Risk Of Aggressive Behavior Research Articles

Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients in Non-Psychiatric Inpatient Units.

To refine and validate an electronic version of the Aggressive Behaviour Risk Assessment Tool (ABRAT) and determine the sensitivity and specificity for identifying potentially violent patients in non-psychiatric inpatient units. A prospective cohort study design was used. All patients admitted or transferred to three inpatient units of an acute care hospital in Nebraska, USA, from 7 February to 9 April 2023, were included. The 10-item ABRAT assessments were performed daily for the first 3 days of admission. The violent events were collected until discharge in three categories: Physical aggression towards others, physical aggression towards property and verbal intimidation/threat towards others. Kendall's tau tests and a multivariate logistic regression procedure were performed to select a parsimonious set of items that best predict violent events. Of 1179 patients, 69 had ≥1 violent event (5.9%). The revised six-item tool with item weighting was named ABRAT for Hospitalised Patients (ABRAT-H). The area under the curve from the Receiver Operating Characteristics analysis was 0.82. The sensitivity and specificity at a cutoff score of two were 68.1% and 85.2%, respectively. As ABRAT-H scores increased, the percentage of violent patients also increased and for patients with scores ≥5, 55.2% became violent. ABRAT-H appears to be useful for identifying potentially violent patients in non-psychiatric inpatient units with satisfactory sensitivity and specificity. The availability of ABRAT-H may help provide focused preventive measures that target patients at high risk for violence and reduce violent events. A majority of the nursing workforce is employed in acute care hospital setting, and the availability of ABRAT-H can further enhance the culture of a safe work environment and have positive impacts not only on the nurses' physical and mental health but also on the quality of patient care. We have adhered to relevant STROBE guidelines for reporting observational studies. No Patient or Public Contribution.

Clinical Variables Influencing Outcomes in Patients with Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas): Single-Institution Study of 95 Surgical Patients.

Atypical intradermal smooth muscle neoplasm, also commonly termed cutaneous leiomyosarcoma, is a soft tissue tumor with a low risk of aggressive behavior. These lesions arise in the dermis with possible superficial subcutaneous extension, demonstrate cytologic atypia, and often show mitotic activity. A retrospective review of patient demographics, tumor characteristics, and treatment methods was conducted in a consecutive series of patients presenting to MD Anderson Cancer Center (MDACC) from 2002 to 2021 (n=95). All pathology was reviewed by MDACC pathologists and determined to be atypical intradermal smooth muscle neoplasm. Median age at diagnosis was 58 years (range 22-86), and 74% were male. Ninety-five percent (n=90) of patients identified as White, non-Hispanic. Most tumors were slow-growing, solitary, and painless nodules. Tumors were in the lower extremities (44.2%), followed by the upper extremity (28.4%), trunk (22.1%), and head and neck (5.2%). All patients (n=44, 46.3%) who had a punch/incisional biopsy for diagnostic purposes had a subsequent tumor excision. Unplanned excision or excisional biopsy was performed on the remaining 46 (48%) patients. Of this subset, 41 of the 46 aforementioned patients (89%) had positive margins and underwent re-excision. Final pathology in 25/38 (66%) re-excision specimens was negative for residual tumor despite an initial positive margin. Two patients in the cohort had local recurrence 2 and 3 years after initial surgery. Both patients had positive margins, underwent excision of the recurrent tumor, and remain free of disease. After median follow-up of 6.9 years (range 1 day-18 years), 5-year recurrence-free survival was 96% and overall survival (OS) of the entire cohort was 78%. In this study of consecutive patients presenting with atypical intradermal smooth muscle neoplasm, we found good OS and local control after definitive surgical excision with negative margins, including excisional biopsy with close margins. Atypical intradermal smooth muscle neoplasm is unlikely to metastasize and has an excellent prognosis. Guidelines to determine optimal surveillance strategies for these patients should be revisited.

A workplace violence prevention program targeting high-risk patients in emergency departments.

Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool. A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed. Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p=0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p=0.418). The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

Genetic and Molecular Biomarkers in Aggressive Pheochromocytomas and Paragangliomas.

Pheochromocytomas and paragangliomas (PPGLs) are rare neoplasms producing catecholamines that occur as hereditary syndromes in 25-40% of cases. To date, PPGLs are no longer classified as benign and malignant tumors since any lesion could theoretically metastasize, even if it occurs only in a minority of cases (approximately 10-30%). Over the last decades, several attempts were made to develop a scoring system able to predict the risk of aggressive behavior at diagnosis, including the risk of metastases and disease recurrence; unfortunately, none of the available scores is able to accurately predict the risk of aggressive behavior, even including clinical, biochemical, and histopathological features. Thus, life-long follow-up is required in PPGL patients. Some recent studies focusing on genetic and molecular markers (involved in hypoxia regulation, gene transcription, cellular growth, differentiation, signaling pathways, and apoptosis) seem to indicate they are promising prognostic factors, even though their clinical significance needs to be further evaluated. The most involved pathways in PPGLs with aggressive behavior are represented by Krebs cycle alterations caused by succinate dehydrogenase subunits (SDHx), especially when caused by SDHB mutations, and by fumarate hydratase mutations that lead to the activation of hypoxia pathways and DNA hypermethylation, suggesting a common pathway in tumorigenesis. Conversely, PPGLs showing mutations in the kinase cascade (cluster 2) tend to display less aggressive behavior. Finally, establishing pathways of tumorigenesis is also fundamental to developing new drugs targeted to specific pathways and improving the survival of patients with metastatic disease. Unfortunately, the rarity of these tumors and the scarce number of cases enrolled in the available studies represents an obstacle to validating the role of molecular markers as reliable predictors of aggressiveness.

The relationships between parental educational practices, pro-aggression beliefs, and aggressive behavior: A cross-sectional study

Adolescent aggression poses a significant challenge to public health and societal well-being, with detrimental consequences for individuals and communities worldwide. Understanding the factors contributing to aggressive behavior during adolescence is crucial for developing effective intervention strategies. Parental influences, including parenting practices and beliefs, have been identified as key determinants of adolescent aggression. However, the mechanisms through which parental factors impact adolescent aggression, particularly the mediating role of cognitive factors such as pro-aggression beliefs, remain underexplored. This study aimed to investigate the associations between parental educational practices, pro-aggression beliefs, and aggressive behavior among middle school students, with a focus on understanding the mediating role of cognitive factors. A sample of 532 middle school students participated in the study and provided self-reported data on parental educational practices, pro-aggression beliefs, and aggressive behavior. The results revealed significant associations between parental educational practices, pro-aggression beliefs, and aggressive behavior. Furthermore, pro-aggression beliefs were found to partially mediate the relationship between parental educational practices and aggressive behavior. These findings underscore the importance of considering both familial and cognitive processes in understanding adolescent aggression. This study contributes to a deeper understanding of the complex interplay between parental factors, cognitive factors, and adolescent aggression, informing the development of targeted intervention programs aimed at promoting positive youth development and reducing violence. By addressing these factors, interventions can effectively mitigate the risk of aggressive behavior among adolescents, ultimately fostering healthier developmental trajectories and enhancing societal well-being.

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.

Validation of screening method based on EEG analysis for the risk assessment of psychiatric and behavioral disorders: a pilot study

To assess the validity of the screening method based on EEG analysis using predictive analytics algorithms with the calculation of linear discriminant functions (LDFs), in comparison with a classification system based on psychometric self-report scales. A comparative cross-sectional study with partial blinding involving healthy volunteers was conducted at two investigational sites. The calculated scores of LDFs used to assess risks of impulsivity, depression and anxiety acted as quantitative characteristics of subjects' mental state. Testing included completing psychometric scales. As a result of the performed validation of the original screening method based on EEG analysis in comparison with the scores of psychometric scales chosen as a reference method, satisfactory results were obtained with the best parameters of sensitivity, specificity, and accuracy for detecting high levels of impulsivity associated with pronounced aggressiveness. Of considerable interest is also the direct correlation found between high levels of LDF impulsivity scores and high levels of self-rated aggression on a psychometric scale (BPAQ-24). The results open up the possibility of using the proposed method to predict a number of emotional and behavioral characteristics of subjects, including a high risk of aggressive behavior as part of professional selection.

