Explanations for violent behaviour—An interview study among forensic in-patients

Radovic, Susanna; Höglund, Pontus

doi:10.1016/j.ijlp.2013.11.011

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Not only are the theory and the findings of this study compatible with existing beliefs embodied within legal principles such as the M’Naughton rules, and epidemiological studies demonstrating an association between psychotic symptoms and violence [15], but the theory also appears to solve two important paradoxes within the field of forensic mental health. First, despite patients [80], clinicians, and the courts believing that psychotic symptoms are a determinant of violence [6], and despite epidemiological evidence supporting an association [1, 2] it has been difficult to empirically demonstrate a causal relationship [8, 9]. The theory that moral cognition is the mediating link between symptoms and violence offers a causal explanation.…”

Section: Discussionmentioning

confidence: 99%

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

et al. 2019

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BackgroundPeople with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence.MethodWe investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence.ResultsPsychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence.ConclusionsMoral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

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Section: Discussionmentioning

confidence: 99%

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

et al. 2019

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“…Another reason to expect (legitimate) variation between how institutional informed consent matches autonomous authorisation is that that informed consent as an institutional practice may legiti-The RighT To Make Decisions mately discharge different institutional rationales, and aim for different ends (in different ways). For instance, Pugh suggests with reference to Manson and O'Neill (2007) that trust might be one such end and, with regards to Archard (2008), that protection of bodily integrity might be another end (Pugh, 2020). An alternative end might be ideals of fair allocation of punishment in criminal justice.…”

Section: Autonomy and Informed Consentmentioning

confidence: 99%

“…This approach is limited since such a professional standard may not exist and, if this standard was accepted at face value, then there would no standard against which one could argue that the information disclosed by healthcare professionals is lacking. The information determined relevant by the professional community may be governed by different ethical con-The RighT To Make Decisions siderations than the promotion of patient autonomy (Beauchamp and Childress, 2013;Pugh, 2020).…”

Section: Informationmentioning

confidence: 99%

Disputing with patients in person-centered care

Munthe

El-Alti

Hartvigsson

et al. 2018

JAIC

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This article explores ethical aspects of using open argumentation in person-centered care (PCC), where health professionals (HPs) openly criticize or contradict factual claims, assumptions, preferences, or value commitments of patients. We argue that suchdisputingmay be claimed to have an important place in advanced versions of PCC, but that it actualizes important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry, and public health interventions, such as antibiotic stewardship programs, as examples. These contexts offer new reasons for why PCC may or should include open disputing with patients, but also introduce new ethical complications. Some of these may transform either to arguments against PCC implementation in these areas, or to a more open view of the extent a HP may seek to dominate patients in a PCC setting. We are especially skeptical of the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of compulsory elements, such as forensic psychiatric detention.

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“…Forensic psychiatric care is challenged by the complexity of the patient's psychiatric status, the legal aspects of the treatment, the protection of society, and the risk of the patients committing violence in the future (Munthe, Radovic, & Anckars€ ater, 2010). Confirming the patient as an autonomous person, in line with the person-centered approach, can therefore meet specific challenges, particularly in relation to the patient's complex mental health needs and because the care is provided under involuntary conditions (Radovic & H€ oglund, 2014). Nurses are at the forefront of meeting these inconsistent demands; that is to say, balancing between violence risk while at the same time inviting the patient to be engaged in and have influence on their care (Hinsby & Baker, 2004;Urheim, Rypdal, Palmstierna, & Mykletun, 2011).…”

Section: Introductionmentioning

confidence: 99%

Mental Health Nurses’ Experiences of Risk Assessments for Care Planning in Forensic Psychiatry

Nyman

Hofvander

Nilsson

et al. 2020

International Journal of Forensic Mental Health

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The risk of patients committing violence implies major challenges throughout the care process in forensic psychiatry and brings risk assessments to the fore. The aim was to explore nurses' experiences of risk assessments for their care planning and risk management in forensic psychiatry. Data were collected through focus groups with 15 nurses. The qualitative content analysis followed a deductive approach guided by the person-centered philosophy. When exploring nurses' reasoning on risk assessment, units related to person-centered principles were identified. The findings showed that nurses made great efforts to confirm the unique person behind the patient, even when challenged by patients' life histories of violence. They also regarded therapeutic alliance as crucial, although this needed to be balanced between caring and restricting actions. A fruitful strategy to preserve therapeutic alliance may be to increase the use of a structured focus on protective factors in treatment plans towards promoting recovery-oriented policies and practices.

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Explanations for violent behaviour—An interview study among forensic in-patients

Cited by 6 publications

References 24 publications

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

Disputing with patients in person-centered care

Mental Health Nurses’ Experiences of Risk Assessments for Care Planning in Forensic Psychiatry

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