Faculty Bibliography

Patients with severe mental illness are at increased risk to commit acts of aggression in the inpatient hospital setting. Aggressive behaviors have severe negative consequences for the patient, victims, clinical staff, and the therapeutic community as a whole. While risk factors of community and inpatient aggression overlap, many predictive factors diverge between the two settings. For example, while medication noncompliance has been a robust predictor of community aggression, this factor has little predictive value for inpatient settings where patients' pharmacotherapy is closely monitored. Relatively fewer investigators have examined a wide range of predictive factors associated with aggressive acts committed on the psychiatry inpatient service, often with conflicting results. The present study examined demographic, clinical, and neurocognitive performance predictors of self, other, object, and verbal aggressiveness in 118 acute inpatients. Results revealed that the arrival status at the hospital (voluntary vs involuntary), female gender, and substance abuse diagnosis were predictors of verbal aggression and aggression against others. Impaired memory functioning also predicted object aggression. Fewer symptoms, combined with higher cognition functioning, however, were significant predictors of self-aggressive acts committed on the inpatient service. The need for relating predictors of specific types of aggressiveness in schizophrenia is discussed

Comments on 'Integrating the psychoanalytic and neurobiological views of panic disorder' by B. Alexander, S. Feigelson, and J. M. Gorman (see record 2005-16563-002). In recent years, there has been a greater emphasis on psychoanalytic treatment as a process of unlearning and relearning. In this model, the intense, safe relationship permits the individual to become more open to looking at the conditions surrounding earlier adaptations and to offer newer ways of dealing with the problems of living. The authors state that early traumatic experiences are stored in the amygdala and that reactivation through talk therapy can ameliorate the effect of those early memories. The psychopharmacologic revolution has at times emphasized biology in a manner that is reductionistic. In a very real sense, the two revolutionary camps have become somewhat overzealous and have difficulty communicating with each other, let alone appreciating what each has to offer. The authors are to be commended for making an attempt to create a truce between these frequently warring camps. While the attempt at peacemaking is often met with dismissiveness, the authors deserve congratulations on an effort that has much to be praised.

Cocaine craving has been implicated as a major factor underlying addiction and drug relapse. From a cognitive viewpoint, craving may reflect, in part, attentional processing biased in favor of drug-related cues and stimuli. Schizophrenic individuals (SZ), however, abuse cocaine in high numbers but typically manifest baseline cognitive deficits that impair their ability to selectively allocate their attentional resources. In this study, we examined the relationship between attentional bias and craving in patients with cocaine dependence (COC; n=20), schizophrenic patients comorbid for cocaine dependence (COC+SZ; n=23), as well as two other comparison groups using a modified version of the Stroop test to include cocaine-relevant words. Results revealed that only the COC patients demonstrated Stroop interference on the cocaine-related words. Moreover, COC patients' attentional processing biases were significantly associated with their cocaine craving severity ratings. COC+SZ patients, in contrast, did not demonstrate Stroop interference and manifested significantly fewer craving symptoms than their COC counterparts. These results suggest that COC+SZ patients' inability to selectively encode their drug-use experience may limit and shape their subjective experience of craving cocaine and motivation for cocaine use