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Frontal Lobe Deficits and Anger As Violence Risk Markers for Males with Major Mental Illness in a High Secure Hospital

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Frontal Lobe Deficits and Anger As Violence Risk Markers for Males with Major Mental Illness in a High Secure Hospital Frontal Lobe deficits and Anger as violence risk markers for males with Major Mental Illness in a High Secure Hospital University of Lincoln Faculty of Health, Life and Social Sciences Doctorate in Clinical Psychology Doctorate in Clinical Psychology 2012 Anne-Marie O’Hanlon, MSc; BSc. Submitted in part fulfilment of the requirements for the Doctorate in Clinical Psychology Acknowledgements Primary thanks are reserved for Dr Louise Braham owing to her guidance and supervision throughout this research project. Her support, dedication and enthusiasm towards this study provided on-going encouragement. Thanks are given to further staff members from the Trent Doctorate Course in Clinical Psychology for their feedback in relation to this research, particularly, Dr Mark Gresswell, Dr Roshan das Nair, Dr David Dawson, Dr Aidan Hart and Dr Nima Moghaddam. The staff team within the hospital’s Mental Health Directorate are also thanked. This includes Responsible Clinicians who assisted with recruitment, David Jones and his team for providing support and supervision during completion of the VRS assessments, as well as administrative and nursing staff, who made conduction of this study possible. Gratitude is further extended to John Flynn for providing support and advice with regard to data analysis. It is recognised that this study would not have been possible without advice and agreement from; the Hospital’s Clinical Director of Mental Health, the University of Lincoln Ethics Committee, Nottingham Research Management and Governance Committee, as well as Nottingham Research Ethics Committee 1. Table of Contents Portfolio Abstract ....................................................................................... 1 Statement of Contribution ........................................................................... 3 Systematic Review ..................................................................................... 4 Abstract ................................................................................................. 5 Introduction ........................................................................................... 6 Violence .............................................................................................. 6 Violence Risk Measurement ................................................................... 9 Anger ................................................................................................ 10 Anger and Violence ............................................................................. 10 Methodology ......................................................................................... 12 Inclusion and Exclusion Search Criteria ................................................. 12 Electronic Pilot Searches ...................................................................... 18 Searching Other Resources .................................................................. 25 Results ................................................................................................ 27 Description of Studies ......................................................................... 36 Participant Demographics .................................................................... 36 Methodological Differences .................................................................. 37 Discussion ............................................................................................ 39 Findings ............................................................................................ 39 Methodological Issues ......................................................................... 40 Temporal factors ................................................................................ 41 Mixed Gender Assessments .................................................................. 43 Violence Typology ............................................................................... 43 Conclusions .......................................................................................... 44 Implications for practise ...................................................................... 44 Future Research ................................................................................. 45 Limitations of review ........................................................................... 46 References ........................................................................................... 48 Journal Paper .......................................................................................... 56 Abstract ............................................................................................... 57 Introduction ......................................................................................... 58 Anger ................................................................................................ 60 Anger and Violence ............................................................................. 61 Frontal Lobe Deficits and Violence ........................................................ 62 Anger and Frontal Lobe Deficits ............................................................ 65 Violence Risk Measurement ................................................................. 65 Violence Risk Markers ......................................................................... 66 Methodology ......................................................................................... 69 Design .............................................................................................. 69 Independent Variables ........................................................................ 73 Dependent Variable ............................................................................ 76 Data Analysis ..................................................................................... 77 Results ................................................................................................ 78 Normality of the data and Inter-rater reliability ...................................... 78 Correlations ....................................................................................... 78 Decision-making and Violence Risk ....................................................... 79 Decision-making and Anger ................................................................. 79 Anger and Violence Risk ...................................................................... 80 Multiple Regression Analysis ................................................................ 80 Discussion ............................................................................................ 82 Main Findings ..................................................................................... 82 Frontal lobe deficits and violence risk judgements .................................. 83 Frontal Lobe deficits and Anger ............................................................ 86 Anger and Violence Risk Judgements .................................................... 87 Predictor variables of violence risk judgements ...................................... 89 Strengths, Limitations and Future Research ........................................... 90 Conclusion ............................................................................................ 92 References ........................................................................................... 93 Extended Paper ..................................................................................... 103 1.0. Extended Introduction ................................................................... 104 1.1. The social and clinical relevance of this study ................................ 104 1.2. Violence Definition ..................................................................... 105 1.3. Violent Populations ..................................................................... 105 1.4. Major Mental Illness ................................................................... 106 1.5. Aggression dichotomy and inconsistent terminology ....................... 107 1.6. The reformulation of the Frustration–Aggression hypothesis ............ 107 1.7. Anger Experience within Violence ................................................. 108 1.8. Critique of the reactive-instrumental violence typologies ................. 108 1.9. Treatments based upon violence typology ..................................... 110 1.10. The construct of Anger .............................................................. 110 1.11. Anger and Violence ................................................................... 111 1.12. Over-controlled and under-controlled Anger ................................ 112 1.13. In-patient and community violence............................................. 112 1.14. Frontal Lobe Deficits ................................................................. 113 1.15. Frontal Lobe Deficits and Violence .............................................. 114 1.16. Risk, Need and Responsivity ...................................................... 115 1.17. Cognitive Remediation Therapy .................................................. 115 1.18. Anger and Frontal Lobe Deficits.................................................. 116 1.19. Violence Risk Measurement ....................................................... 117 2.0. Extended Methodology .................................................................. 118 2.1. Epistemological position .............................................................
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