Brain structural alterations associated with impulsiveness in male violent patients with schizophrenia.

BACKGROUND: Violence in schizophrenia (SCZ) is a phenomenon associated with neurobiological factors. However, the neural mechanisms of violence in patients with SCZ are not yet sufficiently understood. Thus, this study aimed to explore the structural changes associated with the high risk of violence and its association with impulsiveness in patients with SCZ to reveal the possible neurobiological basis. METHOD: The voxel-based morphometry approach and whole-brain analyses were used to measure the alteration of gray matter volume (GMV) for 45 schizophrenia patients with violence (VSC), 45 schizophrenia patients without violence (NSC), and 53 healthy controls (HC). Correlation analyses were used to examine the association of impulsiveness and brain regions associated with violence. RESULTS: The results demonstrated reduced GMV in the right insula within the VSC group compared with the NSC group, and decreased GMV in the right temporal pole and left orbital part of superior frontal gyrus only in the VSC group compared to the HC group. Spearman correlation analyses further revealed a positive correlation between impulsiveness and GMV of the left superior temporal gyrus, bilateral insula and left medial orbital part of the superior frontal gyrus in the VSC group. CONCLUSION: Our findings have provided further evidence for structural alterations in patients with SCZ who had engaged in severe violence, as well as the relationship between the specific brain alterations and impulsiveness. This work provides neural biomarkers and improves our insight into the neural underpinnings of violence in patients with SCZ.

Incident of violence escalation of patients with psychiatric emergencies boarding in the emergency department in the central region of Thailand and its association: a prospective observational study.

BACKGROUND: This study investigates the incidence of violence escalation among psychiatric emergency patients admitted to general emergency departments in hospitals in central Thailand. In addition, patient and service delivery system factors associated with the survival time of violence escalation in 16 emergency departments in the central region of Thailand are determined. This is a prospective observational study, and the study sample includes 507 psychiatric emergency patients who are ≥ 18 years old. The patients are selected through stratified random and purposive sampling. METHODS: Patient data-including demographic data, emergency services used, and clinical characteristics-are analyzed using descriptive statistics. The Kaplan-Meier method estimates the violence escalation curve, and the log-rank test compares the violence escalation-free time between the levels of the violent behavior group. In addition, univariable and multivariable Cox proportional hazard analyses are performed to investigate the factors affecting violence escalation. RESULTS: The incidence of violence escalation in psychiatric emergency patients in the emergency department is 7.3%, whereas the incidence rate of violence escalation is 3 per 100 psychiatric emergency patient visit hours. Factors affecting violence escalation include the violent behavior score at triage (aHR = 2.004; 95% CI: 1.051-3.823) and the nurse competency score (aHR = 0.147; 95% CI: 0.032-0.680). CONCLUSIONS: Assessing the violent behavior of psychiatric emergency patients at triage may assist emergency providers in monitoring patient behavior and providing early intervention to prevent the escalation of violent behavior. Furthermore, training emergency nurses in psychiatric emergency care is necessary.

School climate, attitude toward school violence, and violent behaviors among high school students in Vietnam.

This study aimed to examine the relationship between Vietnamese high school students' violent behaviors and their violence exposure (observing and being victimized by school violence), and attitude, and perceived school climate. The results from 496 Vietnamese high school students show that students' acceptance of school violence and their experience of being the victim of school violence have a significant, and direct, positive effect on their violent behaviors at school. In the moderation model, when students' perception of school climate is more positive, the effect of their acceptance of violence on their violent behaviors at school reduces, implying the moderating effect of school climate. The results have practical implications for educators and policy makers to intervene school violence in Vietnam.

Evolution of impulsivity levels in relation to early cannabis use in violent patients in the early phase of psychosis.

BACKGROUND: Prevention of violent behaviors (VB) in the early phase of psychosis (EPP) is a real challenge. Impulsivity was shown to be strongly related to VB, and different evolutions of impulsivity were noticed along treatments. One possible variable involved in the relationship between VB and the evolution of impulsivity is cannabis use (CU). The high prevalence of CU in EPP and its relationship with VB led us to investigate: 1/the impact of CU and 2/the impact of early CU on the evolution of impulsivity levels during a 3-year program, in violent and non-violent EPP patients. METHODS: 178 non-violent and 62 violent patients (VPs) were followed-up over a 3 year period. Age of onset of CU was assessed at program entry and impulsivity was assessed seven times during the program. The evolution of impulsivity level during the program, as a function of the violent and non-violent groups of patients and CU precocity were analyzed with linear mixed-effects models. RESULTS: Over the treatment period, impulsivity level did not evolve as a function of the interaction between group and CU (coef. = 0.02, p = 0.425). However, when including precocity of CU, impulsivity was shown to increase significantly only in VPs who start consuming before 15 years of age (coef. = 0.06, p = 0.008). CONCLUSION: The precocity of CU in VPs seems to be a key variable of the negative evolution of impulsivity during follow-up and should be closely monitored in EPP patients entering care since they have a higher risk of showing VB.

