Marc Hillbrand

Parricides: Characteristics of offenders and victims, legal factors, and treatment issues

Parricides account for about 2% of all homicides. Perpetrators are typically White middle-class males without a history of prior criminal convictions. Most parricides involve single-victim, single-offender situations, with firearms more likely to be used against fathers than mothers. The popular literature as well as much of the professional literature have presented youths who killed a parent as prosocial individuals who feared for their lives. Adults who killed a parent have typically been presented as suffering from a severe mental disorder. These two scenarios describe many parricides. However, major mental disorders among youthful parricidal offenders, conduct disorder and antisocial personality disorder as well as other psychiatric comorbidities also occur in a significant proportion of parricides. Youthful and adult offenders experience different legal outcomes and receive mental health services in differing contexts. We review offender and victim characteristics, as well as legal and treatment issues, and outline needs for future research.

Clinical predictors of self-mutilation in hospitalized forensic patients

This study evaluated the clinical correlates and inpatient course of self-mutilation in a diagnostically diverse sample of hospitalized forensic patients. Fifty-three male forensic inpatients, treated in a maximum-security hospital, who engaged in at least one instance of self-mutilation during a 2-year period, were studied and compared with 50 male forensic patients at the same hospital who had not engaged in self-mutilation. Self-mutilating patients were younger, more likely to carry a diagnosis of personality disorder or mental retardation, engaged in more outwardly directed aggressive behavior as assessed by the Overt Aggression Scale, were treated with substantially higher doses of neuroleptics, and were more likely to be civil or correctional patients than insanity acquittees. The two groups did not differ on variables such as history of suicide, history of violence, neurological characteristics, and other demographic variables. After an incident of self-mutilation, the probability of recurrence was high. The substantially higher level of outwardly directed aggression of self-mutilating patients, along with their higher apparent need for neuroleptization and the high risk of recurrence of the self-mutilation, suggest that they are a subset of violent individuals who are relatively unresponsive to treatment and who are dangerous to self and others.

Serum cholesterol and aggression in hospitalized male forensic patients

Human studies of the link between serum cholesterol and aggression have yielded equivocal results. Depending on the type of aggression studied (e. g., criminal violence or Type A hostility), investigators have found either a negative or a positive association between cholesterol and aggressive behavior. We conducted a retrospective analysis of aggressive incidents in a sample of hospitalized male forensic patients. The whole sample had lower cholesterol levels than the general population. Patients with low cholesterol levels (<200 mg/dl) engaged in more frequent aggressive behavior but showed no difference in severity of aggression. They also showed no difference in verbal vs physical aggression. The relationship between cholesterol and frequency of aggression was curvilinear, with the most frequent acts of aggression committed by patients with moderately low cholesterol levels. Current research findings regarding the cholesterol-aggression association suggest the need for further clarification of the behavioral parameters under investigation.

Neuropsychological deficit and aggressive behavior: a prospective study.

1. Failures in higher cortical executive functions and dyscontrol of aggressive impulses were hypothesized to co-occur in aggressive men. 2. The performance of a sample of violent forensic patients on selected neuropsychological measures (Judgment of Line Orientation, Stroop Color Word Test, Emotion Perception Test, Test Of Nonverbal Intelligence, Wisconsin Card Sorting Test, and Symbol Digit Modalities Test) were used to predict their overt aggressive behavior during a one-year period using the Overt Aggression Scale. 3. Whole-set correlation analyses revealed that scores on the Judgment of Line Orientation, Stroop Color Word Test, and Emotion Perception Test accounted for 57% of the variance of aggression scores. 4. Frequency of aggression, but not severity of aggression, can be predicted using these three scores.

Efficacy of carbamazepine in assaultive patients with frontal lobe dysfunction

1. A double-blind pilot study using a reversal design was conducted to examine the efficacy of carbamazepine in four cases of assaultiveness associated with frontal lobe dysfunction compared to five control cases. 2. Frontal lobe patients who received carbamazepine demonstrated a pattern of improvement on all cognitive, affective, and behavioral measures. This was followed by return to pretreatment level (measures of assaultiveness, depression, and general cerebral efficiency) or sustained improvement (measures of frontal lobe efficiency) when carbamazepine was discontinued. Control subjects showed only minimal differences across testing.

Serum Cholesterol Concentrations and Mood States in Violent Psychiatric Patients: An Experience Sampling Study

The well-documented negative association between serum cholesterol and aggressive behavior has led Kaplan to propose a cholesterol–serotonin hypothesis of aggression. According to this hypothesis, low dietary cholesterol intake leads to depressed central serotonergic activity, which itself has been reported in numerous studies of violent individuals. In the present study, 25 violent psychiatric patients participated in a microbehavioral experience sampling procedure to examine differences in self-reports of affective and cognitive experiences as a function of serum cholesterol concentrations. For 7 days, they wore signaling devices that emitted an average of seven signals a day. Following each signal, patients filled out a mood questionnaire. Total serum cholesterol (TSC) concentration was positively associated with measures of affect, cognitive efficiency, activation, and sociability, suggesting a link between low TSC and dysphoria. These findings are consistent with the cholesterol–serotonin hypothesis and with the substantive literature linking both aggression and depression to depressed central serotonergic activity.

Cholesterol and aggression

Best known for its etiological influence in the cardiovascular disease process, serum cholesterol also plays a role in numerous psychological processes, including affect, cognition, and overt behavior. Prominently, it is related to aggression in humans and other primates. Lipid studies of violent offenders, primary prevention trials of cholesterol reduction, and experimental dietary manipulations in nonhuman primates all point to a significant negative association between cholesterol and physical aggression. By contrast, a positive though inconsistent association between serum cholesterol elevations and verbal aggression (e.g., hostility) has been reported in many studies and often ascribed to a neurophysiological response to acute or chronic stress. We review the numerous studies that have examined the link between serum cholesterol, verbal and physical aggression, and integrate current findings.

SERUM CHOLESTEROL LEVELS AND SEVERITY OF AGGRESSION

Analysis of serum cholesterol levels of 50 men admitted to a forensic hospital for crimes of violence showed 21 more violent men had lower serum cholesterol levels and a smaller range than those for 29 less violent men.

Rapists and child molesters: psychometric comparisons

The availability of psychosocial treatment for sex offenders is influenced to a considerable extent by the process of adjudication. Convicted rapists are usually incarcerated, and thus receive treatment in a high-structure setting. Convicted child molesters are usually paroled and receive treatment in the low-structure setting of outpatient psychotherapy. In the present study, three types of sex offenders (child molesters, child rapists, and adult rapists) were compared to examine the validity of the match between type of sex offender and type of treatment modality. No differences were found on factoranalytically derived psychological and social historical factor scores between child molesters and child rapists. Adult rapists, however, demonstrated considerably higher levels of pathology characterized by dysphoria, subjective distress, and inhibition, than child molesters and child rapists. The egodystonic psychopathology of the rapists suggests a more favorable prognosis.

SERUM CHOLESTEROL LEVELS AND FREQUENCY OF AGGRESSION

Analysis of serum cholesterol levels of 106 male forensic patients showed significant differences in frequency of aggression, with low cholesterol levels predominant among those more frequently violent.