Introduction: Aggression poses significant challenges in psychiatric rehabilitation, leading to adverse physical and emotional consequences. Occupational therapists in forensic psychiatry are more prone to aggression as forensic inpatients are two times more likely to commit violence comparing to other psychiatric units. Recent study had identified cognition to be one of the determinants of aggression and but little is known among forensic patients.
Objectives: The study aims to investigate the correlations between aggression, violence risk, neurocognition and social cognition; and to examine the predictors of inpatient aggression.
Methods: Fifty-five forensic inpatients were recruited. Neurocognition assessment (The MATRICS Consensus Cognitive Battery), social cognition assessments, (Social Cognition Screening Questionnaire and Facial Emotion Identification Test), and violence risk assessment (Short-term Assessment of Risk and Treatability) were administered. 3-month inpatient aggression would be assessed prospectively and binary logistic regression would be conducted to investigate the predictors.
Results: Neurocognition and social cognition outcomes were found to have significant negative correlations with violence risk; while social cognition outcome have a significant positive correlation with protective factors of violence. There are significant differences in overall neurocognitive performance, theory-of-mind and attributional bias between aggressive and non-aggressive forensic inpatients within the 3-month study period. Paranoid attributional bias and working memory are examined to be significant predictors of 3-month aggression among forensic inpatients.
Contribution to the occupational therapy profession: The results provided preliminary evidence on the relationship between cognition and aggression. This study highlights the potential for integrating social cognitive training and cognitive remediation into occupational therapy practices as a supplementary intervention for more effective aggression management and reduction.