Creatine kinase elevations and aggressive behavior in hospitalized forensic patients.

The relationship between creatine kinase (CK) and aggressive behavior was tested in 195 males consecutively admitted to a forensic hospital. Among patients receiving antipsychotic medication, the most violent patients had higher CK levels than less violent patients. This was not the case in patients who did not receive antipsychotic medication. CK levels were not influenced by age, ethnicity, or clinical diagnosis. CK levels were however influenced by prior assaultiveness and restraints. When these two factors were controlled for, CK levels remained strongly associated with subsequent violence. CK appears to be a potential predictor of violent behavior. It has the advantage of easy availability in comparison to other biological markers of aggression (e.g., 5-HIAA). Prospective studies are needed to confirm the validity of this biobehavioral association.

Ethnicity, aggression and serum creatine kinase in hospitalized male forensic patients.

OBJECTIVE: This study examined the relationship of serum creatine kinase (CK) levels with aggressive behavior as a function of psychosis and ethnicity in a sample of violent forensic patients. DESIGN: CK levels were determined on admission in a sample of 195 males consecutively admitted to a forensic hospital. The patients' aggressive behavior during their hospital stay was monitored using the Overt Aggression Scale (OAS). All data for this study was archival and gathered from hospital records. METHODS: Multivariate analysis of variance was used to examine whether African-American and Caucasian patients differed in serum CK levels and severity, frequency, and type (verbal vs physical) of aggression. T-tests were performed to compare ethnic groups in terms of age, weight, height, systolic and diastolic blood pressure. All patients who had been in restraints, had been administered intramuscular medications, had a history of drug or alcohol abuse, and were classified as schizophrenic were compared using chi-square analysis. For each of these variables further comparisons were made of CK levels between African-American and Caucasian patients. RESULTS: Mean serum CK in African-American patients was 64% higher than in Caucasians. African Americans displayed significantly greater physical aggression than Caucasian patients. In addition, African-American patients with a diagnosis of schizophrenia had significantly higher CK levels than African Americans with other diagnoses, with no significant differences related to schizophrenia noted within the Caucasian group. No significant differences in aggressive behavior related to schizophrenia were found in African-American patients. CONCLUSIONS: This study confirms the findings of previous reports which observed higher CK levels in African Americans than in Caucasians. It is also proposed that a confluence of physiologic and psychosocial factors may affect biological marker presentation, particularly as manifest in CK differences between ethnic groups.

Characteristics and cost of staff injuries in a forensic hospital.

At a maximum-security forensic hospital over a three-year period, 79 patients (35 percent of all patients) were involved in 157 staff injuries. Staff members' average postinjury absence from work was 85 days, at a cost equivalent to about 2 percent of the hospital's budget. Nursing staff, particularly psychiatric technicians, had the highest injury rate. Male staff were about twice as likely to be injured as female staff. More injuries occurred on the second shift. Patients who injured staff were younger than those who did not. Florid psychotic behavior, nonpsychotic agitation, and the recent use of restraints were the most common prodromal signs.

Serum cholesterol and perception of anger and sadness.

Analysis of cholesterol levels in 34 forensic patients indicated significant associations with measures of the patients' perceptions of the emotional content in auditory stimuli. In particular, patients with low cholesterol showed hypersensitivity in the detection of anger and sadness. The authors hypothesize the involvement of serotonin in the hypersensitivity effects. Organicity and age were ruled out as contributing factors.

Serum cholesterol and aggression in hospitalized male forensic patients.

Human studies of the link between serum cholesterol and aggression have yielded equivocal results. Depending on the type of aggression studied (e.g., criminal violence or Type A hostility), investigators have found either a negative or a positive association between cholesterol and aggressive behavior. We conducted a retrospective analysis of aggressive incidents in a sample of hospitalized male forensic patients. The whole sample had lower cholesterol levels than the general population. Patients with low cholesterol levels (< 200 mg/dl) engaged in more frequent aggressive behavior but showed no difference in severity of aggression. They also showed no difference in verbal vs physical aggression. The relationship between cholesterol and frequency of aggression was curvilinear, with the most frequent acts of aggression committed by patients with moderately low cholesterol levels. Current research findings regarding the cholesterol-aggression association suggest the need for further clarification of the behavioral parameters under investigation.

