Paranoia and Violence

Fear and anger in delusional (paranoid) disorder: The association with violence.
Kennedy, H. G., Kemp, L. I., Dyer, D. E.
The British Journal of Psychiatry, Vol 160, Apr, 1992. pp. 488-492.
Abstract:
Hypothesized that delusions and actions in 15 patients (aged 23–45 yrs) with delusional (paranoid) disorder would be congruent with an abnormal mood characterized by fear and anger. Informants and the Ss indicated a pervasive and persistent abnormality of mood (fear and defensive anger), with delusions and actions that were congruent with this mood during the offense and for over a month before. Other behaviors, such as fleeing or barricading to avoid delusional persecutors, were also consistent with congruence of mood and delusions. In all Ss, violent acts and mood were congruent, but in 3 Ss the violent act was unrelated to delusions. Data suggest that moods of fear and anger in delusional disorder are not sufficiently recognized as part of the disorder.

Determinations of dangerousness in forensic patients: An archival study.
Rogers, Richard, Sewell, Kenneth W., Ross, Mary, Ustad, Karen, Williams, A.
Journal of Forensic Sciences, Vol 40(1), Jan, 1995. pp. 74-77.
Abstract:
Examined how conclusions are reached on the dangerousness of patients in maximum security hospitals. Two sequential stages were considered: clinical recommendations and decisions from manifest dangerousness hearings. In an archival study of 245 patients, clinical recommendations found 129 Ss to be dangerous, whereas the review boards found 144 to be dangerous. Lack of progress in the institution and physical assaultiveness were the strongest correlates with dangerousness. However, experts and review boards appeared to be relatively less influenced by diagnosis and sociodemographic variables. Although paranoid diagnosis and delusions were associated with dangerousness, these variables were of secondary importance.

A new variant of ‘subjective’ delusional misidentification associated with aggression.
Silva, J. Arturo, Leong, Gregory B., Rhodes, Linda J., Weinstock, Robert
Journal of Forensic Sciences, Vol 42(3), May, 1997. pp. 406-410.
Abstract:
Delusional misidentification syndromes are psychotic conditions in which the affected individual experiences delusions of radical change concerning the identity of others and/or of the self. These syndromes may lead to aggression, including serious violence toward others. In this article, a 43-yr-old aggressive male with paranoidschizophrenia who suffered from a delusion that physical and psychological replicas of himself existed was analyzed. Specifically the link between the patient’s subjective misidentification delusion and his resulting aggression was analyzed. Both the roles of phenomenology and biology of delusional misidentification are evaluated as potential contributors of aggression.

Homicide and major mental disorders: A 25-year study.
Schanda, Hans., et. al.
Acta Psychiatrica Scandinavica, Vol 110(2), Aug, 2004. pp. 98-107.
Abstract:
Objective: This study was designed to investigate the association between major mental disorders (MMDs) and homicide. Method: The rates of exculpations because of MMDs among 1087 Austrian homicide offenders during 1975 and 1999 were compared with the rates of the respective disorders in the general population. Results: MMDs were associated with an increased likelihood of homicide (two-fold in men and six-fold in women). This was exclusively because of schizophrenia (age-adjusted ORs in men 5.85, CI 4.29-8.01; in women 18.38, CI 11.24-31.55) and delusional disorder in men (OR 5.98, CI 1.91-16.51). Comorbid alcohol abuse/dependence (additionally) increased the odds in schizophrenia, major depression and bipolar disorder. Conclusion: The increased likelihood of homicide in subjects with MMDs cannot be fully explained by comorbid alcoholism. The results point to the special importance of sufficient treatment for a subgroup of mentally ill individuals being at higher risk of violence.

Delusional Disorder and the Law.
Reid, William H.
Journal of Psychiatric Practice, Vol 11(2), Mar, 2005. pp. 126-130.
Abstract:
A recent panel at the annual meeting of the American Academy of Forensic Sciences highlighted ‘pure paranoid delusions.’ This article shows that people with delusional disorder sometimes seem to be in a grey area of criminal forensic psychiatry, somewhere between frank psychosis (such as that found in some patients with schizophrenia, which is often associated with incompetence to stand trial or lack of responsibility for one’s actions) and paranoid personality traits (which generally do not affect competence or responsibility). Once the risk is high in a person with delusional disorder, it is reasonable to assume that it will remain high, particularly in unmonitored settings, unless something happens to create measurable, lasting mitigation of that risk. Several forms of delusionaldisorder are associated with increased risk of violence or damage to others’ property. Treatment is often effective in controlled environments, but outpatient approaches are limited. Those patients who come into contact with the law should be evaluated and treated with considerable attention to the risks they may represent. Three case studies of people with delusional disorders are also presented.

