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Michielsen PJS, Hoogveldt S, L'oihmi N, Sneep S, van Dam A, Mulder CL, Hoogendijk WJG, Roza SJ. Dual harm: Violent behaviour to others and self-harm behaviour in adults compulsorily admitted to a Dutch psychiatric hospital. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101989. [PMID: 38663172 DOI: 10.1016/j.ijlp.2024.101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/18/2024] [Accepted: 04/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Verbal and physical violence in psychiatric hospitals can have harmful consequences for staff members, such as physical injury, traumatisation, and sick leave, and they often accompany involuntary admission. Harm to others may co-occur with self-harm, i.e., dual harm. However, little is known about the association between dual-harm and violent behaviour towards staff members and its clinical outcomes, such as seclusion and rapid tranquilisation after involuntary admission to a psychiatric inpatient unit. METHOD A convenience sample of patients admitted involuntarily (N = 384; mean age = 48.03, SD = 19.92) between January 2016 and December 2019 in Western Brabant, the Netherlands, was used to design a retrospective file audit. Distinct harm groups, marked by the presence/absence of self- and/or other-harm, were investigated using multivariate linear regression modelling on the seriousness of violent acts and the total length of admission. Logistic regression analyses were used to study the association between harm groups and the administration of rapid tranquilisation, seclusion, and extended involuntary admissions. RESULTS Several harm groups were identified, including self-harm only, other-harm only, and dual-harm groups. Psychiatric patients admitted to the hospital because of (the risk of) violence towards others had a higher risk of violent incidents during admission and some restrictive measures. In a subgroup of patients with psychotic disorders, patients with dual harm committed the most serious violent incidents compared to those in the other harm groups. CONCLUSION Distinct harm groups were identified in a sample of involuntarily admitted patients. In a general adult psychiatric setting, patients at risk for violent behaviour, especially dual-harm patients, should be identified and monitored as part of the risk assessment. Future research is needed to explore more clinical correlates in the proposed distinction between harmful groups and to assess long-term prognosis.
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Affiliation(s)
- Philip J S Michielsen
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands; Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands.
| | - Sander Hoogveldt
- Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands.
| | - Nordin L'oihmi
- Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands.
| | - Sascha Sneep
- Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands.
| | - Arno van Dam
- Mental Health Institute, GGZ Westelijk Noord-Brabant, Halsteren, the Netherlands; Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.
| | - Cornelius L Mulder
- Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Parnassia Psychiatric Institute, Rotterdam, the Netherlands.
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Sabine J Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Forensic Psychiatry and Psychology, The Hague, the Netherlands.
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Falkai P, Dombi ZB. Editorial: Community series in novel antipsychotics within and beyond clinical trials: symptom-based treatment of psychiatric disorders with D3-D2 partial agonists, volume II. Front Psychiatry 2023; 14:1266566. [PMID: 37671286 PMCID: PMC10476095 DOI: 10.3389/fpsyt.2023.1266566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Zsófia Borbála Dombi
- Global Medical Division, Gedeon Richter Plc., Budapest, Hungary
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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3
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McIvor L, Payne-Gill J, Winter H, Pollard C, Beck A. Consistency of Violence: Implications for Effective Inpatient Psychiatric Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:461-475. [PMID: 36918493 PMCID: PMC10013979 DOI: 10.1007/s10488-023-01251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 03/16/2023]
Abstract
Instances of violence and aggression in acute psychiatric settings are common and highly distressing for service users and staff. They also incur financial costs. This study aimed to identify the proportion of service users at risk of consistent violence/aggression enactment. It also aimed to analyse associated service use to explore the potential need for specialised, targeted approaches. Five years' worth of data were extracted from 2016 to 2020 on inpatient stays across South London and Maudsley NHS Foundation Trust (SLaM) acute adult wards and Psychiatric Intensive Care Units (PICUs). Service users were divided into cohorts based on relative number of violent/agressive incidents enacted. Differences in frequency of acute service use during the period 1st January-31st December 2020 were analysed. In total, 2524 service users had at least one inpatient stay during 2020. 679 were recorded as having enacted at least one incident of violence or aggression. Just 4% of all service users accounted for 50% of all violence/aggression enactment. Results further showed strong evidence of group differences between violence cohorts in the following domains: internal transfers, occupied bed days, admissions and Place of Safety (PoS) referrals. There was weaker evidence for group differences in referrals to Home Treatment teams (HTTs) and Psychiatric Liaison Teams. A small proportion of service users disproportionately account for the majority of violent and aggressive incidents and higher levels of violence and aggression are associated with more acute service use. The provision of targeted, personalised interventions for this cohort may reduce the enactment of violence and aggression, leading to improved quality life and a reduction in financial expenditure.
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Affiliation(s)
- Lucy McIvor
- Corporate Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - James Payne-Gill
- Corporate Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Helen Winter
- Corporate Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Clair Pollard
- Corporate Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Alison Beck
- Corporate Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
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4
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Alexiou E, Nilsson T, Andiné P, Degl' Innocenti A. Criminal recidivism of patients in Swedish forensic psychiatry: A register-based comparison study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101884. [PMID: 36989591 DOI: 10.1016/j.ijlp.2023.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Another aim was to map previous criminality, types of index crime, and whether there were any changes within this decade. METHODS Crime-, clinical, and treatment-related variables were collected from the Swedish National Forensic Psychiatric Register for all unique inpatients registered from January 1-December 31 in 2010 (N = 717) and 2018 (N = 757). The mean, frequency, percentage, and standard deviation were calculated per variable and stratified by study year and gender. Between-group comparisons were made using t-tests and Chi-square tests. Binary logistic regression was performed to determine whether variables expected to be associated with recidivism showed any relation to criminal recidivism for each study cohort. RESULTS Most patients were male and approximately one-quarter and one-half of the men, respectively, had a previous sentence for non-violent and violent crimes. The 2018 cohort showed significantly lower rates of sentences to forensic psychiatry with special court supervision although the numbers were low in both cohorts and for both men and women. Previous violent conviction was associated with criminal recidivism during treatment in 2010, while this was joined by index crime under the influence of alcohol/illicit drugs for the 2018 cohort. CONCLUSIONS Overall, these results showed more similarities between the 2010 and 2018 cohorts then dissimilarities, while on the other hand some quite substantial differences were described between males versus females. The results of this study indicate that it may be possible to tailor forensic psychiatric treatment to gender as a proxy for other variables related to increased criminal recidivism in offenders sentenced to forensic psychiatric care.