Serum cholesterol levels and frequency of aggression.

Analysis of serum cholesterol levels of 106 male forensic patients showed significant differences in frequency of aggression, with low cholesterol levels predominant among those more frequently violent.

Clinical predictors of self-mutilation in hospitalized forensic patients.

This study evaluated the clinical correlates and inpatient course of self-mutilation in a diagnostically diverse sample of hospitalized forensic patients. Fifty-three male forensic inpatients, treated in a maximum-security hospital, who engaged in at least one instance of self-mutilation during a 2-year period, were studied and compared with 50 male forensic patients at the same hospital who had not engaged in self-mutilation. Self-mutilating patients were younger, more likely to carry a diagnosis of personality disorder or mental retardation, engaged in more outwardly directed aggressive behavior as assessed by the Overt Aggression Scale, were treated with substantially higher doses of neuroleptics, and were more likely to be civil or correctional patients than insanity acquittees. The two groups did not differ on variables such as history of suicide, history of violence, neurological characteristics, and other demographic variables. After an incident of self-mutilation, the probability of recurrence was high. The substantially higher level of outwardly directed aggression of self-mutilating patients, along with their higher apparent need for neuroleptization and the high risk of recurrence of the self-mutilation, suggest that they are a subset of violent individuals who are relatively unresponsive to treatment and who are dangerous to self and others.

Hematological changes and severity of aggression in black and white forensic patients.

Analysis of hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, and red blood-cell count for a group of 46 black and 59 white male forensic patients showed significant hematological differences between the groups, with white patients demonstrating higher mean values for all four measures.

Neuropsychological deficit and aggressive behavior: a prospective study.

1. Failures in higher cortical executive functions and dyscontrol of aggressive impulses were hypothesized to co-occur in aggressive men. 2. The performance of a sample of violent forensic patients on selected neuropsychological measures (Judgment of Line Orientation, Stroop Color Word Test, Emotion Perception Test, Test Of Nonverbal Intelligence, Wisconsin Card Sorting Test, and Symbol Digit Modalities Test) were used to predict their overt aggressive behavior during a one-year period using the Overt Aggression Scale. 3. Whole-set correlation analyses revealed that scores on the Judgment of Line Orientation, Stroop Color Word Test, and Emotion Perception Test accounted for 57% of the variance of aggression scores. 4. Frequency of aggression, but not severity of aggression, can be predicted using these three scores.

Abnormal lateralization in finger tapping and overt aggressive behavior.

1. The relationship between abnormal cerebral lateralization and overt aggressive behavior was examined in 41 violent psychiatric patients in a maximum-security hospital. 2. Cerebral lateralization was measured using the Finger Oscillation Test from the Halstead-Reitan Neuropsychological Battery, and aggressive behavior was measured during a six-month period of hospitalization using the Overt Aggression Scale. 3. Patients with the most abnormal pattern of lateralization exhibited the highest frequency as well as the highest severity of overt aggressive behavior. This pattern could not be explained by the influence of age, race, IQ, history of head trauma, brain damage, or psychiatric diagnosis. History of seizures, alcohol abuse, and drug abuse, however, were found to be intervening variables in the lateralization-aggression link. Once their influence was removed using analysis of covariance, there was no relationship between lateralization and aggression. 4. The results suggest that it is unlikely that there is a direct causal relationship between abnormal lateralization and aggressive behavior.

Efficacy of carbamazepine in assaultive patients with frontal lobe dysfunction.

1. A double-blind pilot study using a reversal design was conducted to examine the efficacy of carbamazepine in four cases of assaultiveness associated with frontal lobe dysfunction compared to five control cases. 2. Frontal lobe patients who received carbamazepine demonstrated a pattern of improvement on all cognitive, affective, and behavioral measures. This was followed by return to pretreatment level (measures of assaultiveness, depression, and general cerebral efficiency) or sustained improvement (measures of frontal lobe efficiency) when carbamazepine was discontinued. Control subjects showed only minimal differences across testing.