Modified Overt Aggression Scale Research Articles

Neurofeedback technique for treating male schizophrenia patients with impulsive behavior: a randomized controlled study.

Schizophrenia is one of the most severe mental disorders, frequently associated with aggression and violence, particularly in male patients. The underlying mechanisms of violent behavior in these patients remain unclear, limiting effective treatment options and highlighting the need for further research into interventions for impulsive behaviors. This study aims to evaluate the clinical efficacy of neurofeedback treatment in hospitalized male schizophrenia patients exhibiting impulsive behaviors. The study was designed as a single-center, randomized, single-blind, sham-controlled parallel trial. Eighty patients were randomly assigned to either a study group or a control group. The control group received risperidone and sham neurofeedback, while the study group received risperidone and active neurofeedback therapy. Both groups underwent training five times per week, with each session lasting 20 minutes, over a six-week period. Clinical symptoms were assessed at baseline, three weeks and six weeks using the Positive and Negative Syndrome Scale (PANSS), the Modified Overt Aggression Scale (MOAS), and the Rating Scale for Extrapyramidal Side Effects (RSESE). Statistical analyses were conducted to compare the therapeutic effects between the two groups at the study's conclusion. Initial comparisons showed no significant differences in baseline data, except for the number of prior hospitalizations (P<0.018). By the end of the study, the study group demonstrate significant improvements in MOAS and PANSS scores (including the Excited, Positive, Cognitive, and Depressive/Anxiety Components), with no significant changes in RSESE scores. Both time and group interactions were significant across most outcomes, underscoring the efficacy of neurofeedback in reducing the severity of impulsive behaviors and associated schizophrenia symptoms. chictr.org.cn, identifier ChiCTR2200063407.

Psychological assessment of violent behaviors in schizophrenic patients followed up in My EL Hassan health center of Kenitra, Morocco

BackgroundDisorders of the aggressive behavior frequently mark the entry in schizophrenia. They are not specific and very varied. The objective of this study was to assess the different risk factors associated with the manifestation of violent and aggressive behavior of schizophrenic patients who follow consultations in service of psychiatry at Kenitra, Morocco. One-hundred twenty-seven patients with schizophrenia were included, and the Modified Overt Aggression Scale (MOAS) and Positive and Negative Syndrome Scale (PANSS) were used respectively to assess the state of aggressiveness and to identify the type of psychotic symptomatology of schizophrenic patients. Clinical and sociodemographic data were obtained from all patients.ResultsThe study shows that criminal history, drug addiction, motives for aggressiveness, and the moment of aggressiveness are all potential factors for aggression, and the profile of the patient likely to take the act is that of young schizophrenics under 39 years old, predominantly male, and the majority are single. Judicial history, habits toxic, and the positive psychotic symptoms are reported as the most frequently risk factors. The index of Cronbach (0.64) showed a strong connection between the four items of aggression and strong relation between MOAS and PANSS categories has been shown by independent test (p < 0.001).ConclusionAggressive behavior is a frequent symptom of schizophrenia in studied population and poses many clinical challenges. It requires collaboration with the patient for handling difficult situations.

Investigation of peripheral inflammatory biomarkers in association with violence in schizophrenia

BackgroundViolent behavior carried out by patients with schizophrenia (SCZ) is a public health issue of increasing importance that may involve inflammation. Peripheral inflammatory biomarkers, such as the systemic immune inflammation index (SII), the neutrophil lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR) and the monocyte lymphocyte ratio (MLR) are objective, easily accessible and cost-effective measures of inflammation. However, there are sparse studies investigating the role of peripheral inflammatory biomarkers in violence of patients with SCZ.Methods160 inpatients diagnosed with SCZ between January and December 2022 were recruited into this study. Violent behavior and positive symptoms of all participants were evaluated using Modified Overt Aggression Scale (MOAS) and Positive and Negative Syndrome Scale (PANSS), respectively. The partial correlation analysis was performed to examine the relationship of inflammatory indices and positive symptoms. Based on machine learning (ML) algorithms, these different inflammatory indices between groups were used to develop predictive models for violence in SCZ patients.ResultsAfter controlling for age, SII, NLR, MLR and PANSS positive scores were found to be increased in SCZ patients with violence, compared to patients without violence. SII, NLR and MLR were positively related to positive symptoms in all participants. Positive symptoms partially mediated the effects of peripheral inflammatory indices on violent behavior in SCZ. Among seven ML algorithms, penalized discriminant analysis (pda) had the best performance, with its an area under the receiver operator characteristic curve (AUC) being 0.7082. Subsequently, with the use of pda, we developed predictive models using four inflammatory indices, respectively. SII had the best performance and its AUC was 0.6613.ConclusionsThese findings suggest that inflammation is involved in violent behavior of SCZ patients and positive symptoms partially mediate this association. The models built by peripheral inflammatory indices have a good median performance in predicting violent behavior in SCZ patients.