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Affiliation(s)
- Eirini Alexiou
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Thomas Nilsson
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Peter Andiné
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Alessio Degl' Innocenti
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
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5
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Neumann M, Klatt T. Identifying Predictors of Inpatient Verbal Aggression in a Forensic Psychiatric Setting Using a Tree-based Modeling Approach. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16351-NP16376. [PMID: 34120498 PMCID: PMC9682497 DOI: 10.1177/08862605211021972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Inpatient violence poses a great risk to the health and well-being of other patients and members of staff. Previous research has shown that prevalence rates of violent behavior are particularly high in forensic psychiatric settings. Thus, the reliable identification of forensic inpatients who are particularly at risk for violent behavior is an important aspect of risk management. In the present study, we analyzed clinicians' assessments of N = 504 male and female inpatients of German forensic mental health institutions in order to identify risk factors for verbal institutional violence. Using a tree-based modeling approach, we found the following variables to be predictors of verbal aggression: gender, insight into the illness, number of prior admissions to psychiatric hospitals, and insight into the iniquity of the offence. A high number of prior admissions to psychiatric hospitals seems to be a risk factor for verbal aggression amongst men whereas it showed the opposite effect amongst women. Our results highlight the importance of dynamic risk factors, such as poor insight into the own illness, in the prediction of violent incidents. With regard to future research, we argue for a stronger emphasis on nonparametric models as well as on potential interaction effects of risk and protective factors.
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Affiliation(s)
- Merten Neumann
- Criminological Research Institute of Lower Saxony, Hanover, Germany
| | - Thimna Klatt
- Criminological Research Service of the Ministry of Justice in North Rhine-Westphalia, Germany
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6
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Celofiga A, Kores Plesnicar B, Koprivsek J, Moskon M, Benkovic D, Gregoric Kumperscak H. Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study. Front Psychiatry 2022; 13:856153. [PMID: 35463507 PMCID: PMC9021532 DOI: 10.3389/fpsyt.2022.856153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Most guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards. METHODS A multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards. RESULTS In the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.221; 0.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.238; 0.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease. CONCLUSION De-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05166278].
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Affiliation(s)
- Andreja Celofiga
- Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Blanka Kores Plesnicar
- University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jure Koprivsek
- Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia
| | - Miha Moskon
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Dominik Benkovic
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Hojka Gregoric Kumperscak
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Child and Adolescent Psychiatry Unit, University Medical Centre Maribor, Maribor, Slovenia
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7
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An Examination of the Performance of the interRAI Risk of Harm to Others Clinical Assessment Protocol (RHO CAP) in Inpatient Mental Health Settings. Psychiatr Q 2021; 92:863-878. [PMID: 33219429 DOI: 10.1007/s11126-020-09857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
We study violence risk prediction at St. Joseph's Healthcare Hamilton. Data from January 2016 to December 2017 have been anonymized and collected, for a total of 870 episodes of inpatient aggressions perpetrated by 337 patients. We examine the predictive performance of a clinical indicator embedded in a mandatory assessment tool for psychiatric facilities in Ontario, the Resident Assessment Instrument for Mental Health (RAI-MH): the Risk of Harm to Others Clinical Assessment Protocol (RHO CAP). The RHO CAP's performance is studied among two groups of patients. Moreover, an analysis of the most important risk factors associated with harmful incidents is presented. The RHO CAP has demonstrated a better performance in discriminating which patients were more at risk to commit some type of aggression than at identifying the risk of harm among those who will commit aggression.
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8
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Ha J, Kim Y, Baek S. Risk factors for self-harm in psychiatric wards: A judicial case analysis. Arch Psychiatr Nurs 2021; 35:178-184. [PMID: 33781397 DOI: 10.1016/j.apnu.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Abstract
Patients hospitalized in a psychiatric ward may engage in self-injurious behavior secretly, leading to fatal consequences. This study aimed to identify risk factors for self-harm in psychiatric wards. In this review, the framework of Taylor and Hignett's medical malpractice analysis was utilized. In the search conducted from March to April 2020, keywords were used to collect relevant judgments and previous studies. The final assessment comprised of 5 cases and 13 previous studies. The results of this study emphasize the creation of a ward environment where inpatients can feel secure, and the staff can actively engage in therapeutic communication.
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Affiliation(s)
- Jeongmin Ha
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
| | - Yoonjung Kim
- Faculty of Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Seungju Baek
- Department of Mental Health Research, National Center for Mental Health, 127, Youngmasan-ro, Gwangjin-gu, Seoul, 04933, Republic of Korea
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9
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia. J Women Aging 2020; 33:635-652. [PMID: 32142386 DOI: 10.1080/08952841.2020.1735925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly VanHaitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Liza Behrens
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Eshraghi
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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10
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Maguire T, Daffern M, Bowe SJ, McKenna B. Evaluating the impact of an electronic application of the Dynamic Appraisal of Situational Aggression with an embedded Aggression Prevention Protocol on aggression and restrictive interventions on a forensic mental health unit. Int J Ment Health Nurs 2019; 28:1186-1197. [PMID: 31290238 DOI: 10.1111/inm.12630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 01/04/2023]
Abstract
Risk assessment is a pre-requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi-experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Faculty of Health, Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
| | - Brian McKenna
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Auckland University of Technology, Auckland, New Zealand
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11
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Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study. BMC Psychiatry 2019; 19:216. [PMID: 31291931 PMCID: PMC6617899 DOI: 10.1186/s12888-019-2192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia. METHODS We conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers. RESULTS Eight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140-3.124), severe agitation (OR 1.846, 95%CL 1.266-2.693), unemployment or retirement (OR 1.614, 95%CL 1.189-2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032-2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436-0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240-0.902) were less likely to be associated with antipsychotic polypharmacy. CONCLUSION The present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy.
