Josanne D. M. van Dongen

Delusional distress partly explains the relation between persecutory ideations and inpatient aggression on the ward

Previous research showed that there is an association between persecutory delusions and inpatient aggression. However, it is not clear why some persons act upon their delusions with aggression. Research showed that persons with persecutory delusions have higher levels of delusional distress resulting from these delusions. This may explain why some persons act upon their delusions. Persecutory ideations lead to ideational distress which in turn can lead to aggression. The main aim of the present study was to test whether persecutory ideations have an indirect effect on inpatient aggression through delusional distress. The sample of the study consisted of 44 male inpatients from different general psychiatric inpatient wards. Results showed that the effect of persecutory ideations on inpatient aggression was partly explained by the level of delusional distress. Insight in the theory of acting upon delusions can be obtained by acknowledging this role of delusional distress in the relation between persecutory ideation and inpatient aggression. Early diagnosis of persecutory ideations and experienced delusional distress can be used in risk assessment of inpatients. Early interventions to reduce delusional distress, such as cognitive behavioral therapy, may prevent inpatient aggression.

Unravelling offending in schizophrenia: Factors characterising subgroups of offenders

BACKGROUND Previous studies have led to suggestions that there are at least three sub-types of offenders with schizophrenia, but these have not previously been examined simultaneously in one sample. AIMS The aims of this study were to investigate categorisation of offenders with psychosis as early or late starters or late first offenders, and test the hypotheses that, compared with non-offenders with psychosis, early starters would be characterised by low educational or occupational achievement, negative childhood experiences and early substance use, whereas positive psychotic symptoms would characterise late starters or late first offenders. METHODS A retrospective file study was conducted, yielding 97 early starters, 100 late starters and 26 late first offenders identified from a specialist inpatient forensic mental health assessment service and 129 non-offenders identified from general psychiatric services in the same geographic region, all with schizophreniform psychoses. RESULTS We found little difference between early and later starters in terms of measured antecedents, but substance misuse was up to 20 times less likely among late first offenders. Persecutory and/or grandiose delusions were more strongly associated with each offender group compared with non-offenders, most so with late first offenders. CONCLUSIONS Our findings underscore the importance of treating delusions--for safety as well as health. Childhood antecedents may be less important indicators of offender sub-types among people with psychosis than previously thought. When patients present with grandiose or persecutory delusions over the age of 35 years without co-morbid substance misuse disorders, but with a history of childhood neglect and low educational achievement, particular care should be taken to assess risk of violence.

Positive symptoms, substance use, and psychopathic traits as predictors of aggression in persons with a schizophrenia disorder.

It is still not clear what the unique contribution of particular psychopathological factors is in explaining aggression in schizophrenia. The current study examined whether persecutory ideations, psychopathy and substance use are associated with different measures of aggressive behavior. We expected that persecutory ideations are associated with reactive aggression, and psychopathic traits are more associated with proactive aggression of inpatients. 59 inpatients with schizophrenia were included. Persecutory ideations we assessed using the Persecutory Ideation Questionnaire (PIQ), psychopathic traits with the revised version of Psychopathic Personality Inventory (PPI-R) and substance use was assessed using the Comprehensive Assessment of Symptoms and History (CASH). In addition, aggression was measured with the Reactive and Proactive Aggression Questionnaire (RPQ), in an experimental task using the Point Subtraction Aggression Paradigm (PSAP) and on the ward using the Social Dysfunction and Aggression Scale (SDAS). Results showed that psychopathy explains most of the variance in self-reported proactive and reactive aggression. In contrast, persecutory ideations explain most of the variance in observed aggression on the ward. Results implicate that it is important to acknowledge comorbid factors in patients with schizophrenia for more precise risk assessment and appropriate treatment for aggressive patients with schizophrenia.

The role of ideational distress in the relation between persecutory ideations and reactive aggression

BACKGROUND People with schizophrenia are more likely to be violent than the people without it. Feeling driven to act on persecutory delusions may be one explanation for this, but it remains unclear why some should act on such delusions but some not. Acquisition of data from people who are very ill is problematic. Our study explores testing of hypotheses on similar ideational and behavioural associations among healthy recruits from the general population. AIMS This study aims to test the effect of distress induced by persecutory ideas on any relationships between those ideas and aggressive behaviour, and the effect of gender. METHODS Twenty-four men and 53 women from the general population participated in this study. The measures of aggressive behaviour were experimentally induced aggressive responding, self-reported aggressive behaviour in general, and self-reported reactive and proactive aggressive behaviours. RESULTS Among men, persecutory ideation predicted reactive aggressive responding and aggressive style of behaviour only in those who experienced higher levels of persecutory ideational distress. Among women, with generally lower levels of aggression, the role of ideational distress was more complicated; Women in the low distress group responded with higher aggression on the task. Women in the higher distress group responded with higher aggressive style. For neither men nor women were there links between persecutory ideation and proactive aggression, regardless of distress. CONCLUSIONS Ideational distress moderates the relation between persecutory ideation and aggression in different measures of aggression in men and women. IMPLICATIONS FOR PRACTICE AND/OR RESEARCH: Recognition of a relation between persecutory ideations and aggression is also important in the general population. Insight in the theory of acting upon delusions may lead to more accurate violence risk assessment. Facilitation of early detection of experienced delusional distress may lead to development of more specific psychotherapeutic interventions to manage violence risk.

Further evidence for reliability and validity of the Triarchic Psychopathy Measure in a forensic sample and a community sample

Psychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory –Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument.

