***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures . The timely use of preventive measures presupposes a preceded risk assessment . The Norwegian Brøset-Violence-Checklist ( BVC ) is one of the few instruments suited for short-time prediction of violence of psychiatric in patients in routine care . Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient setting s by combining the Brøset-Violence-Checklist ( BVC ) with an overall subjective clinical risk- assessment and to test the application of the combined measure in daily practice . Method We conducted a prospect i ve cohort study with two sample s of newly admitted psychiatric patients for instrument development ( 219 patients ) and clinical application ( 300 patients ) .  Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a  Visual Analog Scale . Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve ( AUCROC ) . Results The AUCROC of the new VAS-complemented BVC-version ( BVC-VAS ) was 0.95 in and 0.89 in the derivation and validation study respectively . Conclusion The BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards . The inclusion of the VAS-derived data did not change the accuracy of the original BVC Positive psychotic symptoms , such as threat/"control-override " delusions or comm and hallucinations , have been related to aggression in patients with schizophrenia . However , retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior . In this study , we monitored aggressive behavior and psychopathology prospect ively and in close temporal proximity in 157 treatment-resistant in patients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial . Aggressive behavior was rated with the overt aggression scale ( OAS ) . Psychopathology was assessed using the positive and negative syndrome scale ( PANSS ) . At baseline , subjects who would be aggressive during the study had higher scores on only two PANSS items : hostility and poor impulse control . During the study PANSS positive subscale scores were significantly higher in aggressive subjects . Total PANSS scores were higher within 3 days of an aggressive incident , as were positive and general psychopathology subscale scores . However , in a smaller sub sample for whom PANSS ratings were available within 3 days before aggressive incidents , only scores on the PANSS positive subscale were significantly higher . These findings in chronic , treatment resistant in patients support the view that positive symptoms may lead to aggression Objective : This study examined the predictive validity of the German translation of the Psychopathy Checklist-Screening Version ( PCL-SV ) for negative events during the course of the prison sentence of German prisoners . Method : Using the PCL-SV , we investigated 145 offenders in a German prison at the start of their sentences . We then compared the extreme groups identified by the PCL-SV — the high and low scorers — using a prospect i ve design with respect to negative events and factors during the course of the sentences . This involved the st and ardized collection of data on both objective records of disciplinary incidents and subjective impressions from prison staff on the basis of operationalized criteria . Results : The high scorers were involved in significantly more disciplinary incidents and were also rated significantly less favourably by prison staff than the low scorers . Conclusion : Until now , the PCL has only been shown to predict recidivism following release from prison . The results of our study show that the PCL also has predictive validity for problems during the course of the sentence . It is therefore recommended that the PCL be used routinely at the start of the prison sentence to estimate the likelihood of subsequent difficulties If clinicians in forensic psychiatry want to reduce risk of reoffending in their patients , they require insight into dynamic risk factors , and evidence that these add predictive power to static risk indicators . Predictors need to be evaluated under clinical ly realistic circumstances . This study aim ed to vali date dynamic and static variables as predictors of reconviction in a naturalistic outcome study . Data on  static and dynamic risk factors were collected for 151 patients discharged from Dutch forensic psychiatric hospitals . Community follow-up was prospect i ve , with a 5.5 year minimum . A prediction model was developed using Cox regression analysis . The magnitude of the predictive power of this model was estimated using receiver operating characteristic ( ROC ) analysis . The final prediction model contained four static and no dynamic predictors . The model 's ROC area under the curve was .79 ( 95 % CI .69–.89 ) . Clinical risk ratings were non-predictive . Post hoc analyses exploring the influence of subgroups of patients did not yield better models . It is concluded that a small set of static predictors yielded a good estimate of future reconvictions ; inclusion of