Socio-demographic, clinical and offense-related characteristics of forensic psychiatric inpatients in Hunan, China: a cross-sectional survey.

BACKGROUND: There is still a lack of comprehensive research on the profile of patients in forensic mental health hospitals in China. This study aims to investigate the socio-demographic, clinical, and offense-related characteristics of mentally ill offenders in the Hunan Provincial Forensic Psychiatric Hospital in China. METHODS: This study was conducted from November 1, 2018, to January 30, 2019. The data of socio-demographic, clinical, and offense-related characteristics of the patients were collected. The Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS), and the Clinical Global Impression-Severity (CGI-S) scale were used to measure their psychiatric conditions. RESULTS: A total of 461 participants were enrolled in this study. Among them, 86.3% were males and 56.8% were unmarried; the average age of them was 44.7 ± 10.1 years, and the mean years of education were 7.51 ± 3.3 years. Before their current offense, a total of 345 patients (74.8%) had sought medical help for their mental illnesses. While 303 (87.8%) of these patients were prescribed antipsychotics, 254 (73.6%) failed to take them regularly. Of all the inpatients, 90.5% were diagnosed with schizophrenia; 385 (83.5%) engaged in homicidal offenses, with 54.0% of the victims being their family members. In homicide cases, the relatives were more likely to be victims of female patients. The mean length of stay in the forensic hospital was 8.02 ± 4.74 years, and over 80.0% of the patients had been hospitalized for over 5 years. CONCLUSIONS: To our knowledge, this is the first study investigating the profile of forensic patients receiving compulsory treatments in a forensic psychiatric hospital in China. These results add to the world literature on the characteristics of forensic patients and can help identify common treatment and risk-related needs of this population.

Efficient Violence Detection in Surveillance.

Intelligent video surveillance systems are rapidly being introduced to public places. The adoption of computer vision and machine learning techniques enables various applications for collected video features; one of the major is safety monitoring. The efficacy of violent event detection is measured by the efficiency and accuracy of violent event detection. In this paper, we present a novel architecture for violence detection from video surveillance cameras. Our proposed model is a spatial feature extracting a U-Net-like network that uses MobileNet V2 as an encoder followed by LSTM for temporal feature extraction and classification. The proposed model is computationally light and still achieves good results-experiments showed that an average accuracy is 0.82 ± 2% and average precision is 0.81 ± 3% using a complex real-world security camera footage dataset based on RWF-2000.

The effect of solution-focused approach on anger management and violent behavior in adolescents: A randomized controlled trial.

BACKGROUND: This study was carried out to evaluate the effect of a solution-focused approach on anger management and violent behavior in adolescents. METHOD: The study was an experimental and randomized controlled trial including pre-test and post-test measurements and control group. The sample of experimental (n = 24) and control groups (n = 24) of the study consisted of 48 students. A 7-session program of anger management and prevention of violent behavior based on a solution focused approach was applied to the experimental group. RESULTS: There were no statistically significant differences between trait anger, anger in, anger out, anger control sub-dimensions and VTS scores of the experimental and control groups before the intervention (p > 0.05). In post-test and follow-up test, trait anger (23.32 ± 2.83) (21.10 ± 3.51), anger-out (14.95 ± 4.16) (15.50 ± 3.49) and the mean scores of VTS (30.77 ± 4.01) (32.80 ± 4.53) of the individuals in the experimental group were significantly lower, whereas their mean score of anger control (24.86 ± 3.62) (23.65 ± 4.44) were significantly higher than the control group. CONCLUSION: Solution-oriented approach programs should be used by psychiatric nurses to provide anger management and reduce violence tendencies in adolescents.

Longitudinal predictions of young adults' weapons use and criminal behavior from their childhood exposure to violence.

