Adekunle G. Ahmed

Developing a clinical typology of dysfunctional anger

BACKGROUNDnThis study attempted to validate a clinical typology of dysfunctional anger proposed by DiGiuseppe and Tafrate (2007) using assessment data obtained from 197 participants assessed at an outpatient clinic for anger problems.nnnMETHODSnSeveral self-report scales assessing anger, hostility, impulsivity and aggression, as well as a structured interview regarding anger experience and expression, were administered; Axis I and II comorbidity were assessed using clinical assessment and the SCID-II PQ.nnnRESULTSnWe found support for four of the proposed eight types described by DiGiuseppe and Tafrate - Pervasive Dysfunctional Anger, Impulsive Type; Pervasive Dysfunctional Anger, Mixed Type; Impulsive Aggressive Dysfunctional Anger; and Suppressed Dysfunctional Anger - with significant, predicted group differences on self-report measures of anger, aggression, and impulsivity, as well as differences in Axis I and II diagnoses.nnnLIMITATIONSnPatients were rarely assigned to the other four dysfunctional anger types and thus we could not examine the validity of these types. We relied heavily on self-report data.nnnCONCLUSIONSnAnger is a common symptom in outpatient psychiatry clinics. It is associated with both mood and anxiety disorder diagnoses, and often co-occurs with substance use problems. Different types of angry patients will likely require different assessment and treatment approaches.

The Resting Electrophysiological Profile in Adults With ADHD and Comorbid Dysfunctional Anger A Pilot Study

Although dysfunctional anger is not a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision [DSM-IV-TR]) diagnosis, it sometimes presents as a primary clinical complaint and as a comorbid feature in a subset of adults with attention-deficit/hyperactivity disorder (ADHD). No known studies have examined electroencephalographic (EEG) profiles in adults with comorbid dysfunctional anger and ADHD (ADHD + anger). Resting EEG was recorded in 14 ADHD + anger adults (11 males) and 14 controls. Relative power was assessed at standard frequencies, as was frontal absolute α power asymmetry. A modest increase was noted in β1 power in the ADHD + anger group. Unexpectedly, relatively decreased left (or increased right) frontocortical activity (α assessed) was noted in the ADHD + anger group, which was also characterized by a more diffuse θ/β ratio scalp distribution. Nonmedicated ADHD + anger adults exhibited modest resting cortical hyperarousal, consistent with the findings in a subset of children with ADHD characterized by anger-associated problems. The unexpected frontal α asymmetry may reflect enhanced activity of frontal inhibitory mechanisms.

A Pilot Study of Electrocortical Activity in Dysfunctional Anger: Decreased Frontocortical Activation, Impaired Attention Control, and Diminished Behavioral Inhibition

Dysfunctional anger, though not a primary clinical diagnosis per se, does present clinically as a pathological mood for which treatment is sought. Few studies have probed the neurocortical correlates of dysfunctional anger or assessed if cognitive processes, such as attention, are altered in dysfunctional anger. Though dysfunctional and high trait anger appears to be associated with biased processing of anger-eliciting information, few studies have examined if dysfunctional anger modulates attention more generally. This is a notable gap as volitional attention control is associated with effective emotive regulation, which is impaired in dysfunctional anger and in associated acts of aggression. In this pilot study, we examined performance and electroencephalographic (EEG) profiles during a 12-min continuous performance task (CPT) of sustained attention in 15 adults with dysfunctional anger (Anger group) and 14 controls (control group). The Anger group had fewer hits at the end of the CPT, which correlated with decreased frontocortical activation, suggesting decreased engagement of frontal circuits when attention is taxed. The Anger group had more false alarms overall indicating impaired response inhibition. Increased right cortical activation during the initial portion of CPT existed in the Anger group, perhaps reflecting greater engagement of frontal circuits (i.e. effort) during initial stages of the task compared to controls. Finally, increased overall beta₁ power, suggesting increased cortical activation, was noted in the Anger group. These EEG patterns suggest a hypervigilant state in dysfunctional anger, which may interfere with effective attention control and decrease inhibition. Such impairments likely extend beyond the laboratory setting, and may associate with aggressive acts in real life.

