Overt Aggression Scale Scores Research Articles

Expression level of myocardial enzymes in patients with schizophrenia: Predictive value in the occurrence of violence

BACKGROUND Schizophrenic patients are prone to violence, frequent recurrence, and difficult to predict. Emotional and behavioral abnormalities during the onset of the disease, resulting in active myocardial enzyme spectrum. AIM To explored the expression level of myocardial enzymes in patients with schizophrenia and its predictive value in the occurrence of violence. METHODS A total of 288 patients with schizophrenia in our hospital from February 2023 to January 2024 were selected as the research object, and 100 healthy people were selected as the control group. Participants’ information, clinical data, and laboratory examination data were collected. According to Modified Overt Aggression Scale score, patients were further divided into the violent (123 cases) and non-violent group (165 cases). RESULTS The comparative analysis revealed significant differences in serum myocardial enzyme levels between patients with schizophrenia and healthy individuals. In the schizophrenia group, the violent and non-violent groups also exhibited different levels of serum myocardial enzymes. The levels of myocardial enzymes in the non-violent group were lower than those in the violent group, and the patients in the latter also displayed aggressive behavior in the past. CONCLUSION Previous aggressive behavior and the level of myocardial enzymes are of great significance for the diagnosis and prognosis analysis of violent behavior in patients with schizophrenia. By detecting changes in these indicators, we can gain a more comprehensive understanding of a patient’s condition and treatment.

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.

Evaluation of the association COMT Val158Met variant and childhood trauma on aggression in Turkish SCZ patients

Childhood trauma is a serious form of stress that makes individuals more vulnerable to developing Schizophrenia (SCZ). Many studies have predicted the association between the catechol-O-methyltransferase (COMT) gene Val158Met variant and aggressive attack. We aimed to investigate the association the COMT variant and childhood trauma on aggression in Turkish SCZ patients This study included 89 patients diagnosed with SCZ. Childhood Trauma Questionnaire (CTS) and Overt Aggression Scale (OAS) were used to assess childhood trauma and aggression. COMT Val158Met variant was analyzed by PCR-RFLP method from isolated DNAs. There was no statistically significant difference in comparing the COMT genotype distribution and clinical characteristics including suicide attempts, self-destructive behavior, crime history, substance, alcohol and tobacco use. When we evaluate Spearman’s rank correlation coefficients between CTQ and OAS, the correlation between the OAS and CTQ scores of the patients was statistically significant except for the sexual abuse subgroup of the CTQ. In the univariate logistic regression analysis, in which the dichotomized OAS score was accepted as the dependent variable, it was found that age, suicide attempt, substance abuse, and CTQ total score significantly predicted the higher OAS scores. In the multivariate logistic regression analysis, which included the variables that predicted OAS significantly, age, suicide attempt, and total CTQ score were determined as independent variables predicting OAS. Because of the phenotypic complexity in SCZ, it is difficult to draw strong conclusions about COMT and to highlight a definitive relationship. Larger-scale studies are needed to examine the multifactorial inheritance pattern of schizophrenia in different dimensions.

Aggressive behavior in patients hospitalised for a psychotic relapse

IntroductionPatients in psychotic relapse may exhibit violent behavior towards objects, themselves or others. These behaviors, although usually unconscious, are a common reason for hospitalization and a source of rejection and stigmatization by family and society.ObjectivesThe objective of this study was to evaluate the presence of aggressive behavior in relapsed inpatients with schizophrenia in the F psychiatry department at the Razi Hospital in Tunisia.MethodsThis was a descriptive, cross-sectional study of fifty male patients hospitalized for a psychotic relapse who were naïve or discontinuing treatment for at least two months. Patients were assessed using a semi-structured questionnaire and the Overt Aggression Scale (OAS).ResultsThe age of the patients included ranged from 17 to 65 years, with an average of 36.4±11.51 years. More than half of the patients were without occupation (58%, N= 29). For personnal history : Seven patients (14%) had attempted suicide ; Eight patients (16%) showed evidence of self-harm ; Thirteen patients (26%) had a history of arrests of which eleven (22%) were incarcerated.The OAS score ranged from to 0 to 35 with a mean at 9.7+/- 10.3. Twenty-seven patients were aggressive (54%).ConclusionsPreventive strategies should focus more on predicting the aggressive potential of patients with schizophrenia and its socio-professional implication. Perhaps when using a less holistic approach to the disease and when approaching aggressive behavior as a symptom in its own right, we will be able to find other alternative options.Disclosure of InterestNone Declared