Honor Endorsement in Male Youth: A General Risk Factor for Aggressive Behavior?

Honor refers to socially conferred self-worth, strong norms of reciprocity, and direct retaliation for transgressions. Honor norms have been discussed as relevant in explaining aggressive behavior, particularly for immigrant groups. In this study we examined the endorsement of honor norms and their association with aggressive behavior in a culturally diverse sample in Germany. Online questionnaire data were used from male adolescents aged 11–18 years (N = 774; Mage = 15.37, 34.2% with a migration background). Multiple linear regression analyses indicated that students of Turkish and Russian origin endorsed honor more than students without a migration background, whereas students of Polish origin did not differ. Within negative binomial regression models, honor endorsement was significantly positively related to aggressive behavior, while this effect did not differ between students from different migration backgrounds and students without migration background respectively. Thus, the internalization of honor norms emerged as a general risk for aggressive behavior among male adolescents.

Construction and verification of aggressive behavior risk prediction model in stable patients with schizophrenia

BackgroundAmong all types of mental disorders, individuals with schizophrenia exhibit the highest frequency of aggressive behavior. This disrupts the healthcare environment and poses threats to family life and social harmony. Present approaches fail to identify individuals with schizophrenia who are predisposed to aggressive behavior. In this study, we aimed to construct a risk prediction model for aggressive behavior in stable patients with schizophrenia, which may facilitate early identification of patients who are predisposed to aggression by assessing relevant factors, enabling the management of high-risk groups to mitigate and prevent aggressive behavior.MethodsA convenience sample of stable inpatients with schizophrenia were selected from Daqing Municipal Third Hospital and Chifeng Municipal Anding Hospital from March 2021 to July 2023. A total of 429 patients with stable schizophrenia who met the inclusion criteria were included. A survey was conducted with them using a questionnaire consisting of general information questionnaire, Positive and Negative Symptom Scale, Childhood Trauma Questionnaire-Short Form, Connor-Davidson Resilience Scale and Self-esteem Scale. Patients enrolled in this study were divided into aggressive and non-aggressive groups based on whether there was at least one obvious and recorded personal attack episode (including obvious wounding and self-injurious behavior) following diagnosis. Binary Logistic regression was used to determine the influencing factors, and R software was used to establish a nomogram model for predicting the risk of aggressive behavior. Bootstrap method was used for internal validation of the model, and the validation group was used for external validation. C statistic and calibration curve were used to evaluate the prediction performance of the model.ResultsThe model variables included Age, Duration of disease, Positive symptom, Childhood Trauma, Self-esteem and Resilience. The AUROC of the model was 0.790 (95% CI:0.729–0.851), the best cutoff value was 0.308; the sensitivity was 70.0%; the specificity was 81.4%; The C statistics of internal and external validation were 0.759 (95%CI:0.725–0.814) and 0.819 (95%CI:0.733–0.904), respectively; calibration curve and Brier score showed good fit.ConclusionsThe prediction model has a good degree of discrimination and calibration, which can intuitively and easily screen the high risk of aggressive behavior in stable patients with schizophrenia, and provide references for early screening and intervention.

