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PubMed2005

Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men.

OBJECTIVE: Major depression is a major risk factor for suicide. However, not all individuals with major depression commit suicide. Impulsive and aggressive behaviors have been proposed as risk factors for suicide, but it remains unclear whether their effect on the risk of suicide is at least partly explained by axis I disorders commonly associated with suicide, such as major depression. With a case-control design, a comparison of the level of impulsive and aggressive behaviors and the prevalence of associated psychopathology was carried out with control for the presence of primary psychopathology. METHOD: One hundred and four male suicide completers who died during an episode of major depression and 74 living depressed male comparison subjects were investigated with proxy-based interviews by using structured diagnostic instruments and personality trait assessments. RESULTS: The authors found that current (6-month prevalence) alcohol abuse/dependence, current drug abuse/dependence, and cluster B personality disorders increased the risk of suicide in individuals with major depression. Also, higher levels of impulsivity and aggression were associated with suicide. An analysis by age showed that these risk factors were more specific to younger suicide victims (ages 18-40). A multivariate analysis indicated that current alcohol abuse/dependence and cluster B personality disorder were two independent predictors of suicide. CONCLUSIONS: Impulsive-aggressive personality disorders and alcohol abuse/dependence were two independent predictors of suicide in major depression, and impulsive and aggressive behaviors seem to underlie these risk factors. A developmental hypothesis of suicidal behavior, with impulsive and aggressive behaviors as the starting point, is discussed.

Adult↗

PubMed2005

Brain serotonin transporter distribution in subjects with impulsive aggressivity: a positron emission study with [11C]McN 5652.

OBJECTIVE: The serotonin system is believed to play a role in modulating impulsivity and violence. Previous imaging studies have implicated the anterior cingulate and orbitofrontal cortex in impulsive aggression. This study evaluated regional serotonin transporter distribution in the brain of individuals with impulsive aggression by using positron emission tomography (PET) with the serotonin transporter PET radiotracer [(11)C]McN 5652. METHOD: Ten individuals with impulsive aggression and 10 age- and sex-matched healthy comparison subjects underwent [(11)C]McN 5652 PET. All individuals were medication free at the time of scanning. Regional total distribution volumes were derived by using a one-tissue compartment kinetic model with arterial input function. Outcome measures of serotonin transporter availability included the binding potential and the specific-to-nonspecific partition coefficient (V(3)''). RESULTS: Serotonin transporter availability was significantly reduced in the anterior cingulate cortex of individuals with impulsive aggression compared with healthy subjects, as noted by differences in both binding potential (mean=3.1 ml/g [SD=1.9] versus 5.0 ml/g [SD=2.0], respectively) and V(3)'' (mean=0.15 [SD=0.09] versus 0.26 [SD=0.09]). In other regions examined, serotonin transporter density was nonsignificantly lower in individuals with impulsive aggression compared with healthy subjects. CONCLUSIONS: Pathological impulsive aggressivity might be associated with lower serotonergic innervation in the anterior cingulate cortex, a region that plays an important role in affective regulation.

Adult↗

PubMed2004

Risk factors for aggressive behavior among psychiatric inpatients.

The evaluation of a patient's potential for aggressive behavior is an important component of care on psychiatric units. In this study, the aggressive behavior of 111 new psychiatric inpatients in Taiwan was recorded by nursing staff using the Overt Aggression Scale (OAS) during the patients' hospitalization. Psychiatrists made diagnoses in accordance with DSM-IV criteria and collected information about psychosocial risk factors for aggression. On average, aggressive patients were hospitalized longer than nonaggressive patients. After duration of hospitalization was controlled for, it was found that patients with an earlier onset of illness were more likely to be aggressive than other patients.

Adult↗

PubMed1998

Prevalence and correlates of aggressive behavior in Alzheimer's disease.

The authors assessed a consecutive series of 196 patients with probable Alzheimer's disease (AD) for the presence of aggressive behavior, using a standardized neurological, neuropsychiatric, and neuropsychological battery that included both the Overt Aggression Scale and the Irritability Scale. Twelve percent of patients showed aggressive episodes (5% with verbal aggression, 7% with physical aggression) during the 4 weeks preceding the psychiatric evaluation. Physical aggression was significantly associated with more frequent delusions and more severe irritability.