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12
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Ellison JM, Colvonen PJ, Haller M, Norman SB, Angkaw AC. Examining the relation between PTSD and insomnia on aggression. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1598220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Peter J. Colvonen
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- VA Center of Excellence for Stress and Mental Health, San Diego, California
- National Center for PTSD, White River Junction, Vermont
| | - Abigail C. Angkaw
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, San Diego, California
- National Center for PTSD, White River Junction, Vermont
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13
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Lockertsen Ø, Procter N, Vatnar SKB, Faerden A, Eriksen BMS, Roaldset JO, Varvin S. Screening for risk of violence using service users' self-perceptions: A prospective study from an acute mental health unit. Int J Ment Health Nurs 2018; 27:1055-1065. [PMID: 29171702 DOI: 10.1111/inm.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/26/2022]
Abstract
Service users' self-perception of risk has rarely been emphasized in violence risk assessments. A recent review pointed to the importance of a multidisciplinary approach, because different perspectives may provide a deeper and improved understanding of risk assessment. The aim of this study was to investigate service users' perceptions of their own risk of committing violence, using a self-report risk scale, to determine the feasibility and efficacy of this potential violence risk marker during acute mental health hospitalization. All service users admitted to a psychiatric emergency hospital in Norway during one calendar year were included (N = 512). Nearly 80% self-reported no risk or low risk; only seven (1.4%) reported moderate risk or high risk. Service users who reported moderate risk, high risk, don't know, or won't answer were more likely to be violent (OR = 4.65, 95% CI = 2.79-7.74) compared with those who reported no risk or low risk. There was a significant gender interaction with higher OR for women on both univariate and multivariate analyses. Although the OR was higher for women, women's violence rate (11.0%) was almost half that of men (21.8%). For women, sensitivity and specificity were 0.55 and 0.88, respectively; corresponding values for men were 0.40 and 0.80. Inclusion of self-perception of violence risk is the first step towards service users' collaborative involvement in violence prediction; these results indicate that self-perception can contribute to violence risk assessments in acute mental health settings. Findings also indicate that there are gender differences in these assessments.
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Affiliation(s)
- Øyvind Lockertsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway.,Division of Mental Health and Addiction, Acute Psychiatric Section, Oslo University Hospital, Oslo, Norway
| | - Nicolas Procter
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Solveig Karin Bø Vatnar
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ann Faerden
- Division of Mental Health and Addiction, Acute Psychiatric Section, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Bjørn Magne S Eriksen
- Division of Mental Health and Addiction, Acute Psychiatric Section, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - John Olav Roaldset
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Møre & Romsdal Health Trust, Psychiatric Department, Ålesund Hospital, Ålesund, Norway
| | - Sverre Varvin
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University of Applied Sciences, Oslo, Norway
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Trauma and Aggression: Investigating the Mediating Role of Mentalizing in Female and Male Inpatient Adolescents. Child Psychiatry Hum Dev 2017; 48:881-890. [PMID: 28176177 DOI: 10.1007/s10578-017-0711-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
High rates of posttraumatic stress disorder (PTSD) symptoms and elevated levels of aggression are common among youth in inpatient psychiatric settings. Several models link trauma exposure to aggression through anomalous mental state reasoning. Some theoretical frameworks linking trauma to aggression specify that the over-attribution of hostile mental states contributes to the development of aggressive behavior whereas other theories suggest that an inhibition of mental state reasoning leads to aggressive behavior. Using a sample of inpatient adolescents, the current study examined relations between PTSD symptoms and four forms of aggression, exploring the role of both over- and under-mentalizing (i.e., hypo- and hypermentalizing) as mediators and gender as a moderator. The results suggest that hypermentalizing, but not hypomentalizing, mediates the relation between trauma and aggression, extending prior research related to inpatient adolescents for the first time. Evidence of moderated mediation was noted, such that this mediational relation was evident for females but not males. The current study offers support for differential underlying causes of aggression among males and females with PTSD symptoms.
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15
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Abstract
BACKGROUND Although aggressive behavior in psychiatric settings is a major concern, very few studies have focused exclusively on physical assault in a general inpatient psychiatric population. OBJECTIVES This study had 3 main goals: (1) to evaluate the prevalence of assaultive behavior in an acute psychiatric hospital; (2) to identify the clinical and socio-demographic factors associated with assaultive behavior during hospitalization; and (3) to explore whether a diagnosis of schizophrenia spectrum disorder increases the risk of assaultive behavior. METHODS We conducted a retrospective chart review of patients admitted to acute units in a psychiatric hospital between 2009 and 2012. A subset of occurrence reports identified by a multidisciplinary team as "physical assault" was included in the analysis. Using logistic multivariate regression analysis, these patients were compared with a randomly selected nonassaultive control group, matched for length of stay to identify factors associated with assaultive behavior. RESULTS Of 757 occurrence reports, 613 met criteria for significant assault committed by 356 patients over 309,552 patient days. The assault incident density was 1.98 per 1000 patient days. In the logistic regression model of best fit, the factors significantly associated with assaultive behavior were age, legal status, and substance use. A diagnosis of schizophrenia spectrum disorder was not significantly associated with assaultive behavior. CONCLUSIONS Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault.
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16
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Nicholls TL, Brink J, Desmarais SL, Webster CD, Martin ML. The Short-Term Assessment of Risk and Treatability (START). Assessment 2016; 13:313-27. [PMID: 16880282 DOI: 10.1177/1073191106290559] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new assessment scheme-the Short-Term Assessment of Risk and Treatability (START)- presents a workable method for assessing risks to self and others encountered in mentally and personality disordered clients. This study aimed to demonstrate (a) prevalence and severity of risk behaviors measured by the START, (b) psychometric properties of START, (c) similarities and differences in START scores across different mental health professionals, and (d) concurrent validity of START with diverse negative outcomes. Treatment team members completed the 20-item, dynamically focused START for 137 forensic psychiatric inpatients. Prevalence and severity of START risk domains were measured for 51 patients detained in the hospital for 1 year. Results revealed high rates of generally low-level adverse events. With some exceptions, START scores were meaningfully associated with outcomes measured by a modified Overt Aggression Scale.
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Affiliation(s)
- Tonia L Nicholls
- British Columbia Mental Health and Addictions, Simon Fraser University, Canada.