Application of Facial Expression Analysis Technology in Violence Risk Assessment of Individuals with Mental Disorders in Supervised Settings.

To explore the association between violent behaviors and emotions in individuals with mental disorders, to evaluate the application value of facial expression analysis technology in violence risk assessment of individuals with mental disorders in supervised settings, and to provide a reference for violence risk assessment. Thirty-nine male individuals with mental disorders in supervised settings were selected, the participant risk of violence, cognitive function, psychiatric symptoms and severity were assessed using the Modified Overt Aggression Scale (MOAS), the Historical, Clinical, Risk Management-Chinese version(HCR-CV), the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). An emotional arousal was performed on the participants and the intensity of their emotions and facial expression action units was recorded before, during and after the arousal. One-way analysis of variance (ANOVA) was used to compare the differences in the intensity of emotions and facial expression action units before, during and after the arousal. Pearson correlation analysis was used to calculate the correlations between the intensity of the seven basic emotional facial expressions and the scores of the assessment scales. The intensity difference of sadness, surprise and fear in different time periods was statistically significant (P<0.05). The intensity of the left medial eyebrow lift action unit was found significantly different before and after the emotional arousal (P<0.05). The intensity of anger was positively correlated with the Modified Overt Aggression Scale score throughout the experiment (P<0.05). Eye action units such as eyebrow lifting, eyelid tightening and upper eyelid lifting can be used as effective action units to identify sadness, anger and other negative emotions associated with violent behaviors. Facial expression analysis technology can be used as an auxiliary tool to assess the potential risk of violence in individuals with mental disorders in supervised settings.

Psychometric Properties of the PANS 31-Item Symptom Rating Scale.

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by sudden onset of obsessive-compulsive disorder and/or eating restriction with associated neuropsychiatric symptoms from at least two of seven categories. The PANS 31-Item Symptom Rating Scale (PANS Rating Scale) was developed to identify and measure the severity of PANS symptoms. The objective of this study was to define the psychometric properties of the PANS Rating Scale. Methods: Children with PANS (N = 135) and their parents participated. Parents completed the PANS Rating Scale and other scales on Research Electronic Data Capture. The PANS Rating Scale includes 31 items that are rated on a Likert scale from 0 = none to 4 = extreme. Pearson's correlations were run between the PANS Total score and scores on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Yale Global Tic Severity Scale (YGTSS), Modified Overt Aggression Scale (MOAS), Columbia Impairment Scale (CIS), PANS Global Impairment Score (GIS), and Children's Global Assessment Scale (CGAS). Results: Convergent validity was supported by significant correlations between the PANS Total and scores on the CY-BOCS, YGTSS, MOAS, CIS, GIS, and CGAS. The largest correlations were with measures of functional impairment: PANS Total and CIS (r = 0.81) and PANS Total and GIS (r = 0.74). Cronbach's alpha was 0.89 which demonstrates strong internal consistency of the 31 items. PANS Total score was significantly higher in children in a flare of their neuropsychiatric symptoms compared to children who were not in a flare. Conclusions: This study provides preliminary support for the PANS Rating Scale as a valid research instrument with good internal consistency. The PANS Rating Scale appears to be a useful measure for assessing children with PANS.