In this study, we examine whether youth who are exposed to more weapons violence are subsequently more likely to behave violently with weapons. We use data collected with a 3-cohort, 4-wave, 10-year longitudinal study of 426 high-risk youth from Flint, Michigan, who were second, fourth, or ninth-graders in 2006-2007. The data were obtained from individual interviews with the youth, their parents, and their teachers, from archival school and criminal justice records, and from geo-coded criminal offense data. These data show that early exposure to weapons violence significantly correlates at modest levels with weapon carrying, weapon use or threats-to-use, arrests for weapons use, and criminally violent acts 10 years later. Multiple regression analyses, controlling for children's initial aggressiveness, intellectual achievement, and parents' income, education, and aggression, reveal statistically significant independent 10-year effects: (1) more early exposure to weapon use within the family predicts more using or threatening to use a gun; (2) more cumulative early violent video game playing predicts more gun using or threatening to use weapons, and normative beliefs that gun use is acceptable; (3) more cumulative early exposure to neighborhood gun violence predicts more arrests for a weapons crime; and (4) more cumulative early exposure to movie violence predicts more weapon carrying. We argue that youth who observe violence with weapons, whether in the family, among peers, or through the media or video games, are likely to be infected from exposure with a social-cognitive-emotional disease that increases their own risk of behaving violently with weapons later in life.

Workplace violence and influencing factors among paramedic pre hospital paramedic personnel (city and road) in Iran: a quality content analysis.

BACKGROUND: The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it. AIM: The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel. METHOD: This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. RESULTS: Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected. CONCLUSION: If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, "hostility" will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.

Substance use disorders and violent behaviour in patients with severe mental disorders: A prospective, multicentre study.

OBJECTIVE: The relationship between alcohol and substance use and the risk of violence exhibited by patients with mental disorders is under-researched. This prospective cohort study aims to compare patients with severe mental disorders and with different substance use behaviors in terms of sociodemographic and clinical characteristics, hostility, impulsivity and aggressive behaviors. Furthermore, this study aims to assess differences in violent behaviors during a 1-year monitoring follow-up. METHODS: A total of 378 participants with severe mental disorders from Italian residential facilities and from four Departments of Mental Health (244 outpatients and 134 residential patients) were enrolled. Participants were categorized as Persons with Current Substance Use, Persons with Former Substance Use and Persons with Non-Substance Use. All these patients underwent a complex multidimensional assessment, including the lifetime and current substance use; a subsample of outpatients was also assessed with a laboratory substance assay including the testing for specific substances. We assessed the differences among these three groups in hostility, impulsivity and aggressive behaviors. RESULTS: The results of the close 1-year monitoring show a significantly higher risk of violence for patients with severe mental disorders Persons with Current Substance Use compared to Persons with Former Substance Use and Persons with Non-Substance Use. Persons with Current Substance Use showed significantly higher scores for irritability, negativism and verbal assault compared to Persons with Non-Substance Use. Persons with Former Substance Use showed significantly higher scores for lifetime history of aggressive behaviors compared with patients with Persons with Non-Substance Use. CONCLUSION: These findings suggest that patients with comorbid mental illness and substance use disorders should be referred for specific interventions to reduce aggressive behavior and ensure patient well-being and community safety.

Public knowledge, attitudes, and intention to act violently, with regard to violence directed at health care staff.

BACKGROUND: Violence directed at health care staff is widely prevalent. Few studies have explored public attitudes regarding violence against health care staff. PURPOSES: To examine the Israeli public's attitudes regarding violence against health care staff and their intention to act violently in various health care settings. METHOD: A cross-sectional study among 609 adult participants used a self-report questionnaire. The questionnaire dealt with attitudes regarding violence toward health care staff and presented the participants with three scenarios of violence in a health care setting. Logistic regression was conducted to explore variables that may explain the public's intentions to act violently. FINDINGS: The participants expressed condemnation of violence toward health care staff. Men displayed more violent attitudes than women. Participants who justified violence and were supportive of violent behavior displayed significantly more intentions to act violently. DISCUSSION: Actions taken to eliminate violence in the health system must be based on cooperation between health policymakers, health care workers, and the public.

The Role of Violent and Nonviolent Delinquent Behavior in Educational Attainment.

Given large variations in the etiology and developmental trajectories of violent and nonviolent delinquency, this study examines whether educational outcomes of violent and nonviolent offenders might differ. In particular, this study attempts to remove environmental influences such as family background and neighborhood effects from the effects of delinquency because these factors are likely to differentially confound the effects of violent and nonviolent delinquency on educational attainment. By exploiting variation within sibling pairs, this study finds that the effects of engagement in violent delinquency on education is driven spuriously by shared family background, whereas the effects of nonviolent delinquency are quite robust to adjustment for family fixed effects. Moreover, relying on fixed effects estimates, this study finds that the effects of engagement in nonviolent delinquent activity on educational attainment occur in part through disruption of educational progress, rather than through institutional responses to student delinquency and social-psychological processes.

