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OP-8. - PSYCHOPATHOLOGY AND HUMAN AGGRESSION

OP-8.1.-IS THE GENERAL PUBLIC A TARGET OF VIOLENT MENTALLY-DISORDERED INDIVIDUALS?. FINDINGS FROM A YOUNG ADULT BIRTH COHORT

Arseneault, L., Moffitt, T.E. and Caspi, A.
King's College London - Institute of Psychiatry, SGDP Research Centre, London, UK

We showed in a previous report that at the age when violent incidents are at their peak, individuals who meet diagnostic criteria for schizophrenia-spectrum disorder, alcohol dependence or marijuana dependence account for a significant proportion of violence in the community (Arseneault, Moffitt, Caspi, Taylor, & Silva, 2000). The present study examined victims of violence committed by young mentally-disordered offenders at the age period when they contribute most heavily to the community's violence burden. This study aimed to determine the extent to which young adults with either schizophrenia-spectrum disorder, alcohol dependence or marijuana dependence had assaulted someone living with them, assaulted someone else, or perpetrated violent street crimes. In a total birth cohort (N=961), the past-year prevalence of mental disorders was measured via standardized DSM-III-R interviews, regardless of contacts with the hospital system. Past-year violence was measured via self-reports of offending: two items assessed simple and aggravated assaults against someone living at home (hit someone you lived with; attacked someone you lived with a weapon or with the idea of seriously hurting or killing them); two other items assessed simple and aggravated assaults against someone else (hit someone else; attacked someone else with a weapon or with the idea of seriously hurting or killing them); and two more items assessed serious violent acts, referred to as "street crimes" (used a weapon, force, or strong-arm methods to rob a person; were involved in a gang fight). Findings indicated that compared to controls, young offenders with schizophrenia-spectrum disorder or substance dependence were more likely to assault someone they were living with and also to assault other people or to commit violent street crimes. Ratios of offenses directed against someone living at home versus someone else show that among individuals with schizophrenia-spectrum disorder, an elevated proportion of offenses were committed against victims they were living with; among alcohol-dependent individuals, a slightly elevated proportion of offenses were committed against victims they were not living with; and among marijuana-dependent individuals, proportions of offenses against someone they were living with and against someone else were similar. These findings have implications for community violence prevention initiatives.

OP-8.2.-THE REPORT FORM FOR AGGRESSIVE EPISODES (REFA) IN THE TREATMENT OF VIOLENT PSYCHOTIC  PATIENTS

Bjørkly, S.
Faculty of Health Sciences, Molde College, Molde, Norway

Aggressive episodes significantly affect patients and their treatment milieu. The need for valid, reliable instruments capable of quantifying the nature and frequency of aggressive behaviour is clear.  In this paper three aspects of the clinical implementation of the REFA is presented: a) design and theoretical base; b)  interrater reliability, and c) a ten-year prospective study of  aggression. The REFA is a rating scale which measures aggressive behaviour towards other persons.  The interactional approach of the scale explicitly focuses on detailed situational analyses of aggression. The scale provides a list of 30 situations/interactions, grouped in seven main categories, to help determine the situations/interactions that precipitated the aggressive episode.  There are six vertical sections for the recording of characteristics of aggressive episodes: one for verbal threats, one for physical threats and four sections for physical assaults.Verbal threats are operationalized as: Verbal communication conveying a clear intention to inflict physical injury or death upon another person.  Physical threats: Non-verbal expression of threats, such as shaking one`s first at somebody or otherwise signaling bodily preparation for an assault.  Physical assaults: The intented infliction of bodily injury upon another person or unsuccessful attempts to cause physical injury to another person.  A study of single raters’ assessment showed high levels of interrater agreement and reliability (M = 83% correct assessments, k = .84, N= 48).  Results from a small scale study of group ratings were also promising (M = 96%, confidence limits for the probability of obtaining 100% correct ratings = .961, .999).  In both studies nurses assessed clinical vignettes by means of the REFA.  The main findings from a ten-year prospective study of inpatient aggression in a Norwegian special secure unit were: a) a majority of the aggressive acts were verbal or physical threats; b) a small proportion of patients accounted for the majority of aggressive episodes, and c) most of the aggressive incidents were precipitated by situations pertaining to limit-setting and problems of communication. Finally, some favourable aspects and some flaws  pertaining to the clinical application of the REFA are outlined. 

