Subtypes of aggression in patients with schizophrenia: the role of psychopathy

Abstract

Background Research has repeatedly demonstrated that schizophrenia has a small but significant association with violence. It is further recognised that a subgroup of people with such links also have personality disorders, but the extent to which type of violence or aggression varies according to subgroup is less clear.Aim This study aimed to investigate, among co-morbid cases, if the number or type of personality disorders predicts type of aggression. MethodsIn a cross-sectional study, 108 patients with schizophrenia were assessed for personality disorder, Axis-I diagnosis, verbal IQ, social functioning and type of aggression.Results Logistic regression revealed that the more personality disorders identified (Cluster B personality disorders compared with Clusters A and C) and anti-social personality disorder compared with other Cluster B disorders significantly predicted premeditated aggression.Conclusions These findings suggest that detailed personality assessment should be a routine part of comprehensive assessment of patients with schizophrenia. Improved knowledge of the presence and type of personality disorders may help detect and manage the risk of some types of aggression.Note. Goodness-of-fit test (Hosmer and Lemeshow) X 2 3 = 4.25, p = 0.24. Cox and Snell R 2 = 0.30. Nagelkerke R 2 = 0.40. Model X 2 4 = 37.94, p < 0.001. 132Bo et al.

Assessment of the Affective Dimensions of Psychopathy with the Danish version of the Inventory of Callous-Unemotional Traits among Incarcerated Boys: A study of Reliability, Criterion Validity, and Construct Validity

“…Paranoid and schizotypal personality disorders are severe disorders on their own, but they also increase the risk of the future development of psychosis or schizophrenia (122,123), which suggests that they can be viewed as prodromes of the future psychotic illnesses that are common in forensic populations (124). Furthermore, the tendency toward paranoid thoughts and perceptions is in accordance with recent research that has focused on distorted social cognition and dysfunctional mentalizing characteristics of psychopathy and antisocial personality disorder (43,(125)(126)(127).…”

Co‐morbid personality disorder in early intervention psychosis clients is associated with greater key worker emotional involvement

“…Co-morbid PD in schizophrenia has been associated with poor outcome in a range of domains, including higher risk of relapse, suicidal and aggressive behaviour, higher likelihood of childhood adversity, and earlier age of psychosis onset. 19,[24][25][26][27][28][29][30][31][32][33][34] Differences in service utilization have also been identified, including increased hospital bed use. 35,36 To date, no studies have examined whether co-morbid PD is associated with indicators of service use in EIPS.…”

Violent behaviour in early psychosis patients: Can we identify clinical risk profiles?

“…psychopathological and clinical characteristics contribute to the emergence of such behaviours (Bo et al, 2013;Dumais et al, 2011;Joyal, Côté, Meloche, & Hodgins, 2011;Joyal, Dubreucq, Gendron, & Millaud, 2007). Furthermore, it has been suggested that research in this domain should not only aim at refining our understanding of psychopathological mechanisms leading to VB but also at identifying patient profiles based on "dynamic" risk factors of VB (Coid et al, 2013;Douglas, Guy, & Hart, 2009;Dumais et al, 2011;Hodgins, 2010;Joyal et al, 2007), that is, factors susceptible to evolve with treatment (such as substance abuse or certain types of symptoms), as opposed to "static risk factors" (such as gender or past aggression) which cannot be modified (Webster, Douglas, Eaves, & Hart, 1997).…”

“…The first one is composed of patients with a diagnosis of paranoid schizophrenia with predominant positive symptoms, where VB can be influenced by the content of symptoms (eg delusions of persecution [Dubreucq, Joyal, & Millaud, 2005;Joyal et al, 2011;Joyal, Putkonen, Paavola, & Tiihonen, 2004;Volavka & Citrome, 2008]) and where violent acts are often planned, less impulsive and directed against a family member. A second profile consists of patients with a diagnosis of schizophrenia associated with comorbid substance use disorder (SUD) and APD (Bo et al, 2013;Grann, Danesh, & Fazel, 2008) where VB would derive from the association of APD and drug use (Joyal et al, 2007). Recent studies have proposed a third profile, characterized by the combination of a high level of impulsivity (Bo et al, 2013;Dumais et al, 2011;Enticott, Ogloff, & Bradshaw, 2008;Volavka & Citrome, 2008) and SUD.…”

“…A second profile consists of patients with a diagnosis of schizophrenia associated with comorbid substance use disorder (SUD) and APD (Bo et al, 2013;Grann, Danesh, & Fazel, 2008) where VB would derive from the association of APD and drug use (Joyal et al, 2007). Recent studies have proposed a third profile, characterized by the combination of a high level of impulsivity (Bo et al, 2013;Dumais et al, 2011;Enticott, Ogloff, & Bradshaw, 2008;Volavka & Citrome, 2008) and SUD. Unfortunately, very little is known in this regard for EPP.…”