtype was characterized by greater likelihood of binge eating, greater eating-related psychopathology, and greater body image dissatisfaction. The two subtypes did not differ significantly in scores reflective of clinical syndromes (other than the significantly higher depressive affect in the negative affect subtype), but the dietary-negative affect subtype was characterized by greater personality disturbance and higher reported concerns in clinical areas, including suicidality and childhood abuse. The cluster analysis produced different results from an alternative approach to subtyping by vomiting. These findings provide further support for the reliability and validity of this subtyping scheme for eating pathology. Clinically, the findings suggest that the combination of dieting and negative affect signals a more disturbed variant of eating-disorder related psychopathology in female adolescent psychiatric inpatients.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Suicide Crisis Syndrome Mediates the Relationship Between Long‐term Risk Factors and Lifetime Suicidal Phenomena

In recent years, there has been growing attention to the distinction between acute and long‐term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS ), as a marker of near‐term suicidal risk. Here, we test whether documented long‐term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS . A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS ‐3) as a measure of the SCS . While both STS ‐3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS ‐3 was related to pre‐admission suicide attempts. The STS ‐3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long‐term risk factors increase suicidal risk.     

Brief report: Neurocognitive functioning in adolescents following childhood maltreatment and evidence for underlying planning & organizational deficits

Children and adolescents with a history of childhood maltreatment are at risk for a host of psychiatric conditions, although the underlying neurocognitive functioning of these individuals remains largely understudied. This study examined the neurocognitive functioning of childhood maltreatment victims in an adolescent psychiatric inpatient setting. The sample consisted of adolescent inpatients (ages 13–19) that completed intellectual testing as part of a neuropsychological/psychological assessment during hospitalization (n = 39). The sample was grouped based on childhood maltreatment history with one group categorized by maltreatment history (n = 15) and the other group characterized by no maltreatment history (n = 24). Analyses revealed statistically significant differences (p < .01) between maltreatment groups on the majority of assessed domains. When controlling for intelligence, only performance differences on the RCFT remained. RCFT differences remained after controlling for the influence of visual-motor and visual-perceptual/visual-spatial functioning, highlighting the influence of organizational and planning difficulties in those individuals with maltreatment history. Group differences in the frequency of impaired performance for neuropsychological tasks were largest (p < .001) for FSIQ and RCFT. Compromised neurocognitive functioning may negatively contribute to the clinical presentation of this population, highlighting the importance of the child neuropsychologist in the effective treatment of children and adolescents with a history of childhood maltreatment.     

Ego development and intelligence in a psychiatric population: Wechsler subtest scores

The relationship between Loevinger's measure of ego development and the Wechsler Intelligence Scales subtest scores was investigated in 91 adolescent and young adult psychiatric inpatients. Correlations with Verbal IQ and verbal subtests in general were positive and significant. The correlation with the Comprehension subtest was the highest and remained significant when Full Scale IQ was partialled. Post-conformists obtained the highest mean scores on Picture Arrangement; however, there was no difference among the lower stages on this subtest. The results lend support to a social reasoning component of ego development.     

Sex differences on the MMPI-2 substance abuse scales in psychiatric inpatients.

Sex differences on the MMPI-2 addiction scales (MacAndrew Alcoholism Scale-Revised, Addiction Acknowledgement Scale, Addiction Potential Scale) and their ability to distinguish between substance-abusing and nonabusing psychiatric inpatients were examined. Men obtained higher mean raw scores than women on the MacAndrew Alcoholism Scale-Revised and the Addiction Acknowledgement Scale, and substance abusers scored higher on all three scales. Even relatively low cutoff scores, however, on the MacAndrew Alcoholism Scale-Revised resulted in false negative rates of 37 to 39%. The results support the utility of the MMPI-2 substance abuse scales; however, lower cutoff scores should be used with women and within a psychiatric population.     

WAIS-R scatter with psychiatric inpatients: I Intrasubtest scatter.

Intrasubtest scatter values for eight WAIS-R subtests were estimated for a sample of 150 psychiatric inpatients and compared with those reported for a comparable portion of the WAIS-R standardization group by Kaplan, Fein, Morris, and Delis in 1991, using the normal deviate (z) test. The standardization group's intrasubtest scatter was significantly greater than those reported for the psychiatric inpatients on all subtests except Arithmetic and Information. These results suggested that, contrary to expectation, limited intrasubtest scatter may characterize WAIS-R protocols of psychiatric inpatients, while the presence of scatter may characterize normal WAIS-R performance.     

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal conflict of Oppositional Defiant Disorder (ODD) and the impulsivity of Attention Deficit Hyperactivity Disorder (ADHD) in particular may be indicative of an early developmental path towards BPD. The present study uses longitudinal data from a clinical sample of 177 boys, initially between the ages of 7 and 12, who were followed up annually to age 18, and who were reassessed at age 24 (n = 142). The study examines the prediction from repeated childhood measures of psychopathology measured annually through adolescence to BPD symptoms assessed at age 24, accounting for the effects of covariates including substance use, other personality disorders at age 24 and harsh physical punishment. The prevalence of BPD in this sample was consistent with other population estimates. Attention Deficit Hyperactivity Disorder (ADHD) and ODD were the only child psychiatric disorders to predict BPD symptoms, and the oppositional behavioral dimension of ODD was particularly predictive of BPD. These results indicate possible developmental links between early psychiatric disorders and BPD.     

