The Relation Between Trait Anger and Impulse Control in Forensic Psychiatric Patients: An EEG Study.

Inhibitory control is considered to be one of the key factors in explaining individual differences in trait anger and reactive aggression. Yet, only a few studies have assessed electroencephalographic (EEG) activity with respect to response inhibition in high trait anger individuals. The main goal of this study was therefore to investigate whether individual differences in trait anger in forensic psychiatric patients are associated with individual differences in anger-primed inhibitory control using behavioral and electrophysiological measures of response inhibition. Thirty-eight forensic psychiatric patients who had a medium to high risk of recidivism of violent and/or non-violent behaviors performed an affective Go/NoGo task while EEG was recorded. On the behavioral level, we found higher scores on trait anger to be accompanied by lower accuracy on NoGo trials, especially when anger was primed. With respect to the physiological data we found, as expected, a significant inverse relation between trait anger and the error related negativity amplitudes. Contrary to expectation, trait anger was not related to the stimulus-locked event related potentials (i.e., N2/P3). The results of this study support the notion that in a forensic population trait anger is inversely related to impulse control, particularly in hostile contexts. Moreover, our data suggest that higher scores on trait anger are associated with deficits in automatic error-processing which may contribute the continuation of impulsive angry behaviors despite their negative consequences.

The impact of angry rumination on anger-primed cognitive control.

BACKGROUND AND OBJECTIVES: Recent research suggests that angry rumination augments aggressive behavior by depleting self-control resources. Yet, few studies have been conducted to empirically support this proposal. In the present study, we therefore sought to investigate the effects of angry rumination, relative to distraction, on self-reported anger and a behavioral indicator of self-control. METHODS: Seventy-two participants recalled and imagined an anger-inducing autobiographical memory and were instructed to engage in either angry rumination (n = 37) or distraction (n = 35). Following these emotion regulation instructions, participants performed an affective Go/NoGo task in order to assess behavioral self-control along with several questionnaires to assess anger related constructs. RESULTS: As expected, results revealed that angry rumination augmented anger, whereas anger decreased in the distraction condition. Contrary to predictions, we found no differences between both groups in performance on the affective Go/NoGo task. LIMITATIONS: A potential limitation is we instructed our participants on how to regulate their emotions rather than letting angry rumination occur spontaneously. CONCLUSIONS: The findings indicate that whereas angry rumination results in heightened anger, it does not seem to result in lower self-control as measured with a behavioral task that requires cognitive control. More research is needed to test the boundary conditions regarding the role of self-control in understanding rumination-induced aggression.

Association of Polymorphisms of Serotonin Transporter (5HTTLPR) and 5-HT2C Receptor Genes with Criminal Behavior in Russian Criminal Offenders.

BACKGROUND: Human aggression is a heterogeneous behavior with biological, psychological, and social backgrounds. As the biological mechanisms that regulate aggression are components of both reward-seeking and adversity-fleeing behavior, these phenomena are difficult to disentangle into separate neurochemical processes. Nevertheless, evidence exists linking some forms of aggression to aberrant serotonergic neurotransmission. We determined possible associations between 6 serotonergic neurotransmission-related gene variants and severe criminal offenses. METHODS: Male Russian prisoners who were convicted for murder (n = 117) or theft (n = 77) were genotyped for variants of the serotonin transporter (5HTTLPR), tryptophan hydroxylase, tryptophan-2,3-dioxygenase, or type 2C (5-HT2C) receptor genes and compared with general-population male controls (n = 161). Prisoners were psychologically phenotyped using the Buss-Durkee Hostility Inventory and the Beck Depression Inventory. RESULTS: No differences were found between murderers and thieves either concerning genotypes or concerning psychological measures. Comparison of polymorphism distribution between groups of prisoners and controls revealed highly significant associations of 5HTTLPR and 5-HTR2C (rs6318) gene polymorphisms with being convicted for criminal behavior. CONCLUSIONS: The lack of biological differences between the 2 groups of prisoners indicates that the studied 5HT-related genes do not differentiate between the types of crimes committed.

