Skip to main content
×
×
Home

Executive function and in-patient violence in forensic patients with schizophrenia

  • Rachael S. Fullam (a1) and Mairead C. Dolan (a2)
Abstract
Background

The literature on the association between neuropsychological deficits and in-patient violence in schizophrenia is limited and the findings inconsistent.

Aims

To examine the role of executive function deficits in in-patient violence using measures of dorsolateral (DLPFC) and ventrolateral prefrontal cortical (VLPFC) function.

Methods

Thirty-three violent and forty-nine non-violent male forensic in-patients with schizophrenia were assessed using neuropsychological tasks probing DLPFC and VLPFC function and on measures of symptoms and psychopathy.

Results

There were no significant group differences in neuropsychological task performance. Higher rates of violence were significantly associated with lower current IQ scores and higher excitement symptom scores. The ‘violent’ group had significantly higher interpersonal and antisocial domain psychopathy scores. In a logistic regression analysis, IQ and the interpersonal domain of psychopathy were significant discriminators of violent v. non-violent status.

Conclusions

Personality factors rather than symptoms and neuropsychological function may be important in understanding in-patient violence in forensic patients with schizophrenia.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Executive function and in-patient violence in forensic patients with schizophrenia
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Executive function and in-patient violence in forensic patients with schizophrenia
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Executive function and in-patient violence in forensic patients with schizophrenia
      Available formats
      ×
Copyright
Corresponding author
Correspondence: Rachael Fullam, Centre for Forensic Behavioural Science, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Victorian Institute for Forensic Mental Health, Locked Bag 10, Fairfield, VIC 3078, Australia. Email: rachel.fullam@forensicare.vic.gov.au
Footnotes
Hide All

Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes
References
Hide All
1 Naudts, K, Hodgins, H. Neurobiological correlates of violent behaviour among persons with schizophrenia. Schizophr Bull 2006; 32: 562–72.
2 Krakowski, M, Convit, A, Jaeger, J, Lin, S, Volavka, J. Neurological impairment in violent schizophrenic inpatients. Am J Psychiatry 1989; 146: 849–53.
3 Adams, JJ, Meloy, JR, Moritz, S. Neuropsychological deficits and violent behaviour in incarcerated schizophrenics. J Nerv Ment Dis 1990; 178: 253–6.
4 Forster, HG, Hillbrand, M, Silverstein, M. Neuropsychological deficit and aggressive behaviour: a prospective study. Prog Neuropsychopharmacol Biol Psychiatry 1993; 17: 939–46.
5 Rasmussen, K, Levander, S, Sletvold, H. Aggressive and non-aggressive schizophrenics: symptom profile and neuropsychological differences. Psychol Crime Law 1995; 2: 119–29.
6 Barkataki, I, Kumari, V, Das, M, Morris, R, O'Connell, P, Taylor, P, Sharma, T. A neuropsychological investigation into violence and mental illness. Schizophr Res 2005; 74, 113.
7 Roy, S, Herrera, J, Parent, M, Costa, J. Violent and non-violent schizophrenic patients: Clinical and developmental characteristics. Psychol Rep 1987; 61: 855–61.
8 Lapierre, D, Braun, CM, Hodgins, S, Toupin, J, Leveillee, S, Constantineau, C. Neuropsychological correlates of violence in schizophrenia. Schizophr Bull 1995; 21: 253–62.
9 Lafayette, MD, Frankle, WG, Pollock, A, Dyer, K, Goff, DC. Clinical characteristics, cognitive functioning and criminal histories of outpatients with schizophrenia. Psychiatr Serv 2003; 54: 1635–40.
10 Silver, H, Goodman, C, Knoll, G, Isakov, V, Modai, I. Schizophrenia patients with a history of severe violence differ from non-violent schizophrenia patients in perception of emotions but not cognitive function. J Clin Psychiatry 2005; 66: 300–8.
11 Dinakar, H, Sobel, RN. Violence in the community as a predictor of violence in the hospital. Psychiatr Serv 2001; 52: 240–1.
12 American Psychiatric Association. Diagnostic Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
13 Kay, SR, Opler, LA, Fiszbein, A. The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia: Manual. Multi-Health Systems, 1992.
14 Lindenmayer, JP, Grochowski, S. Bark N. The five factor model of schizophrenia: replication across samples. Schizophr Res 1995; 14: 229–34.
15 Hart, SD, Cox, DN Hare, RD. The Psychopathy Checklist – Screening Version (PCL–SV). Multi-Health Systems, 1995.
16 Hare, RD, Neumann, CS. Structural models of psychopathy. Curr Psychiatry Rep 2005; 7: 5764.
17 Hill, CD, Neumann, CS, Rogers, R. Confirmatory factor analysis of the Psychopathy Checklist: screening version. Psychol Ass 2003; 15: 41–5.
18 Hare, RD. The Psychopathy Checklist–Revised (PCL–R). Multi-Health Systems, 1991.
19 Nelson, H. National Adult Reading Test Manual. nferNelson, 1991.
20 The Psychological Corporation. Wechsler Abbreviated Scale of Intelligence. Harcourt, Brace & Co., 1999.
21 Fray, PJ, Robbins, TW. CANTAB battery: proposed utility in neurotoxicology. Neurotoxicol Teratol 1996; 18: 499504.
22 Rubia, K, Russell, T, Overmeyer, S, Bullmore, ET, Sharma, T, Simmons, A, Williams, SC, Giampietro, V, Andrew, CM, Taylor, E. Mapping motor inhibition: conjunctive brain activations across different versions of go/no-go and stop tasks. Neuroimage 2001; 13: 250–61.
23 Schacher, R, Logan, GD. Impulsivity and inhibitory control in normal development and childhood psychopathology. Dev Psychol 1990; 26: 710–20.
24 British Medical Association & Royal Pharmaceutical Society. British National Formulary. British Medical Journal & Pharmaceutical Press, 2005.
25 Cheung, P, Schweitzer, I, Crowley, K, Tuckwell, V. Violence in schizophrenia: role of hallucinations and delusions. Schizophr Res 1997; 26: 181–90.
26 Taylor, PJ, Leese, M, Williams, D, Butwell, M, Daly, R, Larkin, E. Mental disorder and violence. A special (high security) hospital study. Br J Psychiatry 1998; 172: 218–26.
27 Tengstrom, A, Grann, M, Langstrom, N. Kullgren G. Psychopathy (PCL–R) as a predictor of violent recidivism among criminal offenders with schizophrenia. Law Hum Behav 2000; 24: 4558.
