Assessing the heterogeneity of aggressive behavior traits: exploratory and confirmatory analyses of the reactive and instrumental aggression Personality Assessment Inventory (PAI) scales.

The heterogeneity of violent behavior is often overlooked in risk assessment despite its importance in the management and treatment of psychiatric and forensic patients. In this study, items from the Personality Assessment Inventory (PAI) were first evaluated and rated by experts in terms of how well they assessed personality features associated with reactive and instrumental aggression. Exploratory principal component analyses (PCA) were then conducted on select items using a sample of psychiatric and forensic inpatients (n = 479) to examine the latent structure and construct validity of these reactive and instrumental aggression factors. Finally, a confirmatory factor analysis (CFA) was conducted on a separate sample of psychiatric inpatients (n = 503) to evaluate whether these factors yielded acceptable model fit. Overall, the exploratory and confirmatory analyses supported the existence of two latent PAI factor structures, which delineate personality traits related to reactive and instrumental aggression.

Development and initial validation of a scale for detecting inconsistent responding on the personality assessment inventory-short form.

The goal of this investigation was the development of an inconsistency scale (ICN-SF) for the personality assessment inventory-short form (PAI-SF). In Study 1, 503 inpatient profiles were randomly assigned to a derivation or cross-validation sample. Ten correlated item pairs were identified using the derivation sample and placed on the ICN-SF. Psychometric properties of the ICN-SF total scores were comparable in the derivation and cross-validation samples. Total ICN-SF scores in both samples were significantly lower than scores obtained from computer-generated random samples. Diagnostic efficiency statistics are reported using multiple cut-off scores at various base rate estimates. ICN-SF scores greater than 8 reasonably balanced sensitivity and specificity rates. This cutoff correctly classified 92% of the random protocols and inaccurately classified 9% of the patient protocols in study 1. In study 2, PAI-SF scores from 627 forensic and civil inpatients produced similar results, effectively identifying cases with elevated scores on the full-form inconsistency scale. Overall the results of both studies suggest that the ICN-SF can aid examiners in assessing for inconsistent responding.

A psychometric evaluation of the Personality Assessment Inventory - short form clinical scales in an inpatient psychiatric sample.

Few studies have assessed the psychometric properties of the Personality Assessment Inventory short-form (PAI-SF) clinical scales, and none have conducted these evaluations using participants from psychiatric inpatient units. The present study evaluated item-level tests of scaling assumptions of the PAI-SF using a large (N=503) clinical sample of participants who completed the PAI during their admission to a psychiatric inpatient unit. Internal consistency reliability was high across scales, and tests of item-scale convergence and discrimination generally confirmed hypothesized item groupings. Scale-level correlations supported unique variance being measured by each scale. Finally, agreement between the PAI short- and full-form scales was found to be high. The results are discussed with regards to scale interpretation.

Forensic and civil psychiatric inpatients: development of the inpatient satisfaction questionnaire.

The present study reports on the development of a measure designed to assess satisfaction with service among civil and forensic psychiatric inpatients. Survey items drawn from a review of existing measures were administered to 427 forensic and 416 civil male psychiatric inpatients. In an effort to develop a reliable and valid measure, a rigorous test development procedure was undertaken involving item and principal components analyses followed by a confirmatory factor analysis of the remaining items. For forensic inpatients, a 14-item questionnaire (Forensic Inpatient Satisfaction Questionnaire; F-ISQ) emerged that addressed four domains of satisfaction: Medication and Treatment, Physical Environment, Telephone Access, and Unit Rules and Procedures. For civil inpatients, an 11-item questionnaire (Civil Inpatient Satisfaction Questionnaire; C-ISQ) included two domains of satisfaction: Needs and Opportunities and Food and Comfort. Strong internal reliability and concurrent validity with other established measures of patient satisfaction were demonstrated.

Psychiatric civil and forensic inpatient satisfaction with care: the impact of provider and recipient characteristics.

INTRODUCTION: The goal of the study was to understand what characteristics of the provider and recipient of psychiatric care on inpatient civil and forensic units impact satisfaction ratings. Specifically, we explored how demographic variables (age, race), psychiatric diagnosis (psychotic, affective, substance-related), and patients' interactions with staff influence satisfaction ratings. MATERIALS AND METHODS: After matching inpatient samples on demographic characteristics, 384 psychiatric inpatients (188 civil, 196 forensic) who completed surveys assessing their satisfaction with care were included in the present study. Demographic variables and psychiatric diagnosis information was gathered from chart reviews and in collaboration with the patients' treatment team. A series of univariate analyses of variance (ANOVAs) were conducted to test main and interaction effects influencing mean satisfaction ratings. RESULTS: While ratings did not differ for recipients' unit type, age, diagnosis, or perceiving a connection with staff, significant differences were found for race and perceiving a problem with staff. Interaction effects emerged for unit type by psychotic diagnosis and race by perceiving a problem with staff. Supplemental analyses also examined how provider and recipient characteristics influenced components of satisfaction. CONCLUSION: Increasing patient satisfaction by targeting more "vulnerable" patients and addressing relations with staff may impact treatment compliance.

Trait impulsivity in a forensic inpatient sample: an evaluation of the Barratt impulsiveness scale.

Impulsivity is a fundamental component of psychopathology and an essential trait to consider when working with forensic populations. Nevertheless, impulsivity has not been widely studied in psychiatric forensic patients. The current study evaluated the use of a self-report measure of impulsivity, the Barratt Impulsiveness Scale (BIS-11), in a sample of 425 male forensic psychiatric inpatients with varying degrees of psychopathology and criminality. Patients also completed a measure of psychopathology, the Personality Assessment Inventory (PAI). Descriptive information and psychometric properties of the BIS-11 are presented. The primary findings were elevated Nonplanning versus Motor and Attentional Impulsiveness, and strong associations between impulsiveness and various psychopathologies. Using principal component analysis, the factor structure of the BIS-11 was also evaluated. Results failed to support the previously identified factor structure of impulsivity. The meaning of the revised scales and utility of the BIS-11 in this population is discussed.

A comparative analysis of North American adolescent and adult mass murderers.

Thirty adult mass murderers and 34 adolescent mass murderers in North America are compared on both offender and offense variables to delineate similarities and differences. Findings indicate a plethora of psychiatric disturbances and odd/reclusive and acting-out personality traits. Predisposing factors include a fascination with weapons and war among many of the adolescents and the development of a "warrior mentality" in most of the adults. Precipitating factors indicate a major rejection or loss in the hours or days preceding the mass murder. Results are interpreted through the lens of threat assessment for targeted violence (Borum, Fein, Vossekuil, & Bergland 1999), recognizing that a fact-based, dynamic behavioral approach is most useful for mitigating risk of such an extremely low-base-rate violent crime.