Insomnia and aggression in stable schizophrenic patients: The mediating role of quality of life

Aggression in schizophrenia patients is an issue of concern. Previous studies have shown that aggression in schizophrenia patients may be related to insomnia and quality of life to different extents. This study aimed to explore the potential mediating role of quality of life in the relationship between aggression and insomnia among schizophrenia patients. Demographic factors affecting aggression in schizophrenia patients were also explored. Patients and methodsA total of 781 stable patients aged 18–75 who met the ICD10 diagnosis of “schizophrenia” completed the completed questionnaire. Aggression was assessed using the Modified Overt Aggression Scale (MOAS), sleep was assessed using the Insomnia Severity Index Scale (ISI), and quality of life was assessed using the five Likert options. Descriptive statistics and correlation analysis examined the correlation between aggression and other variables. The mediating role of quality of life in the association between insomnia and aggression was examined by pathway analysis. ResultsA total of 781 patients participated in this study, and approximately 16 % of the schizophrenia patients were aggressive. According to the mediation analysis, the direct effect of insomnia on aggression was 0.147, and the mediating effect of quality of life on insomnia and aggression was 0.021. Specifically, for the four dimensions of the MOAS, the direct effects of insomnia on verbal aggression, aggression toward property, and aggression toward oneself were 0.028, 0.032, and 0.023, respectively, with mediating effects of 0.003, 0.007, and 0.006, respectively, and no mediating effect on physical aggression was found. ConclusionThis study showed that insomnia significantly influenced aggression in schizophrenia patients. Quality of life significantly mediated insomnia and aggression and played a vital role in moderating aggression. Therefore, we suggest that in the future, improving aggression in schizophrenia patients, while paying attention to the importance of sleep, could start with improving quality of life to address this problem from multiple perspectives.

An Exploration of Depression and Aggression Among Patients with Schizophrenia in China Rural Community.

In schizophrenia, aggressive conduct is frequent. And depressed mood can also contribute to the occurrence of aggressive behaviors. The aim of this study was to investigate the risk factors for the occurrence of aggression in stable schizophrenia patients in rural China, mainly to investigate the role of depressed mood in the occurrence of aggression in schizophrenia patients. This is a cross-sectional study conducted in the townships surrounding Chaohu City, Anhui Province, China. Patients' depressive mood was evaluated using the PHQ-9 (The 9-item Patient Health Questionnaire). Patients' aggressiveness was evaluated using the Modified Overt Aggression Scale (MOAS). A score of ≥4 was used as a threshold and divided into aggressive and non-aggressive groups. This study comprised a total of 821 schizophrenia patients. Among them, the prevalence of having aggressive behavior was 18.8%. After correcting for confounders, logistic regression analysis showed that low education level (OR=0.470, 95% CI 0.254-0.870; p=0.016), living with family (OR=0.383, 95% CI 0.174-0.845; p=0.017) depressed mood (OR=1.147, 95% CI 1.112-1.184; p<0.001) was significantly associated with the risk of aggressive behavior in patients with schizophrenia. Multivariate linear regression indicated that higher levels of aggression were linked with lower levels of education and higher depressive mood. This study suggests that aggression is more common in patients with stable schizophrenia, and lower levels of education and higher levels of depression are associated risk factors for its occurrence. Living alone may be helpful in reducing the likelihood of aggression.

Factors associated with aggression in schizophrenia—A cross-sectional study

Background: Schizophrenia is one of the most prevalent and serious mental disorders, affecting many facets of life. One of schizophrenia's five domains is aggression. The risk factors for aggression in schizophrenia have been the subject of numerous studies, but it is still unclear how the socio-demographic and clinical variables relate to these risk factors. This study's goal was to identify the clinical and socio-demographic risk variables for aggressive behavior in schizophrenia patients. Aim: To identify the clinical and socio-demographic risk factors for aggressive behavior in schizophrenia patients. Materials and Methods: Fifty patients who matched the inclusion criteria were selected for a cross-sectional study that was carried out in a tertiary care hospital. Socio-demographic details and clinical variables were collected using semi-structured proforma, and the modified overt aggression scale (MOAS) was applied to schizophrenia patients. Data were analyzed using the SPSS 25 version. Results: Of the 50 participants, 34 (68%) were aggressive patients, and 16 (32%) were non-aggressive patients. Patients with lower SES (R = -0.374, P = 0.007) and those who were single (R = -0.375, P = 0.007) scored statistically significantly on the bivariate correlation analysis. Conclusion: Schizophrenia patients show a significant prevalence of aggressive behavior. Aggression was found to be substantially correlated with patients' lower socio-economic status and single status. To lessen aggressive behavior and its adverse effects, psychiatrists must identify valid clinical and illness predictors for aggression in schizophrenia patients.

