Aggression Subscales Research Articles

Report on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication

Background: Studies of pharmacotherapy for agitation in dementia have primarily been limited to single-drug trials and have not determined if some forms of agitated behaviors are more responsive to treatment than others. Objective: The goal of this study was to determine if manifestations of agitation (ie, physical aggression, physically nonaggressive behavior, and verbally agitated behaviors) show different degrees of response to divalproex sodium (extended release or sprinkles) alone or in combination with second-generation antipsychotic agents. Methods: This was a 6-week, open-label, naturalistic pilot study of patients aged >60 years recruited from a geriatric psychiatry inpatient unit, 2 nursing homes, and 4 assisted living residences. Patients were referred for study if they displayed Behavioral and Psychological Symptoms of Dementia. The primary outcome measure was the Cohen-Mansfield Agitation Inventory (CMAI), an instrument whose subscales allow measurement of physically aggressive behaviors, physically nonaggressive behaviors (eg, wandering), and verbally agitated behaviors. The Neuropsychiatric Inventory-Nursing Home version (NPI-NH) was also used to assess patients' behavior. Results: Fifteen patients were included in the study (10 men, 5 women; mean [SD] age, 81.9 [7.7] years). Total CMAI improved by 17.1% at week 1, showed an additional improvement of 3.4% at week 3, and no further improvement by week 6 (total score dropped by 1.1%). Aggressive behavior improved at weeks 3 and 6 while physically nonaggressive and verbally agitated behaviors improved at weeks 1 and 3, and lost much of the gains by week 6. The NPI-NH agitation/aggression score decreased a mean (SE) of 1.3 (0.5) points ( P = 0.03), the irritability/lability subscale decreased a mean (SE) of 2.3 (0.6) points ( P = 0.005), and the disinhibition subscale decreased a mean (SE) of 1.4 (0.4) points ( P < 0.01). Seven patients were on divalproex monotherapy and 8 patients were on combination therapy. Daily doses of divalproex (mean dose, 656 mg/d) in combination with a second-generation antipsychotic were 28% lower than divalproex monotherapy (mean dose, 914 mg/d). The most common adverse events were somnolence (7 of 15) and gait disturbance (5 of 15). One death was observed in the study; the death was due to a prior medical condition and was judged unlikely to be study related. Conclusions: Patients with higher levels of agitation receiving divalproex had reduced agitation on the physical aggression subscale of the CMAI. Divalproex was less effective on physically nonaggressive behavior and verbal agitation. Irritability, as measured on the NPI-NH, was also reduced. Patients who received both divalproex and an antipsychotic agent were responsive at lower doses of divalproex. In either case, the effective dosage of divalproex was lower than that commonly used for epilepsy or mania in elderly patients. The most common adverse events included somnolence and gait disturbance. ( Am J Geriatr Pharmacother. 2007;5:209-217).

A model for predicting behavioural sleep problems in a random sample of Australian pre‐schoolers

AbstractBehavioural sleep problems (childhood insomnias) can cause distress for both parents and children. This paper reports a model describing predictors of high sleep problem scores in a representative population‐based random sample survey of non‐Aboriginal singleton children born in 1995 and 1996 (1085 girls and 1129 boys) in Western Australia. Longitudinal repeated data were collected up to age 4 years by caregiver report. Children's sleep rhythmicity levels in their first year, as well as conflicted and lax parenting in their second year, predicted higher scores on the sleep problem scale from the Child Behaviour Checklist/2–3 in the children's third year. Higher scores on the sleep problem scale in the children's third year predicted higher scores on the aggressive behaviour subscale of the Child Behaviour Checklist/4–16. The results support a model in which sleep problems mediated the relationship between parental conflict and aggressive behaviour, even when controlling for maternal depression, which has been associated with children's aggressive behaviour. Copyright © 2007 John Wiley &amp; Sons, Ltd.