The Predictive and Incremental Validity of Two Self-Report Risk Assessment Measures With Adult Male Offenders Who Have Mental Health Problems

We examined the predictive and incremental validity of two self-report risk assessment measures—the Self-Appraisal Questionnaire (SAQ) and the Measure of Criminal Attitudes and Associates (MCAA)—in a sample of 121 adult male offenders, with mental health problems in a correctional treatment setting. Both the SAQ and MCAA were significantly and positively correlated with a standard risk/need assessment currently used in corrections, the Level of Service Inventory–Ontario Revision (LSI-OR). All three risk measures significantly predicted general recidivism within 1 year of follow-up. The SAQ and LSI-OR also significantly predicted institutional incidents (threat, verbal aggression, or assault). In addition, the MCAA significantly added to the prediction of general recidivism provided by the LSI-OR, whereas the SAQ did not, likely reflecting the relatively high content overlap of the SAQ and LSI-OR. Neither self-report measure added to the ability of the LSI-OR to predict institutional incidents involving aggression.

Reliability and validity of the DSM-IV-TR and proposed DSM-5 criteria for pedophilia: Implications for the ICD-11 and the next DSM ☆

We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in children. Participants were evaluated by two independent psychiatrists with an interview and questionnaire regarding demographic characteristics, sexual history, and self-reported sexual interests; they also completed phallometric and visual reaction time testing. Kappa was .59 for ever meeting DSM-IV-TR criteria for pedophilia and .52 for ever meeting the proposed DSM-5 criteria for pedohebephilia. Ever meeting DSM-IV-TR diagnosis was significantly related to self-reported index of sexual interest in children (highest AUC=.81, 95% CI=.70-.91, p<.001) and to indices of sexual interest in children from phallometric testing (AUC=.70; 95% CI=.52-.89; p<.05) or a computerized assessment based on visual reaction time and self-report (AUC=.75; 95% CI=.62-.88; p<.005). Ever meeting the proposed DSM-5 diagnosis was similarly related to self-report (AUC=.84, 95% CI=.74-.94, p<.001) and to the two objective indices, with AUCs of .69 (95% CI=.53-.85; p<.05) and .77 (95% CI=.64-.89; p<.001), respectively. Because the pDSM-5 criteria did not produce significantly better reliability or validity results and users are more familiar with the current DSM-5 criteria, we believe these results suggest the revision of DSM-5 and development of ICD-11 could benefit from drawing on the current DSM-5 criteria, which are essentially the same as DSM-IV-TR except for a distinction between having a paraphilia (the interest) and a paraphilic disorder (the paraphilia plus clinically significant distress or impairment).

Assessing Short-term, Dynamic Changes in Risk: The Predictive Validity of the Brockville Risk Checklist

In the present study, we examined the predictive utility of the Brockville Risk Checklist (BRC), a structured assessment tool for clinical care planning, using a semi-parametric regression technique. We examined BRC scores and the frequency and type of incidents (aggression, noncompliance, etc.) over 13 assessments for 121 psychiatric patients at a medium-secure forensic unit. Most patients were male (95%), on average 40.9 (SD = 13.0) years old, and diagnosed with a psychotic disorder (78%). Generalized estimating equation (GEE; Liang & Zeger, 1986) modeling was used in this study to determine if changes in dynamic risk scores over time predicted outcomes (presence or absence of an incident) during the approximately six-week follow-up period. Results showed that scores on the Harm to Others scale assessed at one case conference significantly predicted changes in aggressive and total incidents recorded in the subsequent case conference. The BRC shows promise as a dynamic measure of inpatient aggression, predicting verbal or physical incidents an average of six weeks later.

Evaluation of a substance use treatment program for forensic psychiatric inpatients

ABSTRACT There have been few evaluations of substance use interventions for forensic psychiatric patients. In this study, we evaluated a manualized substance use treatment for forensic inpatients by comparing 35 treatment completers (who attended 75% or more of their sessions) and 30 non-completers (less than 75%) on self-report and urinalysis measures. The treatment completer group showed significant increases in substance-related knowledge and self-reported relapse prevention skills, but there was no significant difference between completers and non-completers in time to first substance use (if any) or in having a positive urine screen result 12 or 24 months after participation in the program. The results indicated improvement in knowledge and self-reported skills, but this did not translate to decreased substance use as measured by urinalysis. Implications for substance use treatment are discussed.