Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Covariation detection in treated and untreated spider phobics.

Twenty treated and 18 untreated spider phobics were exposed to a series of 72 slides. Three different categories of slides were used: phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a tone, or nothing at all. Despite the absence of a systematic correlation between slides and outcomes, untreated phobics strongly overestimated the covariation between spider slides and shock. Treated phobics did not show a covariation bias, suggesting that such bias can be modulated by behavioral treatment. In addition, untreated subjects were more confident about their contingency estimates than were treated subjects. The present results fit with earlier studies.     

Self-reported cognitive failures and neurotic symptomatology

Three studies examined the Cognitive Failures Questionnaire (CFQ) and its psychopathological correlates. In Study 1, the psychometric qualities of the Dutch translation of the CFQ were evaluated in a student sample. Internal consistency and test-retest stability were found to be satisfactory. Furthermore, CFQ was positively correlated with anxiety symptoms, even when the influence of traditional trait variables (i.e., neuroticism and trait anxiety) was partialled out. Study 2 examined the CFQ as a predictor of treatment outcome in spider phobia. No evidence was found to suggest that high CFQ scores are associated with a less favourable treatment outcome. Also, spider phobics had CFQ scores in the normal range. Study 3 evaluated the CFQ in a mixed sample of anxiety disordered and depressive outpatients. Depressive patients, but not anxiety disordered patients, were found to have heightened CFQ scores. Overall, CFQ scores were positively associated with symptom severity. Yet, there were no indications that patients with high CFQ scores profit less from treatment than those with low CFQ scores. Taken together, the results provide support for the view that the CFQ taps daily cognitive routines that are undermined by anxiety and depression. However, the findings do not point to the CFQ being a cognitive vulnerability measure that is related to treatment success.     

Effects of nutritional supplements on aggression,rule‐breaking,and psychopathology among young adult prisoners

Objective: In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule‐breaking, and psychopathology was conducted among young Dutch prisoners. Methods: Two hundred and twenty‐one young adult prisoners (mean age=21.0, range 18–25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1–3 months. Results: As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one‐tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. Conclusion: As the incidents reported concerned aggressive and rule‐breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self‐reported) outcome measures, the results should be interpreted with caution. Aggr. Behav. 36:117–126, 2010. © 2009 Wiley‐Liss, Inc.     

Psychiatric nurses' experiences with inpatient aggression

Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this “Perceptions of Prevalence Of Aggression Scale” (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members were also asked to disclose the number of days missed from work due to inpatient violence. On the basis of these POPAS forms, internal consistency of the instrument, mean reported aggression frequencies, and days missed from work due to violence were calculated. Internal consistency of the POPAS appeared to be reasonable. Verbal abuse and threats were experienced by most of the psychiatric nurses during a one‐year period (i.e., by about 80–90 percent of nurses). Sexual harassment or intimidation was also experienced relatively often on an annual basis (68 percent), particularly by female and young staff members. A minority of staff members (i.e., 16 percent) had experienced severe physical violence. Although not prevalent, this type of behavior was most strongly connected with reporting sick. In particular, staff members working with involuntarily admitted patients experienced much (severe) violence during their work. Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day‐to‐day contact with aggressive behavior. Also, since information on verbal, physical, and sexual violence, and on days missed from work, can be provided anonymously, this rather delicate, but essential management information, may be accessed relatively easily with the POPAS. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

Further Evidence for Reliability and Validity of the Triarchic Psychopathy Measure in a Forensic Sample and a Community Sample

Psychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory –Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument.     

Factors associated with experts' opinions regarding criminal responsibility in The Netherlands

In many jurisdictions, offenders need to have freely chosen to commit their crimes in order to be punishable. A mental defect or disorder may be a reason for diminished or total absence of criminal responsibility and may remove culpability. This study aims to provide an empirically based understanding of the factors on which experts base their judgements concerning criminal responsibility. Clinical, demographic and crime related variables, as well as MMPI-2 profiles, were collected from final reports concerning defendants of serious crime submitted to the observation clinic of the Dutch Ministry of Justice for a criminal responsibility assessment. Criminal responsibility was expressed along a five-point scale corresponding to the Dutch legal practice. Results showed that several variables contributed independently to experts' opinions regarding criminal responsibility: diagnosis (Axis I and II), cultural background, type of weapon used in committing the crime, and whether the defendant committed the crime alone or with others. In contract to jurisdictions involving a sane/insane dichotomy, the Dutch five-point scale of criminal responsibility revealed that Axis II personality disorders turned out to be mostly associated with a diminished responsibility. MMPI-2 scores also turned out to have a small contribution to experts' opinions on criminal responsibility, independently of mere diagnostic variables. These results suggest that experts base their judgements not only on the presence or absence of mental disorders, but also on cultural and crime related characteristics, as well as dimensional information about the defendant's personality and symptomatology.     

The staff observation aggression scale–revised (SOAS‐R)

Proper assessment of aggressive behavior is essential for an understanding of its causes. In 1987, Palmstierna and Wistedt [Acta Psychiatr Scand 76:657‐663] introduced the Staff Observation Aggression Scale (SOAS), an instrument for monitoring the frequency, nature, and severity of aggressive incidents. In the present study, the validity of the SOAS severity scoring system was examined, and the severity scores were refined. The SOAS was used to record aggression on six closed wards of three psychiatric hospitals. The SOAS severity scores of 556 aggressive incidents were compared with severity estimates given on Visual Analogue Scales (VASs) by staff members. The original SOAS scores were found to be moderately correlated with the estimates of severity given by staff on the VAS. The SOAS severity scoring system was refined on the basis of the staff severity estimates. The revised scoring method and other refinements in the contents of the instrument led to the construction of the SOAS‐R. The SOAS‐R seems to be a promising tool for monitoring a wide range of (self‐) destructive acts on psychiatric wards. Aggr. Behav. 25:197–209, 1999. © 1999 Wiley‐Liss, Inc.