History Of Aggressive Behavior Research Articles

Identification of genetic variants associated with a wide spectrum of phenotypes clinically diagnosed as Sanfilippo and Morquio syndromes using whole genome sequencing.

Mucopolysaccharidoses (MPSs) are inherited lysosomal storage disorders (LSDs). MPSs are caused by excessive accumulation of mucopolysaccharides due to missing or deficiency of enzymes required for the degradation of specific macromolecules. MPS I-IV, MPS VI, MPS VII, and MPS IX are sub-types of mucopolysaccharidoses. Among these, MPS III (also known as Sanfilippo) and MPS IV (Morquio) syndromes are lethal and prevalent sub-types. This study aimed to identify causal genetic variants in cases of MPS III and MPS IV and characterize genotype-phenotype relations in Pakistan. We performed clinical, biochemical and genetic analysis using Whole Genome Sequencing (WGS) in 14 Pakistani families affected with MPS III or MPS IV. Patients were classified into MPS III by history of aggressive behaviors, dementia, clear cornea and into MPS IV by short trunk, short stature, reversed ratio of upper segment to lower segment with a short upper segment. Data analysis and variant selections were made based on segregation analysis, examination of known MPS III and MPS IV genes, gene function, gene expression, the pathogenicity of variants based on ACMG guidelines and in silico analysis. In total, 58 individuals from 14 families were included in the present study. Six families were clinically diagnosed with MPS III and eight families with MPS IV. WGS revealed variants in MPS-associated genes including NAGLU, SGSH, GALNS, GNPTG as well as the genes VWA3B, BTD, and GNPTG which have not previously associated with MPS. One family had causal variants in both GALNS and BTD. Accurate and early diagnosis of MPS in children represents a helpful step for designing therapeutic strategies to protect different organs from permanent damage. In addition, pre-natal screening and identification of genetic etiology will facilitate genetic counselling of the affected families. Identification of novel causal MPS genes might help identifying new targeted therapies to treat LSDs.

Persistent stallion-like behavior is rarely associated with changes in hormonal markers in the equine cryptorchid suspects: a retrospective study

Persistent stallion-like and/or aggressive behavior is a common symptom of cryptorchidism or incomplete castration in supposed geldings. Hormones secreted by Leydig and Sertoli cells in testicular tissues, such as testosterone and/or anti-Müllerian hormone (AMH), can be used to evaluate the possible presence of testicular tissues in suspected cryptorchids. Currently, there is little known about the association between the presence of testicular tissue and the prevalence of persistent stallion-like behavior in cryptorchids. In the current study, we evaluated the association between abnormal behaviors and concentrations of AMH and testosterone. From the samples submitted to the UC Davis Endocrinology Laboratory between 2011-2020, 1,202 cases were suspected cryptorchids with behavior complains. These cases included the words “behavior”, “behave”, and/or “behaving” in their submitted histories. Testosterone was the most frequently requested hormone among all the samples. Of the 1,202 cases, testosterone was measured in 1,056 samples (∼88%). Interestingly, in the majority of these cases (875/1,056; 82.8%), the measured concentrationof testosterone was below the laboratory range for cryptorchids (>100pg/ml). Similarly, among 877 samples submitted for AMH measurement, 682 (77.8%) did not reach cryptorchid/stallion-like concentrations (>0.15 ng/ml), indicating an absence of any testicular tissue. Both hormones were measured in 790 cases and both values were below the cryptorchid/stallion-like concentration in 608 of the cases (77%). There was a significant correlation between the concentration of both hormones among the samples (r=0.84; P<0.0001). Additionally, 54 samples that were submitted with a history of aggressive behavior towards people or other horses, but without reported sexual/‘stud-like’ behavior, were analyzed. In 43 cases (79.6 %) both hormones (AMH and testosterone) did not reach cryptorchid-like concentrations. Among the remained 11 horses, all had elevated concentrations of AMH and three cases had elevated concentrations of both AMH and testosterone. The results of this study demonstrate that undesirable behaviors in geldings are rarely associated with presence of testicular tissue as indicated by biomarkers such as AMH and testosterone.

