Violent Behavior In Patients Research Articles

Gender differences in the influencing factors of violent behavior in patients with schizophrenia

BackgroundIn this study, we investigated the gender differences in the influencing factors of violent behavior in patients with schizophrenia.MethodsAbout 519 patients were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Positive and Negative Syndrome Scale (PANSS). A regression analysis model was used to investigate the gender-related factors that influence violent behavior in patients with schizophrenia. We also investigated gender differences in cognitive function among schizophrenia patients exhibiting violent behavior.ResultsWe found that male patients are more likely to engage in violent behavior than female patients (57.28 vs. 46.80%). Previous risk behaviors, police-assisted admission, and education were independently associated with violent behavior among male patients, whereas previous risk behaviors, police-assisted admission, and employment status were independently associated with violent behavior among female patients. Moreover, significant differences were found in immediate memory, visuospatial/constructional, language, delayed memory, and total RBANS scores between the violent and non-violent groups among female patients. Prominent differences were found between the two groups in terms of immediate memory and total RBANS scores among males.ConclusionThese findings suggested that there are gender differences in the influencing factors and cognition of violent behavior in patients with schizophrenia.

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.

Jenis Intervensi Pada Pasien Dengan Perilaku Kekerasan Di Rumah Sakit Jiwa Scoping Review

Violence behaviour poses a potential risk of physical harm to oneself or others. Violence behaviour must be promptly addressed by providing intervention to avoid detrimental impacts on the patient, others, or the surrounding environment. This research aims to identify the types of interventions for patients with violent behaviour in psychiatric hospitals. This review adopts a scoping review approach, following the analysis procedure by Arksey and O'Malley. Articles were identified using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) method. Inclusion criteria for this review article include English or Indonesian language articles, original articles, articles using quantitative, qualitative, and mixed research methods published within the last 5 years. From the review results of 1.128 articles, 8 articles met the inclusion criteria. The analysis results indicate various types of interventions proven to be effective in reducing violent behaviour in patients in psychiatric hospitals. Treatments involving physical, psychological, and belief-based activities are suitable for reducing violent behaviour in patients in psychiatric hospitals. Furthermore, to determine the real impact of reducing violent behaviour, supplemental research is needed to develop interventions in patients in psychiatric hospitals.

EEG biomarkers of behavioral inhibition in patients with depression who committed violent offenses: a Go/NoGo ERP study.

Understanding the neurobiological correlates of behavioral inhibition in patients with depression who committed violent offenses could contribute to the prediction and prevention of violence. The present study recruited 29 depressed patients with violent offenses (VD group), 27 depressed patients without violent behavior (NVD group), and 28 healthy controls (HC group) to complete a visual Go/NoGo task, during which their responses and electroencephalography were simultaneously recorded using an event-related potentiometer. The results showed that the VD group made more commission errors and responded more slowly relative to the NVD and HC groups. The P3 amplitude of the VD group was reduced in the frontal and central brain regions compared to the HC group and increased in the parietal regions compared to the NVD group. In comparison to Go stimuli, NoGo stimuli induced longer P3 latencies in frontal regions in both the VD and NVD groups; however, this difference was not statistically significant in the HC group. These results provide electrophysical evidence of behavioral inhibition deficits in patients with depression, especially in those with violent behaviors. The reduced P3 amplitude in the frontal-central regions, increased P3 amplitude in the parietal regions, and increased NoGo P3 latency may be potential electrophysiological features that can predict violent behavior in patients with depression.