[Correlations among resilience against violent behavior toward the self and others, rumination, and anger in high school students].

Objectives Correlations among resilience against violent behavior toward the self and others, ruminations, and anger were examined to obtain data for preventive interventions for violent behavior toward the self and others in high school students.Methods An anonymous self-report questionnaire was administered to first, second, and third-year high school students (N=327). There were 280 valid responses (85.6%). The following causal model was assumed based on the data: Resilience directly affects violent behavior toward the self and others and simultaneously affects violent behavior through rumination and anger. The goodness of fit of the model and correlations among variables were analyzed using structural equation modeling, with gender and school year as control variables.Results The goodness of fit of the model to the data indicated that the comparative fit index was 0.980 and the root mean square error of approximation was 0.043. Statistically significant negative correlations among the variables were indicated between resilience and rumination and between violent behavior toward the self and others. On the other hand, statistically significant positive correlations were indicated between rumination and anger and between anger and violent behavior toward the self and others. The contribution ratio of the model to violent behavior was 82.9%. Furthermore, gender, which was one of the control variables, had a statistically significant positive correlation with resilience and a negative correlation with violent behavior.Conclusions Results of structural equation modeling indicated that resilience decreased rumination and directly decreased violent behavior toward the self and others. Moreover, rumination had a strong effect on violent behavior mediated by anger. It is suggested that increasing resilience and suppressing rumination that reinforces anger would effectively prevent violent behavior toward the self and others.

Serious violent behavior and antisocial outcomes as consequences of exposure to ethnic-political conflict and violence among Israeli and Palestinian youth.

We examine whether cumulative-past and concurrent exposure to ethnic-political violence among Israeli and Palestinian youth predict serious violent behavior and antisocial outcomes toward the in-group and the out-group. We collected four waves of data from 162 Israeli Jewish and 400 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents. The first three waves were consecutive annual assessments, and the fourth was conducted 4 years after the third wave, when the three age cohorts were 14, 17, and 20 years old, respectively. Based on social-cognitive-ecological models of the development of aggression (Dubow et al., 2009, Clinical Child and Family Psychology Review, 12, 113-126; Huesmann, 1998) and models of the development of beliefs about the "other," (Bar-Tal, 2004, European Journal of Social Psychology, 34, 677-701; Tajfel & Turner, 1986), we predicted that serious violent outcomes directed toward both the in-group and the out-group would be related to both concurrent and to persistent-past exposure to ethnic political violence. Bivariate regression models (prior to including covariates) indicated that both early cumulative exposure to ethnic-political violence during childhood and adolescence and concurrent exposure during late adolescence/early adulthood predicted all six serious violent and antisocial outcomes. When we added to the models the covariates of ethnic subgroup, age, sex, parents' education, and youths' prior physical aggression, concurrent exposure to ethnic-political violence was still significantly associated with a greater likelihood of concurrently perpetrating all six serious violent and nonviolent forms of antisocial behavior, and earlier cumulative exposure remained significantly related to three of these: severe physical aggression, participating in violent demonstrations, and our overall index of violent/antisocial behavior.

Juveniles with a history of violent behavior show cognitive performance and electrophysiology consistent with inhibitory control and emotional feedback processing problems.

Inhibitory control and the effects of negative emotional feedback were investigated in adolescents with a history of violent behavior and normal adolescents using the Taylor Aggression Paradigm (TAP), a task simulating real situations of social interaction to elicit aggressive behavior and negative emotions, with concurrent event related potential recordings. The Reactive Proactive Aggression Questionnaire (RPAQ), the Barratt Impulsiveness Scale (BIS) and the Negative Mood Regulation (NMR) Scale were also presented. These showed that reactive scores, proactive scores, and BIS scores were all significantly higher for the violent offender group whereas scores from the NMR scale were significantly lower for this group. In the TAP, the violent offender group chose significantly higher levels of punishment, indicative of both higher proactive and higher reactive aggression, for their opponent than did the control group. The ERP data showed the N2 amplitude for the decision phase, indicative of inhibitory control, was lower for the violent offender group than for the control group, with mediation analysis showing that the N2 component was related to proactive aggression. The decision-related negativity and the feedback-related negativity in the result phase were also both lower for the violent offender group than for the control group. Adolescent violent offenders showed higher levels of aggressive behavior than normal adolescents. This is associated with both worse inhibitory control and worse negative emotion regulation. Investigation of common factors underlying these processes, in conjunction with possible ways in which they might be improved, should be a priority for future work.