A Multilevel Framework Exploring Domestic Violence Against Immigrant Indian and Pakistani Women in the United States

The purpose of this study was to gather preliminary data about the experience of domestic violence from the perspective of immigrant Indian and Pakistani women residing in the United States. Using hierarchical linear regression, we explored the association between individual-, familial-, and cultural-level variables and the experience of domestic violence as assessed by the four aggression subscales of the Revised Conflict Tactics Scale. Our sample consisted of 78 women who were Indian, residents of Illinois, between 18 and 35 years old, college educated, and employed. Most of the women were married. Results showed a 77% prevalence rate and a 71% incidence rate for the experience of domestic violence for the women in our sample. Results of the hierarchical linear regression analysis indicated that level of education, employment status, domestic violence among immediate and extended family members, and cultural belief in male domination were significantly associated with domestic violence.

Modified Overt Aggression Scale (MOAS) for People with Intellectual Disability and Aggressive Challenging Behaviour: A Reliability Study

Background Reliable measures of aggressive challenging behaviour are required if interventions aimed at reducing this behaviour among people with intellectual disability (ID) are to be formally evaluated. The present authors examined the reliability of the Modified Overt Aggression Scale (MOAS), an instrument not yet formally tested in those with ID, in a sample of people who participated in a randomized trial of neuroleptic medication for aggressive challenging behaviour.Method Sixty interviews using the MOAS were carried out by two interviewers 2–5 days apart with 23 carers of 14 people who had shown aggressive challenging behaviour. Level of agreement between these two ratings was examined for four subscales of aggression and for total MOAS score.Results The level of agreement between the raters was high for verbal aggression (intraclass correlation coefficient, ICC = 0.90), physical aggression against others (ICC = 0.90) and for total MOAS score (ICC = 0.93). Levels of agreement on the other two subscales were lower but still in the good/moderate range.Conclusion The MOAS provides a reliable measure of verbal and physical aggression among people with ID who reside in community settings and is suitable for use in studies evaluating the effectiveness of interventions aimed at reducing aggressive challenging behaviour in this group.

Subjective sleep quality and aggression in antisocial personality disorder

Background:As a symptom, aggression is closely related to antisocial personality disorder (ASP). Prefrontal cortex plays a key role in the regulation of anger and violence and in sleep-wake transitions. The aim of this study is to evaluate the quality of the subjective sleep and to determine its relation to the degree of aggression for the subjects with APD.Methods:Among 155 males who were sent to a pretrial forensic psychiatric examination by the court, 60 were suitable and admitted to the study. All of them were being charged with violent offences (murder or assault). 64 subjects were not involved in crimes involving violence were taken as the control group. All of the subjects met the DSM-IV criteria for ASP. Subjects were interviewed with an assessment battery including a semistructured interview form concerning the sociodemographic factors, SCID-I, SCID-II, Aggression Questionnaire (AQ) and Pittsburgh Sleep Quality Index (PSQI).Results:AQ total point and physical aggression, verbal aggression and anger subscales were found to be significantly higher in the study group. Between the groups significant differences were found in PSQI total points, sleep latency, sleep disorder, use of sleeping pills and in the points of subscales of loss of functionality during day. There has been found a positive correlation between PSQI global point and AQ total point.Conclusions:This study can contribute to further support to evidence of brain dysfunction predisposing to severe aggression and sleep disturbances of individuals with APD.

Is the relationship between self-esteem and physical aggression necessarily U-shaped?

Recent research by Perez, Vohs, and Joiner [Perez, M., Vohs, K. D., & Joiner, T. E., Jr. (2005). Discrepancies between self- and other-esteem as correlates of aggression. Journal of Social and Clinical Psychology, 24, 607–620] has supported a U-shaped curvilinear relationship between self-esteem and physical aggression in a sample of 140 undergraduates. The present study attempted to replicate this effect with a sample size more than 12 times larger. Thus, 1781 undergraduates completed items from Rosenberg’s [Rosenberg, M. (1965). Society and adolescent self-image. Princeton, NJ: Princeton University] Self-Esteem Scale and from the Physical Aggression subscale of Buss and Perry’s [Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63, 452–459] Aggression Questionnaire. The results did not support a U-shaped relationship between self-esteem and physical aggression; if anything, they supported an inverted U-shaped one, such that the simple relationship between self-esteem and physical aggression became more negative and as self-esteem increased. Controlling for gender strengthened these effects, consistent with a pattern of mutual suppression between gender and self-esteem.