Augmenting predictive models in forensic psychiatry with Cultural Consensus Theory

Abstract Forensic psychiatric hospitals regularly monitor the mental health and forensic risk factors of their patients. As part of this monitoring, staff score patients on various items. Common practice is to aggregate these scores across staff members. However, this is suboptimal because it assumes that assessors are interchangeable and that patients are independent. An improvement over averaging scores is the use of Cultural Consensus Theory (CCT), which imposes a hierarchical model across patients, staff members, and items. While accounting for differences between patients and staff members, CCT estimates a ‘true’ score for each patient on each item based on the consensus among staff members. Here, we apply a CCT model to data from a Dutch maximum-security forensic psychiatric centre and use the inferences to predict violent behaviour in patients. The CCT model outpredicts several alternatives, such as random forest and boosted regression trees, albeit by a small margin. We discuss practical limitations and directions for how future monitoring of patients could be adapted to maximize the added value of a CCT-based approach.

Aberrant brain structure in patients with schizophrenia and violence: A meta-analysis

Previous studies have indicated that schizophrenia is associated with an increased risk of violence, which may constitute a public health concern, leading to poor treatment outcomes and stigmatization of patients. Investigating brain structural features of violence in schizophrenia could help us understand its specific pathogenesis and find effective biomarkers. Our study aimed at identifying reliable brain structural changes associated with violence in patients with schizophrenia by conducting a meta-analysis and meta-regression of magnetic resonance imaging studies. Specific brain changes in patients with schizophrenia and violence (VSZ) were studied, compared with patients with schizophrenia and violence (VSZ), patients with non-violent schizophrenia (NVSZ), and individuals with a history of violence only and health controls. Primary outcomes revealed that there was no significant difference of gray matter volume between patients with VSZ and patient with NVSZ. Compared with controls, patients with VSZ exhibited decreased gray matter volume in the insula, the superior temporal gyrus (STG), the left inferior frontal gyrus, the left parahippocampus, and the right putamen. Compared with individuals with a history of violence only, patients with VSZ exhibited decreased volume in the right insula and the right STG. Meta-regression analysis revealed a negative correlation between the duration of schizophrenia and the volume of the right insula in patients with VSZ. These findings may suggest a shared neurobiological basis for both violence and psychiatric symptoms. The impaired frontotemporal-limbic network may serve as a neurobiological basis for higher prevalence of violent behaviour in patients with schizophrenia. However, it is important to note that these changes are not unique to patients with VSZ. Further investigation is needed to explore the neural mechanism that drive the interaction between violent behaviour and specific aggression-related dimensions of schizophrenia.

Application of Therapeutic Communication in Violent Behavior Patients

Introduction: Violent behaviour is a form of behaviour that patients with schizophrenia can demonstrate. This behaviour can cause injury to the patient or others around him. Therapeutic communication applied by nurses becomes one of the intervention options for patients with violent behaviour. Objective: Knowing the application of therapeutic communication in violent behaviour patients. Methods: Qualitative research with phenomenology case study approach method. Result: Shows that patient I have more contact with others. With an attitude that shows violent behaviour that can threaten people around him compared to patient II, who rarely meets others. Conclusion: Therapeutic communication has a very strong relationship with the decreased risk of violent behaviour in patients with violent behaviour. The better the communication the nurse applies, the lower the risk of violent behaviour appearing

Identifying risk factors to predict violent behaviour in community patients with severe mental disorders: A retrospective study of 5277 patients in China.

Patients with Severe Mental Disorders (SMD) have a higher risk of violent behaviour than the general population. The study aimed to investigate the predictive factors for the occurrence of violent behaviour in community SMD patients. The cases and follow-up data were collected from SMD patient Information Management system in Jiangning District, Jiangsu Province. The incidence of violent behaviours was described and analyzed. Logistic regression model was used to examine the influencing factors for violent behaviours in those patients. Among 5277 community patients with SMD in Jiangning District, 42.4% (2236/5277) had violent behaviours. The stepwise logistic regression analysis revealed that the disease-related factors (including disease type, disease course, times of hospitalization, medication adherence, past violent behaviours), the demographic factors (age, male sex, educational level, economic and social living status), and the policy-related factors (like free treatment, annual physical check, disability certificate, family physician services, and community interviews) were significantly related to the violent behaviours in community SMD patients. After gender stratification, we found that male patients with unmarried status and with a longer course of disease were more likely to violent. However, we found that female patients with lower economic status and educational experience were more likely to violent. Our results suggest that community SMD patients had a high incidence of violent behaviour. The findings may provide valuable information for policymakers and mental health professionals worldwide taking a number of measures to reduce the incidence of violence in community SMD patients and to better maintain social security.

