27-03-2013
The impact of many health disorders confers poor quality of life. The resulting conditions could hamper many routine activities making the individual become secluded from societal interactions. To say, this effect severely worsens the physical and psychosocial aspects of life. Very often, the outcome of such disorders could become a problematic issue to the society especially when the affected individual’s behavior goes abnormal. In adverse cases, the outcome would be more probably a violence or aggressive behavior. There is a need to develop awareness about disorders that may contribute or be more likely associated with violence. In such, context, the present description is concerned with highlighting about mental illness and violence.
In the modern day society, mental illness and violence are reported to be firmly associated. They tend to build a hard stigma and even present an unacceptable scenario for psychiatrists. This makes the society develop a kind of negative perception about such individuals and finally make them discriminated and isolated from the society (Rueve & Welton, 2008). In pshychiatry practice, violence is an emerging health care issue. Many aggressive patients who approach at emergency departments enable psychiatrists being called on to assess and treat the condition. Say, in American hospitals, ever year thousands of assaults related to psychiatric units and emergency rooms were reported to occur. These events finally make such workplaces labeled as occupationally hazardous (Rueve & Welton, 2008).
A psychiatrist could receive nearly 48 % of patient induced physical assaults during his or her career and 50% of psychiatry residents are more likely to be attacked by a patient phsycially
during their four-year training program. Profiles of such patient could indicate particular challenges to be met with regard to diagnosis and treatment of psychiatric disorders.
and their violent presentations, as the mental health provider is asked to identify potentially dangerous individuals and to intervene to reduce risk. The connection between mental illness and violence or vice versa is an essential feature to understand. It was reported that children with a family history of antisocial personality disorder take admissions in stable or pathologic or disturbed adoptive homes (Rueve & Welton, 2008). They were mostly found with conduct disorder and increased rate of aggression which could indicate that violence has both environmental and genetic components. Similarly, in younger middle class children with bullying behavior, a concordance rate for monozygotic twins of 0.72 and for dizygotic twins of 0.42 was observed in contras to the general population. This indicated a genetic variation. An significant association was reported between increased levels of hostility in schizophrenic patients and polymorphism in the catechol O-methyltransferase gene on chromosome 22q (Rueve & Welton, 2008).
So, an aggressive phenotype in people could likely occur when several genes could act in a coordinated fashion which reflects polygenetic phenomenon. In patients with impulsive aggressive behavior, an abnormal coding of tryptophan hydroxylase, a rate-limiting enzyme in serotonin synthesis, was found. This could indicate that the linke between mental health and violence is influenced by biochemical defects (Rueve & Welton, 2008). In a pathological model of aggression Studies have shown the involvement of neurotransmitters. Here, a metabolite of serotonin, 5-hydroxyindoleacetic acid (5-HIAA), was reported to exist in low amounts in cerebrospinal fluid (CSF) in psychiatric patients who had a high interntion of committing aggressive acts. This inverse relationship between lifetime history of aggression and 5-HIAA concentrations was aso observed in patients with personality-disorders (Rueve & Welton, 2008).
This link was also observed in populations who constitute arsonists, impulsive murderers, arsonists, suicidal patients and those who had committed infanticide.
In a study it was reported that in people with co-occurring substance abuse and/or dependence ,severe mental illness could be significantly responsible for their higher incidence of violence (Elbogen & Johnson, 2009). It was mentioned that future violence was not solely predictable by severe mental illness. But in fact due to the involvement of other characteristics like a) historical - physical abuse, juvenile detention, past violence, parental arrest record b) clinical- perceived threats and substance abuse, c) dispositional – age, sex, income and d) contextual – victimization, unemployment and recent divorce (Elbogen & Johnson, 2009). These factors were in majority supported by the patients with severe mental illness.So, this may indicate that the connection between mental disorder and violent acts could necessitate a through awareness of variables like history of violence, environmental stressors and substance abuse (Elbogen & Johnson, 2009).
Further, high dopamine secretion characteristic of mesolimbic dopamine pathways could increase irritability and subsequent aggression. Individuals who take drugs that induce enhanced norepinephrine activity in the central nervous system (CNS) could also lead to increased aggression. Neuroimaging investigations have shed light on the involvement of certain regions and circuitry of brain in impulsive and predatory types of violence and aggression
(Rueve & Welton, 2008).
