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Decision Making and Aggression in Forensic Psychiatric Inpatients

This study provides initial empirical support for a novel neurobiological decision-making model proposed by Nussbaum (2005), applied to an aggression typology (Nussbaum, Saint-Cyr, & Bell, 1997). The Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994) was analyzed for forensic inpatients using both the traditional method of scoring reflecting motivational decision making and a novel method developed by Yechiam, Busemeyer, Stout, and Bechara (2005) that provides scores for three cognitive decision-making components: attention, learning, and response-choice consistency. Predatory seclusions were predicted by traditional motivational scoring of the IGT but not by the cognitive scores. Conversely, Irritable seclusions were predicted only by the cognitive scoring system. Based on these findings, the utilization of the aggression typology and the inclusion of these clinical measures could enhance and refine violent risk assessment, suggest specific treatment targets for different aggression types, and monitor responses to interventions prior to release into the community.