Comparison of the sociodemographic, clinical and offense-related data of delusional disorder patients with and without a criminal history

This study investigates the relationship of delusional disorder and its subtypes to criminal and violent behavior by comparing the sociodemographic and clinical characteristics of patients with and without a criminal history and identifying predictors of crime. The records of 346 patients with a delusional disorder diagnosis were retrospectively evaluated using a sociodemographic data form, a crime violence rating scale and the Overt Aggression Scale (OAS). The results show that homicide and attempted homicide were committed more frequently by patients with jealous delusions, whereas verbal assault and crimes against the public were committed more frequently by patients with persecutory and other delusions. Patients with a criminal history had more hospital admissions and longer stays. Marital status, persecutory delusions, a high OAS score and older age were found to be associated with higher risk of crime. Clinical subtypes and sociodemographic characteristics seem to discriminate delusional disorder patients’ risk of crime.

Bilateral Amygdala Radio-Frequency Ablation for Refractory Aggressive Behavior Alters Local Cortical Thickness to a Pattern Found in Non-refractory Patients.

Aggressive behaviors comprise verbal and/or physical aggression directed toward oneself, others, or objects and are highly prevalent among psychiatric patients, especially patients diagnosed with autism spectrum disorder and severe intellectual disabilities. Some of these patients are considered refractory to treatment, and functional neurosurgery targeting the amygdala can result in widespread plastic brain changes that might reflect ceasing of some abnormal brain function, offering symptom alleviation. This study investigated cortical thickness changes in refractory aggressive behavior patients that were treated with bilateral amygdala ablation and compared to control patients presenting non-refractory aggressive behavior [three refractory and seven non-refractory patients, all males diagnosed with autism spectrum disorder (ASD) and intellectual disabilities]. The Overt Aggression Scale (OAS) was used to quantify behavior and magnetic resonance imaging was performed to investigate cortical thickness. Before surgery, both groups presented similar total OAS score, however refractory patients presented higher physical aggression against others. After surgery the refractory group showed 88% average reduction of aggressive behavior. Imaging analysis showed that while refractory patients present an overall reduction in cortical thickness compared to non-refractory patients across both timepoints, the local pattern of thickness difference found in areas of the neurocircuitry of aggressive behavior present before surgery is diminished and no longer detected after surgery. These results corroborate the hypotheses on induction of widespread neuronal plasticity following functional neurosurgical procedures resulting in modifications in brain morphology and improvement in behavior. Further studies are necessary to determine the underlying cause of these morphological changes and to better understand and improve treatment options.

The association between prolactin concentration and aggression in female patients with schizophrenia

Objectives This study assessed the association between serum prolactin (PRL) concentration and aggression in female patients with schizophrenia. Methods Female patients with schizophrenia (N = 120) were diagnosed using SCID-5 based on the DSM-5 criteria. They were sampled at the University Psychiatric Hospital Vrapce during the period from March 2017 to March 2019. Aggression was evaluated using the Positive and Negative Syndrome Scale (PANSS), and Overt Aggression Scale (OAS). Patients were subdivided into aggressive and non-aggressive groups. PRL was determined in serum using electrochemiluminescence (ECLIA) method. Results Aggressive patients with schizophrenia had significantly (p < 0.0001) increased PRL concentration compared to non-aggressive patients. Higher PRL concentration was significantly (p < 0.0001) associated with pronounced aggressive symptoms determined by the OAS scores. When patients were subdivided into those who were treated with risperidone, haloperidol, paliperidone, amisulpride, and a group that was not treated with these antipsychotics, aggressive patients in both groups had significantly higher PRL concentrations than non-aggressive patients. Higher antipsychotic dose was related to increased PRL concentration (p = 0.004). Conclusions Our findings suggest that higher PRL is significantly associated with aggression, irrespective of the antipsychotic medication, in female patients with schizophrenia.