Translated Title: Homicidal acting-out in medical and prison setting.
Bénézech, M.
Annales Médico-Psychologiques, Vol 163(8), Oct, 2005. pp. 632-641.
Abstract:
Little is known about the frequency and characteristics of the homicide of which medical staff, institutionalized patients and prisoners may be victims. To date, several categories of victims have been described: medical staff murdered during their working hours, mentally ill patients assassinated by other patients, patients killed by medical staff and prisoners murdered by other prisoners. The criminological observation of a female general practitioner assassinated by one of her occasional clients, a perverse multirecidivist psychopath, illustrates the complexity and diversity of the utilitarism and/or pathological motives encountered in such affairs. Homicidal attacks on medical staff can be classified into four categories: the first three (fortuitous crime, occasional crime and personal cause crime) have no relation with therapeutic activity; the fourth (crime for a professional cause) involves a one-off or lasting medical relationship between the aggressor and his victim. Murderers in the latter category have been reported to suffer frequently from paranoid schizophrenia or persistent delusionaldisorder(paranoiac delusion). Such homicides on medical staff may be impulsive unforeseeable acts, reactions to conflict, or premeditated acts of vengeance. Homicides perpetrated by medical staff on patients are of a euthanasic or ‘heroic’ nature. In those between hospitalized mental patients or between prisoners, the aggressors are frequently violent psychopaths or delusional psychotic patients. The prevention of such dramas is difficult and raises the problem of how we should evaluate the dangerousness, the conditions of institutional life, and the financial and medical means that are made available to hospitals and prisons.

‘Homicides and major mental disorders: A 25-year study’: Comment.
Malik, M., Silva, E.
Acta Psychiatrica Scandinavica, Vol 113(1), Jan, 2006. pp. 75.
Abstract:
Comments on an article by M. Malik and E. Silva (see record 2004-16054-003). We read the article Homicide and major mental disorders: a 25-year study by Schanda et al. with interest. We find it likely that schizophrenia and delusional disorder would lead to serious violenceand murder with delusions being the prominent driving force. It was interesting to note that personality disorder was not investigated in relation to murder. We would like to know why the authors did not find this given it is such a strong predictor of risk.

‘Homicides and major mental disorders: A 25–yearstudy‘: Commentary reply.
Schanda, Hans.
Acta Psychiatrica Scandinavica, Vol 113(1), Jan, 2006. pp. 75.
Abstract:
Reply by the current authors to the comments made by M. Malik and E. Silva (see record 2005-16280-016) on the original article (see record 2004-16054-003). Dr. Malik correctly noted that personality disorder in particular antisocial personality disorder is associated with a high risk of violence. Characteristically, these studies found individuals with ASPD to be at higher risk compared to individuals with schizophrenia. However, this was not the design of our study. As the title says, it was explicitly restricted to major mental disorders. Moreover, as explained in detail in the Method section, we exclusively examined homicide offenders not guilty by reason of insanity. Of course, comorbid PD and substance use disorders (SUD) play a major role also in homicide offenders with MMD.In our study, we found a statistically significantly higher likelihood of homicide in schizophrenia with compared to schizophrenia without comorbid alcoholism. Therefore, we cannot find any contradiction between Dr Malik’s notion that PD is associated with a high risk of violence in general and our findings. His final question, however, concerning the investigation of the risk of homicide in PD can simply be answered: this was not the aim of our study and would have required a different design.

Stereotypic delusional offending.
Junginger, John.
Behavioral Sciences & the Law, Vol 24(3), 2006. Special Issue: International perspectives on delusional disorders and the law. pp. 295-311.
Abstract:
Some patients with serious mental illness appear to respond violently to the same delusional content throughout the course of their illness. Anecdotal, empirical, and theoretical evidence is presented establishing the premise of ‘stereotypic’ delusional offending. A method for measuring the similarity of two delusions separated in time also is presented. An empirical focus on stereotypic delusional offending may help identify more accurately persons at risk for violence and those at risk for becoming targets of violence. It also may provide a better understanding of successful treatment of outpatient violence and conceivably could inform the ongoing debate on involuntary outpatient commitment laws. Among the major issues of this debate in the United States are the potential benefits of a forced medication provision. One rationale for such a provision may be found in the treatment response of seriously mentally ill outpatients whose violent behavior appears inescapably tied to their persistent or recurrent delusions.

Paranoia in the Criminal Courts.
Gunn, John, Buchanan, Alec.
Behavioral Sciences & the Law, Vol 24(3), 2006. Special Issue: International perspectives on delusional disorders and the law. pp. 373-383.
Abstract:
It is generally accepted that those who suffer from mental illness are less responsible for their criminal actions than others. A fictitious case of a woman suffering from a paranoid psychosis, who severely injures her legal advisor, is considered in two different but related jurisdictions, England & Wales and Connecticut, USA. Four elements of the criminal process are considered. Significant differences between the jurisdictions are found in all four elements. There is greater pragmatism in the English system and a greater chance of the woman ending up in long-term hospital care, but both systems aim to prevent further violence by the use of institutionalization. International and intra-national variations in the care of this hypothetical woman are briefly discussed, and it is clear that in both countries medical care is compromised by attitudinal and political considerations.

Multiaxial evaluation of violent criminals.
Ortiz-Tallo, Margarita, et. al.
Psychological Reports, Vol 100(3,Pt2), Jun, 2007. pp. 1065-1075.
Abstract:
A multiaxial assessment and personality evaluation was performed on a group of 70 people (65 men and 5 women) who were recently incarcerated in Málaga, Spain for having committed violent crimes, such as murder and sex-based violence. Analysis of scores on the MCMI indicated that there were chiefly two clearly differentiated personality profiles related to two personality disorders present in the group, the antisocial and the dependent personality disorder with compulsive traits. The ‘antisocial-psychotic group’ presented a clear relation with clinical syndromes, specifically alcohol and drug abuse with delusional disorder, and they had committed a higher proportion of murders. On the Big Five Questionnaire, the ‘dependent-compulsive group’ scored higher than average on Emotional Stability and Agreeableness, whereas the antisocial-psychotic group scored lower than average on Emotional Stability. These findings are in accord with those of Megargee, who concluded that violent criminals can be divided into two categories, the undercontrolled (antisocial) and the overcontrolled (dependent).

