Faculty Bibliography

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.

This study relates violent behavior of schizophrenic inpatients to demographic, historical, EEG, neurological, and neuropsychological variables. Patients were classified into high (N = 28), low (N = 27), or no (N = 34) violence groups. There were no significant differences among the groups on demographic or historical variables, except for prevalence of violent crime, which was higher in both violent groups than in nonviolent patients. Neurological and neuropsychological abnormalities differentiated the groups, with the high violence group evidencing more abnormalities than the other two groups in the area of integrative sensory and motor functions. The authors suggest that violence as well as neurological and neuropsychological deficits may characterize a more severe form of schizophrenia

This study compared patients who showed persistent violence, transient violence and no violence. The presence of neurological abnormalities was found to be the factor that differentiated most clearly among the three groups. The persistently violent patients, in addition to showing significantly more neurological abnormalities, also evidenced a more disturbed family background. Both violent groups had a higher incidence of violent crime prior to hospitalization than the nonviolent controls. A logistic regression model simultaneously relating the effects of six factors on violent behavior was developed and used to predict violent group membership

The authors followed prospectively a group of 79 newly admitted male schizophrenics for 6 months or until discharged, whichever came first, and monitored their assaultive behavior by review of their charts and the ward journals. Assaults were detected reliably by this method. When the assaultive behavior monitored in this way was contrasted with officially reported assaultiveness, 50% more assaults and 34.5% more patients who had one or more instances of assaultive behavior during the study period were detected. There were no differences in the number of injuries detected by the two methods. The authors contend that a realistic estimate of the incidence of physical assaults in young male schizophrenic inpatients is no less than 1.5 times that reflected by official reports

Inpatient assaults were videotaped and then characterized by tape reviewers as showing high or low hostility. Over a 2-month period, the videotape reviewers documented more than twice as many high-hostility assaults as were documented by other methods of reporting

A sample of 87 psychiatric inpatients known to have been assaultive while in the hospital was contrasted with a matched group of nonviolent patients to identify the personal risk factors that distinguished the two groups. Data were collected using a personal history interview, a neurological examination, and an electroencephalogram. The four risk factors identified--neurological abnormality, history of violent crime, history of violent suicide attempts, and deviant family environment in childhood--were used to develop a statistical model predicting which subjects in a sample of newly admitted patients would become assaultive during the first three months after admission. The predicted classification of patients was found to be significantly related to subsequent assaultive behavior