توسعه مقیاس نظارت برای رفتار پرخاشگرانه (OSAB) برای بستری در بخش روانپزشکی پزشکی قانونی هلندی با اختلال شخصیت ضد اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|37368||2007||12 صفحه PDF||سفارش دهید||6441 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : International Journal of Law and Psychiatry, Volume 30, Issue 6, November–December 2007, Pages 480–491
Abstract The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are “placed at the disposal of the government”. The scale should have the sensitivity to measure changes in the possible determinants of aggressive behavior, such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills. In developing the OSAB 40 items were selected from a pool of 82 and distributed among the following a priori scales: Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent (to aggressive behavior), Sanction (for aggressive behavior) and Social behavior. The internal consistency of these subscales was good, the inter-rater reliability was moderate to good, and the test–retest reliability over a two to three week period was moderate to good. The correlation between the subscales Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent, Sanction was substantial and significant, but the anticipated negative correlation between these subscales and the Social behavior subscale could not be shown. Relationships between the corresponding subscales of the OSAB and the FIOS, used to calculate concurrent validity, yielded relatively high correlations. The validity of the various OSAB subscales could be further supported by significant correlations with the PCL-R and by significant but weak correlations with corresponding subscales of the self-report questionnaires. The Observation Scale for Aggressive Behavior (OSAB) seems to measure aggressive behavior in Dutch forensic psychiatric inpatients with an antisocial personality disorder reliably and validly. Contrary to expectations, a negative relationship was not found between aggressive and social behavior in either the OSAB or FIOS, which were used for calculating concurrent validity.
Introduction Forensic psychiatric inpatients in The Netherlands who are “placed at the disposal of the government” have committed a crime carrying a prison sentence of at least four years. These are offenders for whom a relationship has been established between “deficient mental development or mental disorders” and the crime committed on the basis of examination by a psychiatrist and/or psychologist. In about 75% of the cases the main diagnosis of those inpatients is an antisocial personality disorder on axis II of the DSM-IV and in about 25% of the cases a psychotic disorder on axis I, combined with an antisocial personality disorder on axis II (Van Emmerik, 2001). Cognitive–behavioral therapeutic methods have been increasingly developed and implemented in forensic psychiatric hospitals in The Netherlands in recent years, including Aggression Control Therapy (ACT) for patients with an antisocial personality disorder (Hornsveld, 2004). To evaluate these therapies, there was a need for specifically designed measurement instruments, the psychometric properties of which were understood with the Dutch forensic psychiatric population. Thus, researchers such as Timmerman, Vastenburg, and Emmelkamp (2001) and Brand and Van Emmerik (2001) have published observation scales for inpatients, the Forensic Inpatient Observation Scale (FIOS) and the FP40 respectively. It is advisable to use both self-report questionnaires and observation scales to measure aggressive and social behavior in forensic psychiatric populations (Bech, 1994 and Polaschek and Reynolds, 2001). Forensic psychiatric patients frequently have insufficient insight into their behavior to give accurate reports, although this is tempered by a tendency to provide socially acceptable answers to questions. Observation scales are not affected by these limitations, however they do require expertise and independence on the part of evaluators in the wards (Bech & Mak, 1995). Since the FIOS and FP40 were not available when development of the Aggression Control Therapy began in 2000 (Hornsveld, 2004), a decision was made to construct an observation scale for aggressive behavior in inpatients with an antisocial personality disorder. This scale