El color de la devoción Contextualización del fervor religioso

Returning to the questions asked in the 1970’s (Coccozza and Steadman 1978; 1976) it appears that violence prediction has become a scientific possibility given recent developments (Douglas et al. 1999). The overwhelming impression from this review of the violence prediction literature is that there are gains for clinicians in practice if the findings of state of the discipline research are incorporated into everyday clinical practice (Douglas et al. 1999). Exploring the clinical utility of empirically validated research tools in a clinical setting is the first step in incorporating this w ork into clinical practice. Practitioners who work with mentally disordered and violent patients should investigate the predictive powers of a selection of violence risk assessment schemes as an adjunct to good, even ethical (Douglas et al. 1999) clinical practice.

The present research aims to investigate the possibility that a number of risk assessment tools are able to accurately predict violence during the first month of admission for male psychiatric inpatients resident on a secure unit. Bearing in mind the methodological issues in risk assessment research described above a range of predictor variables will be examined using a number of measures. The HCR-20, a

consent to further assessment, a more detailed assessment of a sub-group of this initial sample will explore a range of variables including impulsivity (BIS-lOand EIS), anger (NAS and STAXI) and psychopathy (PCL-R).

In order to ensure good measurement of violence a standardised scale of violence was used (OAS). In order to ensure the measurement of behaviour was continuous the daily clinical record for each patient in the study was reviewed to complete the OAS for any incident occurring during the first month of admission.

All attempts were made to avoid a constricted sample, therefore, as many subjects as possible were recruited. Unfortunately, at the time of recruiting patients only 4 patients of a total of 58 were female, therefore only males at this site were recruited as it was not possible to recruit enough female patients to usefully examine interactions between predictors of violence and gender.

The aim of the study was to determine whether some measures provide good predictions of inpatient violence. A second aim was to examine which measures produce the most useful information when administered to a forensic inpatient sample. The methods of administration include self-report and notes review measures.

Preliminary research questions are as follows:

Is age associated with violence in the first month of admission? Are HCR-20 scores associated with violence during the first month of admission? Specifically, it is predicted that:

• Age on admission will be associated with scores on the Overt Aggression Scale for the first month of admission.

• Scores on the HCR-20 will be associated with scores on the Overt Aggression Scale for the first month of admission

• That the sub-scales of the HCR-20 will independently be associated with scores on the Overt Aggression Scale for the first month of admission

Do particular individual items on the HCR-20 scale have associations with TAS scores on the Overt Aggression Scale for the first month of admission? Specifically, it is predicted that:

• That young age (under 20) at first violent incident will be associated with scores on the Overt Aggression Scale for the first month of admission.

• That problematic substance use will be associated with scores on the Overt Aggression Scale for the first month of admission.

• Early maladjustment will be associated with scores on the Overt Aggression Scale for the first month of admission.

• That violent behaviour prior to admission will be associated with scores on the Overt Aggression Scale for the first month of admission.

• That evidence of a history of unresponsiveness to treatment efforts e.g. refusal of therapeutic opportunities will be associated with scores on the Overt Aggression Scale for the first month of admission.

• Active symptoms of mental illness on admission will be associated with scores on the Overt Aggression Scale for the first month of admission.

For men who choose to complete self-report measures, are there any associations between the scores on these measures with scores on the Overt Aggression Scale for the first month of admission. Specifically, it is predicted that:

Scores on the Psychopathy Checklist -R evised will be associated with scores on the Overt Aggression Scale for the first month of admission.

Scores on the Novaco Anger Scale will be associated with scores on the Overt Aggression Scale for the first month of admission.

Scores on the Speilberger State Trait Anger Inventory will be associated with scores on the Overt Aggression Scale for the first month of admission.

Scores on the Barratt Impulsivity Scale will be associated with scores on the Overt Aggression Scale for the first month of admission.

Self-reported use of amphetamines will be associated with scores on the Overt Aggression Scale for the first month of admission.

Self-reported use of opiates will be associated with scores on the Overt Aggression Scale for the first month of admission.

Self-reported use of alcohol will be associated with scores on the Overt Aggression Scale for the first month of admission.

CHAPTER 2: METHOD

2.1 Overview

A notes review was carried out for 40 male inpatients resident at a North London Psychiatric Hospital. Eighteen of these 40 men consented to complete self-report measures. Participant’s behaviour on the ward was measured during the initial month of hospitalisation. The daily clinical record for each patient was used to collect the information necessary to complete a standardised scale to measure overt aggression. Presence of psychopathy, drug and alcohol use history and historical information were also assessed via a review of intake notes.