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

Individuals with schizophrenia spectrum disorders (SSD) have an elevated risk for aggressive behavior, and several factors contributing to this risk have been identified, e. g. comorbid substance use disorders. From this knowledge, it could be inferred that offender patients show a higher expression of said risk factors than non-offender patients. Yet, there is a lack of comparative studies between those two groups, and findings gathered from one of the two are not directly applicable to the other due to numerous structural differences. The aim of this study therefore was to identify key differences in offender patients and non-offender patients regarding aggressive behavior through application of supervised machine learning, and to quantify the performance of the model. For this purpose, we applied seven different (ML) algorithms on a dataset comprising 370 offender patients and a comparison group of 370 non-offender patients, both with a schizophrenia spectrum disorder. With a balanced accuracy of 79.9%, an AUC of 0.87, a sensitivity of 77.3% and a specificity of 82.5%, gradient boosting emerged as best performing model and was able to correctly identify offender patients in over 4/5 the cases. Out of 69 possible predictor variables, the following emerged as the ones with the most indicative power in distinguishing between the two groups: olanzapine equivalent dose at the time of discharge from the referenced hospitalization, failures during temporary leave, being born outside of Switzerland, lack of compulsory school graduation, out- and inpatient treatment(s) prior to the referenced hospitalization, physical or neurological illness as well as medication compliance. Interestingly, both factors related to psychopathology and to the frequency and expression of aggression itself did not yield a high indicative power in the interplay of variables, thus suggesting that while they individually contribute to aggression as a negative outcome, they are compensable through certain interventions. The findings contribute to our understanding of differences between offenders and non-offenders with SSD, showing that previously described risk factors of aggression may be counteracted through sufficient treatment and integration in the mental health care system.

Aggressive behavior and severe mental disorders in Prison psychiatry

IntroductionAggressive behavior can be understood as a compelx and social phenomenon. A number of studies have shown that the risk of aggressive behavior is increased for patients with severe mental disorders such as schizophrenia. Although specialized forensic institutions exist in many countries, most offenders with mental disorders are still found in prison settings what corresponds to international literature suggesting an increased prevalence of mental disorders in prison inmates. Still, data on the specific characteristics of patients demonstrating aggressive behavior in medical and mental health settings is limited, especially for prison environments.ObjectivesThe aim of our study was to identify patient characteristics that are potentially associated with aggressive incidents in a prison psychiatric setting.MethodsIn routine documentation in German prisons, specific incidents, as e.g. aggressive behavior are reported through an official reporting system. Analyzing these official reports, we collected all aggressive incidents concerning at the Department of Psychiatry of the Berlin prison hospital between 1997 and 2019. In addition, for each patient acting aggressively, we collected data on an equal number of patients who did not demonstrate this behavior during their hospital stay. For those patients with more than one inpatient treatment period, only the first stay in the prison hospital was included. Furthermore, patients were excluded based on age (younger than 16 or older than 70) or death during treatment. The statistical data was analyzed descriptively.ResultsIn total, 225 treatment episodes were included of which in 118 cases violent behavior were documented. The items older age, German citizenship, previous violent crimes (OR = 0,40, 95 % KI: 0,35 – 1,17) and antipsychotic (OR = 0,28, 95 % KI: 0,14 – 0,55) or antidepressant (OR = 0,35, 95 % KI: 0,13 – 0,88) treatment within six months prior to admission had a rather protective effect on the occurrence of aggressive behavior during inpatient treatment. Alcohol (OR = 1,21, 95 % KI: 0,64 – 2,27) and drug use disorders (OR = 2.18, 95 % KI: 1,09 – 4,44) tended to be risk factors for aggressive behavior. Thus, the results in this prison psychiatric population correspond to the risk factors described in the literature.ConclusionsThe reported results point in the direction that optimising the availability of psychopharmacological treatment options and offering specialized treatment for patients with comorbid substance use disorder may lead to the prevention of aggressive behavior in patients with a schizophrenia diagnosis.Disclosure of InterestNone Declared

Evaluation of Heavy Metal (Lead, Mercury, Cadmium, and Manganese) Levels in Blood, Plasma, and Urine of Adolescents With Aggressive Behavior.

