Positive symptoms, substance use, and psychopathic traits as predictors of aggression in persons with a schizophrenia disorder.

It is still not clear what the unique contribution of particular psychopathological factors is in explaining aggression in schizophrenia. The current study examined whether persecutory ideations, psychopathy and substance use are associated with different measures of aggressive behavior. We expected that persecutory ideations are associated with reactive aggression, and psychopathic traits are more associated with proactive aggression of inpatients. 59 inpatients with schizophrenia were included. Persecutory ideations we assessed using the Persecutory Ideation Questionnaire (PIQ), psychopathic traits with the revised version of Psychopathic Personality Inventory (PPI-R) and substance use was assessed using the Comprehensive Assessment of Symptoms and History (CASH). In addition, aggression was measured with the Reactive and Proactive Aggression Questionnaire (RPQ), in an experimental task using the Point Subtraction Aggression Paradigm (PSAP) and on the ward using the Social Dysfunction and Aggression Scale (SDAS). Results showed that psychopathy explains most of the variance in self-reported proactive and reactive aggression. In contrast, persecutory ideations explain most of the variance in observed aggression on the ward. Results implicate that it is important to acknowledge comorbid factors in patients with schizophrenia for more precise risk assessment and appropriate treatment for aggressive patients with schizophrenia.

Anti-social personality characteristics and psychotic symptoms: Two pathways associated with offending in schizophrenia.

BACKGROUND: Several research groups have shown that people with schizophrenia who offend do not form a homogenous group. A three-group model claimed by Hodgins proposes distinguishing between people who start offending before the onset of psychosis (early starters), after psychosis onset but at age 34 years or under (late starters) and after psychosis onset but at age 35 years or older (late first offenders). AIMS: This study aimed to test the hypotheses (1) that the personality of early starters and non-psychotic offenders would be similar, but different from either late-starter group; (2) that the late-starter groups would be more likely to have positive psychotic symptoms than non-criminal patients with schizophrenia; and (3) that symptom types would differentiate the psychotic groups. METHODS: A retrospective file study was conducted on cases of 97 early starters, 100 late starters and 26 late first offenders all drawn from the Netherlands Institute of Forensic Psychiatry and Psychology (NIFP) archives 1993-2008, 115 non-psychotic offenders from 2005-2008 NIFP archives and 129 patients with schizophrenia and no criminal history from one general service in Rotterdam. RESULTS: Early starters closely resembled the non-psychotic offenders in their premorbid anti-social personality characteristics. The two late-onset offending psychosis groups were more likely to have persecutory and/or grandiose delusions than non-offenders with psychosis, but so were the early starters. IMPLICATIONS: In a first study to compare subgroups of offenders with psychosis directly with non-psychotic offenders and non-offenders with psychosis, we found such additional support for a distinction between early and late starters with psychosis that different treatment strategies would seem indicated, focusing on personality and substance misuse for the former but psychotic symptoms for all. It remains to be seen whether the higher rate of alcohol misuse amongst late first offenders is a fundamental distinction or a function of age difference.

The role of ideational distress in the relation between persecutory ideations and reactive aggression.

BACKGROUND: People with schizophrenia are more likely to be violent than the people without it. Feeling driven to act on persecutory delusions may be one explanation for this, but it remains unclear why some should act on such delusions but some not. Acquisition of data from people who are very ill is problematic. Our study explores testing of hypotheses on similar ideational and behavioural associations among healthy recruits from the general population. AIMS: This study aims to test the effect of distress induced by persecutory ideas on any relationships between those ideas and aggressive behaviour, and the effect of gender. METHODS: Twenty-four men and 53 women from the general population participated in this study. The measures of aggressive behaviour were experimentally induced aggressive responding, self-reported aggressive behaviour in general, and self-reported reactive and proactive aggressive behaviours. RESULTS: Among men, persecutory ideation predicted reactive aggressive responding and aggressive style of behaviour only in those who experienced higher levels of persecutory ideational distress. Among women, with generally lower levels of aggression, the role of ideational distress was more complicated; Women in the low distress group responded with higher aggression on the task. Women in the higher distress group responded with higher aggressive style. For neither men nor women were there links between persecutory ideation and proactive aggression, regardless of distress. CONCLUSIONS: Ideational distress moderates the relation between persecutory ideation and aggression in different measures of aggression in men and women. IMPLICATIONS FOR PRACTICE AND/OR RESEARCH: Recognition of a relation between persecutory ideations and aggression is also important in the general population. Insight in the theory of acting upon delusions may lead to more accurate violence risk assessment. Facilitation of early detection of experienced delusional distress may lead to development of more specific psychotherapeutic interventions to manage violence risk.