A review on eye movement studies in childhood and adolescent psychiatry

The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette’s syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.     

Child,Adolescent and Adult Psychiatric Disorders in Africa: Implications for Psychological Interventions

The authors start by critically discussing some core features of Western psychiatric diagnosis, and present the cultural formulation as one approach to ensure that the cultural aspects of the diagnostic process are addressed, followed by a summary of what is known about the causes of psychiatric disorder. Five arguments are presented that provide support for the importance of psychiatric disorders in Africa: prevalence rates are high; psychiatric disorder is associated with a considerable burden from disability; in most cases, adults with psychiatric disorders experienced the onset of their disorder in childhood or youth; psychiatric disorders are strongly associated with medical conditions; and effective interventions exist for the majority of people suffering from psychiatric disorders. Against this background, current mental health services in Africa are reviewed. Finally, some suggestions are provided for how those providing psychological interventions can contribute to addressing the challenges posed by psychiatric disorders in Africa.     

A review on eye movement studies in childhood and adolescent psychiatry

The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette’s syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.     

Childhood antecedents of serious violence in adult male offenders

Prospective longitudinal studies have shown strong predictions from conduct disorders (CDs) in childhood to antisocial personality disorder (ASPD) and violence in adults. However, little is known of the childhood antecedents of serious violence nor whether these may vary depending on the context in which the violence occurs. In this study, 54 men aged 21-40 years serving prison sentences for violent crime were assessed. Standardized interviews of ASPD and violence were conducted independently of interviews covering retrospective recall of childhood psychiatric disorders and adverse experiences. Analyses of the predictors of overall violence suggested a pathway involving childhood CD and adult ASPD associated with interparental discord, and an additional pathway associated with experiencing interparental violence in childhood. Different results were however obtained when account was taken of the context of the violence. The CD-ASPD pathway was associated with social violence, but not with partner violence. Partner violence was predicted by retrospective reports of having been exposed to interparental violence during childhood but not by reports of childhood CD or adult ASPD. Thus developmental pathways to serious violence may be different depending on the social domain in which the violence occurs.     

Patientensuizid im psychiatrischen Fachkrankenhaus

Suicide prevention especially with psychiatric inpatients is traditionally a very important aspect of psychiatric treatment. During the 1970s and 1980s there was a noticeable increase in so-called hospital suicides in Germany, especially suicides of schizophrenic inpatients. The number of psychiatric inpatient suicides has currently decreased again and a shift to more depressive suicides has also been observed. Furthermore questions which are asked in court are presented and discussed.     

The relationship between childhood adversity,psychiatric disorder and clinical severity: results from a multi-centre study

Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores.     

Peer status and social competence in child psychiatric inpatients: A comparison of children with depressive,externalizing, and concurrent depressive and externalizing disorders

Social competence, peer status, and clinical symptomatology were evaluated in 54 child psychiatric inpatients. Aims were (a) to evaluate whether social competence deficits and peer rejection within an inpatient setting were associated with particular childhood disorders, and (b) to identify predictors of peer status in emerging groups of child inpatients. Results indicated that children with externalizing disorders (conduct or attention deficit disorders) and children with concurrent depressive and externalizing disorders were the most rejected, least liked, and least socially competent children. Depressed children without externalizing disorders had the highest scores on the social status and competence measures. Predictors of peer rejection and acceptance in the hospital differed, with measures of symptomatology predicting peer rejection, and measures of social and intellectual competence predicting peer acceptance. Implications of the results for understanding the role of peer adjustment and social competence in developmental psychopathology were discussed.This research was supported in part by Biomedical Research Support Grant RR756 awarded to the author. The author wishes to thank Donald Guthrie and Sondra Purdue for their statistical consultation, Gwen Gordon for her computer assistance, and Joan Trumbull for her assistance with data collection.     

Social Skills Training for Psychiatric Patients,II

In this second paper on social skills training for psychiatric patients the author critically reviews the controlled clinical outcome studies of social skills training in a number of psychiatric populations: mentally retarded persons, depressed patients, psychiatric outpatients, and psychiatric inpatients. He points out that more research is needed to determine the effectiveness of social skills training, especially for patients with debilitating chronic mental illness.     

Structure of the Computer-Assisted Beck Anxiety Inventory With Psychiatric Inpatients

To determine the dimensions of self-reported anxiety in psychiatric inpatients, the Beck Anxiety Inventory (BAI; Beck & Steer, 1990) was administered by computer to 250 inpatients diagnosed with mixed disorders. An iterated principal-factor analysis was performed on the intercorrelations among the 21 BAI items using a Promax rotation. Two factors were found representing somatic and subjective symptoms of anxiety. These dimensions significantly matched those previously described by Beck, Epstein, Brown, and Steer (1988) for outpatients diagnosed with mixed psychiatric disorders. The generalizability of the somatic and subjective dimensions for inpatients and outpatients is discussed.