The SNAP™ Under 12 Outreach Project: Effects of a Community Based Program for Children with Conduct Problems

We examined the immediate, short- and long-term effectiveness of the SNAP™ Under 12 Outreach Project (ORP)—a community-based program for children under the age of 12 at risk of having police contact. Sixteen pairs of children were matched on age, sex and severity of delinquency at admission, and randomly assigned to the ORP or to a control group which received less intensive treatment. Level of antisocial behavior was assessed pre and post intervention (immediate effects) and at three follow-up periods (up to 15 months post treatment) to investigate maintenance of possible treatment effects. A search of criminal records was also performed to assess long term effects. Results indicated that ORP children decreased significantly more than controls on the Delinquency and Aggression subscales of the Child Behavior Checklist pre- to post-intervention, and these effects were maintained over time. For statistically significant differences, effect sizes were large (.79 to 1.19). Fewer ORP children (31%) had criminal records at follow-up compared to controls (57%), although this difference was not statistically significant. Overall, the ORP appears to be an effective cognitive-behavioral program for antisocial children in the short term, with possible effects that extend into adolescence and adulthood.

Quetiapine in the treatment of acute bipolar mania: Efficacy across a broad range of symptoms

Objective An ideal antimanic therapy is well tolerated and offers full multidimensional symptom relief. The efficacy of quetiapine in the treatment of acute bipolar mania has previously been established. This post-hoc analysis aims to extend our understanding of quetiapine's antimanic efficacy by evaluating its therapeutic effect across the full spectrum of manic symptoms. Methods Patient-level data from four similar, randomized, double-blind, placebo-controlled trials evaluating the efficacy and safety of quetiapine in bipolar disorder patients with DSM-IV acute mania were combined. Two trials investigated quetiapine as monotherapy (twice daily) and two trials assessed the combination of quetiapine with either lithium (Li) or divalproex (DVP). Changes in scores on the total Young Mania Rating Scale (YMRS), and on each of the 11 items comprising the YMRS, were the primary measures of interest in this analysis. Changes in the Supplemental Aggression and Agitation subscales of the Positive and Negative Syndrome Scale (PANSS) were secondary measures analyzed. Results Quetiapine as monotherapy, or in combination with Li or DVP, was a highly effective treatment for acute mania, as shown by overall change scores in the total YMRS. Patients treated with quetiapine monotherapy exhibited a significantly greater reduction (versus placebo) in YMRS total scores at Day 4 (− 3.5 versus − 2.2; p = 0.021), with an increasing between-group difference reported throughout the duration of the trials at Day 21 (− 13.6 versus − 7.8; p < 0.001) and at study endpoint on Day 84 (− 19.0 versus − 9.6; p < 0.001). Quetiapine was also superior in efficacy to placebo on all categorical (i.e., response and remission rates) and secondary outcome parameters. On each of the 11 YMRS items, including the double-weighted core manic items, quetiapine was significantly superior to placebo ( p < 0.05). Effect sizes at Day 84 ranged from 0.37 to 0.61. Quetiapine in combination with Li/DVP offered a significant benefit over Li/DVP monotherapy, starting at Day 7 ( p < 0.05) and continuing to the primary study endpoint on Day 21 ( p = 0.01). Four of 11 YMRS items improved significantly more on quetiapine combination therapy than on Li/DVP monotherapy. The efficacy of quetiapine in these trials appeared independent of baseline disease severity, the presence of psychosis, and treatment-emergent sedation/somnolence. Quetiapine monotherapy produced significantly greater improvement than placebo on the PANSS Activation and the PANSS Supplemental Aggression Risk subscale scores. Similar findings were obtained with quetiapine combined with Li or DVP. Conclusions Patients with bipolar disorder may report severe and complex manic symptoms. The results herein indicate that quetiapine is efficacious across the multiple dimensions of mania, including medically serious symptoms commonly encountered in practice.

