Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T04:07:19.418Z Has data issue: false hasContentIssue false
  • English
  • Français

Breaking down long-term chronic aggression within a forensic hospital system

Published online by Cambridge University Press:  24 April 2020

Benjamin Rose Open the ORCID record for Benjamin Rose [Opens in a new window] ,
Charles Broderick ,
Darci Delgado ,
Rebekah Kornbluh  and
Stephen M. Stahl
Benjamin Rose*
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Charles Broderick
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Darci Delgado
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Rebekah Kornbluh
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Stephen M. Stahl
Affiliation:
California Department of State Hospitals, Sacramento, California, USA University of California San Diego, California, USA
*
* Address correspondence to: Benjamin Rose, California Department of State Hospitals, Sacramento, CA95814, USA. (Email: ben.rose@dsh.ca.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Historically, patients with multiple acts of aggression, or chronic aggressors, have been studied as one large group. It was our objective to subdivide this group into those patients who engage in physical aggression consistently over multiple years and see if common characteristics of chronic aggressors could classify patients into an aggressive or nonaggressive group.

Method.

Within a forensic hospital system, patients who had committed 5 acts of physical aggression, per year, for 3 years (2010 and 2015) were reviewed. Data was collected on clinical and demographic characteristics that have shown to be associated with chronically aggressive patients and compared to nonaggressive matched controls. Data collection and analysis were completed to determine if the variables could classify patients into an aggressive or nonaggressive group.

Results.

Analysis showed that 2 variables, the presence of a cognitive disorder and a history of suicidal behaviors were significant in the univariate and multivariate analyses. The 2 variables were able to correctly classify 76.7% of the cases.

Conclusion.

A cognitive disorder, a history of suicidal behavior, and increased age were factors associated with this subgroup of aggressive patients. Clinicians may want to explore treatment programs aimed at these clinical factors including cognitive rehabilitation and social cognition treatments, which have been shown to reduce aggression in cognitively impaired populations.

Keywords

Aggressionviolencecognitive deficitsschizophreniaforensic hospital.
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 2 , April 2020 , pp. 216 - 222
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The findings and conclusions in “Breaking down long-term chronic aggression within a forensic hospital system” are those of the authors and do not necessarily represent the views or opinions of the Department of State Hospitals or the California Health and Human Services Agency.

References

References:

Broderick, C, Azizian, A, Kornbluh, R, Warburton, KD. Prevalence of physical violence in a forensic psychiatric hospital system during 2011-2013: Patient assaults, staff assaults, and repeatedly violent patients. In: Warburton, KD, Stahl, SM, eds. Violence in Psychiatry. New York, NY: Cambridge University Press; 2016:49–63.Google Scholar
Daffern, M, Mayer, MM, Martin, T. A preliminary investigation into patterns of aggression in an Australian forensic psychiatric hospital. J Forensic Psychiatry Psychol. 2003;14(1):67–84.10.1080/1478994031000074306CrossRefGoogle Scholar
Arango, C, Calcedo Barba, A, Gonzalez, S, Calcedo Ordonez, A. Violence in inpatients with schizophrenia: a prospective study. Schizophr Bull. 1999;25(3):493–503.10.1093/oxfordjournals.schbul.a033396CrossRefGoogle ScholarPubMed
Lussier, P, Verdun-Jones , S, Deslauriers-Varin , N, Nicholls, T, Brink, J. Chronic violent patients in an inpatient psychiatric hospital: prevalence, description, and identification. Crim Justice Behav. 2010;37(1):5–28.10.1177/0093854809347738CrossRefGoogle Scholar
Daffern, M, Howells, K, Ogloff, J. Interaction between individual characteristic and the function of aggression in forensic psychiatric inpatients. Psychiatry Psychol Law. 2007;14(1):17–25.10.1375/pplt.14.1.17CrossRefGoogle Scholar
Barlow, K, Grenyer, B, Ilkiw-Lavalle , O. Prevalence and precipitants of aggression in psychiatric inpatient units. Aust N Z J Psychiatry. 2000;34(6):967–974.CrossRefGoogle ScholarPubMed
Bjørkly, S. A ten-year prospective study of aggression in a special secure unit for dangerous patients. Scand J Psychol. 1999;40(1):57–63.10.1111/1467-9450.00098CrossRefGoogle Scholar
Decaire, MW, Bédard, M, Riendeau, J, Forrest, R. Incidents in a psychiatric forensic setting: association with patient and staff characteristics. Can J Nurs Res. 2006;38(3):69–80.Google Scholar
Flannery, RB Jr. Repetitively assaultive psychiatric patients: Review of published findings, 1978-2001. Psychiatr Q. 2002;73(3):229–237.10.1023/A:1016092822271CrossRefGoogle ScholarPubMed
Cooper, SJ, Browne, FW, McClean, KJ, King, DJ. Aggressive behaviour in a psychiatric observation ward. Acta Psychiatr Scand. 1983;68(5):386–393.CrossRefGoogle Scholar
Owen, C, Tarantello, C, Jones, M, Tennant, C. Violence and aggression in psychiatric units. Psychiatr Serv. 1998;49(11):1452–1457.10.1176/ps.49.11.1452CrossRefGoogle ScholarPubMed
Bader, SM, Evans, SE. Predictors of severe and repeated aggression in a maximum-security forensic psychiatric hospital. Int J Forensic Mental Health. 2015;14(2):110–119.10.1080/14999013.2015.1045633CrossRefGoogle Scholar
Krakowski, M, Czobor, P. Violence in psychiatric patients: the role of psychosis, frontal lobe impairment, and ward turmoil. Comp Psychiatry. 1997;38(4):230–236.10.1016/S0010-440X(97)90031-6CrossRefGoogle ScholarPubMed
Krakowski, MI, Convit, A, Volavka, J. Patterns of inpatient assaultiveness: Effect of neurological impairment and deviant family environment on response to treatment. Neuropsychiatry, Neuropsychology, & Behavioral Neurology. 1988;1(1):21–29.Google Scholar
Langton, CM, Hogue, TE, Daffern, M, Mannion, A, Howells, K. Personality traits as predictors of inpatient aggression in a high-security forensic psychiatric setting: prospective evaluation of the PCL-R and IPDE dimension ratings. Int J Offender Ther Comp Criminol. 2011;55(3):392–415.10.1177/0306624X10370828CrossRefGoogle Scholar
Kraus, JE, Sheitman, BB. Characteristics of violent behavior in a large state psychiatric hospital. Psychiatr Serv. 2004;55(2):183–185.10.1176/appi.ps.55.2.183CrossRefGoogle Scholar
Gudjonsson, G, Rabe-Hesketh , S, Wilson, C. Violent incidents on a medium secure unit over a 17-year period. J Forensic Psychiatry. 1999;10(2):249–263.CrossRefGoogle Scholar
Staniloiu, A, Markowitsch, H. Gender differences in violence and aggression – a neurobiological perspective Procedia. 2012;33:1032–1036.Google Scholar
Barnard, GW, Robbins, L, Newman, G, Carrera, F. A study of violence within a forensic treatment facility. Bull Am Acad Psychiatry Law. 1984;12(4):339–348.Google ScholarPubMed
Best, MW, Bowie, CR. A review of cognitive remediation approaches for schizophrenia: from top-down to bottom-up, brain training to psychotherapy. Expert Rev Neurother. 2017;17(7):713–723.CrossRefGoogle ScholarPubMed
Grube, M. Which types of aggressive behaviour are associated with suicidal and self-injurious behaviour at the time of admission? Psychopathology. 2004;37(1):41–49.10.1159/000077019CrossRefGoogle ScholarPubMed
Jollant, F, Lawrence, NL, Olié, E, Guillaume, S, Courtet, P. The suicidal mind and brain: A review of neuropsychological and neuroimaging studies. World J Biol Psychiatry. 2011;12(5–6):319–339.10.3109/15622975.2011.556200CrossRefGoogle ScholarPubMed
Bredemeier, K, Miller, IW. Executive function and suicidality: a systematic qualitative review. Clin Psychol Rev. 2015;40:170–183.10.1016/j.cpr.2015.06.005CrossRefGoogle ScholarPubMed
Keilp, JG, Gorlyn, M, Russell, M, Oquendo, MA, Burke, AK, Harkavy-Friedman , J, et al. Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt. Psychol Med. 2013;43(3):539–551.10.1017/S0033291712001419CrossRefGoogle ScholarPubMed
Hoptman, MJ, Yates, KF, Patalinjug, MB, Wack, RC, Convit, A. Clinical prediction of assaultive behavior among male psychiatric patients at a maximum-security forensic facility. Psychiatr Serv. 1999;50(11):1461–1466.10.1176/ps.50.11.1461CrossRefGoogle Scholar
Tardiff, K. A survey of five types of dangerous behavior among chronic psychiatric patients. Bull Am Acad Psychiatry Law. 1982;10(3):177–182.Google ScholarPubMed
Darmedru, C, Demily, C, Franck, N. Cognitive remediation and social cognitive training for violence in schizophrenia: a systematic review. Psychiatry Res. 2017;251:266–274.10.1016/j.psychres.2016.12.062CrossRefGoogle ScholarPubMed