Promises and Pitfalls of NMDA Receptor Antagonists in Treating Violent Aggression

Treatment options for chronically aggressive individuals remain limited despite recent medical advances. Traditional pharmacological agents used to treat aggression, such as atypical antipsychotics, have limited efficacy and are often replete with dangerous side effects. The non-competitive NMDAR antagonists ketamine and memantine are promising alternatives, but their effects appear to be highly dependent on dosage, context, and personal experience. Importantly, these drugs can increase aggression when combined with substances of abuse or during periods of heightened stress. This is likely due to mechanistic differences operating at specific synapses under different contexts. Previous findings from our lab and others have shown that early life stress, substance abuse, and attack experience promote aggression through NMDAR-dependent synaptic plasticity within aggression-related brain circuits. Ketamine and memantine affect these types of aggression in opposite ways. This has led us to propose that ketamine and memantine oppositely affect aggression brought on by early life stress, substance abuse, or attack experience through opposite effects on NMDAR-dependent synaptic plasticity. This would account for the persistent effects of these drugs on aggression and suggest they could be leveraged as a more long-lasting treatment option. However, a more thorough examination of the effects of ketamine and memantine on cellular and synaptic function will be necessary for responsible administration. Additionally, because the effects of ketamine and memantine are highly dependent on prior drug use, traumatic stress, or a history of aggressive behavior, we propose a more thorough medical evaluation and psychiatric assessment will be necessary to avoid possible adverse interactions with these drugs.

Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime?

ObjectiveSome persons developing, or presenting, schizophrenia engage in aggressive behaviour (AB) and/or criminal offending. Most of these individuals display AB prior to a first episode of psychosis (FEP). In fact, approximately one-third of FEP patients have a history of AB, some additionally display other antisocial behaviours (A+AB). The large majority of these individuals have presented conduct problems since childhood, benefit from clozapine, have extensive treatment needs, and are unlikely to comply with treatment. A smaller sub-group begin to engage in AB as illness onsets. A+AB persists, often for many years in spite of treatment-as-usual, until a victim is seriously harmed. This article proposes providing multi-component treatment programs at FEP in order to prevent aggressive and antisocial behaviours of persons with schizophrenia.MethodNon-systematic reviews of epidemiological studies of AB among persons with schizophrenia, of the defining characteristics of sub-types of persons with schizophrenia who engage in AB and their responses to treatment, and of FEP service outcomes.ResultsStudies have shown that mental health services that simultaneously target schizophrenia and aggressive behaviour are most effective both in reducing psychotic symptoms and aggressive behaviour. Evidence, although not abundant, suggests that a multi-component treatment program that would include the components recommended to treat schizophrenia and cognitive-behavioural interventions to reduce A+AB, and the other factors promoting A+AB such as substance misuse, victimisation, and poor recognition of emotions in the faces of others has the potential to effectively treat schizophrenia and reduce A+AB. Patients with a recent onset of AB would require few components of treatment, while those with prior conduct disorder would require all. Such a program of treatment would be long and intense.ConclusionsTrials are needed to test the effectiveness of multi-component treatment programs targeting schizophrenia and A+AB at FEP. Studies are also necessary to determine whether providing such programs in hospitals and/or prisons, with long-term community after-care, and in some cases with court orders to participate in treatment, would enhance effectiveness. Whether investing at FEP would be cost-effective requires investigation.

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations.

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.

The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: Variables affecting aggressive behavior, such as male gender, involuntary admission, and a history of aggression, might aid in the early detection of patients who may exhibit more severe aggressive behavior.

Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents.

Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents.Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization.Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively).Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.

Factors Associated with Prolonged Institutionalization in Mentally Ill People with and Without a History of Violence and Legal Involvement: A Cross-Sectional Study.

This is a cross-sectional study carried out on 34 individuals hospitalized for a long period in the Federal District, in Brazil. To evaluate factors related to prolonged institutionalization in mental patients with history of violence and criminal records. Individuals found were assorted into two groups: with and without criminal records. We analyzed 56 items by reviewing medical records and health records. Demographic and social data, history of violence, criminal involvement, medical history, substance use, and other aspects related to long hospitalizations, by reviewing medical and health records. We found a profile of male individuals: single, male, with an average age of 47.6 years, low education, and little professional qualification from correctional facilities or long-term psychiatric clinics and hospitals. Most men had a history of aggressive behavior, a leading psychiatric diagnosis of psychosis, and an issue with polypharmacy. Two factors showed statistical significance and were highly related to longer institutionalizations: polypharmacy and records of hospitalization for violent behavior. Further studies with these populations are needed to increase knowledge on the subject. They can help health care systems to improve and provide broad, humanized and quality assistance with multi-professional teams, aiming to reduce prolonged hospitalizations.