A Pilot Study of Quetiapine Treatment of Aggression Due to Traumatic Brain Injury

A Pilot Study of Quetiapine Treatment of Aggression Due to Traumatic Brain Injury

Can Spouses Provide Knowledge of Each Other's Communication Patterns? A Study of Self‐Reports, Spouses' Reports, and Observational Coding

The purposes of this study were (1) to assess individuals' self-reports of communication and their reports about their spouses' communication in order to examine the congruence of spousal views and (2) to investigate whether each report provided unique information about observed marital interactions. These associations were evaluated in a sample of 119 longtime married couples. The Verbal Aggression and Cooperation subscales from the Conflicts and Problem-Solving Scales were used as measures of negative and positive aspects of communication. The findings indicated that self-reports of both verbal aggression and cooperation were strongly associated with the same individual's report of his or her spouse's verbal aggression and cooperation. Conversely, self-reports were only moderately associated with reports made by spouses (e.g., the husband's report of his wife's communication). Hence, within-reporter agreement was higher than between-reporter agreement about marital communication. When entered into regression models, reports made by spouses, but not self-reports, explained unique variance in observations of marital hostility and affection. There was one exception: Wife self-report of verbal aggression explained unique variance in coders' ratings of wife hostility, controlling for husband report of wife verbal aggression. Findings indicate the importance of assessing partners' views of one another's communication for the most accurate portrayal of marital interactions. Implications for research and clinical work are discussed.

Sleep Apnea as a Possible Factor Contributing to Aggression in Sex Offenders*

Sleep disorders, such as obstructive sleep apnea (OSA), are often unrecognized and undertreated. A disruption in normal sleep may be associated with increased irritability and aggression. To elucidate further the impact of OSA on hostility of forensic patients, we performed a retrospective chart review of 10 consecutive outpatient sex offenders who were diagnosed with OSA and treated with continuous positive airway pressure (CPAP). The Buss-Perry Aggression Questionnaire was compared pre- and posttreatment. Following treatment, the total Buss-Perry score was significantly lower, with lower scores on the anger, physical aggression, hostility, and verbal aggression subscales. These results suggest that in sex offenders suffering from OSA, aggression and hostility may be significantly reduced through CPAP treatment. Further investigation is required to investigate if reducing aggression and hostility in this manner impacts recidivism and overall functioning.

Caught Between Stages: Relational Aggression Emerging as a Developmental Advance in At-Risk Preschoolers

Eighty-two Head Start preschoolers were assessed with a peer rating measure of sociometric status, the Social Skills Rating System for Teachers (Gresham & Elliott, 1990), an Overt Aggression scale culled from items from the Aggressive Behavior subscale of the CBCL-TRF (Achenbach, 1997), and teacher ratings of relational aggression (Crick, Casas, & Mosher, 1997). In a regression model, overt aggression, age, social skills, and an interaction between social skills and overt aggression significantly predicted 27 percent of the variance in relational aggression. Being older, more overtly aggressive, and more socially skilled was predictive of increased relational aggression in this sample of Head Start students. The interaction indicated that at high and middle levels of social skills, relational and overt aggression significantly covaried, whereas at low levels of social skills this covariance was reduced to a trend. In other words, children with average or above average social skills were also significantly more aggressive—both relationally aggressive and overtly aggressive, which was not true for children with below average social skills. Interestingly, relational aggression appeared to be a developmental “advance” of sorts, developing commensurate with social skills, though not yet replacing the use of overt aggression. Of note for preschool educators, improvements in social skills may be associated with increases in indirect forms of aggression.