Group interpersonal psychotherapy (IPT-G) for borderline personality disorder: A randomized controlled study

Recent evidence supported the notion that add-on group therapy should be provided to individuals with borderline personality disorder (BPD) who already undergo individual psychotherapy. The present 20 week-study was aimed to evaluate the efficacy of the adjunction of group interpersonal psychotherapy (IPT-G) to individual interpersonal psychotherapy adapted for BPD - revised (IPT-BPD-R) in comparison with individual IPT-BPD-R alone in a group of BPD patients. In addition, demographical and clinical characteristics that can be considered predictors of response to add-on group therapy were investigated. Forty-six patients were randomly assigned to 1) IPT-BPD-R plus IPT-G or to 2) IPT-BPD-R in the waiting list for IPT-G. Patients were assessed at baseline and after 20 weeks with: the Clinical Global Impression Scale, Severity item (CGI-S); the Social Occupational Functioning Assessment Scale (SOFAS); the Satisfaction Profile (SAT-P); the Borderline Personality Disorder Severity Index (BPDSI); the Modified Overt Aggression Scale (MOAS); the Childhood Trauma Questionnaire - Short Form (CTQ-SF); the Inventory of Interpersonal Problems (IIP-32); and the Reading the Mind in the Eyes Test (RMET). Statistical analyses included: ANOVA for repeated measures to compare score changes of the rating scales within groups (trial duration) and between groups (treatment modalities), and multiple regression analysis to identify which clinical factors are significantly and independently related to the difference of BPDSI score between baseline and week 20 (Δ BPDSI). The significance level was P ≤ 0.05. Both significant within-subjects effects (duration) and between-subjects effects (treatment modalities) were found for the following rating scales: MOAS; BPDSI items “feelings of emptiness”, “outbursts of anger,” and “affective instability”; RMET; SAT-P items “work” and “sleep, food, free time”; and IIP-32 scale “domineering/controlling”. At the multiple regression analysis BPDSI item “impulsivity”, RMET, and the subscale “socially inhibited” of the IIP-32 were significantly and independently related to Δ BPDSI score. In conclusion, the add-on of IPT-G produced higher improvement in core BPD symptoms, social cognition, a dysfunctional interpersonal style, and subjective quality of life. Subjects who were less impulsive, less socially inhibited, and with higher abilities in social cognition obtained greater benefits from the adjunction of group therapy. Clinical trials registration numberACTRN12623000002684, Australian New Zealand Clinical Trials Registry (ANZCTR).

Application of asynchronous teaching method in the treatment of bipolar disorder

BackgroundBipolar affective disorder, as a common mental issue, is characterized by emotional abnormality and manic and depressive states. Traditional medicine has a long course of disease and generates slow poor therapeutic effects. The asynchronous teaching method takes the students’ self-consciousness as an observation perspective. It focuses on the intervention of students’ psychological conditions in a teaching situation of equality and mutual assistance. To explore the effect of asynchronous teaching method on students with bipolar disorder to help improve their mental health.Subjects and MethodsThe research took the students with bipolar affective disorder as the experiment object. The control group applied basic nursing, medication guidance and other conventional nursing approach, while the experimental group was treated with asynchronous teaching method intervention on the basis of the control group, that is, the teacher used a six-stage teaching process to guide students’ personalized development and improvement of their self-consciousness, and timely guided students to pay attention to and examine their own psychological conditions. The intervention time was 3 months. The aggressive behavior and psychological status of the students were evaluated with the Modified Overt Aggression Scale (MOAS) and the Self-reporting Inventory (SCL-90). SPSS22.0 statistical software was used for classification analysis. Measurement data was expressed as (x ± s), and P&lt;0.05 was defined as statistically significant.ResultsAfter receiving nursing care, the students in the two groups all received improvement in their symptoms to varying degrees. The MOAS scores of the students in the experimental group after one month and three months of nursing care were (5.34 ± 0.83) and (0.31 ± 0.91), which were significantly better than those of the control group (5.42 ± 0.92) and the control group (2.08 ± 0.32), with statistical significance (P&lt;0.05). After intervention, the SCL-90 scores of the two groups were significantly different (P&lt;0.05).Conclusions Asynchronous teaching method intervenes students with bipolar affective disorder in a more equal way so that they can correctly and objectively view their own symptoms. The method proposed in this research has a better intervention effect on students’ psychological assessment and mental health status.