The effect of omega-3 long\xa0chain polyunsaturated fatty acids on aggressive behaviour in adult male prisoners: a structured study protocol for a multi-centre, double-blind, randomised placebo-controlled trial and translation into policy and practice

BackgroundInterventions to better manage aggressive behaviour and reduce recidivism are a primary concern for corrective services. Nutritional interventions to correct prisoner behaviour have been largely overlooked in the literature. Emerging evidence suggests that dietary intake influences aggressive behaviours and that nutritional supplementation with omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) could attenuate both the severity and frequency of aggressive behaviour.MethodsAdult male prisoners who have a history of aggressive behaviour (n = 600) will be recruited from at least 6 Correctional Centres and randomised to receive either n-3 LCPUFA or placebo supplementation for a 16-week duration. Treatment will be with either 1 g/day of n-3 LCPUFA (694 mg DHA and 397 mg EPA) or placebo capsules, which are a corn/soy oil blend and are identical in size and colour.The primary outcome measure is the Inmate Behavioural Observation Scale (IBOS): an objective measure of aggressive behaviour. Secondary outcome measures include questionnaires (including aggression, attention deficit disorder, impulsivity, depression/anxiety/stress scales), engagement in programmes, recidivism and quality of life. Baseline and post-intervention assessments include the IBOS, questionnaires and blood to measure the levels of n-3 LCPUFA.DiscussionTo conclusively test the potential that increasing n-3 LCPUFA intakes can improve rates of prisoner aggression and associated mental health and violence-related social system management costs, we propose an adequately powered multi-centre, double-blind, randomised controlled trial, examining the effects of n-3 LCPUFA supplementation on aggressive behaviour in adult male prisoners. If successful, this study will inform prisoner policy with respect to nutrition and by inference contribute to a broader community approach to preventative mental health practices.Trial registrationAustralian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12618001665224. Registered on 10 October 2018.

83. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Adolescents

<h3>Background</h3> Approximately 1.6 million US youth under age 18 experience housing insecurity annually. These adolescents are at higher risk for negative reproductive health outcomes than their sheltered peers. Few studies have examined the relationship biopsychosocial factors have with sexual activity and contraception use in this population. This study aimed to address this gap. We hypothesize that biopsychosocial factors have relationships with sexual activity and contraceptive utilization among homeless adolescents. <h3>Methods</h3> An IRB-approved, retrospective cohort study was conducted on adolescents who presented between 2/21/2015-8/27/2019 for state mandated physical exams at a youth crisis shelter in Bethlehem, Pennsylvania. Statistical analyses were performed using univariate and multivariable techniques to describe the population and determine the relationship age, gender identity, substance use, and childhood trauma history have with sexual activity and contraceptive utilization. <h3>Results</h3> Medical records for 440 adolescents were reviewed. Of those, 53.7% (n=233) reported sexual activity and 65.2% (n=148 of 227) of sexually active youth reported using contraception. Sexual activity was significantly related to age (mean age 15.8+1.4 years in sexually active vs. 14.7+1.6 years in not sexually active youth, p<0.001); remote history of self-harm behavior (RR 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001) (Figure 1). Gender identity was related to contraceptive utilization, with 55.68% of sexually active females vs. 42.50% of sexually active males reporting contraception use (p=0.01). After adjusted analysis, older age and substance use remained significantly associated with sexual activity (AOR 1.58 [95% CI 1.36-1.84]; p<0.001 and AOR 5.25 [95% CI 3.33-8.28]; p<0.001, respectively). <h3>Conclusions</h3> Adolescents experiencing homelessness face challenges engaging in safe sex practices and are at higher risk for poor reproductive health outcomes compared to their housed peers. This analysis demonstrates that specific characteristics have significant relationships with sexual behaviors in this population. Older adolescents were one and a half times more likely and substance users were five times more likely to be sexually active. Further, a significant gap in contraceptive use existed between female and male-identifying youth. Understanding the potential risk factors for unsafe sex practices can inform interventions, careful history taking and further inquiry into methods to reduce poor outcomes and facilitate safe sexual behaviors in this at-risk population.

Internalized Stigma in People With Mood Disorders: Predictors and Associated Factors.