DO POSITIVE PERCEPTIONS OF CORRECTIONAL STAFF MITIGATE INSTITUTIONAL VIOLENCE AMONG YOUTHFUL OFFENDERS?

Juvenile justice facilities can be dangerous places for adolescents and may promote violent behavior among incarcerated youth. With high rates of violence among detained juveniles, youth who do not feel safe may resort to violent behavior to protect themselves. However, this "cycle of violence" may be interrupted if youth can turn to correctional staff for support. Using a 3-wave, longitudinal sample of 373 male incarcerated adolescents, the results indicated that as compared to violence exposure prior to incarceration, exposure to institutional violence more strongly predicts violent behavior. Further, the findings indicated that perceptions of staff serve as a buffer to violence exposure and may interrupt the cycle of violence. Policy implications are discussed.

Early childhood predictors of boys' antisocial and violent behavior in early adulthood.

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.

The moderating effect of neighborhood sense of community on predictors of substance use among Hispanic urban youth.

Hispanic adolescents represent a disproportionate number of youth living in urban communities. These youth confront significant social problems that increase their likelihood for substance use. However, youth that have a greater neighborhood sense of community are postulated, through empowerment theory, to be less influenced by negative environmental experiences and less inclined to engage in drug and alcohol use. We examine the moderating effect neighborhood SOC has on predictors of substance use among Hispanic (N = 538) urban youth in low- (n = 246) and high-conflict homes (n = 292). Using logistic regression analysis and a plotting technique to examine interaction effects, we explore these relationships and provide recommendations for practice and prevention.

Exploring associations of clinical and social parameters with violent behaviors among psychiatric patients.

Evidence has revealed interesting associations of clinical and social parameters with violent behaviors of patients with psychiatric disorders. Men are more violent preceding and during hospitalization, whereas women are more violent than men throughout the 3days following a hospital admission. It has also been proven that mental disorders may be a consistent risk factor for the occurrence of violence. In order to better understand violent behaviors of patients with psychiatric disorders, it is important to investigate both the clinical symptoms and psychosocial factors that accompany violence in these patients. In this study, we utilized a dataset released by the Partners Healthcare and Neuropsychiatric Genome-scale and RDoC Individualized Domains project of Harvard Medical School to develop a unique text mining pipeline that processes unstructured clinical data in order to recognize clinical and social parameters such asage, gender, history of alcohol use, and violent behaviors, and explored the associations between these parameters and violent behaviors of patients with psychiatric disorders. The aim of our work was to demonstrate the feasibility of mining factors that are strongly associated with violent behaviors among psychiatric patients from unstructured psychiatric evaluation records using clinical text mining. Experiment results showed that stimulants, followed by a family history of violent behavior, suicidal behaviors, and financial stress were strongly associated with violent behaviors. Key aspects explicated in this paper include employing our text mining pipeline to extract clinical and social factors linked with violent behaviors, generating association rules to uncover possible associations between these factors and violent behaviors, and lastly the ranking of top rules associated with violent behaviors using statistical analysis and interpretation.

Demographic, Clinical and Polysomnographic Characteristics of Childhood- and Adult-Onset Sleepwalking in Adults.

BACKGROUND: Sleepwalking (SW) is found to affect children predominantly, but it can persist or appear de novo even among adults. In this study, we assessed the demographic, clinical and polysomnographic profile, trigger factors and associated comorbidities of adult-onset (AO-SW) and childhood-onset (CO-SW) adult sleepwalkers. METHODS: In adult sleepwalkers, a structured clinical interview, a battery of questionnaires, video-polysomnography (v-PSG) and standard electroencephalography (EEG) were performed. RESULTS: Among 63 sleepwalkers, 45% had ≥1 episodes/month, 54% had partial recall of the episodes and 36% reported trigger factors for SW. Almost all subjects reported co-occurring parasomnias. In v-PSG, 4% exhibited episodes of SW, 17% confusional arousals, 21% had an increased apnea-hypopnea-index and 6% exhibited features of an overlap parasomnia disorder. In our cohort, 73% reported CO-SW and 27% AO-SW. In subjects with AO-SW, positive family history for parasomnias was found in 33% (vs. 49% in CO-SW), neurological comorbidities in 44% (vs. 14%), psychiatric comorbidities in 25% (vs. 33%), EEG abnormalities in 50% (vs. 29%). Violence during SW episodes was more frequent in males and in subjects with CO-SW (45% for self-injury and 44% for violent behaviour vs. 33 and 29% respectively in the AO-SW group). CONCLUSIONS: Adult SW represents a complex and potentially dangerous condition. The characteristics of AO-SW often differ from those of CO-SW.