Improvements in Treatment Adherence after Family Psychoeducation in Patients Affected by Psychosis: Preliminary Findings.

(1) Background: Family psychoeducation is a well-recognized intervention which aims to improve the outcomes of illness in patients affected by psychosis. It has benefits in treatment adherence and leads to a reduction in relapses, higher levels of patient insight, and lower levels of stress within the family and among caregivers. (2) Methods: Eight patients and their families were recruited and randomly assigned to a Falloon-based family psychoeducation (FPP) intervention, and nine patients and their families were randomized to a Gestalt-based family intervention (GT). We compared the outcomes of these two treatment groups at a baseline assessment (T0), at the end of the programs (T1), and 6 and 12 months after the end of the programs (T2 and T3). The assessments included examinations of cognition (The Mini-Mental State Examination (MMSE) and The Five Point Test (5 Point)), the psychopathology and severity of illness (The Brief Psychiatric Rating Scale (BPRS), The Positive and Negative Syndrome Scale (PANSS), and The Clinical Global Impression Scale (CGI)), expressed emotion in families (Expressed Emotionality (Family Questionnaire-EE)), patient quality of life (The World Health Organization Quality of Life-BREF (WHOQOL-B)), social functioning (The Personal Social Performance (SPS)), aggression (Modified Overt Aggression Scale (MOAS)), and treatment adherence (The Brief Medication Adherence Report Scale (BMARS)). The primary aim was to test whether the FFP vs. GT program was more effective in improving treatment adherence over time. (3) Results: treatment adherence improved much more in the FFP group over time at any follow-up: +43.1% at T1, +24.0% at T2, and +41.6% at T3. Other characteristics, including psychopathology and the clinical stability of the subject, did not change over time. (4) Discussion: Family psychoeducation based on the Falloon program was effective at improving treatment adherence and contributed to avoiding relapses in the long term. Further studies on larger samples should be conducted to confirm this evidence, and similar psychoeducational programs should be routinely promoted in the clinical setting.

Association between overt aggression and anhedonia in patients with major depressive disorder during the acute phase

ObjectiveTo explore the factors influencing anhedonia at baseline and use them as confounding factors. To further investigate the correlation between overt aggression and anhedonia during the acute phase of major depressive disorder. MethodsIn this eight-week prospective study, 384 major depressive disorder patients were recruited from the outpatient section of Shanghai Mental Health Center from May 1, 2017, to October 30, 2018. Standard treatments were performed with escitalopram or venlafaxine for participants. Depressive symptoms, overt aggression, and anhedonia were assessed using the 17-item Hamilton Rating Scale for Depression, Modified Overt Aggression Scale, and Snaith-Hamilton Pleasure Scale at baseline, and in the 4th and 8th weeks. ResultsObsessive-compulsive symptoms and the duration of untreated psychosis were positively associated with aggression (P < 0.05). Patients with aggressive behaviour had worse cognitive impairment and severe anhedonia of pleasurable sensory experiences (P < 0.05). For anhedonia, being female (tau_b = −0.23, P = 0.012) was a protective factor, while number of recurrent, melancholic features, current obsessions, previous combination drug therapies, depressive symptoms, and aggressive behaviour were risk factors (P < 0.05). Social anhedonia related to interests/pastimes, and pleasurable sensory experiences were more severe in major depressive disorder patients with aggressive behaviour in the acute phase (P < 0.05). ConclusionsAnhedonia persisted in major depressive disorder patients with aggressive behaviour after standardized treatment during the acute phase. Being female protected the pleasures from social interaction and sensory experience. However, the number of depressive episodes, melancholic features, current obsessive symptoms, previous combination drug therapies, depressive symptoms, and aggressive behaviour was positively associated with anhedonia.

Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence.

To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence. One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression. Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA. SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.

The Predictive Value of Monocyte/High-Density Lipoprotein Ratio (MHR) and Positive Symptom Scores for Aggression in Patients with Schizophrenia.