4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department

OBJECTIVES/GOALS: Agitation has high prevalence in the emergency department (ED), but limited evidence exists regarding clinical decisions to use sedatives and physical restraint. We examined clinical factors and agitation attributes impacting thresholds for sedative and restraint use in the emergency setting. METHODS/STUDY POPULATION: We conducted a prospective cohort study of adult patients (318 yo) with acute or escalating agitation during their ED visit at an urban tertiary care referral center. Consecutive patients requiring security presence or scoring &gt;1 on an agitation scale were enrolled during randomized 8-h blocks. We recorded patient characteristics, staff/team factors, and environmental/systems data as well as scores on 3 validated agitation scales: Agitated Behavior Scale, Overt Aggression Scale, and Severity Scale. We performed descriptive analyses, bivariable analyses, and logistic regression modeling of factors with relation to sedative/restraint use. We observed 95 agitation events on unique patients over 2 months. RESULTS/ANTICIPATED RESULTS: Median age was 42, and 62.1% were male. Most frequent chief complaints were alcohol/drug use (37.9%) and psychiatric (23.2%). Majority of events (73.7%) were associated with sedative/restraint use. Factors related to treatment course or staff interactions were the primary reasons for agitation in 56.8% of events. A logistic regression model found no association between demographics and odds of sedative/restraint use. Overt Aggression Scale scores were associated with significantly higher odds of sedative use (AOR 1.62 [1.13–2.32]), while Severity Scale scores had significantly higher odds of restraint use (AOR 1.39 [1.12–1.73]) but significantly lower odds of sedative use (AOR 0.79 [0.64–0.98]). DISCUSSION/SIGNIFICANCE OF IMPACT: External factors may be important targets for behavioral techniques in ED agitation management. Further study of the Severity Scale may allow for earlier detection of agitation and identify causal links between agitation severity and use of sedatives and restraints.

Characteristics and Severity of Agitation Associated With Use of Sedatives and Restraints in the Emergency Department.

Agitated patients frequently present to emergency departments, but limited evidence exists regarding clinical decisions to use chemical sedatives and physical restraints. We examined attributes and levels of agitation impacting thresholds for sedative and restraint use in the emergency setting. This was a secondary study focusing on agitation characteristics within a prospective observational study of agitated patients in the emergency department at an urban, tertiary referral center. We recorded scores on 3 validated agitation scales: the Agitated Behavior Scale, the Overt Aggression Scale, and the Severity Scale. Consecutive patients requiring security presence or scoring ≥1 on an agitation scale were enrolled during randomized 8-h blocks. Ninety-five agitation events on unique patients were observed. The median age was 42years, and 62.1% were male. Highest frequency triage chief complaints were alcohol/drug use (37.9%) and psychiatric (23.2%). Most events (73.7%) were associated with sedative or restraint use. Factors related to treatment course or interactions with staff were commonly cited (56.8%) as the primary etiology for agitation. A logistic regression model found no association between demographics and odds of sedative/restraint use. Overt Aggression Scale scores were associated with significantly higher odds of sedative use (adjusted odds ratio [AOR] 1.62 [range 1.13-2.32]), while Severity Scale scores had significantly higher odds of restraint use (AOR 1.39 [range 1.12-1.73]) but significantly lower odds of sedative use (AOR 0.79 [range 0.64-0.98]). External factors may be important targets for behavioral techniques in agitation management. Further study of the Severity Scale scale may allow for earlier detection of agitation and identify causal links between agitation severity and use of sedatives and restraints.

Clozapine in the Treatment of Aggression in Conduct Disorder in Children and Adolescents: A Randomized, Double-blind, Controlled Trial.

ObjectiveThis study was conducted to compare the efficacy of clozapine vs. risperidone in the treatment of aggression in conduct disorder in children and adolescents.MethodsTwenty-four children with conduct disorder aged 6 to 16 years were randomized in a prospective, double-blind trial into two groups to receive clozapine or risperidone for 16 weeks. The Modified Overt Aggression Scale score was used as the primary outcome of the study. Secondary outcomes were Child Behavior Checklist (CBCL) externalization (CBCL-E) and internalization factors; Aggression, Hyperactivity and Delinquency subscales of CBCL-E, Child Global Assessment Scale (CGAS), Barnes Akathisia Rating Scale, and Simpson-Angus Scale.ResultsBoth antipsychotics were similarly effective in the primary outcome and in most of the secondary ones. Clozapine was more effective in CBCL-E, the delinquency subscale and the CGAS scores than risperidone (p=0.039, 0.010, and 0.021). Two subjects from the clozapine group were excluded due to a low neutrophil count at week four.ConclusionClozapine and risperidone are effective for short-term treatment of aggression in children and adolescents with conduct disorder. Clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents. Stronger efficacy of clozapine should be investigated in larger sample sizes using pharmacogenomic studies. White blood cell counts need to be monitored when prescribing clozapine.

