title: Acting on harmful command hallucinations in psychotic disorders: an integrative approach.
abstract: Although harmful command hallucinations have been linked to violent behavior, few studies have examined factors mediating this relationship. The principal aim of this study was to examine a range of factors potentially associated with acting on harmful command hallucinations using a multivariate approach. The sample comprised 75 participants drawn from community and forensic services. Measures assessing characteristics of the command hallucination and the hallucinator, including forensic risk factors, were administered. Using ordinal logistic regression, we found compliance to be associated with increasing age, viewing the command hallucination as positive, congruent delusions, and reporting low maternal control in childhood. Antipsychotic medication was protective while, contrary to expectations, traditional predictors of violence reduced the odds of compliance with command hallucinations viewed as threatening. The findings suggest that compliance with harmful commands is driven by a complex interaction between beliefs related to the command hallucination and personal characteristics, with risk of compliance increasing with age.
authors.affiliation: The Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia. frances.shawyer@med.monash.edu.au
authors.forename: Frances
authors.initials: F
authors.lastname: Shawyer
authors.forename: Andrew
authors.initials: A
authors.lastname: Mackinnon
authors.forename: John
authors.initials: J
authors.lastname: Farhall
authors.forename: Eliza
authors.initials: E
authors.lastname: Sims
authors.forename: Simone
authors.initials: S
authors.lastname: Blaney
authors.forename: Priscilla
authors.initials: P
authors.lastname: Yardley
authors.forename: Maree
authors.initials: M
authors.lastname: Daly
authors.forename: Paul
authors.initials: P
authors.lastname: Mullen
authors.forename: David
authors.initials: D
authors.lastname: Copolov
mesh_terms: D000184:Acting Out; D000328:Adult; D003299:Cooperative Behavior; D003469:Culture; D003617:Dangerous Behavior; D003702:Delusions / Q000175:diagnosis / Q000523:psychology; D003858:Dependency, Psychological; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007206:Individuality; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology*; D009769:Object Attachment; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology*; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D014754:Violence / Q000523:psychology