Background and Objectives: Schizophrenia with aggression often has an inflammatory abnormality. The monocyte/high-density lipoprotein ratio (MHR), neutrophil/high-density lipoprotein ratio (NHR), platelet/high-density lipoprotein ratio (PHR) and lymphocyte/high-density lipoprotein ratio (LHR) have lately been examined as novel markers for the inflammatory response. The objective of this study was to assess the relationship between these new inflammatory biomarkers and aggression in schizophrenia patients. Materials and Methods: We enrolled 214 schizophrenia inpatients in our cross-sectional analysis. They were divided into the aggressive group (n = 94) and the non-aggressive group (n = 120) according to the Modified Overt Aggression Scale (MOAS). The severity of schizophrenia was assessed using the Positive and Negative Syndrome Scale (PANSS). The numbers of platelets (PLT), neutrophils (NEU), lymphocytes (LYM), monocytes (MON) and the high-density lipoprotein (HDL) content from subjects were recorded. The NHR, PHR, MHR and LHR were calculated. We analyzed the differences between those indexes in these two groups, and further searched for the correlation between inflammatory markers and aggression. Results: Patients with aggression had higher positive symptom scores (p = 0.002). The values of PLT, MON, MHR and PHR in the aggressive group were considerably higher (p < 0.05). The NHR (r = 0.289, p < 0.01), LHR (r = 0.213, p < 0.05) and MHR (r = 0.238, p < 0.05) values of aggressive schizophrenia patients were positively correlated with the total weighted scores of the MOAS. A higher MHR (β = 1.529, OR = 4.616, p = 0.026) and positive symptom scores (β = 0.071, OR = 1.047, p = 0.007) were significant predictors of aggression in schizophrenia patients. Conclusions: The MHR and the positive symptom scores may be predictors of aggressive behavior in schizophrenia patients. The MHR, a cheap and simple test, may be useful as a clinical tool for risk stratification, and it may direct doctors' prevention and treatment plans in the course of ordinary clinical care.

Correlates of aggressive behavior in the moroccan context

IntroductionViolence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.ObjectivesThe objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.MethodsIt is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.We used SPSS 15 to analyse resultsResultsSixty-five case files were selected during the study month. The average age was 35.3 (19;64).The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic levelImage:Image 2:ConclusionsIn the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.Disclosure of InterestNone Declared

Predictors of therapeutic response in schizophrenia – preliminary results

IntroductionSchizophrenia is a heterogenous disease and there is wide variation in the therapeutic response in patients, with some being good responders and others - severely disabled and defined as treatment resistant.ObjectivesTo identify specific socio-demographic and clinical characteristics as prognostic factors for therapeutic response in the search of course prognosis and disease outcome.MethodsThe study has naturalistic, non-interventional design and includes one-year prospective follow-up. Schizophrenic patients are being evaluated in three time points – at admission (T1), by discharge (T2), and one year after the hospitalization (T3). Psychopathology is evaluated by the Positive and Negative Syndrome Scale (PANSS), as well as negative symptoms – by the Scale for the Assessment of Negative Symptoms (SANS), aggression by the Modified Overt Aggression Scale (MOAS) and functioning by the GlobalAssessment of Functioning (GAF). Statistical analyses are performed using Descriptive methods, Student’s t-test, Wilcoxon Signed Ranks Test, as well as multiple regression. An ethical approval of the study has been obtained.ResultsThe sample consists of 108 patients with mean age of 39 (SD±12.7) and 89.8 % (N=97) of them were prospectively assessed after one year. All symptom dimensions in the 5 -factor model – positive, negative, disorganized, manic, and depressive, measured by PANSS, as well as negative symptoms (objectified by SANS) and aggression (objectified by MOAS) are significantly lower after inpatient treatment. There is an improvement in functioning one year after admission (z=-8.01, p&lt;.001), although both negative symptoms (z=-2,45, p=0.015) and aggressive behavior (z=-4.260, p&lt;.001) are significantly higher one year after discharge. From the multiple regression, at T1, involuntary admission is a significant predictor for higher aggression and lower functioning (p&lt;.001). The duration of hospitalization is longer with lower compliance (p=.022) and the treatment with atypical antipsychotics decreases the hospital stay (p=.021). One year after admission, employment serves as a positive predictive factor as it decreases the psychopathology (p=.001), negative symptoms (p&lt;.001), and improves the functioning (p&lt;.001). Good compliance is a predictor for lower psychopathology (p=.015), less aggression and higher functioning (p&lt;.001).ConclusionsThe inpatient treatment is efficacious in terms of psychopathology, aggression and is linked to better functioning. The naturalistic design shows depletion of the positive effects of treatment in terms of negative symptoms and aggression probably due to incomplete medication compliance, which is a bad prognostic factor for functioning. This implies the need of continuous psychosocial services and better psychoeducation after discharge.Disclosure of InterestNone Declared