Baseline Characteristics and Early Response at Week 1 Predict Treatment Outcome in Adolescents With Bipolar Manic or Mixed Episode Treated With Olanzapine: Results From a 3-Week, Randomized, Placebo-Controlled Trial.

Early predictors of response and remission in pediatric mania are lacking, requiring further study. This was a post hoc analysis of a 3-week, randomized, placebo-controlled trial of olanzapine conducted between November 2002 and May 2005 in 161 adolescents aged 13-17 years who were diagnosed with a DSM-IV acute manic or mixed episode of bipolar I disorder. Data from the olanzapine arm were analyzed to investigate the predictive power of early response or early nonresponse (≥25% or < 25% reduction in Young Mania Rating Scale [YMRS] score, respectively) at week 1 for ultimate response or nonresponse (≥ 50% or < 50% reduction in YMRS score, respectively) and for remission (YMRS total score ≤ 12 [standard definition] or ≤ 8 [stringent definition]) at week 3. Correlates of early response and ultimate response were examined in multivariable regression models. By week 1, 69.2% of olanzapine-treated adolescents (n = 104, 2.5-20.0 mg/d) achieved early response, and 49.0% reached ultimate response at week 3. Patients with early response and early nonresponse were similar regarding baseline variables except higher scores for sleep and thought content were found with early response (P < .05) and higher olanzapine doses with early nonresponse (P < .01). At week 3, early response was associated with significantly greater improvements in YMRS, Clinical Global Impressions-Severity of Illness scale (both P < .001), and Overt Aggression Scale scores (P = .024). Adverse events were similar in patients with early response and early nonresponse, except for higher AIMS scores for patients with early nonresponse (P = .036). Early response significantly predicted ultimate response (OR = 5.61, P < .001; sensitivity = 86.3, specificity = 47.2, positive predictive value = 61.1, negative predictive value = 78.1). Significantly more early response than early nonresponse patients achieved ultimate response (61.1% vs 21.9%, P < .001) and remission defined by YMRS score ≤ 12 (45.8% vs 12.5%, P < .001) and YMRS score ≤ 8 (33.3% vs 3.1%, P < .001). In multivariable analyses, among other variables, early response remained an independent correlate of ultimate response and remission. In acute pediatric manic or mixed episodes, early response to olanzapine at week 1 was strongly associated with ultimate response and remission at week 3, while absence of early response predicted the unlikely success of further treatment. ClinicalTrials.gov identifier: NCT00050206.

Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey

This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93–8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired.

The Effects of Carbamazepine and Lithium Combination on Serious Aggression and Anger Outbursts in a Case of Seronegative Limbic Encephalitis.

To the Editor: Limbic encephalitis involves the hippocampus, amygdala, and insular cortex1 and causes changes in behavior and personality such as aggression and anger.2 Despite the reported effects of antipsychotics and benzodiazepines,3 some patients with limbic encephalitis may not respond to these drugs. Although antiaggressive effects of lithium and carbamazepine have been reported,4 there is no report showing such effects in limbic encephalitis. We describe a case of limbic encephalitis in which serious aggression and anger outbursts responded to the combination of carbamazepine and lithium. Case report. Mr A, a 22-year-old man with headache, was admitted to the neurosurgery ward after an anger outburst during which he exhibited an automatic masticatory-like movement. Mr A had no prior history of neurologic or psychiatric illness. He was transferred to the neurology ward for further examination wherein seronegative limbic encephalitis (ICD-10 code G04.81) was diagnosed based on laboratory findings and brain imaging. Mr A was admitted to the psychiatric ward because of serious aggression and anger outbursts. He was secluded in a quiet room and received 800 mg/d of valproate, 75 mg/d of levomepromazine, and 4 mg/d of risperidone. The observable aggressive and violent behavior was assessed to be 5 points (normal range: 0) by the Overt Aggression Scale (OAS)5 and 28 points by the excitability subscale (normal range: 0–6) of the Positive and Negative Syndrome Scale (PANSS).6 Despite increases of valproate to 1,200 mg/d (96.5 μg/mL) and levomepromazine to 250 mg/d, his serious aggression and anger outbursts persisted (eg, abusing medical staff and beating himself with his fist). After 500 mg/d (7.8 μg/mL) of carbamazepine was combined, however, Mr A’s symptoms began to improve, but not sufficiently. After lithium was added and gradually increased to 1,000 mg/d (0.98 mEq/L), his serious aggression and anger outbursts subsided significantly, and he was allowed to leave the seclusion room. He began to talk and behave politely to medical staff. Thereafter, valproate, risperidone, and levomepromazine were tapered off without exacerbation. Mr A was able to joke with medical staff with a smile. The OAS score was 0 points and the excitability subscale on the PANSS was 6 points. His parents and friends confirmed that he had completely returned to his premorbid state. Five months after admission to the psychiatric ward, he was discharged on 600 mg/d of carbamazepine (7.4 μg/mL) and 800 mg/d of lithium (0.71 mEq/L). One month after discharge, his mental state was stable and he returned to his job as an office clerk. Three months after discharge, Mr A continued to work and have a good relationship with his family and friends, but his serum carbamazepine and lithium levels were undetectable. In this case, Mr A’s serious aggression and anger outbursts did not respond to valproate, risperidone, or levomepromazine. However, the combination of carbamazepine and lithium was clearly effective, and his behavior and personality completely returned to his premorbid state. Although Mr A’s undetectable serum carbamazepine and lithium levels 3 months after discharge were probably due to noncompliance, his mental state continued to be stable, indicating that both carbamazepine and lithium were unnecessary for long-term treatment most likely because his encephalitis remitted. These findings suggest that the combination of carbamazepine and lithium may be useful for serious aggression and anger outbursts in the acute phase of limbic encephalitis in some patients.