Schizophrenia and delusional disorder.
Crowner, Martha L.
Textbook of violence assessment and management. Simon, Robert I., (Ed); Tardiff, Kenneth, (Ed); pp. 105-121; Arlington, VA, US: American Psychiatric Publishing, Inc.; 2008. xiv, 614 pp.
Abstract:
In this chapter I discuss assessment and management of acutely violent patients with primary psychotic disorders. Most studies of violent patients are of diagnostically mixed populations that include a large proportion diagnosed with schizophrenia, reflecting clinical populations. I highlight studies of groups of adults with schizophrenia but also discuss studies of mixed groups. Some aspects of assessment and much of management can apply to all severely mentally ill adults. Diagnoses are often imprecise, especially in large community surveys, in which patients are often identified by their predominant symptoms rather than diagnosis. There is little literature to guide discussions of violence in patients with delusional disorder, but these patients are similar to those with chronic schizophrenia, with prominent positive symptoms and low levels of negative symptoms. My discussion of management of violence primarily covers environmental and interpersonal strategies to prevent violence.

Translated Title: The frequency, organization and predictive factors of psychotic homicides: Report on three cases with corporal mutilation.
Bénézech, M., Le Bihan, P., Chapenoire, S., Bourgeois, M.-L.
Annales Médico-Psychologiques, Vol 166(7), Aug, 2008. pp. 558-568.
Abstract:
The statistically positive correlation between severe mental disorders and physical violencehas now been firmly established by international studies. In Europe, about 10% of homicides are committed by psychotic patients who may re-offend. Three medicolegal observations of homicides with bodily mutilation are presented. The first concerns a 31-year-old schizophrenic man who killed a passer-by in the street when in a state of paranoid delusion with themes of homosexual rape and persecution. The crime was committed in two separate phases: first, emotional violence and then, a few hours later, operational utilitarian violence with amputation of the victim’s hands. The second case concerns a 21-year-old man suffering from paranoid schizophrenia associated with an antisocial personality disorder. During the night, he assassinated two women who worked in a psychiatric unit, one of whom was decapitated while still alive. Although living freely in the community, the patient acted with premeditation and method under the influence of ideas of persecution and cosmic supernatural terror. The third case concerns a 30-year-old man who had been forcibly hospitalized in a psychiatric unit for delusional disorder of persecution with paranoiac personality disorder. During a period of weekend leave, he killed his own mother in the family home in a totally disorganized emotional moment of acting out, then cut off her leg and threw it out of the window. Six years beforehand, he had already killed a prison inmate who was sharing his cell. In the first two cases, the patients’ behavior was partially or totally organized despite delusional motives of paranoid type. In the light of these three dramas and a literature review, the main psychopathological predictors of physical violencecommitted by psychotic patients are discussed: severe psychotic episode, persecutory delusional beliefs, comorbidity with substance abuse (alcohol, cannabis) and personality disorders, little or no antipsychotic treatment, and poor therapeutic compliance. In France, it appears mandatory to apply a rigorous procedure for evaluating the dangerousness of severe mental patients and violent criminals.

Violent crime and dimensions of delusion: A comparative study of criminal and noncriminal delusional patients.
Teixeira, Eduardo Henrique., Dalgalarrondo, Paulo
Journal of the American Academy of Psychiatry and the Law, Vol 37(2), Jun, 2009. pp. 225-231.
Abstract:
Some aspects of delusional disorders appear to be related to the occurrence of violent crime. A retrospective study was conducted comparing two groups of 30 psychotic, delusionalpatients. The study group consisted of delusionalpatients imprisoned in a high-security forensic hospital in the state of São Paulo, Brazil, and the patients in the comparative group were enrolled in common psychiatric wards. The PANSS (Positive and Negative Syndrome Scale), the MINI (Mini International Neuropsychiatric Interview), and the MMDAS (MacArthur-Maudsley Delusion Assessment Schedule) scales were used. Regarding the dimensions of delusions, the study group had lower scores in two categories: refraining from acting because of belief, and negative affect. Delusions that induce inhibition of actions apparently also reduce the potential for violent acts and, contrary to current beliefs, delusionalpatients who are frightened or who have other negative affects associated with delusional ideas appear to commit fewer violent acts. Intrinsic factors inherent in some dimensions of delusion may be relevant in the occurrence of violent crimes committed by psychotic patients.