OP-8.3.-SLEEP PATHOLOGY AND ANTISOCIAL BEHAVIOR: A NEED FOR RESEARCH

Michael, N.
Castleton State College, Castleton, VT, USA

Subsequent to providing a review of normative sleep, five distinct lines of research are reviewed:  (1) depression and abnormal sleep architecture; (2) REM sleep deprivation in rats; (3) REM sleep and attachment behavior (4) sleep and functioning of the prefrontal cortex; and (5) atypical waking EEG patterns in chronically violent offender populations.  Current research suggests that clinically depressed individuals exhibit substantial sleep pattern anomalies primarily in the form of a higher percentage of time spent in REM sleep. Of interest is that many of the core features of depression appear to be antithetical to those which characterize chronic antisocial behavior.  Experimental studies examining the behavioral effects of selective REM sleep deprivation in rats report augmentation of aggression and impulsivity—key elements of repetitive antisocial conduct in humans.  A recently developed hypothesis asserts that the primary function of REM sleep in mammals is to facilitate attachment behavior while concurrent research also suggests that insecure childhood attachment is a strong etiological risk factor for adolescent and adult antisocial tendencies.  One of the most robust effects of sleep deprivation reported in humans is the deterioration of executive cognitive functioning capacities of the prefrontal cortex.  Similar deficits in executive cognitive functioning evident in many delinquent and criminal populations have been implicated in the etiology of chronic antisocial behavior.  Finally, numerous studies report abnormal waking EEG patterns in habitually violent offenders, which it has been suggested may be the result of irregular sleep patterns.  It is proposed that taken together the results and implications emanating from these five disparate lines of research strongly suggest a potential link between abnormal sleep patterns and antisocial behavior in humans.  Specific research questions in need of being addressed include:  (1) does selective REM sleep deprivation in humans lead to an increase in aggression?; (2) doe chronically antisocial populations manifest substantial sleep architecture anomalies in comparison to the general population?; (3) if there does prove to be a relationship between sleep pathology and antisocial behavior, what is the specific nature and direction of this relationship?; and (4) again presuming that a relationship does exist, what may be some of the primary neurobiological underpinnings of this relationship?

OP-8.4.-TREATMENT OF BORDERLINE PERSONALITY DISORDER - REDUCING VIOLENCE TO SELF AND OTHERS

Hurdle, D.E.
School of Social Work, Arizona State University, USA

Persons with personality disorders, particularly those with borderline personality disorder, have high rates of violence both to themselves and to others.  In particular, these individuals are often chronically suicidal and employ parasuicidal methods of handling stress and relationship issues. They are also prone to become violent with others, particularly when they are disappointed in interpersonal relationships. Persons with borderline personality disorder are overly represented in clinical populations receiving mental health treatment, and in in-patient psychiatric settings. Their psychological dynamics of poor impulse control, emotional dysregulation, and idealization-devaluation in interpersonal relationships create a situation in which violence is common. Until recently, there was no effective method of treating borderline personality disorders.  Psychoanalytical and psychodynamic methods do not result in improvement of the condition.  However, in recent years a new method of treating these individuals, Dialectical Behavior Therapy, has shown promise. There is research evidence indicating that this treatment results in a decrease in violent behaviors as well as an improved ability to live successfully in the community. This method consists of a combination of individual psychotherapy and group skill building sessions; the course of treatment is approximately one year.  The target client population was adults enrolled in a parasuicide clinic in a university setting.  However, there are difficulties adapting this research model to community practice.  In order to meet the needs of community-based practice, an adaptation of the DBT model was developed at a large community mental health center in the United States. This approach, Group Treatment of Adults with Personality Disorders, employs a predominantly group therapy format. It includes three integrated treatment groups which are provided to clients over the period of a year with supplemental psychiatric care.  The groups consist of a process therapy group, a skill-building group, and a recreational/activity therapy group.  While no formal program evaluation has yet occurred, clients have reduced their rate of in-patient hospitalization, and improved their ability to live successfully in the community. Additionally, this approach provides for treatment of clients with a variety of mental health problems in a cost-effective manner that works well in a managed care environment.