Background Heavy metals can cause health problems by affecting the biological structure even at very low concentrations. Asymptomatic heavy metal poisoning causes non-specific symptoms such as behavioral disorders, difficulty in learning, and aggressive behaviors. There is also a great concern about the incidence of aggressive behavior among adolescents. A few research studies have concluded that a complex interaction or combination of factors leads to an increased risk of aggressive behavior in adolescents. This study aims to determine the correlation between the heavy metal levels in blood, plasma, and urine and the aggression level in adolescents. Materials and methods Two hundred twenty-eight adolescents between the ages of 13 and 19 were enrolled in the study. Blood, plasma, and urine heavy metal levels of the participants were measured by an inductively coupled plasma mass spectrometer (ICP-MS) device (Model 7700x; Agilent, Santa Clara, CA, USA). Buss and Perry's aggression questionnaire was used to investigate the correlation between heavy metals and aggressive behaviors in adolescents. Results Lead blood (r=0.34, p<.01), lead plasma (r=0.22, p<0.01), lead urine (r=0.31, p<.01), mercury blood (r=0.35, p<0.01), mercury urine (r=0.21, p<0.01), manganese blood (r=0.34, p<0.01), manganese plasma (r=0.33, p<0.01) and manganese urine (r=0.39, p<0.01) were positively correlated with tendency to aggression whereas no significant relationship was found between cadmium in blood, plasma, urine and mercury in plasma with aggression. Conclusion The study showed valuable data to associate a significant relationship between adolescents' aggression levels and heavy metals. There is an undeniable relationship between the health of adolescents and environmental pollution caused by heavy metals. Therefore, taking the necessary measures to prevent environmental heavy metal pollution is crucial for adolescent health.

Predictors of Adolescent Resilience During the COVID-19 Pandemic in a Community Sample of Hispanic and Latinx Youth: Expressive Suppression and Social Support.

The COVID-19 pandemic has created unprecedented disruptions in the daily lives and mental health of adolescents. Less attention has been given to the psychosocial resources that may mitigate the impact of COVID-19 on adolescent mental health, particularly among minoritized populations. In the present study, 259 youth (aged 11-18) were recruited from a community center for integrated prevention and intervention services in a predominantly Latinx and Hispanic community. Youth completed questionnaires about the impact COVID-19 has had on their lives, psychosocial resources (humor, optimism, emotion regulation, social support), and psychiatric symptoms (depressive symptoms, anxiety symptoms, sleep disturbances, aggression). After accounting for age, sex, and exposure to early life adversity, higher reported COVID-19 impact was associated with more depressive symptoms, b = 6.37 (SE = 1.67), 95% CI [3.08, 9.66], p < 0.001, more anxiety symptoms, b = 9.97 (SE = 1.63), 95% CI [6.75, 13.18], p < 0.001, and more sleep disturbances, b = 1.24 (SE = 0.34), 95% CI [0.57, 1.91], p < 0.001. Youth that reported infrequent expressive suppression and the lowest scores on giving social support were at the greatest risk for aggressive behavior in the context of high COVID-19 impact, ps < 0.007. Increasing emotion regulation skills, such as expressive suppression, and opportunities to give social support may promote resilience among high risk youth in the context of this ongoing community stressor.

Prenatal maternal stress and offspring aggressive behavior: Intergenerational and transgenerational inheritance.

Even though studies have shown that prenatal maternal stress is associated with increased reactivity of the HPA axis, the association between prenatal maternal stress and fetal glucocorticoid exposure is complex and most likely dependent on unidentified and poorly understood variables including nature and timing of prenatal insults. The precise mechanisms in which prenatal maternal stress influence neuroendocrine signaling between the maternal-placental-fetal interface are still unclear. The aim of this review article is to bring comprehensive basic concepts about prenatal maternal stress and mechanisms of transmission of maternal stress to the fetus. This review covers recent studies showing associations between maternal stress and alterations in offspring aggressive behavior, as well as the possible pathways for the “transmission” of maternal stress to the fetus: (1) maternal-fetal HPA axis dysregulation; (2) intrauterine environment disruption due to variations in uterine artery flow; (3) epigenetic modifications of genes implicated in aggressive behavior. Here, we present evidence for the phenomenon of intergenerational and transgenerational transmission, to better understands the mechanism(s) of transmission from parent to offspring. We discuss studies showing associations between maternal stress and alterations in offspring taking note of neuroendocrine, brain architecture and epigenetic changes that may suggest risk for aggressive behavior. We highlight animal and human studies that focus on intergenerational transmission following exposure to stress from a biological mechanistic point of view, and maternal stress-induced epigenetic modifications that have potential to impact on aggressive behavior in later generations.

