Violence in psychiatric patients: The role of psychosis, frontal lobe impairment, and ward turmoil

doi:10.1016/S0010-440X(97)90031-6

Comprehensive Psychiatry

Volume 38, Issue 4, July–August 1997, Pages 230-236

https://doi.org/10.1016/S0010-440X(97)90031-6 Get rights and content

Abstract

The purpose of the study was to identify psychiatric symptoms, neurological impairments, and situational factors associated with the emergence of violence and with its persistence. Psychiatric symptoms were assessed in newly admitted physically assaultive psychiatric patients and nonviolent controls. Patients were then evaluated for 4 weeks to determine the persistence or resolution of these physical assaults. Patients who showed marked resolution of assaults were classified as transiently violent (n = 41), and those who remained assaultive throughout were categorized as persistently violent (n = 34). At the end of 4 weeks, all patients received a comprehensive psychiatric and neurological assessment. Physical assaults were associated initially with prominent positive psychotic symptoms. Both transiently and persistently violent patients were more psychotic than the nonviolent controls; however, transiently violent patients showed better resolution of these symptoms over the 4 weeks. They also evidenced less frontal lobe impairment on the neurological examination than the persistently violent patients. The two violent groups differed in their susceptibility to environmental influences: the surrounding ward agitation fostered physical assaults in transiently but not in persistently violent patients. This differentiation between transiently and persistently violent patients has major implications for the comprehensive treatment of violent behavior.

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About 57% of habitually aggressive subjects had EEG abnormalities (62% frontal) compared to about 12% of other subjects who had committed a single isolated violent act. Similarly, psychiatric inpatients who were more persistently violent were found to have more significant frontal lobe impairment than transiently violent patients (Krakoswki & Czobor, 1997). When considering the specific forensic population of murderers, one study of 31 murderers referred for mitigation evaluations revealed that 64.5% showed some physical evidence of frontal dysfunction (Blake et al., 1995).
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^☆: Supported by Grant No. MH-45454 from the National Institute of Mental Health.

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Violence in psychiatric patients: The role of psychosis, frontal lobe impairment, and ward turmoil☆

Abstract

Compr Psychiatry

Biol Psychiatry

Prog Neuropsychopharmacol Biol Psychiatry

Arch Phys Med Rehabil

Toward a rejuvenation of risk assessment research

Assessing the evidence of a link between mental illness and violence

Hosp Community Psychiatry

Assault, suicide and mental illness

Arch Gen Psychiatry

Inpatient evaluation of aggression in psychiatric patients

J Nerv Ment Dis

The relationship between acute psychiatric symptoms, diagnosis, and short-term risk of violence

Hosp Community Psychiatry

Neuropsychological Concomitants of Persistent Criminal Behavior

Neurologic findings in recidivist aggressors

Neurobiology of Violence

Neural substrates of violent behaviour. A preliminary study with positron emission tomography

Br J Psychiatry

Neurological impairment in violent schizophrenic inpatients

Am J Psychiatry

Clinical symptoms, neurological impairment, and prediction of violence in psychiatric patients

Hosp Community Psychiatry