Translated Title: Homicide and major mental disorder: What are the social, clinical, and forensic differences between murderers with a major mental disorder and murderers without any mental disorder?
Richard-Devantoy, S., et. al.
L’Encéphale: Revue de psychiatrie clinique biologique et thérapeutique, Vol 35(4), Sep, 2009. pp. 304-314.
Abstract:
Objectives: To establish the social, clinical, and forensic differences between murderers suffering from a major mental disorder and murderers without any psychiatric disorder and, in particular, to compare their respective records of psychiatric symptoms and their respective relationship with their victims.
Method: We studied 210 forensic examinations of murderers, the offences related to the murders, and the social and clinical information collected from psychiatric court reports on persons convicted of homicide. Firstly, we identified the socio-demographic, clinical and criminological profiles of 210 murderers from which were distinguished murderers with major mental disorder. Then, we compared the profiles of murderers suffering from a major mental disorder with those of murderers without any mental disease. In other words, we compared 37 persons affected with major mental disorder(schizophrenia, paranoiac delusional disorder, and affective disorder) with 73 persons without any mental disorder. We deliberately excluded subjects with personality disorder or abuse of/dependency on drugs, mental retardation or dementia.
Results: With the exception of certain variables, murderers with major mental disorder have the same characteristics as others murderers: young man, living alone, with psychiatric and offence records and substance abuse. Murderers with major mental disorder are older (37.8 versus 31.7 years old) than perpretators without any mental disorder, and the former have a psychiatric record more often than the latter (81 versus 32.9%). In addition, contrary to the latter, the former show clinical symptoms of a psychopathological process. Depression, delusional and suicidal ideas are frequent among murderers with a major mental disorder, whereas the persons without mental disorder quarrel or have a row with their victim just before their crime. The victim was known to the perpetrator significantly more often in the major mental disorder group than in the no mental disorder group (94,6 versus 76,7%, p = 0,008). The most major mental disorders’ homicide was more likely to be against intimates than strangers. The application of the former article 64 or the present article 122-1 of the French Criminal Code are envisaged more often in the major mental disorder group than in the no mental disorder group.
Conclusion: The main difference between murderers with a major mental disorder and murderers without any mental disorder is the psychopathology of the morbid process which underlies the homicide. Impairment of judgment at the time of the crime should be taken into account. As a clinician, we should focus our attention on general risk factors of violence and homicide (male, young, underprivileged class, abuse of alcohol) and on more specific factors (mental disorder co-morbidities…). To these factors should be added the dynamic characteristics of the meeting of the protagonists.

Translated Title: Sociodemographic, clinical, criminological and forensic characteristics of 210 murderers.
Richard-Devantoy, S., et.al.
Annales Médico-Psychologiques, Vol 167(8), Oct, 2009. pp. 568-575.
Abstract:
Introduction: After a saturated media coverage of some murders, questions were raised about the mentally ill and their dangerous and violent nature which may sometimes culminate in homicide. The popular idea that someone who kills an unknown person in the street is mentally ill is firmly rooted in the collective consciousness. Yet, epidemiological data are reassuring: only 15% of such murders are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia). Aim: To describe the sociodemographic, clinical and forensic characteristics of a convicted population of 210 murderers. Method: Consecutive series of cases of people convicted of murder in Angers between 1975 and 2005. Information on sociodemographic and clinical characteristics of perpetrators of homicide was collected from psychiatric reports prepared for the courts. This retrospective study identifies several types of pathological murders (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania, drugs abuses, personality disorders). Results: The murderers were men whose mean age was 33. Most were single, living alone and jobless. Two thirds of them had psychiatric records and one third a record of violence against persons. There were 14 cases of schizophrenia (6.7%), eight cases of persistent delusional disorder, 15 cases of affective disorder, 11 cases of mental disorder, five cases of neurological symptomatology, 44 cases of personality disorder and 35 cases of alcohol abuse or alcohol dependency disorder. A third of the murderers did not have any kind of mental disorder (n = 73). Fifty-two (24%) were mentally ill. Two thirds had a history of mental illness and one third had a record of previous convictions of violence. Crimes were mostly committed at nighttime and in the house of the victim. The most common method of killing was stabbing. Fourteen percent had symptoms of mental illness at the time of the offence. The 217 victims were, in decreasing order, a family member, a current or former spouse/partner (53%), an acquaintance (30%) or a stranger (17%). The forensic and juridical consequences (via the application of former article 64 or the present article 122-1 of the French Criminal Code) were envisaged in less than 10% of the cases. Conclusions: These data allowed the authors to determine the general risk factors of homicidal violence (male gender, youth and alcohol abuse) as well as some more specific factors (mental illness, comorbidities…). The dynamic characteristics of the meeting of the crime protagonists should be added to these factors.

Monoamine oxidase A alleles in violent offenders with antisocial personality disorder: High activity associated with proactive aggression.
Kolla, Nathan J., et al.
Criminal Behaviour and Mental Health, Vol 24(5), Dec, 2014. pp. 368-372.
Abstract:
Meta-analysis has confirmed that, among males, carriers of the low-activity variant (L) of the monoamine oxidase A (MAOA) gene who experienced childhood physical abuse (CPA) show elevated rates of aggressive and antisocial behaviour. Studies included examined large population samples, and limited outcome variables to conduct disorder diagnoses and measures of aggression that did not distinguish between its proactive and reactive forms. Two studies examined violent convictions: one reported their association with MAOA-L and the other with the MAOA high-activity variant (H), both among men who had experienced CPA. In another study of offenders, MAOA-L was associated with factor 2 scores on the Psychopathy Checklist: Screening Version. MAOA-H has also been associated with aggression among boys and adult men. We have conducted exploratory analyses among violent offenders (VOs) and non-offenders (NOs) to estimate associations between MAOA genotype, CPA, reactive and proactive aggression, and factor 1 and 2 Psychopathy Checklist-Revised (PCL-R) scores.