Anger Assessment in Clinical and Nonclinical Populations: Further Validation of the State-Trait Anger Expression Inventory-2.

OBJECTIVE: The most commonly used instrument for measuring anger is the State-Trait Anger Expression Inventory-2 (STAXI-2; Spielberger, 1999). This study further examines the validity of the STAXI-2 and compares anger scores between several clinical and nonclinical samples. METHOD: Reliability, concurrent, and construct validity were investigated in Dutch undergraduate students (N = 764), a general population sample (N = 1211), and psychiatric outpatients (N = 226). RESULTS: The results support the reliability and validity of the STAXI-2. Concurrent validity was strong, with meaningful correlations between the STAXI-2 scales and anger-related constructs in both clinical and nonclinical samples. Importantly, patients showed higher experience and expression of anger than the general population sample. Additionally, forensic outpatients with addiction problems reported higher Anger Expression-Out than general psychiatric outpatients. CONCLUSION: Our conclusion is that the STAXI-2 is a suitable instrument to measure both the experience and the expression of anger in both general and clinical populations.

Trait anger in relation to neural and behavioral correlates of response inhibition and error-processing.

Effortful control is considered to be an important factor in explaining individual differences in trait anger. In the current study, we sought to investigate the relation between anger-primed effortful control (i.e., inhibitory control and error-processing) and trait anger using an affective Go/NoGo task. Individuals low (LTA; n=45) and high (HTA; n=49) on trait anger were selected for this study. Behavioral performance (accuracy) and Event-Related Potentials (ERPs; i.e., N2, P3, ERN, Pe) were compared between both groups. Contrary to our predictions, we found no group differences regarding inhibitory control. That is, HTA and LTA individuals made comparable numbers of commission errors on NoGo trials and no significant differences were found on the N2 and P3 amplitudes. With respect to error-processing, we found reduced Pe amplitudes following errors in HTA individuals as compared to LTA individuals, whereas the ERN amplitudes were comparable for both groups. These results indicate that high trait anger individuals show deficits in later stages of error-processing, which may explain the continuation of impulsive behaviors in HTA individuals despite their negative consequences.

Open, randomized trial of the effects of aripiprazole versus risperidone on social cognition in schizophrenia.

To date, only few studies have examined the impact of medication on social cognition and none have examined the effects of aripiprazole in this respect. The goal of this 8-week, randomized, multicenter, open-label study was to examine the effects of aripiprazole and risperidone on social cognition and neurocognition in individuals with schizophrenia. Eighty schizophrenia patients (DSM-IV-TR) aged 16-50 years were administered multiple computerized measures of social cognition and neurocognition including reaction times at baseline and the end of week 8. Social functioning was mapped with the Social Functioning scale and Quality of Life scale. The study ran from June 2005 to March 2011. Scores on social cognitive and neurocognitive tests improved with both treatments, as did reaction time. There were few differences between the two antipsychotics on (social) cognitive test-scores. The aripiprazole group performed better (more correct items) on symbol substitution (P=.003). Aripiprazole was also superior to risperidone on reaction time for emotional working memory and working memory (P=.006 and P=.023, respectively). Improvements on these tests were correlated with social functioning. In conclusion, aripiprazole and risperidone showed a similar impact on social cognitive test-scores. However, aripiprazole treatment produced a greater effect on patients' processing speed compared to risperidone, with these improvements being associated with concurrent improvements in social functioning. Further research on the long-term effects of aripiprazole on cognition is warranted.

Psychiatrists' view on the risk factors for aggressive behavior in psychotic patients.