dynamic predictors did not add predictive power OBJECTIVE Outward-directed violence and impulsivity in humans and primates has frequently been related to abnormal brain monoaminergic turnover . Self-rated aggression is likely to be clinical ly relevant , and its psychobiological basis needs investigation . SUBJECTS Sixty-six patients ( 40 women and 26 men ) with persistent depressive disorder ( PDD ) were compared with 497 control subjects from the general Swedish population . METHODS We administered the Aggression Question naire - Revised Swedish Version ( AQ-RSV ) to patients and control subjects . In patients , CSF 5-hydroxyindoleacetic acid ( 5-HIAA ) and 3-methoxy-5-hydroxyphenylglycol ( MHPG ) in CSF were analyzed . Total Aggression score and Aggression subfactors ' Physical Aggression','Verbal Aggression','Anger ' , and ' Hostility'were correlated with CSF concentrations of 5-hydroxyindoleacetic acid ( 5-HIAA ) , and 3-methoxy-5-hydroxyphenylglycol ( MHPG ) . RESULTS Overall , Hostility was positively related to CSF MHPG ( t=2.27 , p=0.015 ) . Split by sex , Hostility was related with 5-HIAA in males ( r=0.62,p=0.003 ) , and with MHPG in females ( r=0.38 , p=0.03 ) . Comparing self rated aggression with age- and sex-matched data from the general Swedish population , the most prominent deviation was increased Hostility score among PDD patients . Among patients , all aggression factors were nominally higher in women than in men , with the most pronounced sex difference in Hostility ( t=-1.89 , p=0.04 ) . CONCLUSIONS Results suggest a clinical ly meaningful sex difference in a positive relationship between hostility and serotonergic/noradrenergic turnover in PDD patients BACKGROUND A critical step for improving the prediction of on-ward violence is the identification of variables that are not only consistently associated with an increased risk of aggression but also easily evaluated during the admission interview . The goal of this prospect i ve study was to assess the predictive utility of hostility during admission interview . METHOD The sample consisted of 80 newly admitted male patients with heterogeneous DSM-IV psychiatric diagnoses recruited from the psychiatric ward of an urban public hospital . Psychiatric symptoms at admission were assessed with the  Brief Psychiatric Rating Scale ( BPRS ) . Aggressive behavior during the first week of hospitalization was measured with the Modified Overt Aggression Scale .  Data were collected between January and June 1998 . RESULTS In a multiple regression model , BPRS items hostility and tension-excitement emerged as significant predictors of verbal aggression , whereas thinking disturbance ( high ) and suspiciousness-uncooperativeness ( low ) emerged as significant predictors of aggression against objects . In contrast , when aggression was treated as a binary dependent variable in a logistic model , hostility during the admission interview had no utility in predicting on-ward aggressive behavior . CONCLUSION This study confirms the importance of distinguishing between different types of aggression to improve the accuracy of predictions of violence . The findings suggest that the question whether hostility is a useful short-term predictor of aggression in psychiatric in patients can not be answered conclusively . The predictive utility of hostility was relatively high for predicting verbal aggression but was negligible for predicting other types of aggressive behavior BACKGROUND Risk assessment of future violent acts is of great importance for both public protection and care planning . Structured clinical assessment s offer a method by which accurate assessment s could be achieved . AIMS To test the efficacy of the Historical , Clinical and Risk Management Scales ( HCR-20 ) structured risk assessment scheme on a large sample of male forensic psychiatric patients discharged from medium secure units in the UK . METHOD In a pseudo- prospect i ve study , 887 male patients were followed for at least 2 years . The HCR-20 was completed using only pre-discharge information , and violent and other offending behaviour post-discharge was obtained from official records . RESULTS The  HCR-20 total score was a good predictor of both violent and other offences following discharge . The historical and risk sub-scales were both able to predict offences , but the clinical sub-scale did not produce significant predictions . The predictive efficacy was highest for short periods ( under 1 year ) and showed a modest fall in efficacy over longer periods ( 5 years ) . CONCLUSIONS The results provide a strong evidence base that the HCR-20 is a good predictor of both violent and non-violent offending following release from medium secure units for male forensic psychiatric patients in the UK The author investigated the acute effects of alcohol intoxication on anger experience and expression among 46 maritally violent ( MV ) and 56 maritally nonviolent ( NV ) men r and