Suicide and Violent Behavior in Psychotic Inpatients

Introduction: This study compares the association between psychosis, suicide, and violent behavior in patients admitted and discharged from the psychiatric ward. Methods: This study used a cross-sectional design. The experimental study was done with all the psychotic patients fulfilling the inclusion criteria upon admission and discharge from a teaching hospital in Malaysia. The study was conducted for a duration of five months from March to July 2022. Psychotic patients with various diagnoses based on the DSM-5 were interviewed. PANSS score was used upon admission and discharge to look at the severity of psychosis. Suicide behavior was assessed using SBQ-R while violent behavior was assessed using MOAS. Sample size consist of 100 consecutive psychotic patients. Results: Suicide behavior was noted to be present in patients no matter the severity of psychosis. Upon discharge, even after the improvement of psychosis, patients were still at risk of suicide behavior. Violent behavior was noted to be present in most of the patients in the PANSS group (except for the moderately ill patients) no matter the severity of psychosis. However, upon discharge from the psychiatric ward, we can see that all patients went home not having violent behavior. This concludes that, when psychosis improves, the risk of having violent behavior reduces. Conclusions: Further exploration on the reasons of why suicide behavior persists in psychotic patients has to be done by clinicians. It is dangerous for clinicians to make assumptions that psychotic patients presenting with suicide behavior are solely due to the psychosis.

Violence against ambulance workers: comparative study of the stations of Yerevan and Gyumri

Introduction. According to the World Health Organization (WHO), violence is widespread in the world, about 1 million people dying from various forms of violence each year. Currently, violence in the workplace is increasing, especially in emergency department against medical personal. Purpose of the research: to study the perception of violence by medical workers in ambulance stations in the cities of Yerevan and Gyumri, to identify the types, causes and qualitative characteristics of the prevalence of violence against medical ambulance workers. Give a comparative description of the violence situation in Yerevan and Gyumri stations.
 Material and methods. Qualitative research was carried out among the medical staff of emergency stations of Yerevan and Gyumri cities using the in-depth interview method in 2021. The tool was the guide, the total number of participants was 61.
 Results. The survey found that violence against emergency workers was common: 42 out of the 61 participants reported about lifetime experience of any type of violent behavior of patients or their relatives. Among the types of violence, physical and psychological were mentioned most often. 
 Conclusions. Violence is a common, frequent occurrence in the emergency department. Emergency medical personnel primarily perceive violence in its psychological and physical manifestations. Among the reasons are, in particular, the apparent delays of the emergency personnel, the nervous and mental overstrain of the abusers, and the use of alcohol.

Risk factors for violent behaviors in patients with schizophrenia: 2-year follow-up study in primary mental health care in China.

The consequences and impact of violent behavior in schizophrenia are often serious, and identification of risk factors is of great importance to achieve early identification and effective management. This follow-up study sampled adult patients with schizophrenia in primary mental health care in a rural area of southern China, in which 491 participants completed a comprehensive questionnaire at baseline and the 2-year follow-up. Sociodemographic, clinical and psychological assessment data were collected from all participants. Paired sample T-Tests and the McNemar Test were performed to examine changes over the follow-up period. Generalized Estimating Equations (GEE) were used to analyze the risk factors for violent behavior. The results showed that about two in five community-dwelling patients with schizophrenia reported violent behavior in the past year. At follow-up, participants were significantly less employed, had more times of hospitalization, more psychotropic medication, and severer depressive symptoms, but had better health-related quality of life than at baseline. Use of clozapine and better insight into medication decreased the possibility of violent behavior, while more severe positive symptoms, insomnia, as well as use of second-generation antipsychotics other than clozapine, antidepressants and mood stabilizers increased the possibility of violent behavior. Risk evaluation, prevention and management of violence in patients with schizophrenia are demanded in primary mental health care.

