Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder. Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial. Aggressive behaviors in the psychiatric emergency service Prevention of aggressive incidents on a closed psychiatric ward. Targeting relational aggression in veterans: the Strength at Home Friends and Family intervention. The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings: report on a pilot study. Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis Demographics, clinical characteristics, and treatment of aggressive patients admitted to the acute behavioral unit of a community general hospital: a prospective observational study. Stimulation of the Prefrontal Cortex Reduces Intentions to Commit Aggression: A Randomized, Double-Blind, Placebo-Controlled, Stratified, Parallel-Group Trial Hostility and violence of acute psychiatric inpatients A Brief Motivational Intervention for Physically Aggressive Dating Couples Neural Correlates of the Propensity for Retaliatory Behavior in Youths With Disruptive Behavior Disorders. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Depression and impulsivity as pathways to violence: implications for antiaggressive treatment. Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial VICARIOUS REINFORCEMENT AND IMITATIVE LEARNING. Asymmetry in the dorsolateral prefrontal cortex and aggressive behavior: A continuous theta-burst magnetic stimulation study
Positive psychotic symptoms , such as threat/"control-override " delusions or comm and hallucinations , have been related to aggression in patients with schizophrenia . However , retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior . In this study , we monitored aggressive behavior and psychopathology prospect ively and in close temporal proximity in 157 treatment-resistant in patients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial . Aggressive behavior was rated with the overt aggression scale ( OAS ) . Psychopathology was assessed using the positive and negative syndrome scale ( PANSS ) . At baseline , subjects who would be aggressive during the study had higher scores on only two PANSS items : hostility and poor impulse control . During the study PANSS positive subscale scores were significantly higher in aggressive subjects . Total PANSS scores were higher within 3 days of an aggressive incident , as were positive and general psychopathology subscale scores . However , in a smaller sub sample for whom PANSS ratings were available within 3 days before aggressive incidents , only scores on the PANSS positive subscale were significantly higher . These findings in chronic , treatment resistant in patients support the view that positive symptoms may lead to aggression BACKGROUND After de-escalation techniques have failed , restraints , seclusion and /or rapid tranquillization may be used for people whose aggression is due to psychosis . Most coercive acts of health care have not been evaluated in trials . METHOD People admitted to the emergency room of Instituto Philippe Pinel , Rio de Janeiro , Brazil , whose aggression/agitation was thought due to psychosis and for whom staff were unsure if best to restrict using physical restraints or a seclusion room  , were r and omly allocated to one or the other and followed up to 14 days . The primary outcomes were ' no need to change intervention early - within 1 h ' and ' not restricted by 4 h ' . RESULTS A total of 105 people were r and omized . Two-thirds of the people secluded were able to be fully managed in this way . Even taking into account the move out of seclusion into restraints , this study provides evidence that embarking on the less restrictive care pathway ( seclusion ) does not increase overall time in restriction of some sort [ not restricted by 4 h : relative risk 1.09 , 95 % confidence interval 0.75 - 1.58 ; mean time to release : restraints 337.6 ( s.d.=298.2 ) min , seclusion room 316.3 ( s.d.=264.5 ) min , p=0.48 ] . Participants tended to be more satisfied with their care in the seclusion group ( 17.0 % v. 11.1 % ) but this did not reach conventional levels of statistical significance ( p=0.42 ) . CONCLUSIONS This study should be replicated , but suggests that opting for the least restrictive option in circumstances where there is clinical doubt does not harm or prolong coercion Introduction : Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and , on event prediction , using behavior-based clinical rating scales . Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification . Methods : We used a prospect ively acquired data base of over 20,900 visits to four services in the province of Quebec , Canada , over a two-year period from September 2002 onwards . A maximum of 72 variables could be acquired per visit . Visits with aggression ( any verbally or physically intimidating behavior ) , both present and past , were tagged . Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression . Results : About 7 % of visits were marked by current aggression ( verbal 49 % , physical 12 % , verbal and physical 39 % ) . Including visits with a “ past only ” history of aggression increased this number to 20 % . Variables associated with aggression were gender ( male ) , marital status ( single/separated ) , education ( high school or less ) , employment ( none ) , judicial history ( any type ) , substance abuse ( prior or active ) , medication compliance ( poor ) , type of arrival to psychiatric emergency services ( involuntary , police , judiciary , l and lord ) , reason for referral ( behavioral dyscontrol ) , diagnosis ( less frequent in anxiety disorders ) , and outcome ( more frequently placed under observation or admitted ) . Conclusion : Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service . Although their sum may not add up to a specific patient profile , they can nevertheless be useful in service planning , being easily integrated alongside state-dependent rating scales in a triage and /or observation instrument for daily use in the psychiatric emergency service OBJECTIVE This study examined whether staff members ' use of interventions for preventing patients ' aggression  reduced the number of incidents of aggression on a closed acute admissions ward of a psychiatric hospital in the Netherl and s. METHODS The number and severity of incidents of aggression on three closed wards were measured using the Dutch version of the Staff Observation Aggression Scale ( SOAS ) . Measurements were made for three months before and after staff implemented interventions for preventing aggression on one of the wards . Interventions included a protocol for talking to patients who exhibited aggressive behavior , discussing treatment goals with the patient shortly after admission , explaining why the ward 's door was locked and the exit rules , providing a schedule of staff meetings to explain staff members ' absence from the ward , and clarifying the procedure for making an appointment with the psychiatrists . RESULTS The frequency of aggressive incidents was reduced on all three wards , with no significant difference between the ward where the interventions were implemented and the two control wards . A marginally significant difference in the severity of aggressive incidents was found between experimental and control wards after the introduction of the preventive measures , with incidents in the experimental ward tending to be less severe . CONCLUSIONS This study failed to find a robust effect of specific intervention measures on aggressive incidents . However , it did find evidence suggesting that st and ardized reporting by staff of aggressive incidents on closed psychiatric wards may in itself result in straightforward reduction of violent incidents OBJECTIVE We evaluated the effectiveness of Strength at Home Friends and Families ( SAH-F ) , a dyadic group intervention to prevent relational aggression and its negative consequences , in a community-based sample of service members/veterans and significant others who reported relational difficulties . METHOD Participants included 70 veterans and their loved ones . Recruitment was conducted from October 2010 through March 2012 . Participants completed an initial assessment that included measures of relational aggression and functioning , depressive symptoms , and posttraumatic stress disorder ( PTSD ) symptoms . Participants were enrolled in the 10-week SAH-F targeting social information-processing mechanisms hypothesized to underlie the relationship between trauma and aggression and were reassessed at program completion and 3 months after intervention . RESULTS Significant reductions in psychological aggression were seen both at program completion and at 3-month follow-up for both veterans ( st and ardized mean gain effect size [ ESsg ] = -0.45 , P < .05 ) and significant others ( ESsg = -0.30 , P < .05 ) . Perpetration of physical aggression remained low after pretreatment and did not increase . Relationship adjustment reported by significant others , but not veterans , indicated a significant improvement from pretreatment to program completion ( ESsg = 0.33 , P < .05 ) . Significant ( P < .05 ) decreases in depressive symptoms were observed from pretreatment to program completion for veterans ( ESsg = -0.30 , P < .05 ) and significant others ( ESsg = -0.55 , P < .05 ) , and significant decreases in PTSD symptoms were observed from pretreatment to follow-up for veterans and significant others ( ESsg = -0.52 , P < .05 ) . CONCLUSIONS Results provide support for the effectiveness of SAH-F in reducing relational aggression in military member/significant other dyads and enhancing relationship quality and mental health Systematic risk assessment and training courses have been suggested as interventions to deal with patient violence in psychiatric institutions . A dual centre prospect i ve feasibility study was conducted on two Swiss psychiatric admission wards to test the hypothesis that such interventions will reduce the frequency and severity of violent events and coercion . A systematic aggression risk assessment , in combination with a st and ardized training course in aggression management was administered and the frequency and severity of aggressive incidents and the frequency of coercive measures were registered . The incidence rates of aggressive incidents and attacks showed no significant reduction from the baseline through risk prediction and staff training , but the drop in coercive measures was highly significant . A ' ward effect ' was detected with one ward showing a decline in attacks with unchanged incidence rates of coercion and the other ward showing the opposite . The severity of the incidents remained unchanged whilst the subjective severity declined after the training course . We conclude that a systematic risk assessment and a training course may assist in reducing the incidence rate of coercive measures on psychiatric acute admission wards . Further testing of the interventions is necessary to measure the effect of the training alone and to counteract ' ward effects ' This study aim ed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis . We prospect ively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period ( n = 157 ) . We used the Modified  Overt Aggression Scale  to retrospectively assess aggression ( a hostile or destructive mental attitude , including verbal aggression , physical aggression and /or violence ) and  violence  ( the exercise of physical force ) , blind to diagnosis . One in three patients with psychosis was aggressive at the time of presentation . One patient in 14 engaged in violence that caused , or was likely to cause , injury to other people . Aggression was independently associated with drug misuse ( odds ratio ( OR ) 2.80 , 95 % confidence interval 1.12 - 6.99 ) and involuntary admission status ( OR = 3.62 , 95 % CI 1.45 - 9.01 ) . Violence in the week prior to presentation was associated with drug misuse ( OR = 2.75 , CI 1.04 - 7.24 ) and involuntary admission status ( OR = 3.21 , CI 1.21 - 8.50 ) . Violence in the week following presentation was associated with poor insight ( OR 2.97 , CI 1.03 - 8.56 ) and pre-contact violence ( OR 3,82 , CI 1.34 - 10.88 ) . In patients with schizophrenia , violence in the week following presentation was associated with drug misuse ( OR = 7.81 , CI 1.33 - 45.95 ) and high psychopathology scores ( OR = 20.59 , CI 1.66 - 254.96 ) . Overall , despite a high rate of verbal aggression , physical violence towards other people is uncommon in individuals presenting with first episode psychosis OBJECTIVE Aggressive patients are not uncommon in acute inpatient behavioral health units of general hospitals . Prior research identifies various predictors associated with aggressive inpatient behavior . This prospect i ve observational study examines the demographic and clinical characteristics of aggressive in patients and the routine medications these patients were receiving at discharge . METHOD Thirty-six adults diagnosed with a DSM-IV mental disorder who met 2 of 6 established inclusion criteria for high violence risk and a Clinical Global Impressions-Severity of Illness ( CGI-S ) scale score ≥ 4 were observed for a maximum of 28 days on the 23-bed case mix acute behavioral health unit of St Luke 's University Hospital , Bethlehem , Pennsylvania , from January 2012 to May 2013 . Primary outcome measures were the Modified Overt Aggression Scale ( MOAS ) and CGI-S ; secondary measures were symptom outcome measures and demographic and clinical characteristics data . Analysis was conducted using repeated measures methodology . RESULTS Younger males with a history of previous violence , psychiatric admissions , and symptoms of severe agitation were more at risk for aggressive behavior . Positive psychotic symptoms , a diagnosis of bipolar disorder , substance use , and comorbid personality disorders also increased risk . Significant improvements from baseline to last visit were observed for the CGI-S and MOAS ( P < .001 for both ) , with a significant correlation between the MOAS and CGI-S at last visit ( P < .001 ) . Only the symptom of agitation was significantly correlated to MOAS scores at both baseline and last visit ( P < .001 ) . CONCLUSION Patients significantly improved over time in both severity of illness and level of aggression Although prefrontal brain impairments are one of the best-replicated brain imaging findings in relation to aggression , little is known about the causal role of this brain region . This study tests whether stimulating the dorsolateral prefrontal cortex using transcranial direct current stimulation ( tDCS ) reduces the likelihood of engaging in aggressive acts , and the mechanism underlying this relationship . In a double-blind , stratified , placebo-controlled , parallel-group , r and omized trial , 81 human adults ( 36 males , 45 females ) were r and omly assigned to an active ( N = 39 ) or placebo ( N = 42 ) condition , and then followed up 1 d after the experiment session . Intentions to commit aggressive acts and behavioral aggression were assessed using hypothetical vignettes and a behavioral task , respectively . The secondary outcome was the perception of the moral wrongfulness of the aggressive acts . Compared with the sham controls , participants who received anodal stimulation reported being less likely to commit physical and sexual assault ( p < 0.01 ) . They also judged aggressive acts as more morally wrong ( p < 0.05 ) . Perceptions of greater moral wrongfulness regarding the aggressive acts accounted for 31 % of the total effect of tDCS on intentions to commit aggression . Results provide experimental evidence that increasing activity in the prefrontal cortex can reduce intentions to commit aggression and enhance perceptions of the moral wrongfulness of the aggressive acts . Findings shed light on the biological underpinnings of aggression and theoretically have the potential to inform future interventions for aggression and violence . SIGNIFICANCE STATEMENT Aggressive behaviors pose significant public health risks . Underst and ing the etiology of aggression is paramount to violence reduction . Investigations of the neural basis of aggression have largely supported correlational , rather than causal , interpretations , and the mediating processes underlying the prefrontal – aggression relationship remain to be well eluci date d. Through a double-blind , stratified , placebo-controlled , parallel-group , r and omized trial , this study tested whether upregulation of the prefrontal cortex reduces the likelihood of engaging in aggression . Results provide experimental evidence that increasing prefrontal cortical activity can reduce intent to commit aggressive acts . They also shed light on moral judgment as one mechanism that may link prefrontal deficits to aggression and , in theory , have the potential to inform future approaches toward reducing aggression Objective The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit . Methods Retrospective analysis of data prospect ively collected in a 6-year period . Results No hostility was observed in 56.1 % , hostility in 40.9 % , and violence in 3.0 % of the admitted cases . Seclusion was never used . Six cases ( 2,5‰ ) required physical restraint . Risk factors associated with violence were younger age , suicidal risk , and diagnosis of schizophrenia . Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder , being single , having no children , lower GAF scores , higher BPRS hostility , SAPS , and CGI scores , lower BPRS anxiety-depression score , higher doses of psychoactive drugs , more frequent use of neuroleptics , diagnosis of mania , personality disorder , substance and alcohol related disorders , no diagnosis of depression . Conclusion The study confirms the low rate of violence among Italian psychiatric in- patients , the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior , the possibility of a no seclusion-no physical restraint policy , not associated either with higher rates of hostility or violence or with more severe drug side effects Motivational interviewing is a brief non-confrontational intervention design ed to enhance motivation to reduce harmful behavior ( Miller and Rollnick 2002 ) . The purpose of this study was to examine the effectiveness of motivational interviewing as a targeted prevention approach for partner aggression in emerging adulthood . Participants were 50 college dating couples between 18 and 25 years old who reported at least one act of male-to-female physical aggression in their current relationships . After completing a 2-hour assessment session , half of all couples were r and omly assigned to a 2-hour individualized motivational feedback session targeting physical aggression and risk factors for aggression . The remaining couples received minimal , non-motivational feedback . Follow-up surveys were conducted 3 , 6 , and 9 months later . Hierarchical linear modeling analyses indicated that , compared to the control condition , the motivational feedback intervention led to reductions in physical aggression and harmful alcohol use and to less acceptance of female psychological aggression and male psychological aggression ( among women only ) . Lagged analyses indicated that changes in physical aggression were predicted by reductions in psychological aggression and by lower acceptance of both male and female psychological aggression . Reductions in physical aggression predicted lower anxiety and greater relationship investment and male relationship commitment over time . These findings suggest that a brief motivational intervention is a useful prevention approach for high-risk dating couples , with benefits to both individual and relationship functioning OBJECTIVE Youths with disruptive behavior disorders ( DBD ) ( conduct disorder and oppositional defiant disorder ) have an elevated risk for maladaptive reactive aggression . Theory suggests that this is due to an elevated sensitivity of basic threat circuitry implicated in retaliation ( amygdala/periaqueductal gray ) in youths with DBD and low levels of callous-unemotional traits and dysfunctional regulatory activity in the ventromedial prefrontal cortex in youths with DBD irrespective of callous-unemotional traits . METHOD A total of 56 youths 10 - 18 years of age ( 23 of them female ) participated in the study : 30 youths with DBD , divided by median split into groups with high and low levels of callous-unemotional traits , and 26 healthy youths . All participants completed an ultimatum game task during functional MRI . RESULTS Relative to the other groups , youths with DBD and low levels of callous-unemotional traits showed greater increases in activation of basic threat circuitry when punishing others and dysfunctional down-regulation of the ventromedial prefrontal cortex during retaliation . Relative to healthy youths , all youths with DBD showed reduced amygdala-ventromedial prefrontal cortex connectivity during high provocation . Ventromedial prefrontal cortex responsiveness and ventromedial prefrontal cortex-amygdala connectivity were related to patients ' retaliatory propensity ( behavioral responses during the task ) and parent-reported reactive aggression . CONCLUSIONS These data suggest differences in the underlying neurobiology of maladaptive reactive aggression in youths with DBD who have relatively low levels of callous-unemotional traits . Youths with DBD and low callous-unemotional traits alone showed significantly greater threat responses during retaliation relative to comparison subjects . These data also suggest that ventromedial prefrontal cortex-amygdala connectivity is critical for regulating retaliation/reactive aggression and , when dysfunctional , contributes to reactive aggression , independent of level of callous-unemotional traits BACKGROUND Little information exists on treatment effectiveness in antisocial personality disorder ( ASPD ) . We investigated the feasibility and effectiveness of carrying out a r and omized controlled trial of cognitive behaviour therapy ( CBT ) in men with ASPD who were aggressive . METHOD This was an exploratory two-centre , r and omized controlled trial in a community setting . Fifty-two adult men with a diagnosis of ASPD , with acts of aggression in the 6 months prior to the study , were r and omized to either treatment as usual ( TAU ) plus CBT , or usual treatment alone . Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse , mental state , beliefs and social functioning . RESULTS The follow-up rate was 79 % . At 12 months , both groups reported a decrease in the occurrence of any acts of verbal or physical aggression . Trends in the data , in favour of CBT , were noted for problematic drinking , social functioning and beliefs about others . CONCLUSIONS CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study . However , the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression , alcohol misuse and improving social functioning and view of others . It is feasible to carry out a rigorous r and omized controlled trial in this group BACKGROUND Difficulties with affect regulation and impulse control have a strong influence on violence . The objective of this study was to determine whether baseline depression and impulsivity predict aggression and whether they predict differential response to antiaggressive treatment . This is important , as we lack knowledge as to the selection of antipsychotics for the treatment of aggression . METHODS Physically aggressive in patients with schizophrenia who received an evaluation of depression and impulsivity at baseline were r and omly assigned in a double-blind , parallel group , 12-week trial to clozapine , olanzapine , or haloperidol . Trait impulsivity was measured by the Barratt Impulsiveness Scale ; depression by the Positive and Negative Syndrome Scale Depression factor . The number and severity of aggressive events , as measured by the Modified Overt Aggression Scale ( MOAS ) , were the outcome measures . RESULTS Baseline depression and impulsivity predicted higher levels of aggression , as measured by the MOAS total score , over the 12-week treatment period across all 3 medication groups . In addition , there was a strong interaction effect between baseline depression/impulsivity and medication grouping in predicting MOAS score . In particular , when higher depression and impulsivity were present at baseline , patients on haloperidol presented with more aggression than patients on the other 3 medications . CONCLUSIONS Depression and impulsivity are important predictors of aggression and of differential response to antiaggressive treatment . This is most likely due to the medications ' dissimilar neurotransmitter profiles . By identifying patients who will respond better to a given medication , we will be able to develop individualized strategies for the treatment of violent behavior Background : Post-traumatic stress disorder ( PTSD ) with co-occurring severe psychopathology such as borderline personality disorder ( BPD ) is a frequent sequel of childhood sexual abuse ( CSA ) . CSA-related PTSD has been effectively treated through cognitive-behavioural treatments , but it remains unclear whether success can be achieved in patients with co-occurring BPD . The aim of the present study was to determine the efficacy of a newly developed modular treatment programme ( DBT-PTSD ) that combines principles of dialectical behaviour therapy ( DBT ) and trauma-focused interventions . Methods : Female patients ( n = 74 ) with CSA-related PTSD were r and omised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list . About half of the participants met the criteria for co-occurring BPD . Individuals with ongoing self-harm were not excluded . The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale ( CAPS ) and by the Posttraumatic Stress Diagnostic Scale ( PDS ) . Hierarchical linear models were used to compare improvements across treatment groups . Assessment s were carried out by blinded raters at admission , at end of treatment , and at 6 and 12 weeks post-treatment . Results : Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS ( 33.16 vs. 2.08 ) and the PDS ( 0.70 vs. 0.14 ) . Between-group effect sizes were large and highly significant . Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome . Safety analyses indicated no increase in dysfunctional behaviours during the trial . Conclusion : DBT-PTSD is an efficacious treatment of CSA-related PTSD , even in the presence of severe co-occurring psychopathology such as BPD VioLit summary : OBJECTIVE : The intent of this article by B and ura et al. was to explore the effects of vicarious reinforcement on conditioned emotional responses among nursery school children with a particular focus on modeling aggression . METHODOLOGY : The authors employed an experimental design by r and omly assigning 40 boys and 40 girls from the Stanford University Nursery School into one of 2 experimental groups or one of 2 control groups . The mean age of the children was 51 months , with a range between 38 and 63 months . The children witnessed a 5 minute televised program which was either : 1 ) The Aggressive Model-Rewarded condition , in which a man 's aggressive verbal and physical behavior in a play room were accompanied by a sense of victory and mastery over another man and his environment . 2 ) The Aggressive Model-Punished condition , in which a man 's aggressive verbal and physical behavior in a play room ( identical to the scenario in the previous model ) were accompanied by severe punishment . 3 ) The Nonaggressive Model-Control group , in which the objects in the play environment were unchanged , but they were utilized by both characters in vigorous but nonaggressive play . 4 ) The Nonexposure Control group received no exposure to any of the models . The children were then tested for the incidence of postexposure imitative and nonimitative aggressive responses , while observed in an experimental play room . Several objects were available in the play room that could be used to reenact the aggressive behavior ( baton , balls , Bobo dolls , hoola hoop , lasso , dart guns , cars , plastic farm animals ) as well as several objects that tended to elicit predominantly nonaggressive responses ( blackboard , doll house , cotton-stuffed dolls , building blocks ) . Each child spent 20 minutes in the play room , with only a noninteractive adult present ( to ensure the child 's comfort in a strange environment ) , and was rated by a hidden evaluator . Scores were obtained in predetermined categories of aggression which matched either those in the experimental aggressive models ( kicking , lassoing or striking the Bobo doll with a ball or baton , shooting darts at cars or plastic farm animals , or repeating the verbal aggression which was displayed in the models ) or those in predetermined categories of nonmatching aggression ( punching or slapping the Bobo dolls , crashing the automobiles , acting out physical attacks toward the dolls or animals , etc . ) . A second rater witnessed 11 of the 80 children to provide an estimate of interrater reliability , and neither rater had knowledge of the treatment conditions to which the children had been exposed . The interscorer reliabilities were high , with product-moment coefficients in the .90s . After the rating each child was asked to discuss the behavior of the characters in the program and to identify the characters he or she preferred to emulate . FINDINGS / DISCUSSION : Many of the children , especially the girls , received low imitation scores and therefore nonparametric techniques were employed to evaluate the significance of the differences which were obtained . Results from the Kruskal-Wallis analysis of variance indicated that imitation was significantly influenced by response-consequences to the model ( rewarded versus punished p AUTHORS ' RECOMMENDATIONS : Additional research , argued the authors , should be implemented in which the difference between performance and learning can be better assessed , in order to identify the depth of impact from the vicarious transmission , rather than the just behavioral manifestation of the vicarious transmission . ( CSPV Abstract - Copyright © 1992 - 2007 by the Center for the Study and Prevention of Violence , Institute of Behavioral Science , Regents of the University of Colorado ) KW - California KW - Early Childhood KW -  Child Aggression KW - Preschool Student KW - Reward KW - Punishment KW - Social Learning KW - Aggression Causes KW - Imitation Language : Aggressive behavior is aim ed at causing damage or pain to another individual . Aggression has been associated with structural and functional deficits in numerous brain areas , including the dorsolateral region of the prefrontal cortex ( DLPFC ) , typically related to inhibition and impulse control . In this study , we used inhibitory continuous theta-burst magnetic stimulation ( cTBS ) to explore the role of the right and left DLPFC in aggression . Sixteen healthy right-h and ed volunteers underwent two sessions involving r and om , real and sham , right and left DLPFC stimulations . These sessions were followed by the Social Orientation Paradigm ( SOP ) , a monetary task that was specially design ed to assess participants ' aggressive tendencies by measuring the patterns of their reactive aggression ( a response to a perceived provocation ) and proactive aggression ( an aggressive act with goal -oriented purpose s ) . Results indicate that using cTBS to target the left DLPFC was associated with a greater increase in aggressive responses than right DLPFC stimulation . This pattern of results was found for both reactive and proactive types of aggressive reactions . It is concluded that DLPFC asymmetry is involved in modulating reactive and proactive aggression . Our results are in line with recent studies suggesting that the left DLPFC plays a major role in aggressive behavior
Using de-escalation techniques  for people with psychosis induced aggression or agitation appears to be accepted as good clinical practice but is not supported by evidence from r and omised trials .
BACKGROUND Aggression is a disposition , a willingness to inflict harm , regardless of whether this is behaviourally or verbally expressed and regardless of whether physical harm is sustained .
De-escalation is a psychosocial intervention for managing people with disturbed or aggressive behaviour .
Secondary management strategies such as rapid tranquillisation , physical intervention and seclusion should only be considered once de-escalation and other strategies have failed to calm the service user .
OBJECTIVES To investigate the effects of de-escalation techniques in the short-term management of aggression or agitation  thought or likely to be due to psychosis .
It is unclear why it has remained such an under- research ed area .