To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale-Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).

Retrospective Review of Facial Dog Bites Treated at MGH over a 20-year Period

Dog bites are consistently among the top 15 causes of nonfatal injuries in the general population and top 10 among 5-9 year olds.1 Children are more likely to be bitten than adults, and these bites are more likely to involve the head and neck region with potential for long-term aesthetic, psychological, and functional consequences.2 This serious public health issue has yet to be adequately addressed in terms of policy and education among vulnerable populations. In designing educational programs, there is a need to fully understand all potential risk factors and provocations. Currently, we lack sufficient knowledge of the circumstances surrounding the injury. This study aims to answer the following: In all patients presenting to a tertiary care hospital for treatment of a facial dog bite, are there identifiable risk factors associated with the injury? In particular, we wish to focus on those provocations and behavioral issues that can be modified in an effort to decrease the incidence of this devastating injury. This will help focus efforts on improved education and outreach programs and identify vulnerable populations who would most benefit. This is a retrospective study analyzing the facial dog bites treated at Massachusetts General Hospital from 1997-2018. Inclusion criteria, in addition to the diagnosis of facial dog bites, were records that included specific information about the circumstances surrounding the bite and descriptors of the type and location of the injury. Incomplete records resulted in exclusion. The predictor variables included: demographics of the victim (e.g., age and gender), circumstantial information regarding the injury (e.g., location of injury, relationship of victim to dog, provocational circumstances), and dog characteristics (e.g., dog breed, fate of attacking dog, and dog’s history of aggressive behavior). Data analyses were performed using IBM SPSS Statistics 25. Descriptive statistics, such as mean, range, and standard deviations, were calculated for applicable study variables. To measure the association among variables of interest, either bivariate t-tests or chi-square testing was performed for the appropriate variables. A P-value of .05 was considered statistically significant. A total of 321 patients were identified with a mean age of 29.5 years (range 0.7-81 years). There were 141 males and 180 females. The majority of patients were adults [> 18 years of age, n = 223(69.5%)]. A preponderance of dogs [n = 281(87.5%)] were known (P < .00001), and provocation was recorded in 207 cases (64.5%, P < .00001). Bites were preceded by the following behaviors: playing with, feeding, and placing face close to the dog. Pitbulls led in number of bites [n = 26 (8.5%)]. Location on the face was predominantly the middle or lower third [n = 299 (93.1%)]. The type of injury (often mixed) included 284 (88.5%) lacerations, 72 (22.4%) punctures, 48 (15.0%) avulsions, and 20 (6.2%) involving contiguous structures including the mental nerve, ear, gingiva, nasal cartilage, and Stenson’s duct. This study highlights the role of provocation in dog bite injuries and suggests that vulnerable populations may benefit from efforts aimed at improved education, outreach programs, and policy changes. Future initiatives will focus on mandatory documentation and reporting to ensure complete collection of information. More effective methods of promulgating educational information is required. Partnering with veterinarians, pediatricians, rescue and adoption agencies, and pet supply companies will help bring this about.

Stress Response in Suicide Attempters with Borderline Personality Disorder: The Role of Behavioral Problems in Childhood

Objective: Suicidal individuals are a heterogeneous population and may differ in systematic ways in their responsiveness to stress. The primary aim of the present study was to identify whether a different pattern of physiological stress response exists among adult suicide attempters with a history of behavioral problems during childhood and adolescence, which earlier studies have related to both decreased activity of the HPA axis and to suicidal behaviors. Method: Seventy-eight participants with Borderline Personality Disorder were assessed using the SCID-II, and completed self-report measures assessing their history of suicide attempts, history of aggressive behaviors, depressive symptoms, history of lifetime abuse and demographics. Participants’ cortisol reactivity was assessed using the Trier Social Stress Test. Results: Analyses indicated that suicide attempters with a history of behavioral problems in youth (n = 30) had a significantly lower response to stress than both suicide attempters without such a history (n = 26) and non-attempters (n = 22), when controlling for lifetime history of abuse. The groups did not differ in basal cortisol. Conclusions: These findings suggest a unique subtype of suicide attempter among those with Borderline Personality Disorder, characterized by a blunted physiological stress response.