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17
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Zhou JS, Zhong BL, Xiang YT, Chen Q, Cao XL, Correll CU, Ungvari GS, Chiu HFK, Lai KYC, Wang XP. Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis. Asia Pac Psychiatry 2016; 8:60-9. [PMID: 26346165 DOI: 10.1111/appy.12209] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/28/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China. METHODS Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis. RESULTS The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies). CONCLUSIONS Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.
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Affiliation(s)
- Jian-Song Zhou
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Qiongni Chen
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Xiao-Lan Cao
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York City, NY, USA
| | - Gabor S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.,Marian Centre, The University of Notre Dame Australia, Perth, WA, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kelly Y C Lai
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Ping Wang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
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18
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Deal N, Hong M, Matorin A, Shah AA. Stabilization and Management of the Acutely Agitated or Psychotic Patient. Emerg Med Clin North Am 2015; 33:739-52. [DOI: 10.1016/j.emc.2015.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Gunenc C, O'Shea LE, Dickens GL. Prevalence and predictors of verbal aggression in a secure mental health service: Use of the HCR-20. Int J Ment Health Nurs 2015; 24:314-23. [PMID: 25970429 DOI: 10.1111/inm.12130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite evidence about the negative effects of verbal aggression in mental health wards there is little research about its prevalence or about the factors that predict the behaviour among inpatients. This study aimed to determine the prevalence of verbal aggression in a secure mental health service, and to examine the relationship of verbal aggression with risk factors for aggression in the risk assessment tool HCR-20 in order to establish whether, and with which factors, the behaviour can be predicted. Verbal aggression was measured using the Overt Aggression Scale (OAS) over a 3-month period across a heterogeneous patient group (n = 613). Over half the patients (n = 341, 56%) engaged in 1594 incidents of verbal aggression. The HCR-20 total, clinical, and risk management subscale scores predicted verbal aggression, though effect sizes were not large. Item-outcome analysis revealed that impulsivity, negative attitudes, and non-compliance with medication were the best predictors of verbal aggression and, therefore, should be targeted for intervention. There are key synergies between factors predicting verbal aggression and the core mental health nursing role. Nurses, therefore, are in a prime position to develop and implement interventions that may reduce verbal aggression in mental health inpatients.
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Affiliation(s)
- Cevher Gunenc
- St. Andrew's Academic Department, St. Andrew's Hospital, Northampton, UK.,School of Psychology, Plymouth University, Plymouth, UK
| | - Laura E O'Shea
- St. Andrew's Academic Department, St. Andrew's Hospital, Northampton, UK.,Institute of Psychiatry, King's College London, London, UK
| | - Geoffrey L Dickens
- St. Andrew's Academic Department, St. Andrew's Hospital, Northampton, UK.,School of Health and Social Sciences, Abertay University, Dundee, UK
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20
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Chen SC, Chu NH, Hwu HG, Chen WJ. Trajectory classes of violent behavior and their relationship to lipid levels in schizophrenia inpatients. J Psychiatr Res 2015; 66-67:105-11. [PMID: 26004299 DOI: 10.1016/j.jpsychires.2015.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/25/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the trajectory patterns of violence in schizophrenia inpatients, examine the relationships between the violence trajectories and baseline clinical features and lipid levels, and generate a model to predict the more violent trajectories. METHODS In a sample of 107 consecutively admitted patients with schizophrenia spectrum disorders, violent behavior was weekly rated using the Violence Scale. The patients' blood levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at admission. A trajectory analysis was used to classify the patients' longitudinal courses in violence, and the correlates of these trajectories were assessed using multinomial logistic regression analyses. A stepwise logistic regression was used to select the best predictor variables for the more violent trajectories. RESULTS Four violence trajectories of inpatients were obtained: class 1 (no violence, 37.4%), class 2 (low-leveling off, 39.2%), class 3 (high-falling sharply, 10.3%), and class 4 (high-falling slowly, 13.1%). Although the relationship between decreasing TC and TG levels and increased violence in the trajectory classes did not reach statistical significance, a decreasing trend in the proportion of high dichotomized-TG levels was significantly associated with more violence in the trajectory classes (p = 0.04). A five-variable model consisting of female gender, early onset, higher scores of positive symptoms, lower scores of negative symptoms, and low dichotomized-TC levels had a predictive accuracy of 0.85 (95% CI = 0.72-0.97). CONCLUSIONS Distinct violence trajectories exist in schizophrenia inpatients, and the more violent trajectories can be predicted using baseline clinical features and lipid levels.
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Affiliation(s)
- Shing-Chia Chen
- School of Nursing, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
| | - Ni-Hsuan Chu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Hai-Gwo Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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21
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Abstract
Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients.
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22
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Chan O, Chow KKW. Assessment and determinants of aggression in a forensic psychiatric institution in Hong Kong, China. Psychiatry Res 2014; 220:623-30. [PMID: 25175913 DOI: 10.1016/j.psychres.2014.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/03/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
Institutional aggression in forensic psychiatric setting is an under-researched subject, despite the magnitude of the problem. No studies have been conducted on the assessment of risk and the examination of predictors of aggression among the Chinese forensic psychiatric population. Our study aimed to examine the determinants of aggression in the only forensic psychiatric institution in Hong Kong, and to test the psychometric properties of a risk-assessment instrument, the Dynamic Appraisal of Situational Aggression (DASA). We recruited a representative sample of 530 consecutively admitted detainees. Qualified nurses completed two risk-assessment instruments, the DASA and the Brøset Violence Checklist (BVC), once daily during the participants׳ first 14 days of admission. Aggressive incidents were recorded using the revised Staff Observation Aggression Scale (SOAS-R), and participants׳ data were collected for multivariate analyses. We showed that female gender, diagnoses of personality disorder and substance-related disorder, and admission at other correctional institutions were associated with institutional aggression. Aggression was perpetrated by 17.7% of the participants, and the DASA was demonstrated to have good psychometric properties in assessing and predicting aggressive incidents. Our findings preliminarily support the use of daily in-patient risk-assessment and affirm the role of dynamic factors in institutional aggression.
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Affiliation(s)
- Oliver Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong.
| | - Kavin Kit-wan Chow
- Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong
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23
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Andreasson H, Nyman M, Krona H, Meyer L, Anckarsäter H, Nilsson T, Hofvander B. Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:635-642. [PMID: 24631525 DOI: 10.1016/j.ijlp.2014.02.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n=125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.