Aged↗

PubMed2006

Aggression and quantitative MRI measures of caudate in patients with chronic schizophrenia or schizoaffective disorder.

Caudate dysfunction is implicated in schizophrenia. However, little is known about the relationship between aggression and caudate volumes. Forty-nine patients received magnetic resonance imaging scanning in a double-blind treatment study in which aggression was measured. Caudate volumes were computed using a semiautomated method. The authors measured aggression with the Overt Aggression Scale and the Positive and Negative Syndrome Scale. Larger caudate volumes were associated with greater levels of aggression. The relationship between aggression and caudate volumes may be related to the iatrogenic effects of long-term treatment with typical antipsychotic agents or to a direct effect of schizophrenic processes on the caudate.

Adult↗

PubMed1987

A model for understanding and managing cycles of aggression among psychiatric inpatients.

A model developed at the Forensic Center of the Mendota Mental Health Institute for understanding and managing aggressive inpatients focuses on the dynamics of inpatient aggression and their impact on staff. Divided into cycles of physical and verbal aggression, the model incorporates staff responses to aggressive behaviors and outlines the responsibilities of the administration in helping staff deal with aggressive patients. It particularly addresses repetitive aggression and the importance of recognizing countertransference issues.

Aggression↗

PubMed1996

Severe aggression and related conduct problems among runaway and homeless adolescents.

OBJECTIVE: The study assessed the prevalence of severe aggressive behavior and conduct disorder in a population of runaway and homeless adolescents and examined relationships between aggression, conduct disorder, other problem behaviors, and background characteristics. METHODS: A total of 219 runaway and homeless youths recruited through a urban drop-in center were surveyed using the Adolescent Health Survey, a questionnaire about background and mental health experiences, and the revised version of the Diagnostic Interview Schedule for Children. RESULTS: More than half of study participants met criteria for conduct disorder, and 62 percent reported a history of severe aggressive behavior. Although these constructs were related to each other, a third of the subjects met criteria for only one. Childhood sexual abuse was associated with conduct disorder, while living in a home where drugs were used was associated with aggression. Severe aggressive behavior was associated with other problem behaviors, including attempted suicide, behavior that precipitated residential psychiatric treatment, pregnancy, arrests, and convictions. CONCLUSIONS: The assessment and systematic treatment of conduct disorder and aggression among runaway and homeless youths is urgently needed to reduce the effects of the disorder and associated problem behaviors.

Adolescent↗

PubMedDate not supplied

Gaps in pediatricians' advice to parents regarding early childhood aggression.

Persistent early childhood aggression is a strong predictor of violence later in life. To determine how well general pediatricians counsel parents regarding aggression management strategies, responses to open-ended questions and endorsements of specific aggression management strategies, among 27 pediatricians were evaluated. Sixteen (59%) screened regularly for aggression and 23 (85%) counseled (rather than referred) if there were parental concerns. Pediatricians were most likely to spontaneously recommend time-outs (85%) and verbal reprimands (78%) and much less likely to recommend other strategies such as redirecting (26%, p < 0.01) and promoting empathy (22%, p < 0.001). Pediatricians did endorse other aggression management strategies, however, when specifically asked about them. Pediatricians appear to take a limited approach to counseling parents of children with hurtful behavior. To increase health care providers' role in violence prevention, more systematic efforts are needed to increase rates of screening for early childhood aggression and to broaden the scope of how pediatricians counsel parents.

Adult↗

PubMed2001

Levels of aggression among a group of anabolic-androgenic steroid users.

There have been numerous case studies and press reports of individuals committing acts of extreme violence while taking large doses of Anabolic-Androgenic Steroids (AAS). However, research using psychometric measures of aggression has tended to use small numbers of subjects which makes generalizing results difficult. In the current study the State Trait Anger Expression Inventory (STAXI) was administered to 50 AAS users and 40 non AAS-using control subjects. Subjects also underwent a semistructured interview focusing on AAS's effects on levels of aggression. Results showed that AAS users reported being significantly less in control of their aggression than controls. The semi-structured interview findings showed that elevations in aggression due to AAS use were reported by 60 per cent of AAS users. However, these elevations appeared more related to irritability and bad temper than acts of physical violence. The study also found that more AAS users than controls had worked as doormen/bouncers. This highlights the issue of whether AAS use causes aggression or whether aggressive individuals are attracted to AAS use. Future research should investigate this question.