28 Hodgins, S, Hiscoke, UL Freese, MD. The antecedents of aggressive behaviour among men with schizophrenia: a prospective investigation of patients in community treatment. Behav Sci Law 2003; 21: 523–46.
29 Dolan, M Davies, G. Psychopathy and institutional outcome in patients with schizophrenia in forensic settings in the UK. Schizophr Res 2006; 81: 277–81.
30 Raine, A. The Psychopathology of Crime: Criminal Behavior as a Clinical Disorder. Academic Press, 1997.
31 Gendreau, P, Goggin, C, Little, T. Predicting Adult Offender Recidivism: What Works! Public Works and Government Services Canada, 1997.
32 Walsh, Z, Swogger, MT, Kosson, DS. Psychopathy, IQ, and violence in European American and African American county jail inmates. J Consult Clin Psychol 2004; 72: 1165–69.
33 Matarazzo, JD, Herman, DO. Relationship of education and IQ in the WAIS–R standardization sample. J Consult Clin Psychol 1984; 52: 631–4.
34 Elliott, AK, Mirsky, AF. Cognitive antecedents of violence and aggression. In The Neurobiology of Criminal Behaviour (ed Glicksohn, J): 111–36. Kluwer Academic Publishers, 2002.
35 Sabri, M, Radnovich, AJ, Li, TQ, Kareken, DA. Neural correlates of olfactory change detection. Neuroimage 2005; 25: 969–74.
36 Abu-Akel, A, Abushualeh, K. ‘Theory of mind’ in violent and nonviolent patients with paranoid schizophrenia. Schizophr Res 2004; 69: 4553.
37 Silver, H, Feldman, P, Bilker, W, Gur, RC. Working memory as a core neuropsychological dysfunction in schizophrenia. Am J Psychiatry 2003; 160: 1809–16.
38 Elliott, R, McKenna, PJ, Robbins, TW, Sahakian, BI. Specific neuropsychological deficits in schizophrenic patients with preserved intellectual function. Cog Neuropsychiatry 1998; 3: 4570.
39 Bowie, CR, Moriarty, PJ, Harvey, PD, Parrella, M, White, L, Davis, KL. Aggression in elderly schizophrenia patients: a comparison of nursing home and state hospital residents. J Neuropsychiatry Clin Neurosci 2001; 13: 357–66.
40 Fresan, A, Apiquian, R, de la Fuente-Sandovol, C, Löyzaga, C, Garcia-Anaya, M, Meyenberg, N, Nicolini, H. Violent behavior in schizophrenia patients: Relationship with clinical symptoms. Aggress Behav 2005; 31: 511–20.
41 Arango, C, Calcedo-Barba, A, González-Salvador, T, Calcedo-Ordóñ, A. Violence in inpatients with schizophrenia: a prospective study. Schizophr Bull 1999; 25: 493503.
42 Nolan, KA, Volavka, J, Czober, P, Sheitman, B, Lindenmayer, JP, Citrome, LL, McEvoy, J, Lieberman, J.A. Aggression and psychopathology in treatment resistant inpatients with schizophrenia and schizoaffective disorder. J Psychiatr Res 2005; 39: 109–15.
43 Hare, RD. Psychopathy: a clinical and forensic overview. Psychiatr Clin North Am 2006; 29: 709–24.
44 Skeem, JL. Mulvey EP. Psychopathy and community violence among civil psychiatric patients. Results from the MacArthur Violence Risk Assessment Study. J Consult Clin Psychol 2001; 69: 358–74.
45 Skeem, JL, Mulvey, EP, Grisso, T. Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: screening version. Psychol Assess 2003; 15: 4155.
46 Skeem, JL, Miller, JD, Mulvey, E, Tiemann, J, Monahan, J. Using a five-factor lens to explore the relation between personality traits and violence in psychiatric patients. J Consult Clin Psychol 2005; 73: 454–65.
47 Vitacco, MJ, Neumann, CS, Jackson, RL. Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence. J Consult Clin Psychol 2005; 73: 466–76.
48 Blair, KS, Newman, C, Mitchell, DG, Richell, RA, Leonard, A, Morton, J, Blair, RJ. Differentiating among prefrontal substrates in psychopathy: neuropsychological test findings. Neuropsychology 2006; 20: 153–65.
49 Morgan, AB, Lilienfeld, SO. A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function. Clin Psychol Rev 2000; 20: 113–36.
50 Dolan, M. Park I. The neuropsychology of antisocial personality disorder. Psychol Med 2002; 32: 417–27.
51 Gadon, L, Johnstone, L, Cooke, D. Situational variables and institutional violence: a systematic review of the literature. Clinl Psychol Rev 2006; 26: 515–34.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Fullam and Dolan supplementary material
Supplementary Table S1