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Affiliation(s)
- Helena Andreasson
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden.
| | - Marielle Nyman
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Hedvig Krona
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Lennart Meyer
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Henrik Anckarsäter
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden
| | - Thomas Nilsson
- Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden
| | - Björn Hofvander
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden; Department of Psychiatry, Autism Research Centre, Cambridge University, UK
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24
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Nourse R, Reade C, Stoltzfus J, Mittal V. Demographics, clinical characteristics, and treatment of aggressive patients admitted to the acute behavioral unit of a community general hospital: a prospective observational study. Prim Care Companion CNS Disord 2014; 16:13m01589. [PMID: 25317364 DOI: 10.4088/pcc.13m01589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/11/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Aggressive patients are not uncommon in acute inpatient behavioral health units of general hospitals. Prior research identifies various predictors associated with aggressive inpatient behavior. This prospective observational study examines the demographic and clinical characteristics of aggressive inpatients and the routine medications these patients were receiving at discharge. METHOD Thirty-six adults diagnosed with a DSM-IV mental disorder who met 2 of 6 established inclusion criteria for high violence risk and a Clinical Global Impressions-Severity of Illness (CGI-S) scale score ≥ 4 were observed for a maximum of 28 days on the 23-bed case mix acute behavioral health unit of St Luke's University Hospital, Bethlehem, Pennsylvania, from January 2012 to May 2013. Primary outcome measures were the Modified Overt Aggression Scale (MOAS) and CGI-S; secondary measures were symptom outcome measures and demographic and clinical characteristics data. Analysis was conducted using repeated measures methodology. RESULTS Younger males with a history of previous violence, psychiatric admissions, and symptoms of severe agitation were more at risk for aggressive behavior. Positive psychotic symptoms, a diagnosis of bipolar disorder, substance use, and comorbid personality disorders also increased risk. Significant improvements from baseline to last visit were observed for the CGI-S and MOAS (P < .001 for both), with a significant correlation between the MOAS and CGI-S at last visit (P < .001). Only the symptom of agitation was significantly correlated to MOAS scores at both baseline and last visit (P < .001). CONCLUSION Patients significantly improved over time in both severity of illness and level of aggression.
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Affiliation(s)
- Rosemary Nourse
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Cynthia Reade
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Jill Stoltzfus
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Vikrant Mittal
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
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25
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Reinharth J, Reynolds G, Dill C, Serper M. Cognitive predictors of violence in schizophrenia: a meta-analytic review. SCHIZOPHRENIA RESEARCH-COGNITION 2014. [DOI: 10.1016/j.scog.2014.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine. J Clin Psychopharmacol 2014; 34:124-8. [PMID: 24346752 DOI: 10.1097/jcp.0000000000000050] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Agitation is a major problem in acute schizophrenia. Only a few studies have tested antipsychotic agents in severely agitated patients, mainly because of legal issues. Furthermore, most studies were limited to the first 24 hours. We aimed to investigate the efficacy of oral haloperidol, risperidone, and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over 96 hours using a prospective, randomized, rater-blinded, controlled design within a naturalistic treatment regimen. METHODS In total, 43 severely agitated patients at acute care psychiatric units were enrolled. Participants were randomly assigned to receive either daily haloperidol 15 mg, olanzapine 20 mg, or risperidone 2 to 6 mg over 5 days. Positive and Negative Syndrome Scale psychotic agitation subscale score was the primary outcome variable. A mixed-model analysis was applied. RESULTS All drugs were effective for rapid tranquilization within 2 hours. Over 5 days, the course differed between agents (P < 0.001), but none was superior. Dropouts occurred only in the risperidone and olanzapine groups. Men responded better to treatment than did women during the initial 2 hours (P = 0.046) as well as over the 5-day course (P < 0.001). No difference between drug groups was observed regarding diazepam or biperiden use. CONCLUSIONS Oral haloperidol, risperidone, and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders. Response to oral antipsychotics demonstrated a gender effect with poorer outcome in women throughout the study.
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Tishler CL, Reiss NS, Dundas J. The assessment and management of the violent patient in critical hospital settings. Gen Hosp Psychiatry 2013; 35:181-5. [PMID: 23260370 DOI: 10.1016/j.genhosppsych.2012.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 09/28/2012] [Accepted: 10/23/2012] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Patient violence and aggression is prevalent in critical care settings, yet clinicians are often inadequately trained to assess and respond to these types of behaviors. Targeted toward trainees as well as seasoned clinicians, this articles provides an updated review of the literature regarding the management of violence in the emergency department. METHODS This narrative review is largely derived from research articles and reviews published since 2000. We conducted a systematic search of electronic databases for review articles or studies examining patient violence and aggression in critical care settings. Electronic searches were supplemented by manual searches of reference lists. RESULTS Current statistics, risk factors and imminent signs of violent patient behavior are presented. We conclude with recommendations for pharmacological and psychological interventions that can help manage aggressive behavior in the emergency department. CONCLUSIONS The relatively high frequency of aggressive and violent behavior in critical care settings increases the likelihood that clinicians working in this environment will encounter this situation. It is our hope that providing additional information about the factors associated with and techniques for managing violent patient behavior will reduce the occurrence of injuries in health care professionals in emergency departments.
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Affiliation(s)
- Carl L Tishler
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA.