Aggression, Self-Understanding, and Social Competence in Swiss Elementary-School Children

This study examined the relation between aggression, self-understanding, and social competence in a sample of 93 Swiss elementary-school children. Aggression was rated by the parents using the aggression subscale of the Child Behavior Checklist (CBCL/4-18). Self-understanding was assessed with a short version of Damon and Hart’s (1988) self-understanding interview. The social competence of the children was observed in a quasi-experimental, cooperative play situation. The results revealed that aggression was related to domain-specific content aspects of self-understanding. Aggression was, however, negatively associated with social competence. Moreover, nonaggressive children with high levels of self-understanding showed more social competence than aggressive children with both high and low levels of self-understanding.

The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders

Purpose The current study examines both the quantity and quality of sleep reported by male adolescents detained in prison, with a focus on exploring the association between the quantity and quality of sleep with aggression, impulsivity, or anger. This represents a novel area of study not yet explored among incarcerated male adolescents. Method One hundred eighty-four offenders took part; 104 young (average age 19 years) and 80 juvenile (average age 16 years). All completed a questionnaire exploring sleeping problems, and measures assessing aggression, anger, and impulsivity. Results Aggression was found to relate both to the quantity and quality of sleep reported, with reduced quantity and quality predicted by increased overall aggression. Across aggression subscales, only increased hostility was predictive of reduced current hours of sleep and increased problems in sleep quality. Apnea risk scores were not predicted by aggression, anger, or impulsivity. Differences in sleep behavior before and during prison were demonstrated, with evidence for increased poor sleeping habits within detention. No differences were observed between young and juvenile offenders. Conclusions This study suggests a potential relationship between aggression and sleep among an incarcerated adolescent male sample, highlighting in particular a role for hostility. The findings are discussed in relationship to implications for treatment and directions for future research.

Common and Specific Genetic Influences on Aggressive and Nonaggressive Conduct Disorder Domains

To explore the genetic and environmental influences on DSM-IV conduct disorder (CD) aggressive and nonaggressive subscales, taking into account age and sex differences. A community sample of 1,100 twin pairs (ages 11-18) was interviewed using the Diagnostic Interview Schedule for Children. Bivariate analyses, using variable threshold models accounting for age and sex differences, were used to determine the extent to which the genetic and environmental influences on aggressive and nonaggressive CD domains are shared or unique. The phenotypic correlation between aggressive and nonaggressive CD domains was 0.32. The most parsimonious bivariate model included additive genetic effects and nonshared environmental effects only (AE model). The results of behavior genetic model fitting suggest that the DSM-IV CD domains are influenced by unique genetic and environmental factors, but also share some common genetic and environmental influences. A large percentage of the covariation (61%) is caused by genetic factors. These results are consistent with a previous report on the bivariate heritability of aggressive and nonaggressive antisocial behavior, but extend the findings to DSM-IV domains.

Child Mania Rating Scale: Development, Reliability, and Validity

To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IVsymptoms. A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 +/- 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78-.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29-.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of.91 to.96). The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania.

Relations of Parental Report and Observation of Parenting to Maltreatment History

Parenting assessments (the Parent-Child Conflict Tactics Scale, CTSPC; and a mother-child observation) were examined for their ability to identify mothers with a history of physically abusing or neglecting their child. Participants were mothers of 139 children (age 3 to 6 years; 58 with a history of maltreatment). Mothers with a history of maltreatment reported higher scores on the Neglect, Nonviolent Discipline, and Psychological Aggression subscales of the CTSPC. These group differences, however, were limited to mothers who acknowledged a history of maltreatment, as mothers who concealed their maltreatment history rated themselves similar to controls. Observation of parental behaviors during a brief, nonstressful task did not discriminate mothers who maltreated from mothers who did not maltreat. The findings suggest that parental report using the CTSPC may be useful in assessing parenting behaviors among mothers with a history of maltreatment, although socially desirable responding is a significant problem.