Explaining the relationship between insecure attachment and partner abuse: the role of personality characteristics.

Studies have found that male batterers are more often insecurely attached as compared with nonbatterers. However, it is still not clear how insecure attachment is related to domestic violence. Many studies compared batterers and nonbatterers regarding pathological personality characteristics that are related to attachment (e.g., dependency, jealousy) and generally found that batterers report more personality characteristics. However, these studies did not investigate which role these characteristics played in the relationship between insecure attachment and battering. The first aim of this study is to test which personality characteristics are good candidates to explain the relationship between insecure attachment and domestic violence. The second aim is to test whether personality characteristics are predictive of battering over and above attachment. Seventy-two mainly court-mandated family-only males who were in group treatment for battering are allocated to a securely and an insecurely attached group and compared with 62 nonbatterers. Using questionnaires, self-esteem, dependency, general distrust, distrust in partner, jealousy, lack of empathy, separation anxiety, desire for control, and impulsivity were assessed. This was the first study that examined distrust, separation anxiety, and desire for control in relation to battering. The results show that the relationship between insecure attachment and domestic violence can be explained by separation anxiety and partner distrust. Moreover, only partner distrust increased the risk for battering over and above insecure attachment. The findings suggest the presence of two subtypes among batterers based on attachment style, which has similarities to the family-only and dysphoric-borderline subtypes suggested by Holtzworth-Munroe and Stuart. Implications of the present findings for therapy are discussed.

Young serious and vulnerable offenders in the Netherlands: a cohort follow-up study after completion of a PIJ (detention) order.

BACKGROUND: About 150-200 'Placement in an Institution for Juveniles Orders' (PIJ orders) are imposed each year in the Netherlands. Many of the young people under these orders have mental disorders or 'threatened psychological development' and are thought to be at high risk of recidivism. There are no previous studies of the range of judicial, correctional or psychiatric contacts after the PIJ order, but this could extend understanding of any links between post-treatment psychological development of these young offenders and their reoffending or desistence from it. AIMS: To examine reoffending and judicial, correctional or psychiatric contacts of juveniles after a PIJ order, any relationship between seriousness of the index offence and first reoffence, and to test the hypothesis that 'threatened psychological development' is associated with higher recidivism rates. METHODS: A records-based follow-up study of a 9-year (1995-2003) national release cohort of 781 Dutch juvenile offenders finishing a PIJ order under the Juvenile Entrustment Act. Descriptive statistics were used to show patterns of reoffending and the reoffending and non-reoffending groups compared. RESULTS: The mean length of the PIJ order was 2.5 years, and mean time subsequently at risk for offending was 83.5 months (range 51-135 months). After treatment under a PIJ order, serious criminal offending was reduced by 50%, and there was a trend towards less serious property offences. Contrary to prediction, 'threatened psychological development' was not associated with worse outcomes. CONCLUSIONS: The data offer support for the value of the PIJ order. The recidivism rate remains high, and although the trend to less serious offending is encouraging, the findings raise questions about whether criminogenic needs are sufficiently met. By contrast, the apparently low rates of adult mental disorder, even among those regarded as having had 'threatened psychological development', suggest that PIJ institutions are doing a good job with respect to mental health.