would have to have the sensitivity to measure changes in “criminogenic” problem behaviors (Andrews & Bonta, 2003), such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills, as they arise in Aggression Control Therapy (Appendix 1). A literature search showed that most observation scales for aggressive behavior have been developed for (chronic) psychotic patients in closed wards of general psychiatric hospitals. One type of scale, such as the Overt Aggression Scale (OAS: Yudofsky, Silver, Jackson, Endicott, & Williams, 1986; MOAS: Kay, Wolkenfeld, & Murrill, 1988), categorizes acts of aggression according to type, i.e. verbal aggression, physical aggression towards objects, physical aggression towards oneself, and physical aggression towards others. Another approach is to view aggressive behavior as part of a behavioral chain, as seen with the Calgary General Hospital Aggression Scale (CGH Aggression Scale: Arboleda-Florez, Crisanti, Rose, & Holley, 1994; SOAS-R: Nijman, 1999), which includes five aspects of aggressive behavior, i.e. provocation, means used by patients, target of aggression, consequences for victims, and measures to stop aggression. Other scales measure both aggressive behavior and social competence (NOSIE: Hafkenscheid, 1991) or mood (MIBS: Evenson & Dong, 1987; SDAS: Wistedt et al., 1990). To evaluate the effect of ACT (Hornsveld, 2004), an observation scale was required that could record the following behaviors: (1) emotions or moods displayed that play a possible mediating role in aggressive behavior (e.g. irritation, anger, anxiety or gloominess); (2) aggressive behavior towards fellow patients (e.g. threats), staff (e.g. abusive language) or oneself (e.g. self-inflicted lacerations); (3) antecedents of aggressive behavior (e.g. restrictive measures); (4) sanctions for the patient as consequences of aggressive behavior (e.g. sent to his room); and (5) prosocial behavior towards fellow patients or staff (e.g. giving constructive criticism or adequately making contact). Further, it had to be possible for group supervisors on the ward to fill out such a scale in a short time without the need for extensive instructions. This article describes the development of the OSAB. In this context, the terms “irritation,” “anger,” and “rage” are understood to mean emotions exhibited in response to a (perceived) provocation, as manifested in behaviors such as staring, talking too loudly, and standing too close to another person. “Anxiety” and “gloominess” are used to refer to moods that last a longer period of time, as can be inferred from behaviors such as restlessness, complaining, and lack of initiative. The term “aggressive behavior” is seen as any form of behavior that is intended to injure someone, physically or psychologically (Berkowitz, 1993); the term violence is used to refer to aggressive behavior where above all physical means are used (Browne & Howells, 1996). Where personality traits are referred to, this is in the context of the “big five” (Hoekstra, Ormel, & de Fruyt, 1996); specifically, antisocial personality disorder refers to the medical–psychiatric classification on axis II of DSM-IV (American Psychiatric Association, 1994).
نتیجه گیری انگلیسی
Results As expected, mutual correlations between the OSAB subscales Irritation/Anger, Anxiety/Gloominess, Aggressive Behavior, Antecedent, and Sanction were high and significant (p < .01). Contrary to expectations, however, negative relationships were not found between aspects of aggressive and social behavior (see Table 3). Table 3. Correlations between the OSAB subscales (n = 90) Subscale Emotion Aggressive behavior Antecedent Sanction Social behavior Irritation/anger Anxiety/gloominess Total Towards institution Towards fellow patients Total Towards staff Emotion Anxiety/gloominess .59⁎⁎ – Aggressive behavior Total .70⁎⁎ .51⁎⁎ – Towards institution .70⁎⁎ .52⁎⁎ .98⁎⁎ – Towards fellow patients .48⁎⁎ .31⁎⁎ .78⁎⁎ .62⁎⁎ – Antecedent .67⁎⁎ .56⁎⁎ .72⁎⁎ .70⁎⁎ .56⁎⁎ – Sanction .68⁎⁎ .49⁎⁎ .69⁎⁎ .66⁎⁎ .57⁎⁎ .62⁎⁎ – Social behavior Total − .10 .08 − .06 − .09 .04 − .09 − .04 – Towards staff − .18 .07 − .14 − .15 − .04 − .20 − .09 .95⁎⁎ – Towards fellow patients .01 .10 − .04 − .00 .13 − .03 .02 .94⁎⁎ .77⁎⁎ ⁎⁎p < .01 (two sided). Table options To examine concurrent validity, the subscales of