Acting on delusions: the role of negative affect in the pathway towards serious violence |
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| Authors: | Simone Ullrich Robert Keers Jenny Shaw Michael Doyle Jeremy W Coid |
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| Institution: | 1. Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London , UK;2. Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London , UK;3. School of Health Sciences, Division of Psychology and Mental Health, University of Manchester , UK |
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| Abstract: | Acting violently on delusions is a significant clinical problem. Recent research has identified state anger as key component in the pathway from persecutory/threat delusions to serious violence. To determine the magnitude of the effect of delusional anger and to investigate a dose-response relationship we carried out a prospective follow-up study of forensic in-patients discharged into the community. Men and women (n = 409) were assessed before/after discharge at 6 and 12 months (Positive and Negative Syndrome Scale, MacArthur Community Violence Interview). No association was found with a content un-specific measure of delusions, thought disorder, hallucinations, grandiosity and violence. Suspiciousness/persecution was significantly associated with both violence and anger. Anger was also associated with violence. Mediation analyses suggested that 84% of the association between suspiciousness/persecution and violence was explained by anger. Key target of interventions should primarily be the anger; treatment of delusional beliefs plays a secondary role in the management of risk. |
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| Keywords: | Paranoid delusions angry affect violence indirect pathway dose-response |
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