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Wetenschappelijk onderzoek 2020

Zondag 13 Juni 2021

De Pompestichting heeft in 2020 verschillende onderzoeken uitgevoerd en afgerond over verscheidene onderwerpen. Zo werd Virtual Reality met betrekking tot agressie regulatie onderzocht, maar ook hoe slaap en trauma invloed kan hebben op agressie bij patienten.


Virtual Reality Aggression Prevention Therapy (VRAPT) versus waiting list control for forensic psychiatric inpatients: A multicenter randomized controlled trial


Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N= 64) or waiting list control group (N= 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility.


Lees het artikel: Klein Tuente, S., Bogaerts, S., Bulten, E., Keulen-de Vos, M., Vos, M., Bokern, H., ... & Veling, W. (2020). Virtual reality aggression prevention therapy (VRAPT) versus waiting list control for forensic psychiatric inpatients: a multicenter randomized controlled trial. Journal of clinical medicine9(7), 2258.


A Comparison of English and Dutch Long-Stay Patients in Forensic Psychiatric Care


Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients.

Aims: To compare the characteristics of representative samples of long-stay patients in England and in the Netherlands in an attempt to draw conclusions on the degree to which the Dutch service model might be relevant to England.

Method: This cross-sectional study explores the relevance of the Dutch service model by comparing the characteristics of representative samples of long-stay patients in England (n = 401) and the Netherlands (n = 102). Descriptive statistics and analyses of differences between groups are presented. The Risk-Need-Responsivity model was used to guide the selection of the study variables and structure the interpretation of the findings.

Results: Compared to their English counterparts, the long-stay Dutch patients were less likely to be diagnosed with schizophrenia, but more likely to have personality disorder and have committed sex offences. The English group were younger at first conviction and at first custodial sentence. The total number of offences and the proportion of violent offenders were similar, but the Dutch HCR-20 scores indicated a significantly higher risk of violence.

Conclusions: Whilst there may be barriers to adopting the Dutch service model in England, the differences in the characteristics of the two groups studied here do not necessarily preclude this approach.

Keywords: forensic mental health, length of stay, long-stay patients with mental illness, mentally disordered offenders (MDOS), service development

Lees het artikel: Senn, D., Bulten, E., Tomlin, J., & Völlm, B. (2020). A comparison of English and Dutch long-stay patients in forensic psychiatric care. Frontiers in Psychiatry11.


Sleep quality is associated with aggression in forensic psychiatric patients, independent of general psychopathology


Several studies found associations between poor sleep quality and aggression in general and (forensic) psychiatric populations. Both poor sleep and aggression have been related previously to general psychopathology, but studies rarely have addressed this possible confounding factor appropriately. The current study aimed to replicate the association between sleep quality and aggression in a forensic psychiatric sample, including adjustment for psychopathology. We used cross-sectional data from an observational study in forensic psychiatric inpatients (n = 166). Poor sleep quality was significantly associated with higher self-reported aggression, independent of general psychopathology. Poor sleep quality accounted for a substantial part of the variance in aggression. This was observed for self-reported physical aggression, verbal aggression, anger, and hostility, all showing relations with poor sleep quality that were not better accounted for by general psychopathology. Poor sleep quality was related to higher clinician-rated hostility as well, however, this association was weak and the explained variance low. These results confirm and substantiate previously found associations between sleep quality and aggression in forensic psychiatric patients. They highlight the importance of targeting sleep problems as part of the treatment of psychiatric patients with disruptive behavior and encourage further research aimed at unraveling the relation between sleep and aggression.


Lees het artikel: Van Veen, M. M., Karsten, J., Verkes, R. J., & Lancel, M. (2020). Sleep quality is associated with aggression in forensic psychiatric patients, independent of general psychopathology. The Journal of Forensic Psychiatry & Psychology31(5), 699-713.


Associations of multiple trauma types and MAOA with severe aggressive behavior and MAOA effects on training outcome


Previous research showed that the disposition to react with disproportionate aggression in adults is influenced by an interaction between a variant in the X-chromosomal monoamine oxidase A gene (MAOA) and early traumatic events. Such studies have often focused on a single type of trauma, whereas we know that experiencing multiple trauma types is associated with more detrimental consequences. The differential susceptibility hypothesis suggests that individuals who are most susceptible to adversity, are also most likely to benefit from supportive experiences in childhood. Differences in susceptibility are thought to be partly genetically driven. In the present study we explored whether a genotype of MAOA linked to lower expression of the gene (MAOA-L) modified the effect of multiple types of trauma on aggression and/or altered responsiveness to treatment among adults with severe aggression. Forensic psychiatric outpatients (FPOs) (N=150) receiving treatment for aggression regulation problems were recruited. Traumatic events and aggression were measured using self-report. FPOs with multiple trauma types and those with the MAOA-L allele reported more severe levels of aggression. No interaction effects between MAOA genotype and trauma emerged. There were no differences in response to the intervention between FPOs with and without the MAOA-L variant, whereas FPOs with a single type of trauma showed the slowest reduction of aggression. FPOs with multiple types of trauma reported the highest levels of aggression over the course of treatment. Future research is needed to elucidate this association in further detail. The current study emphasized the importance of early recognition of early traumatic events.


Lees het artikel: Smeijers, D., Bulten, E., Franke, B., Buitelaar, J., & Verkes, R. J. (2020). Associations of multiple trauma types and MAOA with severe aggressive behavior and MAOA effects on training outcome. European Neuropsychopharmacology30, 66-74.


Threat-Avoidance Tendencies Moderate the Link Between Serotonin Transporter Genetic Variation and Reactive Aggression


The short (S) allele of the serotonin transporter-linked promoter region (5-HTTLPR)
polymorphism has been linked to reactive aggression in men, but this association is less
consistent in females. Reactive aggression has been particularly described as a result of
fear-driven defense to threat, but how this interaction between defensive behavior and
aggression is expressed in S-allele carriers remains unknown. In order to explore this
interplay between 5-HTTLPR genotype, defensive behavior and reactive aggression, we
combined genotyping with objective measures of action tendencies toward angry faces
in an approach-avoidance task (AAT) and reactive aggression in the Taylor aggression
paradigm (TAP) in healthy females, N = 95. This study shows that female S-allele carriers
in general display increased implicit reactive aggression (administering aversive white
noise) toward opponents. Furthermore, we found that threat-avoidance tendencies
moderate the association between 5-HTTLPR genotype and aggression displayed on
the TAP. Together, these findings indicate a positive correlation between avoidance
of angry faces in the AAT and reactive aggression in the TAP exclusively present in
S-allele carriers.


Lees het artikel: Peeters, D. G., Lange, W. G., Von Borries, A. K. L., Franke, B., Volman, I., Homberg, J. R., ... & Roelofs, K. (2020). Threat-avoidance tendencies moderate the link between serotonin transporter genetic variation and reactive aggression. Frontiers in behavioral neuroscience14.


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