In violent individuals, variations in positron emission tomography (PET) and
in violent individuals were correlated with deficits in either prefrontal or frontal functioning. This indicated difficulties in performing executive functions and perceiving a stimulus as threatening or safe from the environement. Similarly, in subjects who committed homicide reduced levels of glucose metabolism indicating that the ventral prefrontal cortex could be involved in controlling impulsive urges, including aggressive behavior
(Rueve & Welton, 2008).
Structural magnetic resonance imaging (MRI) revealed that violent behavior was linked with various cortical region thinning, that varied differed in the schizophrenic and antisocial patients and schizophrenic patients in contrast to control groups. Research has reported key associations between violent behavior and some medical conditions and this should be considered as an exclusion criterion to consider subjects for aggression (Rueve & Welton, 2008). Say, nearly, 70% of patients with brain injury, regarded next to blunt trauma, present aggression and irritability and aggression. Like wise, cerebrovascular accidents, neoplasms or malformations, trauma, infections that collectively reflect intracranial pathology and several kinds of degenerative diseases could develop as affective, delirious or psychotic syndromes that accompany violent behaviors in people (Rueve & Welton, 2008).
Metabolic conditions like Cushing’s disease, or estrogen or estrogen dysregulation, thyroid storm were reported to have a link with aggression. Environmental toxins, adverse effects of drugs, systemic infections could contribute to violence.Aggressive symptoms could manifest due to complex partial seizures and it was reported that patients found with aggression who had temporal lobe foci on abnormal EEGs, anticonvulsants are recommended for treatment. Hence, research findings suggest that emergency evaluation of a violent patient must be focused on complete history and physical examination to find the precise medical cause of the behavior (Rueve & Welton, 2008).
Various policy measures taken by the government organizations or federal agencies could help in the efficient management of the mentally ill people .For example, Canadian Mental Health Association is the potential body in addressing every aspect of mental illness (Public Policy, 2013). They facilitate and advocate via robust associations with, policymakers, mental health consumers, their families, stakeholders, the media, educators and other service providers. Their support is more centered on peer and family support, basic principles of empowerment, active involvement in decision-making and citizenship (Public Policy, 2013).
According to World Health Organization (WHO), the prevention of violence needs increased societal efforts (Prevention of mental disorders, 2004). But mental health professionals could able to improve the negative consequences of mental illnesses by establishing certain preventive measures and by providing their humanitarian support much mental health friendly. This was reported to be accomplished by evidence-based prevention programs (Prevention of mental disorders, 2004).The most efficient preventive strategy to decrease the risk of aggression and conduct disorders is to focus on enhancing the prosocial behavior and social competence of children, parents, teachers and peers. Further, universal interventions could improve conduct problems when implemented at schools based. These involve multimodal strategies, enhancing child social skills and classroom behavior management (Prevention of mental disorders, 2004).
Multimodal strategies focus on interventions across settings or within the school setting
like the associating a school-based child social skill intervention with parent management training program. The outcome of this measure was low rates of conduct problems , theft, vandalism and theft. Child social skills programmes provides cognitive skills in children to hep them cope with difficult social circumstances. This may include empathy, listening, empathy and
anger management .This approach minimized conduct problems as reported by children and teachers (Prevention of mental disorders, 2004). Classroom behavior management approach could support children in meeting their classroom social demands via motivation of desired behaviors and discouragement of undesired behaviors. This approach lessened aggression, disruptive behavior, and improved children teacher relationship. Other programs like selective interventions created for different settings could help in eliminating conduct problems. Indicated intervention programs also help in preventing conduct disorder by focusing on children particularly identified by parents or teachers as clearly exhibiting significant conduct problems (Prevention of mental disorders, 2004).
Therefore, it can be concluded that mental illnesses and violence appear to pose a threat to individuals especially of younger age or school children. The resulting outcome seems to be influenced by genetic, biochemical and environmental factors. However, policy solutions implemented on evidence based approach could be of great help in decreasing conduct or aggressive behavior.
References
Elbogen, E.B., & Johnson, S.C (2009). The intricate link between violence and mental disorder:
results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch
Gen Psychiatry, 66, 152-61
Prevention of mental disorders. (2004). Retrieved 26, April 2013 from
http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
Public Policy.(2013). Retrieved 26 April 2013 from
http://www.cmha.ca/public-policy/
Rueve, ME & Welton, RS.(2008).Violence and Mental Illness.
Psychiatry (Edgmont), 5, 34–48.
