Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS.

Leonardo Fernandez Meyer,Lisieux E De Borba Telles,Alexandre Martins Valença,Kátia Mecler,Ana Luiza Alfaya Galego Soares,Renata Santos Alves

doi:10.1590/2237-6089-2017-0039

Abstract

This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.

Highlights

The available evidence suggests that HCR-20 is more effective in schizophrenia and mental retardation than in affective and personality disorders.[5,6]
The main objective of Violence risk assessment (VRA) in psychiatric patients is the identification of characteristics related to violent behavior and the planning and implementation of therapeutic strategies aimed at reducing that specific risk.[1,2]
The final sample consisted of 38 male participants with a diagnosis of schizophrenia; 19 were classified as violent and 19 as nonviolent

Summary

Introduction

Psychotic disorders have been consistently associated with aggressive behavior.[1,2,3] Violence risk assessment (VRA) began in forensic psychiatry, used especially for verifying cessation of dangerousness.[1,3] Such assessment was originally based on clinical psychiatric examination, and a number of scientific advances have been made since the 1990s in complementing traditional VRA.[1,2,4]The development of psychometric instruments such as the Historical, Clinical, and Risk Management-20 scale (HCR-20) is important for reducing evaluation bias, since objective violence-related parameters are traditionally stablished and evaluated through clinical examination in the mentally ill.[1,2,4] Regarding psychiatric diagnosis, the available evidence suggests that HCR-20 is more effective in schizophrenia and mental retardation than in affective and personality disorders.[5,6]The main objective of VRA in psychiatric patients is the identification of characteristics related to violent behavior and the planning and implementation of therapeutic strategies aimed at reducing that specific risk.[1,2] The HCR-20 was first developed especially for VRA in forensic psychiatric patients. Psychotic disorders have been consistently associated with aggressive behavior.[1,2,3] Violence risk assessment (VRA) began in forensic psychiatry, used especially for verifying cessation of dangerousness.[1,3] Such assessment was originally based on clinical psychiatric examination, and a number of scientific advances have been made since the 1990s in complementing traditional VRA.[1,2,4]. The development of psychometric instruments such as the Historical, Clinical, and Risk Management-20 scale (HCR-20) is important for reducing evaluation bias, since objective violence-related parameters are traditionally stablished and evaluated through clinical examination in the mentally ill.[1,2,4] Regarding psychiatric diagnosis, the available evidence suggests that HCR-20 is more effective in schizophrenia and mental retardation than in affective and personality disorders.[5,6]. Subsequent research with psychiatric patients demonstrated the instrument’s reliability in this population.[5,7]

Methods

Results

Conclusion