Adolescent↗

PubMed2005

Correlates and consequences of exposure to video game violence: hostile personality, empathy, and aggressive behavior.

Research has shown that exposure to violent video games causes increases in aggression, but the mechanisms of this effect have remained elusive. Also, potential differences in short-term and long-term exposure are not well understood. An initial correlational study shows that video game violence exposure (VVE) is positively correlated with self-reports of aggressive behavior and that this relation is robust to controlling for multiple aspects of personality. A lab experiment showed that individuals low in VVE behave more aggressively after playing a violent video game than after a nonviolent game but that those high in VVE display relatively high levels of aggression regardless of game content. Mediational analyses show that trait hostility, empathy, and hostile perceptions partially account for the VVE effect on aggression. These findings suggest that repeated exposure to video game violence increases aggressive behavior in part via changes in cognitive and personality factors associated with desensitization.

Adolescent↗

PubMed2004

Noradrenergic activity is associated with response to pindolol in aggressive Alzheimer's disease patients.

Loss of noradrenergic (NE) neurones in the locus ceruleus and compensatory changes in NE activity have been described in Alzheimer's disease (AD), but have never been linked to treatment. The hypothesis of this study was that central NE responsivity would predict aggression response to treatment with a NE medication, pindolol. Fifteen institutionalized AD subjects [Mini-Mental State Examination (MMSE), mean 3.3 +/- 4.6] with significant behavioural disturbances (Neuropsychiatric Inventory Score, mean 30.6 +/- 14.6) were studied. Growth hormone (GH) response to clonidine challenge (5 microg/kg) was used as a measure of central NE responsivity. Subjects were then randomized to 7 weeks of treatment with pindolol, maximum dose 20 mg b.i.d., or an identical placebo capsule in a cross-over design. The primary outcome measure was change on the retrospective Overt Aggression Scale (r-OAS). Five of 11 completers (45%) had decreased total r-OAS scores. There was significant improvement noted on the r-OAS verbal aggression subscale (paired t = -2.5, p = 0.03) compared to placebo, but not r-OAS total. Higher baseline aggression, higher MMSE and lower GH response predicted improvement in aggression, accounting for 82% of the variance (r = 0.91, F = 10.5, p = 0.006). Changes in NE responsivity, as reflected by a blunted GH response to clonidine challenge and more severe aggression, were associated with better response to the NE agent pindolol. Individual patient characteristics, including underlying neurotransmitter changes, may be useful for predicting response to therapy.

Administration, Oral↗

PubMed2006

Intimate partner aggression reporting concordance and correlates of agreement among men with alcohol use disorders and their female partners.

This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men's antisocial personality disorder characteristics were the strongest predictor of higher concordance for male- and female-perpetrated aggression. Higher alcohol problem severity, poorer relationship adjustment, and higher psychopathic personality features were associated with better concordance in some analyses. Women reported experiencing more physical aggression than men reported perpetrating, and women reported perpetrating more psychological aggression than men reported experiencing. Findings highlight the importance of obtaining aggression reports from both partners and the need for research investigating methods for improving concordance.

Adjustment Disorders↗

PubMed2001

Abusive early child rearing and early childhood aggression.

Childhood aggression is significant for children, their families, and the society because aggressive children often become violent adolescents. This article examines the relationship between maltreatment and early childhood aggression. Data are from a longitudinal study of maltreated and nonmaltreated children assessed as preschoolers and again at school age. The dependent variable is the child's teacher's rating of aggression at school age. The independent variables are from preschool and school age observations of the mother-child interaction and the mother's report of physical discipline practices. Using structural equation modeling, harshness of interaction at preschool age but not school age and severity of physical discipline at school age but not preschool age, relate to aggression at school age. Results suggest a difference in the developmental stage at which different features of harsh child rearing exert their influence. Strategies for intervening to prevent the development of childhood aggression are suggested.

Adult↗

PubMed1988

The aetiology of aggression in temporal-lobe epilepsy.