The Maltreatment-Aggression Link among Prosecuted Males: What about Psychopathy?

Criminal offenders constitute a high-risk sample regarding experiences of childhood maltreatment and engagement in severe aggression. Moreover, psychopathic traits are more common in samples of offenders than non-offenders. Although research has underlined the relationship between childhood maltreatment and adult aggression, the influence of psychopathy on this link is still unclear. We examined the dynamics of maltreatment, aggression, and psychopathy in a mixed sample of 239 male violent, sexual, and other offenders using latent factor structural equation modeling. We found a consistent positive association of maltreatment with aggression. Psychopathy did not mediate this relation. Maltreatment was not associated with psychopathy, although psychopathy had a positive effect on aggressive behavior. These dynamics appeared similar for violent, sexual, and other offenders. However, latent variables were constructed somewhat differently depending on the offender status. For instance, sexual abuse appeared to be of specific importance in sexual offenders. Violent offenders showed high rates of psychopathy compared to sexual and other offenders. The current findings may inspire future research to focus more closely on the different subtypes of psychopathy when examining its role in the prediction of aggression based on childhood maltreatment. Moreover, childhood maltreatment must not be neglected in treatment and prevention approaches aimed at reducing the risk of aggressive behavior.

Soft drink consumption and depressive symptoms among the adolescents of United States: The mediating role of aggressive behaviors

BackgroundThere is limited evidence for the association among soft drink consumption, aggressive behaviors, and depressive symptoms among the adolescents. MethodsData were derived from a national representative sample of Youth Risk Behavior Surveys of United States during 2011 to 2019. Binary logistic regression models with complex sampling design were used to estimate the effect of soft drink consumption on aggressive behaviors and depressive symptoms. Mediating analysis was used to explore the association between soft drink consumption and depressive symptoms by aggressive behaviors. FindingsThe total prevalence of depressive symptoms was 3l.2 % (30.3 %–32.0 %). Compared with none of soft drink consumption, <1 time/day (OR: 1.29, 95%CI: 1.19–1.41), 1–2 times/day (OR: 1.49, 95%CI: 1.33–1.67), and ≥3 times/day (OR: 1.95, 95%CI: 1.70–2.24) were significantly associated with increased risk of aggressive behaviors. High levels of soft drink consumption (1–2 times/day, OR: 1.19, 95%CI: 1.07–1.32; ≥3 times/day, OR: 1.61, 95%CI: 1.42–1.81) and aggressive behaviors (OR: 1.98, 95%CI: 1.84–2.13) were found to be significantly associated with increased risk of depressive symptoms. A linear dose-response relationship of soft drink consumption with aggressive behaviors and depressive symptoms was found in this study (all p < 0.001). Aggressive behaviors partially mediated the association between soft drink consumption and depressive symptoms and each pathway was statistically significant. LimitationsThe causal relationship was not able to certain because of the cross-sectional design. ConclusionsThe mediating role of aggressive behaviors on the association of high levels of soft drink consumptions with depressive symptoms should be paid more attention among the adolescents.

Aggression, Alexithymia and Sense of Coherence in a Sample of Schizophrenic Outpatients.