Attention and behavioural problems of Finnish adolescents may be related to the family environment

Adolescents' attention and behavioural problems in relation to the family environment were studied in the Northern Finland 1986 Birth Cohort. Fifteen-year-old adolescents (N=6888) completed the Youth Self-Report (YSR) questionnaire and their parents (N=6643) completed the Strengths and Weaknesses in ADHD and Normal Behaviours (SWAN) questionnaire. The ratings were compared in relation to gender and family characteristics. Girls scored higher than boys on the YSR attention problems subscale (means 4.61 vs. 3.41), the rule-breaking behaviour subscale (means 4.25 vs. 3.69) and the aggressive behaviour subscale (means 7.18 vs. 5.63). Parents reported more SWAN attention problems in their sons than in their daughters. Living in an other than intact family increased YSR and SWAN attention problems and YSR behavioural problems in both genders. Adolescents living in very large families (11-19 children) had least attention and behavioural problems. Attention and behavioural problems seem to be common among adolescents in Finland. For both genders, living in other than intact families increases especially behavioural problems. Additionally, a very large family seems to be a protective factor against those problems.

Verbal Mistreatment in Older Adults: A Look at Persons with Alzheimer's Disease and Their Caregivers in the State of Florida

ABSTRACTPurpose. This study examined verbal aggression in a sample of community dwelling older adults with Alzheimer's Disease (AD) using the Risk and Vulnerability model as a means for identifying factors associated with verbal mistreatment in caregiver/patient dyads.Design and Methods. Subjects were recruited in the State of Florida through their association with state-funded memory disorder clinics or with local chapters of the Alzheimer's Association. The sample for this analysis consisted of 254 caregivers who completed both a questionnaire and an in-home interview between the years 1998 and 2002. Verbal mistreatment was measured using the verbal aggression sub-scale of the Conflict Tactics Scale and logistic regression analysis was used to examine factors associated with increased risk.Results. Verbal aggression as a conflict resolution style was self reported by 60.1% of caregivers, and was reported as a technique used against them by 74.8% of family members with AD. Logistic regression analysis suggests that factors associated with increased risk for verbal aggression by caregivers included being female, providing care to verbally aggressive elders, caregiver's diminished cognitive status, high levels of psychiatric symptoms, depression, or experiencing a high degree of caregiver hassle. Additionally, a significant interaction effect was found between levels of depression in caregivers and dementia symptoms in elders, as well as between levels of psychiatric symptoms in caregivers, feelings of caregiver hassle, and depression in care recipients and risk for verbal mistreatment.Implications. This study highlights the importance of both risks and vulnerabilities in the outcome of verbal mistreatment, and identifies that in many cases verbal mistreatment may be a reciprocal phenomenain dyads of caregivers and persons with AD.

Community Outcomes Following Traumatic Brain Injury

To investigate the contribution of preinjury differences and potential biases in outcome measurement in explaining outcome differences between white and African American persons with moderate and severe traumatic brain injury (TBI). Prospective, 2 group longitudinal study with retrospective self-assessment of preinjury status. Inpatient and outpatient TBI rehabilitation program. Ninety-four persons with moderate and severe TBI (55 whites and 39 African Americans) who provided data on both preinjury status and 1-year outcome. Community Integration Questionnaire, aggression and depression subscales of Neurobehavioral Functioning Inventory-Revised, Satisfaction With Life Scale, other questions on demographic and social status; all measures were selected by a biracial focus group. Whites and African Americans did not differ significantly on demographic factors except gender; nor on retrospective, self-reported preinjury status on any of the outcome measures. At 1 year post-TBI, African Americans reported significantly lower social integration subscale scores than whites. African Americans may also have lost more income than did whites. All other outcome measures were comparable between groups and showed declines in community productivity, increases in depression symptoms, and lower satisfaction with life for both whites and African Americans compared to preinjury. A higher rate of change in living situation post-TBI may partially account for lower levels of social integration for African Americans. Whites and African Americans who are comparable prior to injury may experience generally similar outcomes, but differences in social and financial outcomes require further investigation.