Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0039
Trends in Psychiatry and Psychotherapy
Original Article

Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS

Esquizofrenia e violência: estudo em um hospital psiquiátrico clínico com o HCR-20 e a MOAS

Leonardo Fernandez Meyer; Lisieux E. de Borba Telles; Kátia Mecler; Ana Luiza Alfaya Galego Soares; Renata Santos Alves; Alexandre Martins Valença

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Abstract

Abstract Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.

Keywords

Aggressiveness, psychosis, schizophrenia, HCR-20, risk assessment, MOAS

Resumo

Resumo Objetivo: Este estudo preliminar tem por objetivo identificar e comparar características relacionadas ao comportamento violento em pacientes com esquizofrenia internados em um hospital psiquiátrico utilizando o Historical, Clinical, and Risk Management 20 (HCR-20), a Modified Overt Aggression Scale (MOAS), e dados sociodemográficos. Método: Foram selecionados participantes com e sem histórico de comportamento violento, referidos nos relatórios de internação hospitalar. Participantes violentos e com escore total do HCR-20 ≥ 21 na internação foram selecionados para o grupo violento. Participantes não violentos com escore total do HCR-20 < 21 na internação foram selecionados para o grupo não violento. A MOAS foi aplicada para caracterizar o grau de severidade do comportamento violento. Resultados: O HCR-20 e suas subescalas foram eficazes na diferenciação entre os participantes dos grupos. Doze dos 20 itens do HCR-20 foram úteis na diferenciação entre os grupos, apesar do escore total do HCR-20 ter sido mais confiável quando aplicado ao grupo não violento. A MOAS não apresentou graus de severidade elevados para os tipos de agressividade observados nos participantes. Conclusão: O HCR-20 foi útil e confiável na distinção entre pacientes esquizofrênicos violentos e não violentos em ambiente psiquiátrico clínico, já que a análise dos itens identificou as características mais relevantes em cada grupo. O uso do HCR-20 em ambientes psiquiátricos clínicos deveria ser encorajado.

Palavras-chave

Agressividade, psicose, esquizofrenia, HCR-20, avaliação de risco, MOAS

References

Monahan J, Steadman HJ, Silver E, Appelbaum OS, Robbins PC, Mulvey EP. Rethinking risk assessment: the MacArthur study of mental disorder and violence. 2001.

Douglas KS, Guy LS, Hart SD. Psychosis as a risk factor for violence to others: a meta-analysis. Psychol Bull. 2009;135:679-706.

Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20 assessing risk for violence version 2. 1997.

Singh JP, Grann M, Fazel S. A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants. Clin Psychol Rev. 2011;31:499-513.

Singh JP, Serper M, Reinharth J, Fazel S. Structured assessment of violence risk in schizophrenia and other psychiatric disorders: a systematic review of the validity, reliability, and item content of 10 available instruments. Schizophr Bull. 2011;37:899-912.

Gray NS, Taylor J, Snowden RJ. Predicting violence using structured professional judgment in patients with different mental and behavioral disorders. Psychiatry Res. 2011;187:248-53.

Crocker a G, Côté G. Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services. Eur Psychiatry. 2009;24:356-64.

Daffern M. The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings. Aggress Violent Behav. 2007;12:116-30.

Nilsson T, Wallinius M, Gustavson C, Anckarsater H, Kerekes N. Violent recidivism: a long-time follow-up study of mentally disordered offenders. PLoS One. 2011;6.

Fullam R, Dolan M. The criminal and personality profile of patients with schizophrenia and comorbid psychopathic traits. Pers Individ Dif. 2006;40:1591-602.

Doyle M, Carter S, Shaw J, Dolan M. Predicting community violence from patients discharged from acute mental health units in England. Soc Psychiatry Psychiatr Epidemiol. 2012;47:627-37.

Tengstrom a. Long-term predictive validity of historical factors in two risk assessment instruments in a group of violent offenders with schizophrenia. Nord J Psychiatry. 2001;55:243-9.

Gray NS, Snowden RJ, MacCulloch S, Phillips H, Taylor J, MacCulloch MJ. Relative efficacy of criminological, clinical, and personality measures of future risk of offending in mentally disordered offenders: a comparative study of HCR-20, PCL:SV, and OGRS. J Consult Clin Psychol. 2004;72:523-30.

Gray NS, Fitzgerald S, Taylor J, Macculloch MJ, Snowden RJ. Predicting future reconviction in offenders with intellectual disabilities: the predictive efficacy of VRAG, PCL-SV, and the HCR- 20. Psychol Assess. 2007;19:474-9.

Telles LE de B, Day VP, Folino JO, Taborda JGV. Reliability of the Brazilian version of HCR-20 Assessing Risk for Violence. Rev Bras Psiquiatr. 2009;31:253-6.

McNiel DE, Gregory AL, Lam JN, Binder RL, Sullivan GR. Utility of decision support tools for assessing acute risk of violence. J Consult Clin Psychol. 2003;71:945-53.

Diagnostic and Statistical Manual of Mental Disorders. 2000.

Del-Ben CM, Vilela JA, Crippa JAS, Hallak JEC, Labate CM, Zuardi AW. Reliability of the Structured Clinical Interview for DSM-IV - Clinical Version translated into Portuguese. Rev Bras Psiquiatr. 2001;23:7-10.

Oliver PC, Crawford MJ, Rao B, Reece B, Tyrer P. Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behavior: a reliability study. J Appl Res Intellect Disabil. 2007;20:368-72.

Telles LE de B, Folino JO, Taborda JGV. Incidência de conduta violenta e antissocial em população psiquiátrica forense. Rev Psiquiatr Rio Gd Sul. 2009;33:3-7.

Telles LE de B, Folino JO, Taborda JGV. Accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil. Int J Law Psychiatry. 2012;35:427-31.

Dumais A, Potvin S, Joyal C, Allaire J-F, Stip E, Lesage A. Schizophrenia and serious violence: a clinical-profile analysis incorporating impulsivity and substance-use disorders. Schizophr Res. 2011;130:234-7.

Mcdermott BE, Quanbeck CD, Busse D, Yastro K, Scott CL. The accuracy of risk assessment instruments in the prediction of impulsive versus predatory aggression. . 2008;777:759-77.

O'Shea LE, Mitchell AE, Picchioni MM, Dickens GL. Moderators of the predictive efficacy of the Historical, Clinical and Risk Management-20 for aggression in psychiatric facilities: Systematic review and meta-analysis. Aggress Violent Behav. 2012;18:255-70.

Ho H, Thomson L, Darjee R. Violence risk assessment: the use of the PCL-SV, HCR-20, and VRAG to predict violence in mentally disordered offenders discharged from a medium secure unit in Scotland. J Forens Psychiatry Psychol. 2009;20:523-41.

Dolan M, Blattner R. The utility of the Historical Clinical Risk-20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security-a UK perspective. BMC Psychiatry. 2010;10:76.

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