In meta-analytic studies it was found that patients diagnosed with a psychotic disorder are at increased risk for displaying violent behavior. However, it remains largely unclear which specific factors contribute to the heightened risk for aggression in this patient group, nor what the views of psychiatrists are on this issue. A cross-sectional survey study was carried out and a survey questionnaire was developed to investigate the view of 652 psychiatrists on the relative contributions of various factors (e.g., illness related, personality, social influences) that might explain aggression in psychosis. It was found that psychiatrists generally view illness-related features as the most important determinant of aggression in these patients, followed by impulsivity/lack of insight and social influences, whereas personality characteristics are considered as least relevant. Latent class cluster analysis revealed that there are several subgroups of psychiatrists who attach different levels of importance to various types of risk factors. In these subgroups, two cluster contrasts were found: one representing differences in response style, and one representing differences in the evaluation of personality characteristics. Overall, psychiatrists seem to adopt a medical model when interpreting aggression in psychotic patients, although several subgroups of psychiatrists can be identified who have different opinions of such behavior.

Kallmann syndrome and paranoid schizophrenia: a rare combination.

Kallmann syndrome (KS) is a genetically heterogeneous and rare disorder characterised by the combination of hypothalamic hypogonadism and anosmia/hyposmia, a variable degree of intellectual disability and several somatic anomalies. In about one-third of the patients, mutations have been identified in at least seven different genes. Virtually no data are available about possible neuropsychiatric symptoms in KS. Here, a young adult male is described with a previous clinical diagnosis of KS and recent paranoid schizophrenia of which positive, but not negative symptoms, fully remitted upon treatment with antipsychotics. Neither genome-wide array analysis nor mutation analyses disclosed imbalances or mutations in any of presently known KS disease genes. This is the first report on a patient with KS and paranoid schizophrenia in whom extensive genetic analyses were performed. It is concluded that further studies are warranted in order to elucidate a possible increased risk for psychiatric symptoms in patients with KS.

Risk factors for overweight and diabetes mellitus in residential psychiatric patients.

OBJECTIVE: To investigate the prevalence of and risk factors for overweight and diabetes mellitus in long-stay psychiatric inpatients. METHOD: Statistical analysis of data collected from medical, laboratory, and pharmacy files. RESULTS: 80% of the 256 patients were suffering from schizophrenia or other psychotic disorders. The prevalence of diabetes mellitus was 15%. The prevalence of a disturbed glucose tolerance was 14%. Severe overweight (BMI > 30) was positively associated with the use of clozapine (odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.31-5.75), but negatively with the diagnosis schizophrenia (OR = 0.4; 95% CI: 0.22-0.88). Diabetes mellitus was associated with severe overweight (OR = 3.5; 95% CI: 1.57-7.69). Caucasian patients were at a lower risk for diabetes mellitus (OR = 0.2; 95% CI: 0.08-0.54). CONCLUSIONS: In residential psychiatric patients, diabetes mellitus is especially associated with overweight and non-Caucasian origin. In this survey, the use of clozapine was associated with overweight, but not directly with diabetes mellitus. Diabetes mellitus is highly prevalent, which calls for screening for diabetes mellitus at regular intervals.

Psychometric properties of an instrument for measuring threat/control-override symptoms.

Threat/control-override symptoms refer to delusional persecutory thoughts and feelings of losing control over mind and body. The Threat/Control-Override Questionnaire (TCOQ) was developed to assess such symptoms, and the purpose of the present study was to examine the psychometric properties of this measure in nonclinical students (n = 759) and acute and stabilized psychotic patients (n = 111 and 33, respectively). Factor analysis of TCOQ data in students and acute psychotic patients yielded a two-factor solution, with components referring to "threat" and "control-override" symptoms. Internal consistency and test-retest reliability were satisfactory and concurrent and discriminant validity were shown by a meaningful pattern of correlations with other self-report and interview measures. Group comparisons showed that patients displayed significantly higher scores on the TCOQ than did the nonclinical students. Altogether, it can be concluded that the TCOQ is a reliable and valid index for assessing feelings of persecution and losing control.