Age structure at diagnosis affects aggression in a psychiatric inpatient population: age structure affecting inpatient aggression.

Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU.

Effects of quetiapine and olanzapine in patients with psychosis and violent behavior: a pilot randomized, open-label, comparative study.

ObjectivePatients suffering from psychosis are more likely than the general population to commit aggressive acts, but the therapeutics of aggressive behavior are still a matter of debate.MethodsThis pilot randomized, open-label study compared the efficacy of quetiapine versus olanzapine in reducing impulsive and aggressive behaviors (primary endpoints) and psychotic symptoms (secondary endpoints) from baseline to days 1, 7, 14, 28, 42, 56, and 70, in 15 violent schizophrenic patients hospitalized in a maximum-security psychiatric hospital.ResultsQuetiapine (525±45 mg) and olanzapine (18.5±4.8 mg) were both efficacious in reducing Impulsivity Rating Scale from baseline to day 70. In addition, both treatments reduced the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression Scale scores at day 70 compared to baseline, and no differences were observed between treatments. Moreover, quetiapine, but not olanzapine, yielded an improvement of depressive symptoms in the items “depression” in Brief Psychiatric Rating Scale and “blunted affect” in Positive and Negative Syndrome Scale. Modified Overt Aggression Scale scores were also decreased from baseline to the endpoint, but due to the limited number of patients, it was not possible to detect a significant difference.ConclusionIn this pilot study, quetiapine and olanzapine equally decreased impulsive and psychotic symptoms after 8 weeks of treatment. Double-blind, large studies are needed to confirm the validity of these two treatments in highly aggressive and violent schizophrenic patients.

Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria

IntroductionThe number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. MethodsProspective data were collected over 56 months (n=431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. ResultsAdopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=.086). ConclusionsThe over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more.

An Investigation of Factors Increasing the Risk of Aggressive Behavior among Schizophrenic Inpatients

Aim of the study: This study tried to identify risk factors of aggressive behavior in a population of schizophrenic inpatients. We tested the association between aggressive behavior and socio-demographic characteristics, addictive disorders, history of suicide attempt, and sexual violence, impulsivity, and sensation seeking.Methods: All consecutive schizophrenic inpatients (100) were assessed during 6 months. Aggressive behavior was quantified with a standardized scale, the Overt Aggression Scale (OAS). We studied socio-demographic characteristics and the history of suicide attempt and sexual violence with a specific standardized questionnaire. Addictive disorders were identified with the Fagerström and CAGE questionnaires and with the DSM-IV-R diagnostic criteria for nicotine, alcohol, cannabis opiates, and cocaine abuse and dependence disorders. Lastly, we studied sensation seeking with the Zuckerman scale and impulsivity with the Barratt scale.Results: Linear regression identified four factors associated with aggressive behavior: male gender (odd ratio = 12.8), history of sexual violence (odd ratio = 3.6), Fagerström score (odd ratio = 1.3), number of cigarettes smoked each day (odd ratio = 1.16). Patients with nicotine use or dependence had significantly higher levels of OAS scores. This difference was not observed between patients with or without alcohol dependence. OAS scores were correlated to the number of cigarettes smoked each day and to Fagerström scores. Patients with a higher level of sensation seeking and impulsivity also had higher OAS scores.Conclusion: A typical schizophrenic patient at risk of showing aggressive behavior is a man, who smokes and presents a history of sexual violence.