Association of violence with emergence of persecutory delusions in untreated schizophrenia.
Keers, Robert, Ullrich, Simone, DeStavola, Bianca L., Coid, Jeremy W.
The American Journal of Psychiatry, Vol 171(3), Mar 1, 2014. pp. 332-339.
Abstract:
Objective: Psychosis is considered an important risk factor for violence, but studies show inconsistent results. The mechanism through which psychotic disorders influence violence also remains uncertain. The authors investigated whether psychosis increased the risk of violent behavior among released prisoners and whether treatment reduced this risk. They also explored whether active symptoms of psychosis at the time of violent behavior explained associations between untreated psychosis and violence. Method: The U.K. Prisoner Cohort Study is a prospective longitudinal study of prisoners followed up in the community after release. Adult male and female offenders serving sentences of 2 or more years for a sexual or violent offense were classified into four groups: no psychosis (N = 742), schizophrenia (N = 94), delusional disorder (N = 29), and drug-induced psychosis (N = 102). Symptoms of psychosis, including hallucinations, thought insertion, strange experiences, and delusions of persecution, were measured before and after release. Information on violence between release and follow-up was collected through self-report and police records. Results: Schizophrenia was associated with violence but only in the absence of treatment (odds ratio = 3.76, 95% CI = 1.39–10.19). Untreated schizophrenia was associated with the emergence of persecutory delusions at follow-up (odds ratio = 3.52, 95% CI = 1.18–10.52), which were associated with violence (odds ratio = 3.68, 95% CI = 2.44–5.55). The mediating effects of persecutory delusions were confirmed in mediation analyses (β = 0.02, 95% CI = 0.01–0.04). Conclusions: The results indicate that the emergence of persecutory delusions in untreated schizophrenia explains violent behavior. Maintaining psychiatric treatment after release can substantially reduce violent recidivism among prisoners with schizophrenia. Better screening and treatment of prisoners is therefore essential to prevent violence.

Male inmate profiles and their biological correlates.
Horn, Mathilde, et al.
The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, Vol 59(8), Aug, 2014.
Abstract:
Objective: Borderline and antisocial personality disorders (PDs) share common clinical features (impulsivity, aggressiveness, substance use disorders [SUDs], and suicidal behaviours) that are greatly overrepresented in prison populations. These disorders have been associated biologically with testosterone and cortisol levels. However, the associations are ambiguous and the subject of controversy, perhaps because these heterogeneous disorders have been addressed as unitary constructs. A consideration of profiles of people, rather than of exclusive diagnoses, might yield clearer relationships. Methods: In our study, multiple correspondence analysis and cluster analysis were employed to identify subgroups among 545 newly convicted inmates. The groups were then compared in terms of clinical features and biological markers, including levels of cortisol, testosterone, estradiol, progesterone, and sulfoconjugated dehydroepiandrosterone (DHEA-S). Results: Four clusters with differing psychiatric, criminal, and biological profiles emerged. Clinically, one group had intermediate scores for each of the tested clinical features. Another group comprised people with little comorbidity. Two others displayed severe impulsivity, PD, and SUD. Biologically, cortisol levels were lowest in the last 2 groups and highest in the group with less comorbidity. In keeping with previous findings reported in the literature, testosterone was higher in a younger population with severe psychiatric symptoms. However, some apparently comparable behavioural outcomes were found to be related to distinct biological profiles. No differences were observed for estradiol, progesterone, or DHEA-S levels. Conclusions: The results not only confirm the importance of biological markers in the study of personality features but also demonstrate the need to consider the role of comorbidities and steroid coregulation.

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample.
Howard, Richard C., et al.
Journal of Forensic Psychiatry & Psychology, Vol 25(6), Nov, 2014. pp. 658-672.
Abstract:
Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.

On the pervasiveness of event-specific alcohol use, general substance use, and mental health problems as risk factors for intimate partner violence.
Reingle, Jennifer M., et al.
Journal of Interpersonal Violence, Vol 29(16), Nov, 2014. pp. 2951-2970.
Abstract:
The aim of this study was to evaluate the role of demographic, mental health, and substance use as risk factors for intimate partner violence (IPV). Data were derived from Wave II of the National Epidemiological Survey on Alcohol and Related Conditions (2004-2005). Eligible participants (N = 25,778) reported having an intimate partner 1 year before the survey. Clustered survey multivariate multinomial regression methods were used to assess risk factors for episodes of IPV. IPV victimization, perpetration, and both victims/perpetrators were assessed. Bivariate analyses indicated that African Americans, Hispanics, and women were more likely to be victims, perpetrators, or victim/perpetrators as compared with men and Whites. Multivariate analyses suggested that having a marijuana use disorder was strongly associated with IPV victimization (odds ratio [OR] = 2.61) and victim/perpetration (OR = 2.65). Post-traumatic stress disorder was consistently associated with all IPV typologies. Depression was associated with victimization (OR = 2.00) and IPV victim/perpetration (OR = 1.74). Antisocial Personality Disorder and Mania were both related to IPV perpetration (ORs = 2.53 and 2.32) and victim/perpetration (ORs = 3.15 and 2.31). Results also indicated that alcohol use during episodes of IPV is common (i.e., 35% of those who reported IPV also reported that alcohol was involved). Results indicate several substance- and mental health–related correlates of IPV. In addition, findings indicate that alcohol use by the victim and/or perpetrator is common during IPV events. Policy implications and directions for future research are discussed.

