Interactions of Aggression, Mentalizing, Metacognition and Empathy in a forensic population of persons with a psychotic disorder

Primary Objective:

This study seeks to examine the differences between healthy controls, patients with a psychotic disorder that have never been in care at a forensic clinic, and patients with a psychotic disorder in care at a forensic clinic on several measures of metacognition. The primary objective is to identify risk factors amongst these variables.


Secondary:

Secondary objective is to use network analysis to determine whether metacognitive deficits and aggressive behaviour ‘clusters’ in the manner which Bo et al. (2012) propose.

This study compares persons with a psychotic disorder currently in treatment at a forensic clinic (F-P), with patients with a psychotic disorder currently not in treatment at a forensic clinic (P) and with healthy controls (HC). Confounders such as current mood state, threat/control-override(TCO), temperament and character, trauma and the existence of a diagnosis of psychopathy will be statistically controlled for.

The study will test four hypotheses:


1) (F-P) show a pattern of more affective metacognitive impairments than (HC) and (P). Cognitively oriented aspects of metacognition are expected to be equally impaired in (P) and (F-P) (Abu-Akel & Abushua’leh, 2004; Bogaerts, Polak, Spreen, & Zwets, 2012).

2) We expect that in (F-P) deficits in metacognitive “mastery” as measured by the MAS-A are more severe than those found in (P), and correlate significantly with assessments of risk for future violence (Brüne, Schaub, Juckel, & Langdon, 2011; Lysaker, Erickson, Buck, et al., 2011; Lysaker, Erickson, Ringer, et al., 2011).

3) We expect that in F-P metacognitive deficits in understanding others and empathy, are significantly correlated with “Clinical” items of the HKT-30 regarding Empathy, Hostility and Social and Relational skills.

4) Persons with aggression where the primary explanation is positive psychotic will score elevated on measures of Threat/Control-override (TCO). This group will be more prone to impulsive violence as measured by the IPAS, while those with personality-related difficulties (psychopathic traits) will show a tendency toward premeditated violence as measured by the IPAS (Nederlof et al., 2011a; Nederlof, Muris, & Hovens, 2011b).

Based on hypotheses 1 – 4 we expect to be able to gain further insight into the manner in which various elements of metacognition interact with one another and characteristics of violence, using network analysis (Borsboom & Cramer, 2013; Cramer, Waldorp, van der Maas, & Borsboom, 2010)

T1: Single measure.

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