Risk assessment of agressive behavior in schizophrenia and schizoaffective disorder : a cross-sectional study

IntroductionPsychotic disorders have been consistently associated with aggressive behaviors. Psychiatrists are frequently asked to perform assessment regarding potentially aggressive patients. Thus, many psychometric instruments can be useful for identifying the risk of violence and thereby offering appropriate treatment for these individuals.ObjectivesThe aims of this study were to assess the risk of agressive behavior in inpatients with schizophrenia or schizoaffective disorder and to determine its correlates.MethodsUsing face-to-face interviews, inpatients diagnosed with schizophrenia or schizoaffective disorder, in psychiatric department of the University Hospital in Sfax (Tunisia) were included in this cross-sectional, descriptive and analytical study, carried out between novembre 2020 and octobre 2022.The modified overt aggression scale (MOAS) and historical clinical risk management-20 (HCR-20) questionnaire were used for data acquisition. The HCR-20 score of 20 was used as threshold to divide the sample to violent patients (scoring&gt;20) and non-violent patients (scoring ≤ 20).ResultsThe sample consisted of 60 male inpatients. The mean age was 38.23± 10.37 years.In our sample, 68.3% were single, 35% didn’t reach the secondary educational level, 16.7% used psychoactive substance(s), 35% had prior criminal record, 30% had a history of suicidal attempt and 81.7% had previous hospitalization.The mean score of MOAS was 13.08±8.19. The mean total HCR-20 score was 19.25±5.26. The Historical, Clinical and Risk Management subscales showed mean scores of 8.33±2.96, 5.62±1.89, and 5.28±2.42, respectively.The violent patients represented 45% of the sample.The mean scores of the items H3, H10, C1, C2, C4 and R5 of HCR-20 were respectively : 1.33±0.79, 1.20±0.77, 1.22±0.88, 0.38±0.71, 1.30±0.64 and 1.28±0.73.There was no statistical difference between the two groups in socio-demographic factors.A history of suicidal attempts was significantly more common in the group of violent patients (p=0.029).Regarding the HCR subscales, H3 score (relationship instability) and H10 score (Prior supervision failure) were significantly higher among violent patients (p=0.018 and 0.003 respectively). The C1 score (lack of insight), the C2 score (negative attitudes) and the C4 score (impulsivity) were also significantly higher among violent patients (p=0.016, 0.009 and 0.005 rescpectively).The item R5 (stress) of the risk management subscale was significantly higher in the group of violent patients (p=0.003).The total MOAS score detected severe agression in the nonviolent group (p=0.031).ConclusionsOur study suggests the efficacy of HCR-20 in identifying and distinguishing between violent and nonviolent patients with schizophrenia or schizoaffective disorder. The use of such reliable instrument in clinical psychiatric settings should be encouraged.Disclosure of InterestNone Declared

Socio-demographic, clinical and offense-related characteristics of forensic psychiatric inpatients in Hunan, China: a cross-sectional survey

BackgroundThere is still a lack of comprehensive research on the profile of patients in forensic mental health hospitals in China. This study aims to investigate the socio-demographic, clinical, and offense-related characteristics of mentally ill offenders in the Hunan Provincial Forensic Psychiatric Hospital in China.MethodsThis study was conducted from November 1, 2018, to January 30, 2019. The data of socio-demographic, clinical, and offense-related characteristics of the patients were collected. The Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS), and the Clinical Global Impression-Severity (CGI-S) scale were used to measure their psychiatric conditions.ResultsA total of 461 participants were enrolled in this study. Among them, 86.3% were males and 56.8% were unmarried; the average age of them was 44.7 ± 10.1 years, and the mean years of education were 7.51 ± 3.3 years. Before their current offense, a total of 345 patients (74.8%) had sought medical help for their mental illnesses. While 303 (87.8%) of these patients were prescribed antipsychotics, 254 (73.6%) failed to take them regularly. Of all the inpatients, 90.5% were diagnosed with schizophrenia; 385 (83.5%) engaged in homicidal offenses, with 54.0% of the victims being their family members. In homicide cases, the relatives were more likely to be victims of female patients. The mean length of stay in the forensic hospital was 8.02 ± 4.74 years, and over 80.0% of the patients had been hospitalized for over 5 years.ConclusionsTo our knowledge, this is the first study investigating the profile of forensic patients receiving compulsory treatments in a forensic psychiatric hospital in China. These results add to the world literature on the characteristics of forensic patients and can help identify common treatment and risk-related needs of this population.