Associations between dysfunctional personality traits and intimate partner violence in perpetrators and victims.
Sijtsema, Jelle J., et al.
Journal of Interpersonal Violence, Vol 29(13), Sep, 2014. pp. 2418-2438.
Abstract:
In the current study, the role of borderline and antisocial personality traits and psychological and physical forms of intimate partner violence were examined. Using self- and partner-reports, 30 perpetrators (28 males) and 30 victims (29 females) of partner violence, including 23 (former) couples, were interviewed. Results showed that perpetrators (i.e., males) were higher on antisocial personality traits than victims (i.e., females), but the two groups did not differ on borderline traits and self-reported violence. Moreover, borderline traits were associated with partner violence in general, whereas antisocial personality traits were associated with physical, but not psychological, partner violence. Analyses on (former) couples suggest that there is little congruence between perpetrators’ and victims’ reports of partner violence. In conclusion, the findings of the current study not only emphasized the complex nature of intimate partner violence but also showed that dysfunctional personality traits and gender play a significant role in both the display and reporting of partner violence.

‘Bad genes’ & criminal responsibility.
González-Tapia, María Isabel, Obsuth, Ingrid.
International Journal of Law and Psychiatry, Vol 39, Mar, 2015. pp. 60-71.
Abstract:
The genetics of the accused is trying to break into the courts. To date several candidate genes have been put forward and their links to antisocial behavior have been examined and documented with some consistency. In this paper, we focus on the so called ‘warrior gene’, or the low-activity allele of the MAOA gene, which has been most consistently related to human behavior and specifically to violence and antisocial behavior. In preparing this paper we had two objectives. First, to summarize and analyze the current scientific evidence, in order to gain an in depth understanding of the state of the issue and determine whether a dominant line of generally accepted scientific knowledge in this field can be asserted. Second, to derive conclusions and put forward recommendations related to the use of genetic information, specifically the presence of the low-activity genotype of the MAOA gene, in modulation of criminal responsibility in European and US courts.

Examining the role of antisocial personality disorderin intimate partner violence among substance use disordertreatment seekers with clinically significant trauma histories.
Dykstra, Rita E., et al.
Violence Against Women, Vol 21(8), Aug, 2015. pp. 958-974.
Abstract:
This study examined the associations among posttraumatic stress disorder (PTSD) symptom severity, antisocialpersonality disorder (ASPD) diagnosis, and intimate partner violence(IPV) in a sample of 145 substance abuse treatment-seeking men and women with positive trauma histories; sex was examined as a moderator. ASPD diagnosis significantly predicted both verbal and physical aggression; sex moderated the association between ASPD diagnosis and physical violence. PTSD symptom severity significantly predicted engaging in verbal, but not physical, aggression. Overall, these results suggest that an ASPD diagnosis may be an important risk factor for engaging in IPV among women seeking treatment for a substance use disorder.

Developmental trajectories of marijuana use among men: Examining linkages with criminal behavior and psychopathic features into the mid-30s.
Pardini, Dustin, et al.
Journal of Research in Crime and Delinquency, Vol 52(6), Nov, 2015. pp. 797-828.
Abstract:
Objectives: Examine whether young men who chronically use marijuana are at risk for engaging in drug-related and non-drug-related criminal offending and exhibiting psychopathic personality features in their mid-30s.
Methods: Patterns of marijuana use were delineated in a sample of predominately Black and White young men from adolescence to the mid-20s using latent class growth curve analysis. Self-report and official records of criminal offending and psychopathic personality features were assessed in the mid-30s. Analyses controlled for multiple factors indicative of a preexisting antisocial lifestyle and co-occurring use of other substances and tested for moderation by race.
Results: Four latent marijuana trajectory groups were identified: chronic high, adolescence-limited, late increasing, and low/nonusers. Relative to low/nonusers, chronic high and late increasing marijuana users exhibited more adult psychopathic features and were more likely to engage in drug-related offending during their mid-30s. Adolescence-limited users were similar to low/nonusers in terms of psychopathic features but were more likely to be arrested for drug-related crimes. No trajectory group differences were found for violence or theft, and the group differences were not moderated by race.
Conclusions: Young men who engage in chronic marijuana use from adolescence into their 20s are at increased risk for exhibiting psychopathic features, dealing drugs, and enduring drug-related legal problems in their mid-30s relative to men who remain abstinent or use infrequently.

Trait psychopathy, emotional intelligence, and criminal thinking: Predicting illegal behavior among college students.
Fix, Rebecca L., Fix, Spencer T.
International Journal of Law and Psychiatry, Vol 42-43, Sep-Dec, 2015. pp. 183-188.
Abstract:
Research focusing on individuals high on trait psychopathy remains limited. Higher trait psychopathy is associated with lower levels of emotional intelligence and increased participation in illegal behavior. Additionally, research has confirmed significantly higher levels of criminal thinking and lower levels of empathy in the incarcerated psychopathic population. However, the relationships between trait psychopathy and criminal thinking have not been researched in the community or college population. To test for such differences, questionnaires containing relevant measures were administered to 111 college students. Results indicated that higher levels of trait psychopathy were significantly related to less caring for others, intrapersonal understanding, and general mood, and greater interpersonal functioning and stress management. Furthermore, trait psychopathy was a strong predictor of violent, property, drug, and status offenses. Power-oriented criminal thinking was also predictive of violent behaviors, and entitlement predicted property offending. Results suggest emotional intelligence is important for predicting psychopathy, and trait psychopathy is a strong predictor of all types of illegal behaviors among the non-incarcerated population.