Smaller amygdala subnuclei volume in schizophrenia patients with violent behaviors

To investigate the association between the volume of amygdala subnuclei and violent behaviors in patients with schizophrenia (SCZ). In the present study, we recruited 40 SCZ patients with violent behaviors (VS), 26 SCZ patients without violent behaviors (NVS), and 28 matched healthy controls (HC) who completed T1-weighted magnetic resonance imaging. Both the total amygdala and amygdala subnuclei volumes were estimated with FreeSurfer. When comparing the SCZ patients with HC, SCZ patients had a smaller volume of the left basal nucleus (P < 0.05, uncorrected). Further, the VS patients had a smaller volume of the left amygdala central nucleus than the NVS group (P < 0.05, Bonferroni corrected). Our study suggests that a smaller volume of the left amygdala basal nucleus may be a biomarker for SCZ and that a smaller volume of the left central nucleus may be relevant to violence risk in patients with schizophrenia.

Structural Deficits in the Frontotemporal Network Associated With Psychopathic Traits in Violent Offenders With Schizophrenia.

People with schizophrenia (SZ) are at increased risk of violence compared to the general population. However, the neural mechanisms of violent behavior in patients with SZ are still unclear due to the heterogeneity of the diseased population. In this study, we aimed to examine the neural correlates of violent behavior in SZ and to determine whether the structural deficits were related to psychopathic traits. A total of 113 participants, including 31 SZ patients with violent behavior (vSZ), 39 SZ patients without violent behavior (nvSZ), and 43 healthy controls (HC), completed the T1-weighted magnetic resonance imaging (MRI) scan and were analyzed using voxel-based morphometry approach. The psychopathic traits were assessed using the Psychopathy Checklist: Screening Version (PCL:SV). The results showed decreased gray matter volume (GMV) in the vSZ group in the right temporal lobe and bilateral inferior frontal gyri compared to HCs; while reduced GMV in the inferior parietal lobe, parahippocampal and orbital frontal gyri was found in the nvSZ group compared with HCs. Correlation analyses showed that psychopathic traits were negatively associated with the GMV in the right superior temporal and left fusiform gyri in the vSZ group, indicating that psychopathic traits, as reflected by the score of antisocial factor, might be related to structural deficits in the temporal lobe, which led to a propensity to violent behavior in patients with SZ. Our findings suggest that violent behavior in patients with SZ might have a personality background associated with the frontotemporal network aberrance. In future studies, we need to take a closer look at psychopathic traits for better understanding of the mechanism of interpersonal violence in patients with SZ and to explore whether the imaging findings from this study can serve as a biomarker to predict future violent behaviors and community living.

The Prediction and Influential Factors of Violence in Male Schizophrenia Patients With Machine Learning Algorithms.

BackgroundEarly to identify male schizophrenia patients with violence is important for the performance of targeted measures and closer monitoring, but it is difficult to use conventional risk factors. This study is aimed to employ machine learning (ML) algorithms combined with routine data to predict violent behavior among male schizophrenia patients. Moreover, the identified best model might be utilized to calculate the probability of an individual committing violence.MethodWe enrolled a total of 397 male schizophrenia patients and randomly stratified them into the training set and the testing set, in a 7:3 ratio. We used eight ML algorithms to develop the predictive models. The main variables as input features selected by the least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) were integrated into prediction models for violence among male schizophrenia patients. In the training set, 10 × 10-fold cross-validation was conducted to adjust the parameters. In the testing set, we evaluated and compared the predictive performance of eight ML algorithms in terms of area under the curve (AUC) for the receiver operating characteristic curve.ResultOur results showed the prevalence of violence among male schizophrenia patients was 36.8%. The LASSO and LR identified main risk factors for violent behavior in patients with schizophrenia integrated into the predictive models, including lower education level [0.556 (0.378–0.816)], having cigarette smoking [2.121 (1.191–3.779)], higher positive syndrome [1.016 (1.002–1.031)] and higher social disability screening schedule (SDSS) [1.081 (1.026–1.139)]. The Neural Net (nnet) with an AUC of 0.6673 (0.5599–0.7748) had better prediction ability than that of other algorithms.ConclusionML algorithms are useful in early identifying male schizophrenia patients with violence and helping clinicians take preventive measures.