OSAB and the FIOS were correlated. The OSAB Irritation/Anger and Aggressive Behavior subscales were significantly correlated (p < .01) with the FIOS Oppositional Behavior subscale. There was also a significant correlation between the OSAB Anxiety/Gloominess subscale and the FIOS Distress subscale. Moreover, the OSAB Social Behavior subscale showed a relatively high positive correlation with the FIOS Social Behavior subscale. No significant correlations were found for either the OSAB or FIOS between and the Aggressive and Oppositional Behavior subscales and Social behavior respectively. As shown in Table 4, there was also a significantly negative relationship between the OSAB Aggressive Behavior subscale and the FIOS Social Behavior subscale. Table 4. Correlations between OSAB subscales and FIOS subscales (correlations between two observation scales) Scale Subscale OSAB Emotion Aggressive behavior Social behavior Irritation/anger Anxiety/gloominess OSAB Anxiety/gloominess .56⁎⁎ (168) – Aggressive behavior .81⁎⁎ (168) .46⁎⁎ (168) – Social behavior − .20⁎⁎ (168) − .24⁎⁎ (168) − .11 (202) – FIOS Distress .53⁎⁎ (102) .73⁎⁎ (102) .56⁎⁎ (121) − .29⁎⁎ (121) Oppositional behavior .77⁎⁎ (102) .36⁎⁎ (102) .75⁎⁎ (121) − .06 (121) Social behavior − .31⁎⁎ (102) − .40⁎⁎ (102) − .27⁎⁎ (121) .62⁎⁎ (121) ⁎p < .05; ⁎⁎p < .01 (two sided); the number of subjects is in parentheses. Table options As shown in Table 5, there was a low but positive correlation between the OSAB Irritation/Anger subscale and total score on the PCL-R, PCL-R Factor 1, the NEO-FFI Neuroticism subscale, the ZAV Disposition to anger subscale, and the AVL Anger subscale. Significant but relatively low correlations were found for the OSAB Anxiety/Gloominess subscale with the NEO-FFI Neuroticism subscale and the ZAV Disposition to anger subscale. The OSAB Aggressive Behavior subscale was significantly correlated with PCL-R Total, PCL-R Factor 1, PCL-R Factor 2, the ZAV Disposition to anger subscale, the AVL Total, the AVL Verbal Aggression subscale, and the AVL Anger subscale. Finally, there was a positive but low correlation between the OSAB Social Behavior subscale and the IOA Frequency scale (social skills). In general, the OSAB (observation) subscales were positively but slightly associated with comparable measures in the self-report questionnaires. When items of the OSAB subscale Social behavior were compared with IOA subscales, significant positive correlations were found between corresponding formulated items of the OSAB and of the IOA subscales of Giving your opinion (p < .05) and Making contact (p < .01). Probably, correlations between observation and self-report questionnaires are only significantly positive if there is close concurrence between the description of the items of the scale and of the questionnaire. Table 5. Correlations between the OSAB (observation scale), the PCL-R (structured interview), and self-report questionnaires Measurement instrument Factor or subscale Emotion Aggressive behavior Social behavior Irritation/anger Anxiety/gloominess PCL-R Total .21⁎ (131) −.06 (131) .25⁎⁎ (154) .12 (154) Factor 1 .23⁎ (115) − .06 (115) .17⁎ (137) .11 (137) Factor 2 .17 (115) .01 (115) .18⁎ (137) .15 (137) NEO-FFI Neuroticism .21⁎ (98) .21⁎ (98) .14 (118) − .15 (118) Extraversion − .10 (98) − .16 (98) − .01 (118) .26⁎⁎ (118) Openness − .00 (97) .08 (97) − .03 (117) .29⁎⁎ (117) Agreeableness − .09 (98) .02 (98) − .17 (118) .12 (118) Conscientiousness − .04 (98) − .12 (98) − .03 (118) .18⁎ (118) ZAV Disposition to anger .25⁎ (93) .21⁎ (93) .27⁎⁎ (108) − .10 (108) AVL Total .17 (101) − .00 (101) .20⁎ (120) − .13 (120) Physical aggression .04 (101) − .12 (101) .14 (120) .05 (120) Verbal aggression .19 (101) .05 (101) .22⁎⁎ (120) − .19⁎ (120) Anger .29⁎⁎ (101) .12 (101) .26⁎⁎ (120) − .11 (120) Hostility .09 (101) .03 (101) .08 (120) − .23⁎ (120) NAS Part A .15 (98) .09 (98) .18 (113) − .19 (113) IOA Social anxiety − .03 (90) .07 (90) − .05 (108) − .12 (108) Social skills − .08 (99) − .10 (99) − .00 (118) .22⁎ (118) ⁎p < .05; ⁎⁎p < .01 (two sided). Note: The number of subjects is in parentheses. PCL-R = Psychopathy Checklist-Revised; NEO-FFI = Five Factor Inventory; ZAV = Zelf-Analyse Vragenlijst; AVL = Agressie Vragenlijst; NAS = Novaco Anger Scale; IOA = Inventarisatielijst Omgaan met Anderen.