Schizophrenia elevates the risk for aggressive behavior, and there is a need to better understand the associated variables predicting aggression for treatment and prevention purposes. The aim of the present study is to determine the relationship between alexithymia, sense of coherence and aggressive behavior in a sample of schizophrenic outpatients. Using a correlational research design, standardized self-report questionnaires assessed aggression (brief aggression questionnaire—BAQ), alexithymia (Toronto Alexithymia Scale—TAS) and sense of coherence (sense of coherence questionnaire—SOC) in a sample of 100 schizophrenic outpatients in clinical remission. Participants reported high levels of aggression and alexithymia along with reduced sense of coherence. Significant negative correlations were evidenced among scores on the SOC scale (p < 0.001) with both the TAS as well as with the BAQ scales. However, a positive correlation (p < 0.001) was observed between the TAS and BAQ scales. Regression indicated that 27% of the variation in the BAQ rating was explained by the TAS, while an additional 17.8% was explained by the sense of coherence. The difficulty identifying feelings of alexithymia and the comprehensibility and manageability components of sense of coherence significantly predicted anger, hostility and physical aggression. Sense of coherence mediated the relationship between alexithymia and aggression. From the path analysis, comprehensibility emerged as the key factor counterbalancing alexithymic traits and aggressive behaviors, and manageability effectuated higher anger control. The findings hold practical implications for the treatment and rehabilitation of schizophrenic patients.

Alcohol use disorder as a risk factor for violent offending in a sample of female forensic-psychiatric inpatients

IntroductionFemale gender is associated with a lower risk for aggressive behaviour and violent offending. Well established risk factors for aggressive behaviour are alcohol and other substance use, but previous studies focused mainly on male offenders and the general population. However, for therapeutic and prognostic reasons it is important to understand pathways to female offending.ObjectivesTo examine a sample of female forensic-psychiatric inpatients regarding the association of alcohol (AUD) and other substance use disorders (SUD) with violent offending (homicide, assault, robbery).MethodsWe conducted a retrospective cohort study of 334 female patients discharged before 01.01.2019 from a secure psychiatric hospital in Germany.ResultsIn total, 72% of the patients with AUD committed a violent crime, leading to admission to secure psychiatric treatment. In comparison a statistically significant lower rate (19%) of the SUD group was convicted of violent offending. Over 70% of the participants with AUD had a family history of AUD, and over 83% experienced physical violence in adulthood. We found no group differences (AUD vs. SUD) regarding aggressive behaviour during inpatient treatment.ConclusionsAccording to our results, AUD compared to other SUD, is a significant risk factor for violent offending in women. A family background with AUD and a history of physical abuse might function as a risk factor for both: developing an AUD and violent offending. The comparable rates of aggression in both groups during inpatient treatment suggest that abstinence is a protective factor.DisclosureNo significant relationships.

Clinical Factors Associated with Violence Behavior in Persons with Schizophrenia Spectrum Disorders: A Case Control Study

IntroductionStudy of clinical risk factors of violent behavior in persons with schizophrenia still remains actual in research literature. This is especially important for Georgia as ongoing mental health reform aims to shift from institutional care to community based services, which in turn requires better understanmding and management of risk of aggressive behavior in the community.ObjectivesTo study clinical risk factors for violence in persons with schizophrenia spectrum disorders (SSD) who have committed a violent act in the past and in persons with SSD who have not committed a violent act.MethodsThe survey design was retrospective case-control study. Case-control groups were defined according to the outcome (violent act in the past). We studied the impact of clinical symptoms on each person using standardized scales for assessment of the positive and negative symptoms and global level of functioning. Data were collected through patient interviews and medical records.ResultsStudy results showed that diagnosis of delusional disorder and ideas of persecution were associated with increased risk of violence (28.7% cases versus 7.5% controls); Hallucinations if presented were less severe compared with controls (2.1% vs. 7.5%). Negative symptoms were marked in cases but more severe in controls. Of cases 43,6% showed serious impairment of global functioning (vs 25,5% controls).ConclusionsStudy findings confirmed that a focus on improving controllable clinical factors, including global level of functioning, might help to prevent aggressive behavior. It is discussed that developments and implementation needs-specific services to reduce risk of violence behavior should be prioritized by mental health national strategy plan.DisclosureNo significant relationships.

Factors Influencing the Intention to Pursue Surgery among Female Pre-Medical Students: A Cross-Sectional Study in Pakistan.

While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision. An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery. Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cutting-edge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239). Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.