Effects of Integrated Moral Reasoning Development Intervention for Management of Violence in Schizophrenia
Condition: Schizophrenia; Moral Status; Violence
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      Moral cognition is an important and multidimensional, but often overlooked, determinant of
      violence. Very few interventions have systematically examined the role of moral reasoning,
      anger management and problem-solving together in violence. A randomized controlled trial was
      conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning
      Development Intervention (MRDI) on management of repetitive violence in schizophrenia. This
      study placed special emphasis on essential components related to moral reasoning and violence
      in patients with schizophrenia. Evaluations including measures of violence, moral reasoning,
      ethical valuation and judgement, decision-making, conflict management style, and personality
      traits, were performed at baseline, end of intervention, and 1-month follow-up after
      intervention. MRDI was superior to treatment-as-usual in improving moral reasoning and
      related variables and violence outcomes. In comparison with the treatment-as-usual group,
      patients in the MRDI group showed improved levels of moral reasoning whereas decreased levels
      of violent behaviors. The MRDI participants also experienced significantly greater
      improvements or changes in their ethical valuation and judgement, decision-making style and
      preferences, and conflict management style. Our findings provide important implications for
      risk assessment and violence management and prevention.
    

Detailed description: 
      Moral cognition is an important and multidimensional, but often overlooked, determinant of
      violence. Very few interventions have systematically examined the role of moral reasoning,
      anger management and problem-solving together in violence. A randomized controlled trial was
      conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning
      Development Intervention (MRDI) on management of repetitive violence in schizophrenia. This
      study placed special emphasis on essential components related to moral reasoning and violence
      in patients with schizophrenia. Evaluations including measures of violence, moral reasoning,
      ethical valuation and judgement, decision-making, conflict management style, and personality
      traits, were performed at baseline, end of intervention, and 1-month follow-up after
      intervention. MRDI was superior to treatment-as-usual in improving moral reasoning and
      related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual
      group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning
      whereas decreased levels of violent behaviors. The MRDI participants also experienced
      significantly greater improvements or changes (p < 0.05) in their ethical valuation and
      judgement, decision-making style and preferences, and conflict management style. Our findings
      provide important implications for risk assessment and violence management and prevention.

      The triggering point of violence is multi-faceted and dynamic. Many risk factors for violence
      intertwined and interacted at multiple levels. This integrated moral reasoning development
      intervention, when applied in conjunction with psychiatric standard care, could display
      synergistic and effective effects on moral reasoning and ethical evaluation, and impulsivity
      and personality features of repetitive violence in patients with schizophrenia. Suggestions
      for future research are made. There is a need to concurrently examine moral reasoning,
      violence and conflict handling styles in a dyadic context such as vSZ patients and their
      family members involved, so that a whole picture of the violence can be better observed.
    

Intervention name(s): integrated Moral Reasoning Development Intervention (MRDI)
Intervention type(s): Other
Intervention description(s): The MRDI is comprised of 4 components that are run concurrently: moral reasoning, strategies of anger management and problem-solving and social skills.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care