 PDF (42 KB)
42 KB
UNKNOWN
Supplementary materials

Fullam and Dolan supplementary material
Supplementary Material

 Unknown (516 bytes)
516 bytes
PDF
Supplementary materials

Fullam and Dolan supplementary material
Supplementary Table S1

 PDF (42 KB)
42 KB
PDF
Supplementary materials

Fullam and Dolan supplementary material
Supplementary Table S1

 PDF (42 KB)
42 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Executive function and in-patient violence in forensic patients with schizophrenia

  • Rachael S. Fullam (a1) and Mairead C. Dolan (a2)
Submit a response

eLetters

Author response to Abbott et al

Rachael Fullam, Adjunct Lecturer
17 April 2009

The e letter by Drs Abbott and Kirk reflects a basic misunderstandingof the issue under investigation and of the scientific principals used in the study. This was not a prevalence study examining the generic links between executive dysfunction and inpatient violence. We are aware of the findings regarding acquired or organically based brain damage and violence; however, this was not the focus of the study. The article describes a scientific research study designed to address a very specific issue, namely, the relationship between executive function, symptoms, psychopathy and inpatient violence in forensic patients with schizophrenia. Due to the fact that this was a research study we had to gain informed consent from participants. In addition, in order to scientifically investigate our hypotheses we introduced appropriate controls for confounding variables such as medication side effects. We also had to ensure that patients were stable enough to complete the neuropsychological assessment battery. However, regardless of these controls, our overall sample showed significant levels of executive dysfunction, producing similar scores on the neurocognitive tasks to thoseseen in other samples of patients with chronic schizophrenia and patients with frontal lobe damage.1,2 We have highlighted the limitations of the study in the article and point out that the findings are not necessarily generalisable to a more acute population.

1.Pantelis C, Barber FZ, Barnes TR, Nelson HE, Owen AM, Robbins TW. Comparison of set-shifting ability in patients with chronic schizophrenia and frontal lobe damage. Schizophr Res 1999; 37:251-70.2.Pantelis C, Barnes TR, Nelson HE, Tanner S, Weatherley L, Owen AM, Robbins TW. Frontal-striatal cognitive deficits in patients with chronic schizophrenia. Brain 1997; 12:1823-43.

Declaration of interest: None
... More

Conflict of interest: None Declared

Write a reply

Executive function and inpatient violence in forensic patients with schizophrenia

Patricia Abbott, Consultant Rehabilitation Psychiatrist
06 November 2008

Fullam & Dolan?s finding that dysexecutive dysfunction was not a predictor of inpatient violence in a forensic population was surprising,, but may be explained by the selection criteria for inclusion in the study.These authors excluded subjects who were unable to give informed consent and only accepted individuals who were ?stable on medication?. These criteria would have excluded a significant number of individuals with the most severe forms of treatment-resistant schizophrenia who could not consent to participate in this study because of formal thought disorder orserious cognitive impairment. They would also have excluded those with more severe dysexecutive disorder who may exhibit ?organic impulsive aggression? (Yudovsky, 1990) and therefore not be considered sufficiently ?stable on medication? to be selected.

Participants selected for this study are likely to be those whose illnesses are reasonably responsive to treatment and who have relatively minor dysexecutive deficits with limited behavioural consequences, as indicated by the incident data in this paper. Relatively minor dysexecutive deficits may not be readily detectable in terms of behavioural change in the general population following brain injury even though they are critical in terms of functional outcome in this group (McCullagh & Feinstein, 2005).

In the Centre for Cognitive Rehabilitation at Ashworth Hospital, we provide a treatment programme for men in high secure services who have severe impulsive behaviour secondary to dysexecutive disorder, caused by acquired brain injury, treatment-resistant schizophrenia or other conditions. Almost all of our high dependency population would not have fulfilled the inclusion criteria for this study by virtue of high rates ofincidents (rendering them insufficiently ?stable?) or absence of capacity to consent. In our experience there is a similar sub-group in longer term medium secure settings who may also have been excluded for the same reasons.

In our view, by virtue of excluding the population in high secure services with the most severe forms of both treatment-resistant schizophrenia and dysexecutive disorder, Fullam & Dolan have effectively excluded the group most likely to exhibit high rates of violence. This is an area which should be investigated further before it is safe to conclude that psychopathy is a bigger factor than dysexecutive disorder in inpatient violence in people with schizophrenia.

1 Fullam RS & Dolan MC . Executive function and inpatient violence in forensic patients with schizophrenia, Br J Psychiatry 2008,193 , 247-253

2 McCullagh S & Feinstein A Cognitive Changes (chapter) in Textbook of Traumatic Brain Injury (eds Silver JM, McAllister TW &YudofskySC), 2005, American Psychiatric Publishing, Inc., Washington DC, London

2 Yudofsky SC, Silver JM, Hales RE Pharmacologic management of aggression in the elderly Journal of Clinical Psychiatry 1990, 51, suppl 10, 22-28.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *