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Title: Frontal lobe deficits and anger as violence risk markers for males with major mental illness in a High Secure hospital
Author: O'Hanlon, Anne-Marie
Awarding Body: University of Lincoln
Current Institution: University of Lincoln
Date of Award: 2012
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Prediction of violent recidivism is an essential component of forensic in-patient assessment and treatment. The significant impact of violent recidivism upon individual victims, families and our wider society is clear. In addition, high numbers of re-admission, coupled with potential for prolonged periods of detention following revision of the Mental Health Act, present high financial costs to already limited High Secure services. With unacceptable levels of post discharge violent crime reported, increasing demand is seen for the identification of valid and reliable violence risk markers. However, recent violence risk research appears to have moved towards community follow-up studies, which hold limited utility for improvement of in-patient assessment and treatment. As such, this study set out to conduct violence risk marker research with males with Major Mental Illness in a High Secure hospital. Consideration of the existing violence risk marker research revealed positive yet inconsistent findings with regard to anger and neglect surrounding the study of frontal lobe deficits. The utility of two measures of frontal lobe ability, specifically related to reasoning and decision-making, in addition to anger expression and control, were investigated as violence risk markers for patients with Major Mental Illness. 39 male adult in-patients were assessed using the Wisconsin Card Sorting Test (WCST), the Iowa Gambling Task (IGT) and the second edition of the State-Trait Anger Expression Inventory (STAXI-2). Finally, participants’ scores on the Violence Risk Scale (VRS) were used to quantify predicted risk of violent recidivism. It was hypothesised that poorer performance on the frontal lobe measures, higher anger expression index scores and lower anger control scores, would be associated with higher violence risk scores. In addition, it was hypothesised that poorer performance on the frontal lobe measures would be associated with poorer outward anger control. Finally, it was hypothesised that these frontal lobe and anger variables would be found to be significant predictors of violence risk score. Correlational analysis revealed that the Anger Control-Out and Anger Expression indices from the STAXI-2, as well as WCST total score, significantly correlated with Violence Risk Scale score in the hypothesised directions. Following linear multiple regression, WCST total score and the Anger Control-Out index score were found to significantly and independently contribute to the subsequent Violence Risk Scale predictive model [F(2, 36)=8.175, p <.01]. Discussion embeds these findings within the context of previous literature. Strengths and limitations of this study are discussed, as well as suggestions made for future research directions. Recommendations are made for new frontal lobe screening procedures, as well as the modification or refinement of existent treatments. Finally, an extended paper is presented in complement to the journal paper. This contains additional information relating to the research context which was beyond the scope of the journal paper. Extended methodological factors are addressed, with additional findings provided. This extended paper concludes with further discussion offered and a reflective commentary drawing focus upon the research process. Examples of materials used within the study and evidence of ethical approval can be found within the appendices of this portfolio.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: C840 Clinical Psychology