A retrospective case-note survey was carried out on 31 subjects admitted with temporal-lobe epilepsy to the Maudsley hospital from 1974-1983 inclusive. Fourteen aggressive subjects were compared with the non-aggressive patients on 95 organic, developmental, and social variables. Aggressive behaviour was associated with male sex, early onset of seizures, and a history of long-standing behavioural problems. Aggressive subjects had lower mean IQ scores and poorer occupational records than controls. No relationship was found between aggression and the presence of specific EEG or CAT scan findings, or a history of psychosis. The results demonstrate the complex interplay between organic and socially mediated factors underlying aggressive behaviour in temporal-lobe epilepsy.

Adolescent↗

PubMed2003

"Bark parks"--a study on interdog aggression in a limited-control environment.

As limited-control dog parks become more popular, concerns arise about whether these parks encourage interdog aggression. Systematic observations made at 1 park over 72 hr across 8 months found that 28 conflicts or potential conflicts occurred (< 0.5%). Of these, 14 were clear aggressive episodes. Each lasted less than 1 min (< 0.33% of total observation time). There were 14 other incidents of possible aggression that were ambiguous in nature. Each lasted less than 30 sec (< 0.17%). None of these incidents led to serious injury. Of the 177 dogs observed, only 9 were aggressive toward other dogs (5%): 6 aggressors, once each; 2 aggressors, twice each; 1 aggressor, 3 times. Results indicate that aggression in limited-control dog parks may be relatively rare and probably presents only a limited risk to dogs and their caregivers (owners). In part, this may be because owners who frequent dog parks are self-selecting, self-monitoring, and self-limiting in regard to dog aggression.

Aggression↗

PubMed1976

The relationship between behavioral indices of aggression and hostile content on the TAT.

The role played by fantasy in mitigating the overt expression of aggression was investigated by examining the relationship between aggressive behavior and aggressive story content on the Thematic Apperception Test. A rating scale, checklist, and offense scale were used to measure the aggressive behavior of 76 juvenile offenders. While only one measure correlated significantly with hostile content on the TAT, all three correlations were negative, suggesting an inverse relationship between measure of aggression and aggressive content on the TAT.

Adolescent↗

PubMed1993

A Rorschach study of narcissism, defense, and aggression in borderline, narcissistic, and cluster C personality disorders.

We examined the differences between narcissism, mode of defense, and level of aggression on the Rorschach. We also investigated differences in borderline, narcissistic, and Cluster C personality disorders by examining responses to Rorschach content variables. The Lerner Defense Scale (P. Lerner & H. Lerner, 1980), the aggressive content section of the Holt (1977) method for assessing primary process manifestations, a modified version of Exner's (1986a) Egocentricity Index, Wagner's (1965) exhibitionistic M score, and grandiosity were scored on the Rorschach protocols of 17 borderline, 17 narcissistic, and 17 Cluster C personality disorders. Borderlines were found to employ primitive defensive structures to a greater degree and severity, show more intense and overall aggression as well as more responses on the three forms of aggression in the Holt method, and have higher levels of grandiosity. Narcissists evinced significantly higher levels of egocentricity than borderlines and higher levels of idealization than the Cluster C group. Convergent validity was found on the measures of defense and aggression, which showed a strong relationship between primitive aggression and primitive defense.

Adult↗

PubMed2000

Further exploration of the Rorschach Aggressive Content (AgC) variable.

Based on the recommendations of Baity and Hilsenroth (1999), this study further investigated the reliability and validity of the Rorschach Aggressive Content (AgC) variable developed by Gacono and Meloy (1994). Eighty-five aggressive objects identified by Gacono and Meloy, 19 potentially aggressive objects and 22 neutral (nonaggressive) objects were rated for aggressiveness based on the definition of AgC. Two hundred seventy-six participants rated objects on the Object Rating Scale (0-6), where a score of 0 indicates that an object does not fit the definition of AgC. In addition, objects rated a 4 (moderately aggressive) or higher were then classified into 5 qualitative groupings (weapons, animal/part of animal, environmental danger, fictional creature, and other). Analysis of the results indicates that the AgC list can be replicated and that objects rated as at least moderately aggressive (4) can be reliably classified into distinct categories. One-month test-retest reliability (r = .99) suggests that objects can be scored consistently using the definition of AgC and provides support for the utility of the AgC variable. Based on the results of this study, recommendations for the addition of the AgC variable to the list of content categories of Exner's (1993) Comprehensive System are presented and discussed along with scoring examples.

Adult↗