Aggression in bipolar II disorder and its relation to the serotonin transporter

BackgroundAggression is frequently observed in patients diagnosed with bipolar disorder (BD). Previous studies found a negative association between aggression and serotoninergic function in patients with BD, as well as in healthy subjects. The objective of this study was to determine whether there is an association between aggression and the availability of the serotonin transporter (SERT) in euthymic BD II patients. MethodsThirty-eight age-matched healthy controls (HCs) and 24 BD II patients were recruited. BD II patients were under stable treatment in the euthymic state. The Overt Aggression Scale (OAS) was used for the assessment of aggression. Single photon emission computed tomography with 123I-ADAM was used for SERT imaging. A specific uptake ratio, which represents availability, was the primary measured outcome. ResultsThe total OAS scores, as well as the scores on all of the sub-items, were significantly higher in BD II patients than in the HCs group. There was no significant difference in SERT availability between BD II and HCs subjects in different brain regions. The Pearson’s correlation between the total OAS scores and the sub-item aggression and SERT availability was significant. LimitationThe OAS was used for the assessment of the past week of the patients’ condition and thus did not reflect their trait status. ConclusionsThe higher total scores of OAS in euthymic BD II patients than in HCs support the idea that aggression might be a trait marker for BD. Although SERT availability in euthymic BD II patients and in HCs did not differ significantly, the correlation of SERT availability and total OAS provides the possible explanation of aggression in BD II.

Bir eğitim hastanesinde yatarak tedavi gören şizofreni hastalarında tedavi uyumu, içgörü ve agresyon ilişkisi / Relationship between treatment adherence, insight and violence among schizophrenia inpatients in a training hospital sample

Objective: The aim of the study was to explore the correlation of violent behavior with insight, clinical symptoms and treatment adherence in patients with schizophrenia. Method: 104 randomly selected inpatients between 20 and 65 years of age, treated with a diagnosis of schizophrenia according to DSM-IV-TR criteria at Bakirkoy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry were included in the study. The Schedule For Assessment of Three Components of Insight (SAI), Overt Aggression Scale (OAS), Positive and Negative Syndrome Scale (PANSS) Turkish forms were applied to the patients. Results: Treatment adherence was correlated with insight levels. Mean OAS scores of “non-adherent” patients were significantly higher than patients with treatment adherence. SAI scores were inversely correlated with PANSS positive and negative symptoms, but not correlated with PANSS general psychopathology scores. The OAS scores were found to be correlated with PANSS positive symptoms scores merely. There was no correlation between SAI and OAS scores. Conclusion: The results indicate that treatment adherence is correlated positively with insight and negatively with aggression. Aggression and severity of illness are correlated as well in our sample. Community-based treatment programs and psychoeducation of outpatients should be conducted to maintain treatment adherence. Thus, violent behavior could be minimized by diminishing the severity of illness.

Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness

Objective: To perform a preliminary study on the effects and safety of bilateral cingulotomy and anterior capsulotomy in patients with aggressive behavior. Patients and Methods: Twenty-three psychiatric patients showing aggressive behavior refractory to conventional treatment were initially evaluated. The subjects were clinically selected using the Overt Aggression Scale (OAS) and the Global Assessment of Functioning Scale (GAF). Each case was carefully reviewed by the Ethics Committee of Mexico’s General Hospital. Once selection criteria were met, stereotactic lesions were made using radiofrequency on the anterior limb of the internal capsule and supragenual cingulum. Statistical differences were evaluated with a Wilcoxon test at 6 months and at 4 years. Results: Ten patients underwent surgery. Their OAS and GAF scores decreased after the procedure at the 6-month (p < 0.05) and at the 4-year (p = 0.068) follow-up. Four patients showed mild and transitory postsurgical complications (hyperphagia and somnolence). Conclusions: Bilateral anterior capsulotomy in combination with cingulotomy may reduce aggressive behavior and improve clinical evaluations. Very strict clinical and ethical evaluations were applied prior to considering patients for this treatment.