Effects of the MAOA gene and levels of exposure to violence on antisocial outcomes.
Ouellet-Morin, Isabelle, et al.
The British Journal of Psychiatry, Vol 208(1), Jan, 2016. pp. 42-48.
Abstract:
Background: The monoamine oxidase A (MAOA) gene has been shown to moderate the impact of maltreatment on antisocial behaviour. Replication efforts have, however, yielded inconsistent results.
Aims: To investigate whether the interaction between the MAOA gene and violence is present across the full distribution of violence or emerges at higher levels of exposure.
Method: Participants were 327 male members of the Québec Longitudinal Study of Kindergarten Children. Exposure to violence comprised retrospective reports of mother’s and father’s maltreatment, sexual and physical abuse. Conduct disorder and antisocial personality symptoms were assessed in semi-structured interviews and partner violence, property-violent crimes and arrest were self-reported.
Results: Non-linear interactions between the MAOA gene and violence were detected, suggesting that the genetic moderation may come about once a certain level of violence is experienced.
Conclusions: Future studies should investigate the mechanisms translating substantial violence exposure, which could, subsequently, trigger the expression of genetically based differences in antisocial behaviour.

Domestic homicide: Neuropsychological profiles of murderers who kill family members and intimate partners.
Hanlon, Robert E., et al.
Journal of Forensic Sciences, Vol 16(Suppl 1), Jan, 2016.  Pp. S163-S170.
Abstract:
Domestic homicide is the most extreme form of domestic violence and one of the most common types of homicide. The objective was to examine differences between spontaneous domestic homicide and nondomestic homicide offenders regarding demographics, psychiatric history, crime characteristics, and neuropsychological status, utilizing neuropsychological test data from forensic examinations of 153 murderers. Using standard crime classification criteria, 33% committed spontaneous domestic homicides (SDH) and 61% committed nondomestic homicides (NDH). SDH offenders were more likely to manifest psychotic disorders, but less likely to be diagnosed with antisocial personality disorder or to have prior felony convictions. SDH offenders manifested significantly worse neuropsychological impairments than NDH offenders. The mean number of victims was lower for the SDH than the NDH group and only 14% of SDH offenders used a firearm, whereas 59% of NDH offenders used a firearm. These findings corroborate the notion that spontaneous domestic homicide may represent a discernible criminological phenotype.

The relationship between paranoia and aggression in psychosis: A systematic review.
Darrell-Berry, Hannah.,  Berry, Katherine., Bucci, Sandra
Schizophrenia Research, Vol 172(1-3), Apr, 2016. pp. 169-176.
Abstract:
Aggression in the context of schizophrenia has significant detrimental personal, clinical and societal implications. Whilst understanding the precise pathways to aggression in people with a diagnosis of schizophrenia is critical for risk management and treatment, these pathways remain unclear. A paranoid belief that others intend harm is one psychotic symptom that might contribute to aggressive behaviours. This is the first review to investigate the relationship between paranoia and aggression in psychosis. A systematic review of published literature pertinent to the relationship between paranoia and aggression was conducted. A search of online databases from inception to November 2014 was performed with keywords related to ‘schizophrenia’, ‘paranoia’ and ‘aggression’. Fifteen studies, primarily cross-sectional in design (n = 9), met eligibility criteria. Studies reviewed showed mixed support for an association between paranoia and aggression in both inpatients and community settings. However, when study quality was taken into account, more methodologically rigorous studies tended to show a positive association between factors. Mixed findings are most likely due to important methodological shortcomings, including heterogeneous samples and studies using a diverse range of aggression/violence measures. In light of methodological limitations of individual studies reviewed, further investigation of the relationship between paranoia and aggression in psychosis using robust methodology is needed before definitive clinical recommendations regarding the hypothesised relationship between paranoia and aggression can be made. This paper sets out key recommendations for future studies, including operationalizing the specific components of aggression and paranoia under investigation and methods to delineate important mediators in the paranoia and aggression relationship.