War stress and late-life mortality in World War II male civilian resistance veterans.

The mental and physical health of 146 Dutch males exposed to severe war stress during their young adulthood were examined in 1986-1987 when they were at ages 61 to 66 years. The veterans' data were compared with a randomly selected population-based sample of same-aged males. In 2005, 70% of the war stress veterans had died, and only 35% of the comparison group. The baseline quality of life was significantly poorer in the war stress veterans than in the comparison group. Baseline variables explained 42% of the increased risk of mortality among war stress veterans. Smoking was the largest single contributor to mortality.

Threat/control-override symptoms and emotional reactions to positive symptoms as correlates of aggressive behavior in psychotic patients.

This cross-sectional multicenter study was carried out to examine whether the experience of threat/control-override symptoms and emotional reactions to positive symptoms (e.g., anger, anxiety) are related to aggressive behavior. Patients diagnosed with schizophrenia, delusional disorder, psychotic disorder not otherwise specified, or a schizoaffective disorder (N = 124) were interviewed and filled out self-report questionnaires. Results indicated that, in particular, threat/control-override symptoms were significantly related to aggressive behavior in psychotic patients. Further analysis revealed that the threat symptoms especially, but not the control-override symptoms, carried this effect. Anger disposition also accounted for a significant and unique proportion of the variance in the aggressive behavior of psychotic patients, whereas state anger and anxiety in reaction to positive symptoms did not. These results seem to suggest that feeling threatened by positive psychotic symptoms and anger disposition play a role in the origins of aggressive behavior of psychotic patients.

Psychometric evaluation of a Dutch version of the Dimensions of Anger Reactions.

Two studies were conducted to investigate the psychometric properties of a Dutch translation of the Dimensions of Anger Reactions, a brief test to measure anger disposition. In the first study, the factor structure, internal consistency, and validity of the scale were examined in a sample of 97 students. Factor analysis essentially yielded one factor, although further inspection found some evidence for a two-factor structure referring to "anger response" and "impairment." The internal consistency was acceptable, and convergent and divergent validities were supported by a theoretically meaningful pattern of correlations with other self-report measures, such as the Aggression Questionnaire, Barratt's Impulsivity Scale-11, and the Symptom Checklist-90. In a second study, the test-retest reliability of the scale was examined in a separate sample of 37 students. A correlation coefficient of .84 was found, supporting the reliability of the scale. Altogether, it can be concluded that the Dutch Dimensions of Anger Reactions seems to be reliable and valid for assessing anger disposition.

Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands.

BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. METHODS: A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. RESULTS: This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. CONCLUSION: Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands.

CONTEXT: Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. OBJECTIVES: The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. DESIGN, SETTING, AND PARTICIPANTS: A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). MAIN OUTCOME MEASURES: General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. RESULTS: More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. CONCLUSIONS: Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

Utility of the impact of event scale in screening for posttraumatic stress disorder.

This study assesses the optimal cut-off point for the Impact of Event Scale and compares its screening properties with those of the Self-rating Inventory for Posttraumatic Stress Disorder among war-related trauma victims. 74 patients with war-related trauma were administered the Impact of Event Scale and the Self-rating Inventory for Posttraumatic Stress Disorder, followed 1 wk. later by the Clinician-administered PTSD Scale. Receiver operating characteristic analysis indicated for the Impact of Event Scale a sensitivity of .77 and a specificity of .51 at a cut-off value of 36. For the Self-rating Inventory for Posttraumatic Stress Disorder a sensitivity of .86 and a specificity of .69 were found at a cut-off value of 52. The authors conclude that careful use of the Impact of Event Scale as a screening measure for Posttraumatic Stress Disorder is warranted.

Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study.

BACKGROUND: This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services. METHODS/DESIGN: The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600), as these are among the largest groups within the reception centres and municipalities in the Netherlands. The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization), mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire), utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study) and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose. This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.