Childhood Trauma Predicts Sadistic Traits and Violent Behavior in Incarcerated Youth.

Childhood trauma exposure is prevalent among incarcerated youth and associated with antisocial traits and behavior. It has been proposed as a risk factor for the development of sadistic traits, which has been shown to predict future violence in youth. Using regression analyses, we examined the association between self-report and expert-rated measures of childhood trauma, sadistic traits (i.e., verbal, physical, vicarious sadism), and violence (i.e., homicide and non-homicide violent acts) in 54 incarcerated juveniles. Expert-rated (but not self-report) severity of physical abuse was associated with physical and vicarious sadistic traits. Other trauma types (e.g., emotional or sexual abuse) were not significantly associated with sadistic traits. Physical abuse coupled with vicarious sadistic traits conferred the highest risk of non-homicide violence. The findings support and clarify links between childhood trauma, sadistic traits, and violent behavior in youth, and are distinct from those found in other antisocial profiles.

A report on staff injuries and ambulatory restraints: dealing with patient aggression.

1. During a 6 1/2-year period on a unit designed for repetitively aggressive male patients, nursing staff members were the recipients of 95% of aggressions and 97% of serious injuries. 2. Two-point ambulatory restraints, called Preventive Aggression Devices (PADS) help liberate the patient from prolonged seclusion, but in a safe manner. 3. Patient aggression is underreported; there is a need for a standardized aggression reporting system across facilities.

The impact of the right to refuse treatment in a forensic patient population: six-month review.

In December of 1987, the Wisconsin supreme court held that all involuntarily committed mental patients in the state had the right to refuse psychotropic medication unless a court held that they were incompetent to make treatment decisions. The authors studied the effects of this decision in a 165-bed forensic hospital over the first six months after implementation of the decision. They found that 29 percent of patients already on psychotropic medication initially refused further treatment as opposed to 75 percent of newly admitted patients. Of refusers, 32 percent eventually resumed taking medication voluntarily; courts overturned the refusals of all the 51 percent who maintained their refusals, after an average delay of over a month. The length of procedural delays actually increased over the six months of the study as the courts learned of the decision. The authors compare their findings with other reported studies of implementation of right to refuse treatment decisions and discuss differences between the right to refuse treatment for civilly and criminally committed patients.

Preventive aggression devices (PADS): ambulatory restraints as an alternative to seclusion.

The authors introduce an ambulatory restraint procedure developed for a specialized inpatient unit with repetitively aggressive patients. Preventive Aggression Devices (PADS) reduce the length and frequency of seclusion and humanely foster a safer, more therapeutic environment for patients requiring a highly controlled environment. Indications and contraindications for PADS are listed, and criteria for their use are described.

A model for understanding and managing cycles of aggression among psychiatric inpatients.

A model developed at the Forensic Center of the Mendota Mental Health Institute for understanding and managing aggressive inpatients focuses on the dynamics of inpatient aggression and their impact on staff. Divided into cycles of physical and verbal aggression, the model incorporates staff responses to aggressive behaviors and outlines the responsibilities of the administration in helping staff deal with aggressive patients. It particularly addresses repetitive aggression and the importance of recognizing countertransference issues.