Association of ventral striatum monoamine oxidase-a binding and functional connectivity in antisocial personalitydisorder with high impulsivity: A positron emission tomography and functional magnetic resonance imaging study.
Kolla, Nathan J., et al.
European Neuropsychopharmacology, Vol 26(4), Apr, 2016. pp. 777-786.
Abstract:
Impulsivity is a core feature of antisocial personality disorder (ASPD) associated with abnormal brain function and neurochemical alterations. The ventral striatum (VS) is a key region of the neural circuitry mediating impulsive behavior, and low monoamine oxidase-A (MAO-A) level in the VS has shown a specific relationship to the impulsivity of ASPD. Because it is currently unknown whether phenotypic MAO-A markers can influence brain function in ASPD, we investigated VS MAO-A level and the functional connectivity (FC) of two seed regions, superior and inferior VS (VSs, VSi). Nineteen impulsive ASPD males underwent [¹¹C] harmine positron emission tomography scanning to measure VS MAO-A V_T, an index of MAO-A density, and resting-state functional magnetic resonance imaging that assessed the FC of bilateral seed regions in the VSi and VSs. Subjects also completed self-report impulsivity measures. Results revealed functional coupling of the VSs with bilateral dorsomedial prefrontal cortex (DMPFC) that was correlated with VS MAO-A VT (r = 0.47, p = 0.04), and functional coupling of the VSi with right hippocampus that was anti-correlated with VS MAO-A V_T (r = −0.55, p= 0.01). Additionally, VSs-DMPFC FC was negatively correlated with NEO Personality Inventory-Revised impulsivity (r = −0.49, p = 0.03), as was VSi-hippocampus FC with Barratt Impulsiveness Scale-11 motor impulsiveness (r = −0.50, p = 0.03). These preliminary results highlight an association of VS MAO-A level with the FC of striatal regions linked to impulsive behavior in ASPD and suggest that phenotype-based brain markers of ASPD have relevance to understanding brain function.

Antisocial personality disorder and physical partner violence among single and dual substance-abusing couples.
Kelley, Michelle L., Braitman, Abby L.
Journal of Family Violence, Vol 31(4), May, 2016. pp. 423-431.
Abstract:
The current study examined how antisocial personality disorder (APD) and substance use disorder contributed to partners’ reports of physical partner violence among single and dual substance-abusing couples. Participants were 69 heterosexual couples entering treatment in which one or both partners met criteria for substance use disorder. APD diagnosis of the male partner was linked to significantly higher male-to-female and female-to-male perpetration of physical partner violence and victimization. Female partner’s APD diagnosis was associated with women’s reports of victimization by their male partners. Dual substance use diagnosis emerged as a moderator, in which the effect of men’s APD diagnosis on men’s perpetration of physical partner violence and victimization was significantly reduced if both partners had substance use disorder. Findings underscore the importance of both partners’ APD diagnosis and substance use status for understanding physical partner violence among single and dual substance-abusing couples.

Paranoid ideation and violence: Meta-analysis of individual subject data of 7 population surveys.
Coid, Jeremy W., et al.
Schizophrenia Bulletin, Vol 42(4), Jul, 2016. pp. 907-915.
Abstract:
There is controversy whether associations between psychosis and violence are due to coexisting substance misuse and factors increasing risk in nonpsychotic persons. Recent studies in clinical samples have implicated independent effects of paranoid delusions. Research findings suggest that individual psychotic-like-experiences on the psychosis continuum in the general population are associated with violence; it remains unclear whether this association is due to psychiatric comorbidity. We pooled data from 7 UK general population surveys (n = 23 444) and conducted a meta-analysis of individual subject data. Further meta-analyses were performed to identify heterogeneity. Main exposure variables: 5 psychotic-like-experiences and a categorical measure of psychosis. Comorbidity was established through standardized self-report instruments. Information was collected on violence, severity, victims. Paranoid ideation was associated with violence (AOR 2.26, 95% CI 1.75–2.91), severity and frequency, even when controlling for effects of other psychotic-like-experiences. Associations were not explained by comorbid conditions, including substance dependence. Psychotic disorder was associated with violence and injury to the perpetrator but associations were explained by paranoid ideation. Individual associations between hypomania, thought insertion, hallucinations, and violence were nonsignificant after adjustments, and significantly associated only when comorbid with antisocial personalitydisorder. Strange experiences were only associated with intimate partner violence. Paranoid ideation on a psychosis-continuum in the general population was associated with violence. All other associations were explained by comorbidity. Further investigation should determine whether paranoid ideation among persons in the community require preventive interventions, similar to those presenting to mental health services. Nevertheless, risks are considerably increased for psychotic-like-experiences with co-occurring antisocial personality disorder.

Auditory and non-auditory hallucinations in first-episode psychosis: Differential associations with diverse clinical features.
Galletti, Chiara, et.al.
Psychiatry Research, Vol 254, Aug, 2017. pp. 268-274.
Abstract:
Data from 247 first-episode psychosis patients were used to explore associations between types of hallucinations and nine diverse clinical characteristics. Psychopathology was rated using the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms (SANS). Childhood adversity was assessed with seven instruments; family history with an adapted version of the Family Interview for Genetic Studies; age at onset of psychosis and duration of untreated psychosis (DUP) with the Symptom Onset in Schizophrenia inventory; and insight with the Birchwood Insight Scale. Both principal component analysis-derived Auditory and Non-Auditory Hallucinations were similarly associated with delusions of influence, negative affect delusions (jealousy and sin/guilt), interpersonal childhood abuse, DUP, and insight. However, the two hallucination domains had different associations with grandiose/religious, paranoid, and somatic delusions; SANS score; childhood violence exposure; cannabis use disorders; and cocaine/other drug use disorders. Neither Auditory nor Non-Auditory Hallucinationswere associated with childhood neglect, age at onset, alcohol use disorders, family history, or mode of onset of psychosis. Findings support considering hallucinations not as a unitary psychopathological construct. They represent at least two domains and are correlated in different ways with diverse clinical variables.