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28
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Lewin TJ, Carr VJ, Conrad AM, Sly KA, Tirupati S, Cohen M, Ward PB, Coombs T. Shift climate profiles and correlates in acute psychiatric inpatient units. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1429-40. [PMID: 22068211 DOI: 10.1007/s00127-011-0448-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 10/17/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Inpatient psychiatric units are dynamic in nature, potentially creating a different treatment experience for each person, which may be difficult to quantify. Among the goals of this multi-centre service evaluation project was an assessment of shift-to-shift changes in unit-level events and their impact on the social-emotional environment. METHODS Over 1 year, various nurse-completed logs were used within the 11 participating Australian psychiatric units (n = 5,546 admissions) to record patient- and unit-level events per shift, including ratings of the overall social-emotional climate using a novel shift climate ratings (SCR) scale (n = 8,176 shifts). These were combined with admission-level patient characteristics to investigate shift climate profiles and correlates. RESULTS Occupancy rates averaged 88% and two-thirds of admissions were involuntary. The psychometric performance of the SCR scale was considered to be satisfactory (e.g., high internal consistency, unidimensional factor structure, and evidence of discriminant and predictive validity). A series of hierarchical regressions revealed considerable variation in SCR total scores, with poorer climates being significantly associated with: day/afternoon shifts; higher occupancy levels; higher proportions of experienced staff, and male, older, or involuntary patients; higher rates of less serious aggressive incidents; reporting of additional staffing demands; and unit location in a stand-alone psychiatric hospital. CONCLUSIONS The day-to-day social-emotional climate can have important consequences for patient engagement and recovery. Improved understanding of the role played by unit, staff and patient characteristics, together with routine monitoring, should facilitate the development and evaluation of targeted interventions to reduce adverse incidents and improve the overall social-emotional climate.
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Affiliation(s)
- Terry J Lewin
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, University of Newcastle, PO Box 833, Newcastle, NSW, 2300, Australia.
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Neufeld E, Perlman CM, Hirdes JP. Predicting Inpatient Aggression Using the InterRAI Risk of Harm to Others Clinical Assessment Protocol. J Behav Health Serv Res 2012; 39:472-80. [DOI: 10.1007/s11414-011-9271-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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30
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Abstract
This study assessed the relationship between self-perceived clinical and social needs and aggressive behavior in outpatients with schizophrenia. A total of 895 outpatients with schizophrenia were enrolled. The presence of aggressive episodes was assessed using the Modified Overt Aggression Scale. Self-perceived needs were assessed using the Camberwell Assessment of Need in six areas of needs (food, household skills, self-care, daytime activities, psychotic symptoms, satisfaction with treatment, and company). The most common areas of needs were "psychotic symptoms" (81.6%), "daytime activities" (60.6%), and "household skills" (57.5%). More needs were expressed by patients who had more severe illnesses (p < 0.001) and more aggressive behavior (p < 0.001). Multivariate analysis showed that, in schizophrenia outpatients, self-perceived needs were associated with aggressive behavior (adjusted odds ratio, 11.43; 95% confidence interval, 5.11 to 25.56). Appropriate compliance with antipsychotic treatment was related with lower aggressive behavior (p < 0.001).
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31
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Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011; 189:10-20. [PMID: 21236497 DOI: 10.1016/j.psychres.2010.12.024] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/04/2010] [Accepted: 12/08/2010] [Indexed: 01/13/2023]
Abstract
Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses.
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Affiliation(s)
- Cesare Maria Cornaggia
- Department of Clinical Psychiatry, University of Milano-Bicocca, Monza, Italy; Organic Psychiatry Unit, Zucchi Clinical Institute, Carate Brianza, Italy
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Isaksson U, Graneheim UH, Åström S, Karlsson S. Physically violent behaviour in dementia care: Characteristics of residents and management of violent situations. Aging Ment Health 2011; 15:573-9. [PMID: 21815849 DOI: 10.1080/13607863.2011.556600] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Physically violent behaviour (PVB) is common among residents with dementia and often complicates nursing care. This study aims to explore types of caring situations, resident characteristics related to PVB and professional caregivers' management of PVB. METHODS The study included 40 group homes for 309 residents with dementia. Data was gathered by means of structured interviews, the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale. RESULTS Ninety-eight of the residents (31.7%) were assessed as showing PVB during the preceding week. Three factors were independently associated with PVB: male gender, antipsychotic treatment and decline in orientation. Violent residents were more likely to have impaired speech, difficulties understanding verbal communication and prescribed analgesics and antipsychotics than were non-violent residents. PVB occurred mainly in intimate helping situations and was managed by symptom-oriented approaches, such as distraction, medication and isolation. The working team also held frequent discussions about the residents with PVB. CONCLUSION This study shows that PVB is frequently displayed among residents in group homes for persons with dementia and the caregivers mainly manage PVB in a symptom-oriented way. To enhance the quality of care for patients with dementia, there is a need for interventions that aim to understand and manage the residents' physical violent behaviour.
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Affiliation(s)
- Ulf Isaksson
- Department of Nursing, Umeå University, The Caring Science Building, Umeå, Sweden.
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Abasiubong F, Abiola T, Udofia O. A comparative study of aggression amongst Nigerian university students in Niger Delta region. PSYCHOL HEALTH MED 2011; 16:86-93. [PMID: 21218367 DOI: 10.1080/13548506.2010.507775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is genuine concern over social violence and aggression among youths in many countries. Despite considerable efforts directed toward molding the pattern of model behavior, frequent disturbances and various antisocial vices among youths in our environment may be due to failure to acknowledge the risk factors associated with aggression. The objective of this study was to assess the level of aggressive traits among students in higher institutions, as well as identifying the possible predictive factors. Using a two-stage random sampling method, 515 fifteen students, comprising 306 from arts and 209 from medicine faculties, University of Uyo were screened for aggressive traits; using Buss-Perry Aggression (BPAQ) Questionnaire. A total of 306 arts students and 209 medical students fully completed the questionnaire. Among the arts students, 127 (41.5%) were males and 179 (58.5%) females. Similarly, of the 209 medical students, 143 (68.4%) were males and 66 (31.6%) females. The mean age for arts students was 28.7 years (SD = 7.9); while that of medical students was 23.6 years (SD = 4.9). The difference in the mean was statistically significant (t = 8.15, P = 0.001). A total of 139 (45 .4%) of arts students showed abnormal overall score for aggression as against 74 (35.4%) of medical students. This difference was statistically significant (χ(2) = 5.139, P = 0.01). There was also significant difference in the physical and verbal aggression subscales as 123 (40.2%) of arts against 53 (25.4%) medical students showed physical aggression (χ(2) = 12.15, P = 0.001), while 82 (26.8%) against 109 (52.2%) showed verbal aggression (χ(2) = 34.218, P = 0.001). Verbal aggression was positively correlated with female students; males have 2.98 odds ratio of being aggressive (P = 0.001). There is a high level of aggressive traits among students in higher institutions of learning. This can manifest in behaviors and vices capable of disturbing public peace and academic activities in schools. Therefore, there is need to curb aggression in order to create conducive learning environment and maintain societal norms.
