JAMA Psychiatry: Violence Topic Collection

The Relationship Between Delusions and Violence Findings From the East London First Episode Psychosis Study Relationship Between Delusions and Violence

Coid JW, Ullrich S, Kallis C, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Psychotic persons who are violent often explain their violence as being due to delusions. However, research has failed to confirm associations between delusions and violent behavior.

Objectives

To investigate which delusional beliefs and characteristics are associated with violent behavior during a first episode of psychosis and whether these associations are mediated by affect due to delusions.

Design

Population-based epidemiological survey of first-episode psychosis during a 2-year study period.

Setting

Three inner-city boroughs in East London, England.

Participants

A total of 458 patients with first-episode psychosis who were 18 to 64 years of age.

Interventions

Patients were clinically assessed (using the Schedules for Clinical Assessment in Neuropsychiatry and the Maudsley Assessment of Delusions Schedule) and interviewed about their displaying violent behavior while experiencing psychotic symptoms during the 12-month period prior to interview.

Main Outcome Measures

Violence was classified at 2 levels of severity: minor and serious violence.

Results

The prevalence of violence was 38% during the 12-month period, and 12% of the sample engaged in serious violence. Distinct sets of demographic and comorbid risk factors were associated with minor and serious violence. These were adjusted for in subsequent analyses. Anger was the only affect due to delusions that was positively associated with violence. The population-attributable risk percentage was 30.8% for minor violence and 55.9% for serious violence. A small number of uncommon delusional beliefs demonstrated direct pathways leading to minor violence. Three highly prevalent delusions demonstrated pathways to serious violence mediated by anger due to delusional beliefs: persecution (z = 3.09, P = .002), being spied on (z = 3.03, P = .002), and conspiracy (z = 2.98, P = .002).

Conclusions and Relevance

Anger due to delusions is a key factor that explains the relationship between violence and acute psychosis. A subset of delusional beliefs may be causally linked to violence, and certain uncommon beliefs demonstrated a direct association with minor violence. Highly prevalent delusional beliefs implying threat were associated with serious violence, but they were mediated by anger.

Disrupted Reinforcement Learning and Maladaptive Behavior in Women With a History of Childhood Sexual Abuse A High-Density Event-Related Potential Study Disrupted Reinforcement Learning

Pechtel P, Pizzagalli DA. — Wed, 01 May 2013 00:00:00 GMT

Importance

Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major depressive disorder (MDD), and high-risk behaviors. Despite the epidemiological data available, the mechanisms underlying these maladaptive outcomes remain poorly understood.

Objective

We examined whether a history of CSA, particularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in reinforcement learning, and whether such dysfunction is linked to maladaptive behavior.

Design

Participants completed a clinical evaluation and a probabilistic reinforcement task while 128-channel event-related potentials were recorded.

Setting

Academic setting; participants recruited from the community.

Participants

Fifteen women with a history of CSA and remitted MDD (CSA + rMDD), 16 women with remitted MDD with no history of CSA (rMDD), and 18 healthy women (controls).

Exposure

Three or more episodes of coerced sexual contact (mean [SD] duration, 3.00 [2.20] years) between the ages of 7 and 12 years by at least 1 male perpetrator.

Main Outcomes and Measures

Participants' preference for choosing the most rewarded stimulus and avoiding the most punished stimulus was evaluated. The feedback-related negativity and error-related negativity—hypothesized to reflect activation in the anterior cingulate cortex—were used as electrophysiological indices of reinforcement learning.

Results

No group differences emerged in the acquisition of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological differentiation between correct and incorrect responses (relative to controls), and (3) increased activation in the subgenual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with impairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer performance of previously rewarded, but not previously punished, trials.

Conclusions and Relevance

Irrespective of past MDD episodes, women with a history of CSA showed neural and behavioral deficits in utilizing previous reinforcement to optimize decision making in the absence of feedback (blunted “Go learning”). Although our study provides initial evidence for reward-specific deficits associated with CSA, future research is warranted to determine if disrupted positive reinforcement learning predicts high-risk behavior following CSA.

Association of Maternal Exposure to Childhood Abuse With Elevated Risk for Autism in Offspring Autism and Maternal Exposure to Childhood Abuse

Roberts AL, Lyall K, Rich-Edwards JW, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Adverse perinatal circumstances have been associated with increased risk for autism in offspring. Women exposed to childhood abuse experience more adverse perinatal circumstances than women unexposed, but whether maternal abuse is associated with autism in offspring is unknown.

Objectives

To determine whether maternal exposure to childhood abuse is associated with risk for autism in offspring and whether possible increased risk is accounted for by a higher prevalence of adverse perinatal circumstances among abused women, including toxemia, low birth weight, gestational diabetes, previous induced abortion, intimate partner abuse, pregnancy length shorter than 37 weeks, selective serotonin reuptake inhibitor use, and alcohol use and smoking during pregnancy.

Design and Setting

Nurses' Health Study II, a population-based longitudinal cohort of 116 430 women.

Participants

Nurses with data on maternal childhood abuse and child's autism status (97.0% were of white race/ethnicity). Controls were randomly selected from among children of women who did not report autism in offspring (participants included 451 mothers of children with autism and 52 498 mothers of children without autism).

Main Outcome Measures

Autism spectrum disorder in offspring, assessed by maternal report and validated with the Autism Diagnostic Interview–Revised in a subsample.

Results

Exposure to abuse was associated with increased risk for autism in children in a monotonically increasing fashion. The highest level of abuse was associated with the greatest prevalence of autism (1.8% vs 0.7% among women not abused, P = .005) and with the greatest risk for autism adjusted for demographic factors (risk ratio, 3.7; 95% CI, 2.3-5.8). All adverse perinatal circumstances except low birth weight were more prevalent among women abused in childhood. Adjusted for perinatal factors, the association of maternal childhood abuse with autism in offspring was slightly attenuated (risk ratio for highest level of abuse, 3.0; 95% CI, 1.9-4.8).

Conclusions and Relevance

We identify an intergenerational association between maternal exposure to childhood abuse and risk for autism in the subsequent generation. Adverse perinatal circumstances accounted for only a small portion of this increased risk.