Üniversite Öğrencilerinde Öfke ve Saldırganlığı Etkileyen Duygu ve Düşünceler ile İlişkili Faktörler

Objectives: The aim of the study was to determine the relationship between emotions, thoughts with anger and aggression. Methods: The cross-sectional study was conducted at the Vocational School of a university. A total of 238 students participated in this study. The data collection tools of the study are sociodemographic data form, Buss-Perry aggression scale, trait anger and anger expression style scales. The study of descriptive statistical results of data were calculated with arithmetic mean, standard deviation, number, percentage. In determining the factors affecting the average of aggression and anger score were calculated independent sample t test, Mann-Whitney U test, one-way analysis of variance and Kruskal Wallis variance analysis. In the analysis, the obtained p value less than 0.05 was accepted as significant difference. Results: The smoking, family income, family verbal violence and family history of violence were found to be significant in predicting the anger score. The mean scores of anger subscale scores were significantly higher in the students who had high risk taking behaviors, who did not understand her and who did not agree and disagreed, thought that who thinks life is meaningless and looking hopeless for the future that students (p &lt;0.016). The mean score of physical aggression was significantly higher in male students (p &lt;0.0001). The scores of aggression subscale scores were significantly higher in the students who were smoking, had verbal violence between their parents, had a childhood history of violence, their parents had been violent in childhood, had a history of aggressive behavior, and who reported depressive mood in the last year (p &lt; 0.05). Conclusion: In this study, ıt was found that anger and aggression were found to be high and risky behaviors along with family and friend relationships were an important in young people.

Oxytocin, vasopressin and trust: Associations with aggressive behavior in healthy young males

Oxytocin enhances trust during social interactions and reduces the tendency for social betrayal. Animal studies have revealed that oxytocin is also an important factor in the establishment and regulation of aggression, for which social interaction is a critical precondition. In humans, however, the effects of oxytocin appear more nuanced and influenced by social context and personality traits. Moreover, the pro-social effects of oxytocin are not mirrored by vasopressin, despite their high chemical similarity. Rather, vasopressin has been associated with an increase of aggressive responses. Therefore, we sought to investigate the association of oxytocin and vasopressin with trust and aggressive behavior. Overnight urinary oxytocin and vasopressin levels were obtained from 62 healthy males (age range: 18–26 years) to compare with trait measures of trust and aggressive behavior. We found a significant interaction of oxytocin and trust on aggression in which low trait measures of trust, in combination with low levels of oxytocin, were associated with a history of aggressive behavior. Notably, we found no significant associations for vasopressin. Although both oxytocin and vasopressin have been shown to be important in the emergence of violent behavior, our study suggests that oxytocin may be particularly modified by affiliative behaviors. These findings provide insights into the neuropsychological influences of oxytocin, and highlights the potential for clinical translation regarding the treatment of patients who exhibit recurrent aggressive behavior.

Concentric Group Therapy for Aggression: A Historical Perspective

The purpose of this study is to present themes from a novel group therapy intervention for veterans with aggression. The groups were designed based on a psychodynamic rather than cognitive?behavioral theoretical framework, in which there are two overlapping short and long-term groups. Content analysis revealed six themes including, control your anger, helplessness, improvement, disagreements, where are the boundaries, and co-leadership, parallel process. This unique and innovative approach for the treatment of veterans with a history of aggressive behavior helped improved their understanding of aggression and decreased these behaviors. This group model may also have potential to be expanded to other patient populations with similar behaviors.

Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting

Little has been reported about how to improve health care access and delivery for adolescents and adults with autism spectrum disorder. To understand the contributions to the health disparities in the autism spectrum disorder population, we conducted two independent research approaches to learn about current medical needs. A retrospective chart review was performed to evaluate medical comorbidities and medication use. A focus group was also created to address barriers faced in providing medical care. Of 126 charts reviewed, 49% (n = 62) had intellectual disability, 49% (n = 62) had attention-deficit hyperactivity disorder, 52% (n = 65) had anxiety, 41% (n = 52) had obesity, 31% (n = 39) with a history of aggressive behavior, 31% (n = 31) had depression, 22% (n = 28) had seizures, and 9% (n = 11) had hypertension. A Medical Regimen Complexity Index score was determined to examine medication use trends in the autism spectrum disorder population. Medical Regimen Complexity Index scores were significantly higher for patients with intellectual disability, patients with seizures, and patients with a history of aggressive behavior. Both the focus group and our pre-visit assessment identified the waiting room and waiting time as barriers to care. Understanding the comorbidities, polypharmacy, and medical barriers should provide a better understanding of the current health care access and delivery needs of adolescents and adults with autism spectrum disorder.