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Affiliation(s)
- Festus Abasiubong
- Faculty of Clinical Sciences, Department of Psychiatry, College of Health Sciences, University of Uyo, Nigeria.
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Clarke DE, Brown AM, Griffith P. The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting. J Psychiatr Ment Health Nurs 2010; 17:614-20. [PMID: 20712684 DOI: 10.1111/j.1365-2850.2010.01558.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.
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Affiliation(s)
- D E Clarke
- Associate Professor and Associate Dean, Research Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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Colasanti A, Paletta S, Moliterno D, Mazzocchi A, Mauri MC, Altamura AC. Symptom dimensions as predictors of clinical outcome, duration of hospitalization, and aggressive behaviours in acutely hospitalized patients with psychotic exacerbation. Clin Pract Epidemiol Ment Health 2010; 6:72-8. [PMID: 21283648 PMCID: PMC3026339 DOI: 10.2174/1745017901006010072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/31/2010] [Accepted: 06/06/2010] [Indexed: 12/04/2022]
Abstract
In the present study we extract clusters of symptoms in acute hospitalized psychotic patients during a re-exacerbation phase, using factor analysis of BPRS-E. We aim to investigate the relative contribution of each symptom dimension in predicting the severity of symptoms at discharge, the length of acute hospitalization, and the occurrence of aggressive behaviours during acute hospitalization. The data are drawn from a prospective, naturalistic, observational study of 183 patients with Psychotic Disorders consecutively admitted to a psychiatric ward, during a re-exacerbation phase. General symptomatology has been measured through BPRS-E at admission and at discharge. Statistical analyses include principal component analysis and multiple linear regression. We found symptoms of acute psychosis disorder to cluster together in four distinct domains, labelled "Excitement/Activation", "Positive symptoms", and "Negative symptoms", and "Depression/Anxiety". Excitement/activation was the dimension most associated with occurrence of aggressive behaviours and severity of psychopathological symptoms at discharge. The negative symptoms dimension, also, predicted the severity of symptoms at discharge. Positive and negative symptoms dimensions were both predictors of duration of hospitalization. The depressive dimension was significantly associated only to self-aggression. These data indicate that during acute hospitalization due to re-exacerbation of psychosis each symptom dimension has a specific impact on distinct measures of outcome.
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Affiliation(s)
- Alessandro Colasanti
- Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milan, Italy
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Hanrahan NP, Aiken LH, McClaine L, Hanlon AL. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals. Issues Ment Health Nurs 2010; 31:198-207. [PMID: 20144031 PMCID: PMC2856615 DOI: 10.3109/01612840903200068] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.
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Affiliation(s)
- Nancy P Hanrahan
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania 19104, USA.
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Lin CH, Hsu CW, Teng CY, Sun PPC, Hsu HC, Wung YT, Lin CH. Factors predicting transferal after psychiatric emergency management in the elderly. Psychiatry Clin Neurosci 2009; 63:741-6. [PMID: 19747188 DOI: 10.1111/j.1440-1819.2009.02024.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The purpose of this study was to examine the demographic and clinical characteristics that differentiate between elderly and non-elderly visitors in the psychiatric emergency room (ER), and to identify factors predicting transferal after psychiatric emergency management in the elderly. METHODS Data were collected over four years for patients who visited the psychiatric ER. The elderly were defined as patients older than 65 years old. Demographic and clinical characteristics were analyzed using the chi(2)-test for categorical data and t-tests for continuous data. Multivariate logistic regressions were carried out to find predictive factors associated with being transferred to a general hospital for elderly visitors in the psychiatric ER. RESULTS Elderly patients made up 3.4% of all included visitors (n = 243) during the four-year period. The mean number of visits for elderly visitors was 1.63 +/- 1.18, ranging from 1 to 7. The chi(2)-test and the t-test indicated that the elderly visitors were different from controls in many demographic and clinical variables. Multivariate logistic regression analysis showed that being transferred to a general hospital for elderly visitors in the psychiatric ER was associated with age (odds ratio = 1.32) and a greater number of previous psychiatric hospitalizations (odds ratio = 1.42). Patients without a thought-form problem also required transferal to a general hospital more often in our study. CONCLUSIONS The study suggested that elderly visitors in the psychiatric ER were a unique group, and specific considerations should be included in the intervention for these patients.
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Loughland CM, Lawrence G, Allen J, Hunter M, Lewin TJ, Oud NE, Carr VJ. Aggression and trauma experiences among carer-relatives of people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2009; 44:1031-40. [PMID: 19333531 DOI: 10.1007/s00127-009-0025-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exposure to aggression and associated psychological outcomes are poorly characterised among carer-relatives of people with psychosis. METHOD Carer-relatives (N = 106) completed questionnaires assessing socio-demographics and perceived prevalence of aggression in their caring role in the last 12 months. Carers exposed to moderate-severe levels of aggression were re-approached to assess PTSD and coping strategies. RESULTS Most respondents (77.4%) reported experiencing moderate-severe levels of aggression. Increased contact with (M = 15.12 vs. M = 6.71 days per month), and significantly higher ratings of affective, antisocial, negative and psychotic symptomology in affected relatives were associated with experiences of moderate-severe aggression. Approximately half of the moderate-severe respondents reported potentially significant levels of PTSD (52%, N = 34), which was associated with greater exposure to verbal aggression and increased usage of coping strategies. CONCLUSIONS Comparable ratios of physical to non-physical aggression to those reported by professional carers working in acute psychiatric treatment settings were reported. Carer-relatives require greater levels of information and support to assist them in their community caring roles.
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Affiliation(s)
- Carmel M Loughland
- Centre for Brain and Mental Health Research, Hunter New England Mental Health, The University of Newcastle, PO Box 833, Newcastle, NSW 2300, Australia.
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Abstract
Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members. Variables associated with violent behavior were: male gender, <24 years of age, unmarried status, receiving a disability pension, having a secondary school degree, compulsory admission, hostile attitude at admission, and a diagnosis of schizophrenia, bipolar disorder, personality disorder, mental retardation, organic brain disorder or substance/alcohol abuse. Violent behavior during hospitalization was a predictive factor for higher Brief Psychiatric Rating Scale scores and for lower Personal and Social Performance scale scores at discharge. Despite the low percentage of violent and hostile behavior observed in Italian acute inpatient units, this study shed light on a need for the careful assessment of clinical and treatment variables, and greater effort aimed at improving specific prevention and treatment programs of violent behavior.