Personality factors as correlates of aggression in COVID-19-infected individuals’ postrecovery – A cross-sectional study

ABSTRACT Background: The COVID-19 pandemic had a significant effect not only on physical health but also on one’s psychological health. Global research reveals that one-third of those affected with COVID-19 experience sequelae of psychiatric symptoms, commonly seen as depression, anxiety, and posttraumatic stress disorder. No clear data exist from India on aggression in COVID-19-infected patients during the postillness phase. Hence, we aimed to assess the prevalence of aggression and personality factors associated with aggression in post-COVID individuals. Materials and Methods: This study was conducted in a tertiary institute in South India. One hundred and thirty-four patients, inpatients and outpatients, who recovered from COVID-19 were recruited based on purposive sampling. The data from patients were collected using semi-structured proforma with 59 questions on domains such as sociodemographic profile with clinical parameters, occupational factors, aggression, and personality profile. Standardized rating scales such as the Brief Aggression Questionnaire and Modified Overt Aggression Scale were used to assess aggression, while the Big Five Inventory-10 was used to assess personality profile. Results: About 17.9% of the study population had positive scores in one or more of the six components of aggression. Those with aggression had a significantly longer duration recovery period when compared to nonaggressive individuals (P &lt; 0.001). Those with aggression had significantly lower mean scores of agreeableness when compared to the other group (P = 0.01). Conclusion: With the fourth wave of COVID-19 on the horizon, psychological issues as a part of COVID sequelae need to be acknowledged. Clinicians should emphasize liaison with psychiatrists during follow-up of COVID-19 patients, to screen for any psychiatric symptoms postillness, thereby enhancing the chances of early detection and management.

Affective temperaments mediate aggressive dimensions in bipolar disorders: A cluster analysis from a large, cross-sectional, international study

BackgroundAffective temperaments show potential for aggressive behavior (AB) preventive strategies in bipolar disorder (BD). We aim to define intra-diagnostic subgroups of patients with BD based on homogeneous behaviors related to AB. Subsequently, to assess whether affective temperament dimensions may contribute to the presence and severity of AB. MethodsPatients with BD were recruited. AB was evaluated through the modified overt aggression scale (MOAS); affective temperaments were assessed with the TEMPS-A. A cluster analysis was conducted based on TEMPS-A and MOAS scores. Stepwise backward logistic regression models were used to identify the predictive factors of cluster membership. Results799 patients with BD were enrolled. Three clusters were determined: non-aggressive (55.5 %), self-aggressive (18 %), and hetero-aggressive (26.5 %). Depressive, irritable, and anxious temperament scores significantly increased from the non-aggressive (lower) to the self-aggressive (intermediate) and the hetero-aggressive group (highest). A positive history of a suicide attempt (B = 5.131; OR = 169.2, 95 % CI 75.9; 377) and rapid cycling (B = −0.97; OR = 0.40, 95 % CI 0.17; 0.95) predicted self-aggressive cluster membership. Atypical antipsychotics (B = 1.19; OR = 3.28, 95 % CI 2.13; 5.06) or SNRI treatment (B = 1.09; OR = 3, 95 % CI 1.57; 5.71), psychotic symptoms (B = 0.73; OR = 2.09, 95 % CI 1.34; 3.26), and history of a suicide attempt (B = −1.56; OR = 0.20, 95 % CI 0.11; 0.38) predicted hetero-aggressive cluster membership. LimitationsRecall bias might have affected the recollection of AB. ConclusionsClinical factors orientate the prevention of different ABs in BD. Affective temperaments might play a role in preventing AB since patients with more pronounced affective temperaments might have an increased risk of showing AB, in particular hetero-AB.