Serum testosterone level and its relation to aggressive behavior in schizophrenia

This work is presenting partial preliminary outcomes of our study focused on evaluating the levels of testosterone in psychotic patients and its relationship to aggressive behavior.Our study group included 10 male patients (from planned 20), with history of aggressive behavior at baseline and 24 male patients (from planned 40), without history of aggressive behavior. Non-aggressive patients were considered as control group. All included patients were hospitalized in psychiatric hospital Hronovce with diagnose of psychotic disorder. Levels of testosterone were measured by laboratory evaluation. Aggressive behavior was assessed by HCR scale, which was linked with every TSH evaluation. The level of testosterone was measured in all subjects at the baseline and in the group of aggressive patients was realized next measurement after 14 days of hospitalization.According to our preliminary findings, the average level of TSH in our whole study group was 478.66 ng/dl (range from 158.06 to 767.81). The control group showed average value of TSH 486,84 ng/dl (range from 158.06 to 767.81). The group of patients with history of aggressive behavior showed average value of TSH 459.04 ng/dl (range from 191.81 to 638.02) and after 14 days of cure the levels were of average value 452.55 ng/dl (range from 253.53 to 657.92).These preliminary findings don’t show significant intergroup differences, but there are some clear casuistic declines in TSH. After collecting the envisaged group of patients we plan to correlate values of testosterone level with the score of HCR, intergroup comparison and detailed analysis (including demography, pharmacology).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Voluntary Genital Ablations: Contrasting the Cutters and Their Clients

IntroductionSome healthy males voluntarily seek castration without a recognized medical need. There are currently no standards of care for these individuals, which cause many of them to obtain surgery outside of a licensed medical setting. We seek to understand who performs these surgeries.AimThis study aims to characterize individuals who perform or assist in genital ablations outside of the healthcare system.MethodsA cross-sectional Internet survey posted on eunuch.org received 2,871 responses. We identified individuals who had performed or assisted in human castrations (“cutters”; n = 98) and compared this group with all other survey respondents (n = 2,773), who had not assisted in castrations. Next we compared the cutters with the voluntary eunuchs. Lastly, because many of the cutters have themselves been castrated, we also divided the physically castrated population (n = 278) into cutters (n = 44) and noncutters (n = 234) and compared them.Main Outcome MeasuresSelf-reported questionnaires were used to collect demographic information, gender identity and presentation, selected childhood experiences, and history of aggressive behaviors, self-harming behaviors, and hospitalization.ResultsDistinguishing characteristics of cutters included: (i) presenting themselves as very masculine, (ii) having had their longest sexual relationship with a man, (iii) growing up on a farm, (iv) witnessing animal castrations, (v) having a history of sexually inappropriate behavior, (vi) having been threatened with genital mutilation as a child, (vii) having a history of self-harm, (viii) being raised in a devoutly Christian household, (ix) having had an underground castration themselves, and (x) having body piercings and/or tattoos.ConclusionsThis study may help identify individuals who are at risk of performing illegal castrations. That information may help healthcare providers protect individuals with extreme castration ideations from injuring themselves or others. Jackowich RA, Vale R, Vale K, Wassersug RJ, and Johnson TW. Voluntary genital ablations: Contrasting the cutters and their clients. Sex Med 2014;2:121–132.

Association of Empathy of Nursing Staff With Reduction of Seclusion and Restraint in Psychiatric Inpatient Care

Disruptive behavior leading to seclusion or restraint increases with patients in a high-acuity stage of mental illness who have histories of aggressive behavior. The study examined whether greater nursing staff empathy skills and motivation reduced use of seclusion and restraint and whether empathy training can further this effect. In 1,098 nursing shifts in 2 six-month periods one year apart, hierarchical analyses examined the effects of nursing shift and patient characteristics, the effect for each shift of nurses' skill and motivation to use empathy, and whether empathy training reduced use of seclusion and restraint. With controls for shift, patient, and other staffing variables, analyses showed that the presence of more nursing staff with above-average empathy ratings was strongly associated with reduced use of seclusion and restraint but empathy training showed no further benefit. Recruiting and retaining empathic nursing staff may be the best way to reduce the use of seclusion and restraint.