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Biomedical subjects

M Hillbrand

Publications and source records attributed to M Hillbrand.

At least 19 recordsLinked to original sources
PubMed2000

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.

Adult↗
PubMed1999

Medication adherence failure in schizophrenia: a forensic review of rates, reasons, treatments, and prospects.

Forensic patients with schizophrenia who fail to adhere to prescribed antipsychotic medication risk recidivism, which continues to be a serious concern. It affects all stages of trial proceedings and impacts on the treaters' liability. Although much remains unchanged since the authors reviewed the subject in 1986, significant advances have occurred. A patient's insight can be assessed with greater precision. Risks posed by past noncompliance, substance abuse, and a dysphoric response to medication are more clearly documented. Clinical and laboratory methods for assessing compliance have improved. Major advances in the effective amelioration of adverse effects can be applied to promote adherence. New augmentation strategies enable adequate treatment at lower doses. The development of atypical antipsychotic agents makes compliance easier to achieve and maintain. Other advances apply to the containment of relapse when it does occur. This review organizes the literature documenting these trends for use in both treatment and consultation.

Antipsychotic Agents↗
PubMed1998

Creatine kinase elevations and aggressive behavior in hospitalized forensic patients.

The relationship between creatine kinase (CK) and aggressive behavior was tested in 195 males consecutively admitted to a forensic hospital. Among patients receiving antipsychotic medication, the most violent patients had higher CK levels than less violent patients. This was not the case in patients who did not receive antipsychotic medication. CK levels were not influenced by age, ethnicity, or clinical diagnosis. CK levels were however influenced by prior assaultiveness and restraints. When these two factors were controlled for, CK levels remained strongly associated with subsequent violence. CK appears to be a potential predictor of violent behavior. It has the advantage of easy availability in comparison to other biological markers of aggression (e.g., 5-HIAA). Prospective studies are needed to confirm the validity of this biobehavioral association.

Adolescent↗
PubMed1997

Ethnicity, aggression and serum creatine kinase in hospitalized male forensic patients.

OBJECTIVE: This study examined the relationship of serum creatine kinase (CK) levels with aggressive behavior as a function of psychosis and ethnicity in a sample of violent forensic patients. DESIGN: CK levels were determined on admission in a sample of 195 males consecutively admitted to a forensic hospital. The patients' aggressive behavior during their hospital stay was monitored using the Overt Aggression Scale (OAS). All data for this study was archival and gathered from hospital records. METHODS: Multivariate analysis of variance was used to examine whether African-American and Caucasian patients differed in serum CK levels and severity, frequency, and type (verbal vs physical) of aggression. T-tests were performed to compare ethnic groups in terms of age, weight, height, systolic and diastolic blood pressure. All patients who had been in restraints, had been administered intramuscular medications, had a history of drug or alcohol abuse, and were classified as schizophrenic were compared using chi-square analysis. For each of these variables further comparisons were made of CK levels between African-American and Caucasian patients. RESULTS: Mean serum CK in African-American patients was 64% higher than in Caucasians. African Americans displayed significantly greater physical aggression than Caucasian patients. In addition, African-American patients with a diagnosis of schizophrenia had significantly higher CK levels than African Americans with other diagnoses, with no significant differences related to schizophrenia noted within the Caucasian group. No significant differences in aggressive behavior related to schizophrenia were found in African-American patients. CONCLUSIONS: This study confirms the findings of previous reports which observed higher CK levels in African Americans than in Caucasians. It is also proposed that a confluence of physiologic and psychosocial factors may affect biological marker presentation, particularly as manifest in CK differences between ethnic groups.

Adolescent↗
PubMed1996

Recurrent self-injurious behavior in forensic patients.

A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The present study examined forensic patients who engaged in multiple acts of self-injury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or diagnostic measures, but the recurringly self-injurious patients were more frequently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention.

Adult↗
PubMed1996

Characteristics and cost of staff injuries in a forensic hospital.

At a maximum-security forensic hospital over a three-year period, 79 patients (35 percent of all patients) were involved in 157 staff injuries. Staff members' average postinjury absence from work was 85 days, at a cost equivalent to about 2 percent of the hospital's budget. Nursing staff, particularly psychiatric technicians, had the highest injury rate. Male staff were about twice as likely to be injured as female staff. More injuries occurred on the second shift. Patients who injured staff were younger than those who did not. Florid psychotic behavior, nonpsychotic agitation, and the recent use of restraints were the most common prodromal signs.

Absenteeism↗
PubMed1995

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.

Adult↗
PubMed1995

Aggression against self and aggression against others in violent psychiatric patients.

In spite of recent calls for the study of the comorbidity among behavior disorders, little is known about the coexistence of aggression against self and aggression against others. In this article, the relationship between indices of these 2 types of aggression is examined retrospectively in a sample of 103 male forensic inpatients during a 3-year period. Patients with both self-destructiveness during hospitalization and suicidal behavior before hospitalization engaged in the highest frequency of aggression against others. The implications of these findings for the assessment, prediction, and treatment of violence and self-destructiveness are discussed.

Aggression↗
PubMed1994

The everyday experience of an institutionalized sex offender: an idiographic application of the experience sampling method.

The Experience Sampling Method (ESM) is a novel assessment strategy that allows random sampling of thoughts, affects, and behaviors. In ESM studies subjects wear beepers that signal at randomly generated, preprogrammed times at which subjects fill out a questionnaire containing items related to current activity, location, thought content, mood states, etc. The ESM was used to examine the relationship between mood states and thought content in a hospitalized sex offender. The patient exhibited a very high frequency of thoughts with sexual content, as well as thoughts indicative of anger against women, personal inadequacy, and distress. He appeared to be a poor judge of his state of optimal well-being. Whereas he considered support from others to be related to optimal well-being, it was actually sexual thoughts about a woman that were associated with his optimal well-being. The present case study illustrates the value of the ESM in the study of complex thought-affect-behavior relationships.

Activities of Daily Living↗
PubMed1994

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.

Adult↗
PubMed1994

Carbamazepine lowers aggression: a review.

A small but growing number of reports document the antiaggressive effect of carbamazepine. Although it is supported by a small total number of patients studied with less than ideal rigor, the use of this medication as a means of reducing aggressive behavior is becoming an established clinical practice. The target diagnostic spectrum is broad, and the effect appears within days when it occurs. To promote both wider practice and further study, the authors summarize and briefly evaluate the reported investigations, single case studies, and articles related to the efficacy of carbamazepine for reducing aggression. Conceptual problems in aggression research, the relationships between epilepsy and aggression, possible mechanisms of action for this effect of carbamazepine, and practical clinical considerations are outlined.

Aggression↗
PubMed1993

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.

Adult↗