Topic 12 Forensic Psychiatry
Melvyn W.B. Zhang, Cyrus S.H. Ho, Roger C.M. Ho, Basant K. Puri in Get Through, 2016
Violence in patients with schizophrenia Violence in people with schizophrenia is uncommon, but they do have a higher risk than the general population.Prevalence of recent aggressive behaviour amongst outpatients with schizophrenia is 5%.The types of violence and aggression are classified as follows: verbal aggression (45%), physical violence towards objects (30%), violence towards others (20%) and self-directed violence (10%). Family members are involved in 50% of the assaults, with strangers being attacked in about 20%.Psychiatrists need to be competent in identifying patients at risk and protecting both patients and others.
An introduction to traumatic brain injury and suicidality
Alyson Norman in Life and Suicide Following Brain Injury, 2020
Acquired brain injury (ABI) is any event sustained during or after birth that results in an alteration to brain function (Headway UK, 2018a). The most common causes of ABI include illness or infection (e.g. meningitis, encephalitis, tumours), or injury (e.g. accidents, falls or assaults). This last cause is categorised as a subset of ABI, called traumatic brain injuries (TBIs). ABIs and TBIs can cause an array of difficulties with physical, emotional, behavioural and cognitive functioning. I am going to focus predominantly on TBI throughout this book, as my brother ‘Tom’ experienced a TBI in 1993 as a result of a car accident. Common physiological side effects include mobility impairments, difficulties with speech, sensory impairments and ongoing fatigue (Headway UK, 2018a). Emotional difficulties include anxiety and depression, an increased risk of developing psychosis and personality disorders, and wider changes to personality (Holloway, 2014). Behavioural side effects include irritability and aggression. Finally, cognitive difficulties include language impairments, attentional difficulties, impaired concentration, memory problems and executive impairments (Holloway, 2014). Executive impairments include difficulties with planning, problem solving, decision-making, and inhibiting and initiating behaviour (Maas et al., 2017). Executive impairment can also lead to a lack of insight into the level of disability the individual is experiencing (George & Gilbert, 2018).
Social psychology
Devinder Rana, Dominic Upton in Psychology for Nurses, 2013
Assertiveness enables you to express yourself with confidence, without the inappropriate use of aggressive, passive or manipulative behaviours (Bishop, 2000). When being assertive it is important for the individual to see themselves as being of worth, while at the same time valuing others equally (Bupa, 2004). Assertiveness can often be confused with aggression. This can happen when the individual is passionate about something or needs particular issues addressed immediately. The hurried or passionate viewpoint of the individual may come across as being aggressive. On the other hand, like nurse Nigel, an individual can be perceived as being passive. There are many reasons for this, e.g. low self-esteem, being a new member of the team or not being briefed appropriately. Another reason that is widely documented is that practitioners such as nurses may not be equipped with the assertiveness skills they need within professional practice. Nurses need to be assertive when acting in the patient's best interest (Morris, 2004).
The Association between Social Dominance Orientation, Critical Consciousness, and Gender Minority Stigma
Published in Journal of Homosexuality, 2020
Jae A. Puckett, L. Zachary DuBois, Jayvien N. McNeill, Cylie Hanson
Aggression specifically refers to behaviors that are intended to harm others (Parrott & Giancola, 2007). There are other related constructs that are frequently conflated with aggression, including hostility (a cognitive variable) and anger (an emotional state; Eckhardt, Norlander, & Deffenbacher, 2004). These constructs are distinct from aggression in that they refer to cognitive and emotional experiences, respectively, whereas aggression is a behavioral construct (Parrott & Giancola, 2007). Even so, aggression has also been conceptualized more broadly, as a trait. Trait aggression refers to “individual differences in thoughts (e.g., hostility), emotions (e.g., anger), and behavior (e.g., verbal and physical aggression) that are intended to harm another person” (Webster et al., 2014, p. 121). Trait aggression has been associated with more negative reactions to transgender men and transgender women in public restrooms (Callahan & Zukowski, 2017) and with more negative attitudes towards transgender people for cisgender men (Nagoshi, Adams, Terrell, Hill, Bruzy, & Nagoshi, 2008), especially when assessing perceptions of transgender women (Nagoshi, Cloud, Lindley, Nagoshi, & Lothamer, 2018).
Cognitive behavioural therapy for aggression among individuals with moderate to severe acquired brain injury: a systematic review and meta-analysis
Published in Brain Injury, 2018
Jerome Iruthayarajah, Fatimah Alibrahim, Swati Mehta, Shannon Janzen, Amanda McIntyre, Robert Teasell
After a traumatic brain injury (TBI), individuals often experience cognitive, behavioural and physical changes. Aggression is one of the most challenging behaviours post injury since it can occur with minimal provocation and at a high frequency and intensity. Aggression is defined as a hostile, violent or destructive behaviour towards one self or others; aggression can be physical and/or verbal (1). The literature suggests that 12% to 42% of individuals display aggressive behaviour post TBI (2–5), with verbal aggression being most common (6,7). Rates of aggression are influenced by time post injury, how aggression is defined, and the method of evaluation. A longitudinal study found that the prevalence rates of aggression at 6, 24 and 60 months post TBI were consistently 25% (7). Although the prevalence of aggression did not significantly change over time, patients moved between aggressive and non-aggressive groups in no particular pattern (7). Furthermore, when comparing patients post TBI who had and did not have aggression, the incidence of neurobehavioral symptoms, specifically impulsivity, disinhibition, social withdrawal, tiredness, poor drive and motivation, and poor sleep patterns were significantly more common in the aggression group (8).
Recommendations for the pharmacological management of irritability and aggression in conduct disorder patients
Published in Expert Opinion on Pharmacotherapy, 2020
Aggression does not imply a diagnosis of conduct disorder. Other mental disorders (i.e. mood, personality, psychotic or post-traumatic stress disorders) should be ruled out, but they may be also co-morbid to a CD. Aggression can vary according to severity, type (verbal, physical against objects, against self and against other people) and associated emotional state. Two subtypes of aggression have been described, proactive and reactive, with a wide range of mixed conditions. The first is associated with planned, goal-directed, predatory behavior, the expectation of reward or to achieve a goal, callousness and lack of empathy, and antisocial outcomes. The second is associated with impulsive, rule-breaking and risk-taking behavior [6]. When ODD is related to subsequent or associated CD, the headstrong dimension is mostly related to CD with aggression and rule-breaking behaviors, while the hurtful dimension is related to CD with predatory aggression and callousness [7].
Related Knowledge Centers
- Assertiveness
- Classical Conditioning
- Violence
- Pain
- Frustration
- Verbal Aggression
- Frustration–Aggression Hypothesis
- Affect
- Fear
- Intensity