Anti‐social personality characteristics and psychotic symptoms: Two pathways associated with offending in schizophrenia

BACKGROUND Several research groups have shown that people with schizophrenia who offend do not form a homogenous group. A three-group model claimed by Hodgins proposes distinguishing between people who start offending before the onset of psychosis (early starters), after psychosis onset but at age 34 years or under (late starters) and after psychosis onset but at age 35 years or older (late first offenders). AIMS This study aimed to test the hypotheses (1) that the personality of early starters and non-psychotic offenders would be similar, but different from either late-starter group; (2) that the late-starter groups would be more likely to have positive psychotic symptoms than non-criminal patients with schizophrenia; and (3) that symptom types would differentiate the psychotic groups. METHODS A retrospective file study was conducted on cases of 97 early starters, 100 late starters and 26 late first offenders all drawn from the Netherlands Institute of Forensic Psychiatry and Psychology (NIFP) archives 1993-2008, 115 non-psychotic offenders from 2005-2008 NIFP archives and 129 patients with schizophrenia and no criminal history from one general service in Rotterdam. RESULTS Early starters closely resembled the non-psychotic offenders in their premorbid anti-social personality characteristics. The two late-onset offending psychosis groups were more likely to have persecutory and/or grandiose delusions than non-offenders with psychosis, but so were the early starters. IMPLICATIONS In a first study to compare subgroups of offenders with psychosis directly with non-psychotic offenders and non-offenders with psychosis, we found such additional support for a distinction between early and late starters with psychosis that different treatment strategies would seem indicated, focusing on personality and substance misuse for the former but psychotic symptoms for all. It remains to be seen whether the higher rate of alcohol misuse amongst late first offenders is a fundamental distinction or a function of age difference.

Brain activity elicited by reward and reward omission in individuals with psychopathic traits: An ERP study

Psychopathy has been associated with behavioral adaptation deficits, which might be associated with problems in feedback and reward processing. In the present study, we examined the relation between psychopathic traits and reward processing in a passive gambling task. A total of 39 male participants who scored high (HP) and 39 male participants who scored low (LP) on the Triarchic Psychopathy Measure (TriPM), total score were tested. Feedback-related Event-Related Potentials (ERPs; i.e., P2, FRN, and P3) on predicted and unpredicted rewards and reward omissions were compared between both groups. It was found that in HP individuals, the P2 was enhanced for predicted rewards and reward omissions, but not for unpredicted stimuli. Moreover, HP individuals as compared to the LP individuals demonstrated a generally reduced P3 amplitude. The FRN amplitude, however, did not differ between the two groups. In addition, HP individuals showed enhanced reward sensitivity on the self-report level. Taken together, these findings suggest that HP individuals show enhanced sensitivity to early and reduced sensitivity to later markers of processing reinforcement learning signals, which points in the direction of compromised behavioral adaptation.

First Offenders With Psychosis Justification of a Third Type Within the Early/Late Start Offender Typology

Within the early/late start typology of offenders with schizophrenia, a third type, first offenders (FO), has been proposed. The aim of this study was to examine the justification of this first offender type. Retrospective file study consisted of 97 early starters (ES), 100 late starters, and 26 FO. Variables in different domains were scored. There were significant differences between the groups within the domains life functioning, abuse and family-related problems, psychiatric functioning, substance misuse, antisocial personality, and offense characteristics. Most differences were between the ES and FO. The existence of the first offender type is justified by the present findings. These findings underscore the importance of offender subtyping for better offender treatment interventions.

The Robustness of the Early and Late Start Typology of Criminal Behaviour in Major Mental Disorder: A Conceptual Replication

The purpose of this study was to examine whether the early and late start typology of criminal behaviour in major mental disorder can be generalized to different populations than evaluated to date and is replicable in two different countries. A Dutch forensic sample (Sample 1) consisted of 260 reports to the court with early start offenders (n = 62) and late start offenders (n = 198). A Canadian civil psychiatric sample (Sample 2) consisted of file information collected from 78 involuntarily hospitalized civil psychiatric patients with an early start group (n = 38) and a late start group (n = 40). In both samples, early and late starters were compared on different domains. Results showed that in general, early starters have a higher risk of having problems in different domains. There were also differences in the early and late start typology between the Dutch and Canadian samples. Our results partially support the early and late starter typology within two different samples. This study showed that early starters typically have a higher risk of problems in different domains. This highlights the importance of different risk management and treatment strategies for both the early start and the late start group.

Examination of the Triarchic Assessment Procedure for Inconsistent Responding in Six Non-English Language Samples

The Triarchic Assessment Procedure for Inconsistent Responding (TAPIR; Mowle et al., 2016) was recently developed to identify inattentiveness or comprehension difficulties that may compromise the validity of responses on the Triarchic Psychopathy Measure (TriPM; Patrick, 2010). The TAPIR initially was constructed and cross-validated using exclusively English-speaking participants from the United States; however, research using the TriPM has been increasingly conducted internationally, with numerous foreign language translations of the measure emerging. The present study examined the cross-language utility of the TAPIR in German, Dutch, Swedish, and Italian translations of the TriPM using 6 archival samples of community members, university students, forensic psychiatric inpatients, forensic detainees, and adolescents residing outside the United States (combined N = 5,404). Findings suggest that the TAPIR effectively detects careless responding across these 4 translated versions of the TriPM without the need for language-specific modifications. The TAPIR total score meaningfully discriminated genuine participant responses from both fully and partially randomly generated data in every sample, and demonstrated further utility in detecting fixed “all true” or “all false” response patterns. In addition, TAPIR scores were reliably associated with inconsistent responding scores from another psychopathy inventory. Specificity for a range of tentative cut scores for assessing profile validity was modestly reduced among our samples relative to rates previously obtained with the English version of the TriPM; however, overall the TAPIR appears to demonstrate satisfactory cross-language generalizability.