Faculty Bibliography

Twenty-one consecutive right-handed male psychiatric inpatients treated on a unit designed for the management of violent behavior were given computerized EEGs. We recorded their violent behaviors, the number of staff interventions needed to control their behavior, and their medications. The number of instances of violence as well as the number of staff interventions were related to increased delta band activity and to decreased alpha band activity in the temporal and the parietooccipital areas. These relationships were independent of the current medications and of the length of stay on the special unit. Furthermore, our results demonstrate that violence is very significantly related to the hemispheric asymmetry in EEG for the frontotemporal derivations. With increased levels of violence there was a greater level of delta power in the left compared with the right

We sought to explore the relationship between type of psychopathology and consent bias. Using the Brief Psychiatric Rating Scale we assessed a group of 48 forensic psychiatric inpatients. These patients were later independently approached by a researcher who attempted to get their consent for a study on the validity of self-reported criminal behavior. Thirty agreed to participate and 18 did not. The consenting patients were significantly younger and had significantly more negative symptoms than the nonconsenters. The difference in negative symptoms remained significant after age and medication dose, in chlorpromazine equivalents, were covaried out. The authors discuss the implications of these findings for forensic research

This double-blind, placebo-controlled study tested the effectiveness of tryptophan (TRP) in the treatment of aggressive psychiatric inpatients. After a baseline observation period of 1 month, patients were randomly assigned to treatment either with TRP (up to 6 g/day) or with placebo. There were 10 subjects in each treatment group. These treatments were administered for 25-35 days, after which the patients were observed for 1 month. Throughout this study, patients were receiving other medications. Injections of antipsychotics and sedatives were administered as needed to control agitated or violent behavior. Blood levels of TRP and other large neutral amino acids were obtained repeatedly, and ratios between TRP and other amino acids were computed. These analyses confirmed significant increases of TRP ratios in TRP-treated patients. TRP treatment had no effect on the number of violent incidents, but it significantly reduced the need for injections of antipsychotics and sedatives. The study thus provided indirect support for beneficial effects of TRP in aggressive psychiatric inpatients

Investigations of assaults in psychiatric hospitals have found that a small proportion of inpatients are responsible for a large percentage of the violence that occurs. In a large state hospital patients who were repeatedly violent (recidivists) were compared with patients who were violent only once or twice (nonrecidivists), and the relationships between repeatedly violent behavior and gender, age, and diagnosis were examined. All reports of violent incidents over a six-month period for a population of 1,552 inpatients--a total of 497 incidents involving 313 patients--were reviewed. Seventy patients were involved in three or more incidents each and were responsible for 53 percent of all violence. Recidivist men inflicted serious injuries at a rate ten times higher than that for all the other violent patients. Recidivist women were significantly younger than nonrecidivist assaultive women and were about the same mean age as the assaultive men. Recidivist women were also more likely to have organic brain disorder or personality disorder

Self reports of criminal activity are known to be valid in general populations. Little is known about the validity of self-reports of crime in psychiatric inpatients. A group of 41 psychiatric inpatients had their self-reported arrests contrasted with their official arrest records. Sixty-six percent of the patients gave accurate reports. Twelve percent denied having arrests when their record showed arrests. Twenty-two percent reported arrests when their official records showed none. The authors discuss the implications of these findings

Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed

Replies to comments of L. A. Graham et al (see record 1991-04614-001) on the M. I. Krakowski et al (see record 1989-36627-001) study on the prediction of violent behavior. Graham et al miss the point of the distinction between low and high violence; the emphasis was not on the seriousness of incidents. Frequency of assaults is also an important dimension. Also, various assaultive behaviors seemed to have the same neurological underpinnings. Data showing greater neurological impairment in a high violence group of patients suggest an association between high violence and more severe schizophrenia.