Validation and recalibration of OxMIV in predicting violent behaviour in patients with schizophrenia spectrum disorders

Oxford Mental Illness and Violence (OxMIV) addresses the need in mental health services for a scalable, transparent and valid tool to predict violent behaviour in patients with severe mental illness. However, external validations are lacking. Therefore, we have used a Dutch sample of general psychiatric patients with schizophrenia spectrum disorders (N = 637) to evaluate the performance of OxMIV in predicting interpersonal violence over 3 years. The predictors and outcome were measured with standardized instruments and multiple sources of information. Patients were mostly male (n = 493, 77%) and, on average, 27 (SD = 7) years old. The outcome rate was 9% (n = 59). Discrimination, as measured by the area under the curve, was moderate at 0.67 (95% confidence interval 0.61–0.73). Calibration-in-the-large was adequate, with a ratio between predicted and observed events of 1.2 and a Brier score of 0.09. At the individual level, risks were systematically underestimated in the original model, which was remedied by recalibrating the intercept and slope of the model. Probability scores generated by the recalibrated model can be used as an adjunct to clinical decision-making in Dutch mental health services.

Identification of violent patients with schizophrenia using a hybrid machine learning approach at the individual level

Despite numerous risk factors associated with violence in patients with schizophrenia, predicting and preventing violent behavior is still a challenge. At present, machine learning (ML) has become a promising strategy for guiding individualized assessment. To build an effective model to predict the risk of violence in patients with schizophrenia, we proposed a hybrid ML method to improve the prediction capability in 42 violent offenders with schizophrenia and 33 non-violent patients with schizophrenia. The results revealed that the final model, which combined multimodal data, achieved the highest prediction performance with an accuracy of 90.67%. Specifically, the model, which fused three modalities of neuroimaging data, achieved a better accuracy than other fused models. In addition, the msot discriminative neuroimaging features involved in the prefrontal-temporal cognitive circuit and striatum reward system, indicating that dysfunction in cortical-subcortical circuits might be associated with high risk of violence in patients with schizophrenia. This study provides the first evidence supporting that the combination of specific multimodal neuroimaging and clinical data in ML analysis can effectively identify violent patients with schizophrenia. Furthermore, this work is crucial for the development of neuro-prediction models that could facilitate individualized treatment and interventions for violent behaviors in patients with schizophrenia.

Command Voices and Aggression in a Lebanese Sample Patients with Schizophrenia.

The impact of command voices (CV) on violent behaviors in patients with schizophrenia remains unclear. The literature has produced mixed results, with no research existing on CV and violence among the Lebanese population. The study objecttives were to (1) evaluate the association between voice beliefs, psychosis severity, treatment, demographic factors and command voices, and (2) evaluate the association between command voices and violence among patients with schizophrenia in Lebanon. A cross-sectional study, conducted between April and August 2019, enrolled 280 patients with schizophrenia. The results showed that 111 (39.6%) patients with schizophrenia had auditory hallucinations, among whom 93 (83.8%) patients had command voices; from these 93 patients, 53 (57.0%) were compliant with voices. Higher positive (ORa=1.09) and general psychopathology (ORa=1.04) PANSS subscales scores were significantly associated with higher compliance to voices. A higher resistance to beliefs about voices (ORa=0.91) was significantly associated with lower compliance to voices. The prevalence of CV in patients with schizophrenia that report auditory hallucinations, was high in our sample. The vast majority of violent acts committed by patients was in compliance to CV, with a significantly high rate of the violence committed being directed towards property. Our findings were able to connect positive symptoms to higher probability of compliance to CV.

Substance use disorders and violent behaviour in patients with severe mental disorders: A prospective, multicentre study.

The relationship between alcohol and substance use and the risk of violence exhibited by patients with mental disorders is under-researched. This prospective cohort study aims to compare patients with severe mental disorders and with different substance use behaviors in terms of sociodemographic and clinical characteristics, hostility, impulsivity and aggressive behaviors. Furthermore, this study aims to assess differences in violent behaviors during a 1-year monitoring follow-up. A total of 378 participants with severe mental disorders from Italian residential facilities and from four Departments of Mental Health (244 outpatients and 134 residential patients) were enrolled. Participants were categorized as Persons with Current Substance Use, Persons with Former Substance Use and Persons with Non-Substance Use. All these patients underwent a complex multidimensional assessment, including the lifetime and current substance use; a subsample of outpatients was also assessed with a laboratory substance assay including the testing for specific substances. We assessed the differences among these three groups in hostility, impulsivity and aggressive behaviors. The results of the close 1-year monitoring show a significantly higher risk of violence for patients with severe mental disorders Persons with Current Substance Use compared to Persons with Former Substance Use and Persons with Non-Substance Use. Persons with Current Substance Use showed significantly higher scores for irritability, negativism and verbal assault compared to Persons with Non-Substance Use. Persons with Former Substance Use showed significantly higher scores for lifetime history of aggressive behaviors compared with patients with Persons with Non-Substance Use. These findings suggest that patients with comorbid mental illness and substance use disorders should be referred for specific interventions to reduce aggressive behavior and ensure patient well-being and community safety.

Research Progress on the Relationship between Genetic Polymorphism and Violent Behavior of Patients with Schizophrenia.

Schizophrenia is a common disease characterized by thinking obstructions and accompanied by cognitive, emotional and behavioral disorders. Under the control of psychiatric symptoms, patients with schizophrenia may self-injure or impulsively wound others, resulting in public risk and increase in the burden of family and society. In recent years, many studies have shown that the violent behavior of patients with schizophrenia is related to genetic factors. This article reviews the research progress on the relationship between genetic polymorphism and violent behavior of patients with schizophrenia, analyzes the possible mechanism of the correlation between the two, puts forward the limitations of current research and the directions of future research, and provides scientific basis for risk assessment and prevention of violent behavior of patients with schizophrenia.

Hubungan Komunikasi Terapeutik dan Risiko Perilaku Kekerasan pada Pasien Skizofrenia di Rumah Sakit Jiwa Provinsi Bali

Violent behavior is one of symptoms that can be demonstrated by patients with schizophrenia which it can cause injury to the patient and others. Therapeutic communication is one of the nursing intervention for patients with violent behavior. This study aimed to identify the relationship of communication and risk of violent behavior in schizophrenic patients. This study used a descriptive correlational with a cross-sectional design, which involved 68 patients with schizophrenia who were selected by consecutive sampling technique. The instrument in this study used a therapeutic communication checklist and observation sheets for changes in violent behavior. The results showed that as many as 35 patients (51.5%) who received good therapeutic communication from nurses, and 37 (54.4%) patients showed moderate risk of violent behavior. The results of the analysis by the Gamma ordinal by ordinal test found that there was a significant relationship between therapeutic communication and the risk of violent behavior with p value= 0.001 (&lt;0.05). It showed that the better therapeutic communication applied, the lower of the incidence of violent behavior in schizophrenic patients. Thus it is expected that nurses can practice therapeutic communication techniques to improve the patient's condition so that violent behavior in patients can be reduced.