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Reduced impulse control and emotion dysregulation are associated with an increased risk of violence in psychosis. We used an emotional stop-signal task (ESST) with angry and neutral facial expressions stimuli to examine the differences in inhibition in neutral and emotional contexts between acutely violent (N = 117) and non-violent (N = 50) patients with schizophrenia spectrum disorders and healthy volunteers (N = 50). However, 66 violent patients (56.41%) from the final sample with a higher level of self-reported impulsivity did not finish the behavioral task. Inhibition was found to be weaker in emotional than in neutral contexts in both the violent (n = 51) and non-violent patient groups in comparison with healthy controls. At the same time, violent patients had weaker inhibition in both neutral and emotional contexts than non-violent patients and healthy controls. Violent patients also showed significant associations between response inhibition and positive schizophrenia symptoms. These results show that emotion regulation impairment is present in schizophrenia patients in general and violent behavior is associated with higher impulsivity regardless of the emotional context. Impaired response inhibition seems to be a stronger indicator for violent patients than the disorder itself, and it may constitute a marker for the risk of violent behavior in psychotic patients. Positive symptoms might fall into underlying factors of increased impulsivity in acutely violent psychotic patients. However, the emotional stop-signal task seemed to be too strenuous for highly impulsive patients and acutely violent patients with psychosis, and its use was limited to the patients who were able or willing to complete the task., Author(s): Veronika Jurícková [sup.1] [sup.2] , Pavla Linhartová [sup.3] , Petr Adámek [sup.1] [sup.4] , Andrea Nichtová [sup.2] [sup.5] , Jakub Figueroa [sup.6] , Marek Páv [sup.5] , Marek Preiss [...]

People suffering from serious mental illness are at increased risk of various forms of violent victimisation, especially domestic or sexual violence. Victimisation negatively affects the manifestations of mental illness and the quality of life of patients. Patients rarely inform their therapist that they have been victims of violence. This article is a follow-up to the article Victimization of patients with psychotic illness (I.) and deals with the victimization of patients with serious mental illness. The prevalence of victimization in patients with SMI ranges from 22.5 to 71.2%. These ranges are wide. The main reasons, in our opinion, are (I) inaccuracies in the definition of victimization, (II) heterogeneity of the study cohorts, and (III) reporting of victimization over different time periods. More than a quarter of SMI patients (weighted mean 27.9%) were victims of violent victimization during the 12 months. Although comorbid PTSD occurs in 15-43% of patients, it is rarely diagnosed. Consensus on the definition of this term is important for studying the prevalence of victimization. Without this consensus, the ranges of victimization across articles are quite wide. To further explore victimization, it is essential to define it in a consistent way, to map the co-occurrence of victimization, violence, aggression and self-aggression, and to examine their interrelationships in more detail. Improving the diagnosis of comorbidity of psychotic disorders and victimization and its consequences is an important task, as it opens an accessible and known pathway to improve the prognosis of the disease. [ABSTRACT FROM AUTHOR]

Trauma in childhood is likely to be a causal factor in psychotic disorders, and trauma in adulthood negatively contributes to the course of these disorders. However, the detection of trauma in clinical practice is inadequate. Our paper builds on the 2014 systematic review by Látalová, Kamarádová and Praško and focuses on data on specific types of victimization in patients with psychotic disorders. In the first part, we present data on victimization in patients with psychotic disorders. Prevalence of victimization in patients with psychosis varies from 30.4 to 74.1%. This range is wide. In our opinion, the main reasons for this are (I) inaccuracies in the definition of victimization, (II) heterogeneity of the cohorts studied, and (III) reporting of victimization over different time periods. A quarter of patients (weighted mean 24.8%) with psychotic disorder were victims of violent victimization during the 12 months. One-fifth and one-sixth of patients with psychosis experienced physical and sexual victimization in childhood (21.2% and 16.4%, respectively). Between 15% and 20% of patients suffered from comorbid PTSD. However, these comorbidities are not diagnosed in Czech clinical practice. Diagnosis of comorbidity of psychotic disorders, victimization and its consequences is an important task that path the way to improve the prognosis of psychotic illness. Unfortunately, the treatment of PTSD as a comorbidity of psychosis is not established in the Czech Republic and its effectiveness has not been investigated. [ABSTRACT FROM AUTHOR]

Our primary goal was to determine the sources of assaultive behaviour in acutely psychotic patients. To find a few underlying structures for many different questions regarding assaultive behaviour based on Nolan's semi-structured interview, the Assaults Interview Checklist (AIC), we used factor analysis. Data of 289 psychiatric patients in acute psychotic states perpetrating 820 assaultive attacks were analysed using the polychoric correlation matrix of the AIC items and exploratory factor analysis (EFA). We found five independent factors, i.e. underlying structures of assaultive behaviour: Predatory factors, Personality, Acute psychosis, Contextual Factors, and Cognitive control with high factor loadings explaining an overall 69% of the variance in the acute psychotic assaults. In women, the largest factor loadings were in Personality with Predatory/Psychopathic factors second, whereas in men Psychotic with Predatory gains played the prominent role. We interpret current findings in the framework of the triarchic theory of aggression in psychosis (psychotic, impulsive and predatory/psychopathic) when Predatory factors are dominant with interrelated facets of Personality and Contextual factors, whereas Acute psychosis contributes to psychotic and Cognitive control to impulsive factors. Surprisingly, our analyses show the possible evolutionary role of aggression (co-opting the resources of others) even in an acute psychotic state. [ABSTRACT FROM AUTHOR]

Most patients with stable mental illness do not present an increased risk of aggressive behavior; however, they are frequently victims of violent acts. The aggression by patients predominantly occurs in patients with psychotic disorder, bipolar affective disorder or in patients with organic brain damage. Almost every healthcare worker meets patients with aggressive behavior and - under these conditions - it is always necessary to keep in mind that the health of the healthcare professional is essential. Although this behavior takes place in our territory, ie in a hospital, we are not always fully prepared for dealing it. In the current article we summarize the possibilities of primary prevention of violent behavior and strategies to prevent conflict escalation. [ABSTRACT FROM AUTHOR]

Deescalation is the way of behavior and communication which leads to a decrease of tension in the patient as well as caregivers. The first important step is an assessment of the situation which consists of finding out patient's anamnestic data. In the initial phase of diagnostic process, it is not necessary to set the right psychiatric diagnosis, but to exclude the somatic comorbidities threatening patient's life and identify the reasons, states and risk factors of the conflict. It is important to be aware of our own reactions, stay calm, don't give an impulsive answer and identify the reason of patient's agitation. The second step is a correct communication based on informing patient about what happens and will happen which enhances his trust. The consistency of verbal and nonverbal communication is of most importance. In nonverbal communication, the emphasis is on proxemics, kinesis and adequate prosody. The third step is a negotiation, which primary aim is to change the confrontation to the discussion. We have to reach a consensus with the patient. To facilitate communication, it is advisable to provide the patient with at least some degree of control, even if he behave violently; however we should always try to set limits. The proper use of the deescalation of violence can prevent escalation of the conflict and avoid a patient's traumatization. [ABSTRACT FROM AUTHOR]