omly assigned to receive alcohol , placebo , or no alcohol . Participants completed an anger-arousing articulated thoughts in simulated situations ( ATSS ) paradigm and imagined marital conflict scenarios . Anger experience was operationalized as subjective ratings of anger experienced during ATSS , and anger expression was measured as ATSS anger statements and aggression verbalizations . MV men given alcohol articulated significantly more aggressive verbalizations than all other groups , with high trait anger and increased anger experience predicting more aggressive verbalizations . Thus , alcohol may exert proximal effects on abusive behavior among individuals already prone to respond to conflict with increased anger This study evaluated the predictive validity of violence risk assessment s conducted using the HCR-20 , the Psychopathy Checklist : Screening Version ( PCL : SV ) , and by the Violence Screening Checklist ( VSC ) in a sample of 268 involuntarily hospitalized male and female psychiatric patients . Information pertaining to violence and crime was coded from medical charts and correctional records . The HCR-20/PCL : SV evidence d modest non-significant associations in postdictive assessment s of inpatient violence among men . Moderate to strong significant associations were found between the HCR-20/PCL : SV and inpatient violence among women . Pseudo- prospect i ve assessment s using the HCR-20 and PCL : SV result ed in moderate to large relationships with violence and crime in men and women following community discharge . It is concluded that the VSC is a promising tool for assessing acute inpatient violence risk with men . Findings offer preliminary validation of the predictive validity of the HCR-20 and PCL : SV with female civil psychiatric patients Prospect i ve longitudinal studies have shown strong predictions from conduct disorders ( CDs ) in childhood to antisocial personality disorder ( ASPD ) and violence in adults . However , little is known of the childhood antecedents of serious violence nor whether these may vary depending on the context in which the violence occurs . In this study , 54 men aged 21 - 40 years serving prison sentences for violent crime were assessed .  St and ardized interviews of ASPD and violence were conducted independently of interviews covering retrospective recall of childhood psychiatric disorders and adverse experiences . Analyses of the predictors of overall violence suggested a pathway involving childhood CD and adult ASPD associated with interparental discord , and an additional pathway associated with experiencing interparental violence in childhood . Different results were however obtained when account was taken of the context of the violence . The CD-ASPD pathway was associated with social violence , but not with partner violence . Partner violence was predicted by retrospective reports of having been exposed to interparental violence during childhood but not by reports of childhood CD or adult ASPD . Thus developmental pathways to serious violence may be different depending on the social domain in which the violence occurs This prospect i ve study explores the predictive value of  insight  for suicide , violence , hospitalization , and social adjustment for a group of schizophrenic out patients over 1 year . The  Schedule of Assessment of Insight ( SAI ) and its exp and ed version ( SAI-E ) were used to provide a baseline  insight  score for 74 schizophrenic out patients considered to be in remission or to have minimal psychopathology . Subjects were reassessed at the end of the period to determine the predictive value of initial insight rating by comparison . Insight into treatment was associated with less hospitalization and better social adjustment , but insight into mental illness or psychotic experience was not . It was also found that insight could neither predict suicidal behavior or violent tendencies . Therefore , some dimension of insight may predict hospitalization and social adjustment in schizophrenics , although its predictive efficacy for other clinical outcomes and behaviors may be limited BACKGROUND The MacArthur Violence Risk Assessment Study ( MacVRAS ) in the USA provided strong evidence to support an actuarial approach in community violence risk assessment . AIMS To examine the predictive accuracy of the MacVRAS measures , in addition to structured professional judgement , in a UK sample of patients discharged from in-patient care in the north-west of Engl and . METHOD A prospect i ve study of 112 participants assessed pre-discharge and followed up at 24 
    Output:
    
However , there is evidence of some convergence around a small number of high-performing instruments and identification of the components of a high- quality evaluation approach , including AUC analysis .
The upper limits ( AUC ≥ 0.85 ) of instrument-based prediction have probably been achieved and are unlikely to be exceeded using instruments alone .