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Hage S, Van Meijel B, Fluttert F, Berden GFMG. Aggressive behaviour in adolescent psychiatric settings: what are risk factors, possible interventions and implications for nursing practice? A literature review. J Psychiatr Ment Health Nurs 2009; 16:661-9. [PMID: 19689560 DOI: 10.1111/j.1365-2850.2009.01454.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was aimed to identify the risk factors of aggressive behaviour in adolescents (1318 years), and to describe available intervention strategies. The findings are evaluated on the basis of their implications for nursing practice. Aggressive behaviour in adolescent psychiatric settings is a neglected research area. The consequences of aggressive behaviour on nurses, other patients and the therapeutic environment can be profound. For the development and implementation of innovative intervention strategies aimed at preventing aggressive behaviour in adolescent psychiatric patients, knowledge of risk factors and evidence-based interventions for aggressive behaviour are of the utmost importance. A systematic search of PubMed, Cinahl, PsychINFO and Cochrane Systematic Reviews (19912007) was employed. The risk factors for aggressive behaviour comprise personal and environmental risk factors. Some risk factors can be influenced by nursing intervention strategies. Available intervention programmes range from interpersonal skills training to massage therapy, parent management training, functional family therapy and multi-systemic therapy. The most effective programmes combine interpersonal skills training with parent management training. No specific nursing intervention programmes were found for dealing with aggressive behaviour in adolescent patients. Nursing staff can assist in achieving a systematic improvement in the treatment outcomes of existing intervention programmes for the prevention of aggression. There is a need for specific nursing intervention programmes to deal with aggressive behaviour in adolescent psychiatric settings.
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Affiliation(s)
- S Hage
- INHolland University for Applied Sciences, Research Group Mental Health Nursing, P.O. Box 403, 1800 AK Alkmaar, The Netherlands.
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Song H, Min SK. Aggressive behavior model in schizophrenic patients. Psychiatry Res 2009; 167:58-65. [PMID: 19359046 DOI: 10.1016/j.psychres.2008.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 08/31/2007] [Accepted: 01/02/2008] [Indexed: 11/25/2022]
Abstract
This study aimed to determine the optimal model for explaining the aggressive behavior of schizophrenic patients in relation to certain behavioral variables including anger, schizophrenic symptoms, and cognitive function. Schizophrenic patients were evaluated with the Modified Overt Aggression Scale (MOAS) for aggressive behaviors, with irritability and resentment; with the Buss-Durkee Hostility Inventory (BDHI) for anger; with the Wisconsin Card Sorting Test (WCST) and the Grooved Pegboard Test for cognitive function; and with the Positive and Negative Syndrome Scale (PANSS) for schizophrenic symptoms. The structural equation model (SEM) in AMOS 7 for the score of "aggressive behavior in the last week" in the MOAS, was used for statistical analysis. For the SEM, two factors (irritability and resentment) were selected from the BDHI and constituted the anger construct. Through factor analysis, two factors (executive function and motor function) were selected from the cognitive function measurements to constitute the cognitive function construct. Two factors (positive and negative symptoms) in the PANSS constituted the symptom construct. The best model for aggressive behavior (MOAS) with three constructs revealed a direct, significant path of "anger emotion to aggressive behavior". This result suggests that the aggressive behavior of schizophrenic patients is directly related to anger. Schizophrenic symptoms and cognitive function were indirectly related to aggressive behavior through the relationship between the emotion of anger and aggressive behavior.
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Affiliation(s)
- Hyunjoo Song
- Department of Counseling and Psychotherapy, Graduate School of Professional Therapeutic Technology, Seoul Woman's University, Seoul, Republic of Korea
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Fassino S, Amianto F, Gastaldo L, Leombruni P. Anger and functioning amongst inpatients with schizophrenia or schizoaffective disorder living in a therapeutic community. Psychiatry Clin Neurosci 2009; 63:186-94. [PMID: 19335389 DOI: 10.1111/j.1440-1819.2009.01940.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study explored the functional correlates of anger amongst therapeutic community inpatients. METHODS The sample consisted of 44 subjects diagnosed with schizophrenic/schizoaffective disorder who were involved in a community treatment program. Assessment involved administration of the Health of Nation Outcome Scales and the Global Assessment of Functioning as well as self-evaluations using the Social Adaptation Self-evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptoms Scale. Angry feelings and coping skills were self-assessed with the State-Trait Anger Expression Inventory and the Symptom Checklist-90 Hostility Scale. Multiple regression analyses correlated anger with functioning, controlling for psychopathology. RESULTS Angry feelings related to self-harm, hyperactivity, physical problems, and to global weight independently from Positive and Negative Symptoms Scale scores. They also predicted interest and pleasure in housekeeping, quality of social relationships and relational exchanges. CONCLUSIONS Results showed that angry feelings were not merely derivations of schizophrenic psychopathology; rather, they were independently related to self-damaging behaviors, to attentional demands towards the staff, to agreement to community tasks and to low quality of social relationships. Indeed, anger was related to adaptation's level in a therapeutic community setting demonstrated by subjects with psychoses and it may represent an indirect measure of their experienced quality of life. Therapeutic and management approaches to anger amongst subjects with schizophrenia are discussed.
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Affiliation(s)
- Secondo Fassino
- Neurosciences Department, Psychiatry Section, University of Turin, Turin, Italy.
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Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues Ment Health Nurs 2009; 30:214-26. [PMID: 19363726 DOI: 10.1080/01612840802701083] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review examines the research on ecologic factors that may contribute to or lessen the likelihood of inpatient unit violence. Understanding these factors can provide psychiatric inpatient unit staff with valuable therapeutic relational and cultural strategies to decrease violence. International and US studies from OVID Medline, CINAHL, and PsycInfo that evaluated aggression and violence on psychiatric inpatient units between 1983 and 2008 were included in this review. The review revealed that violence results from the complex interactions among the patient, staff, and culture of the specific unit. Inpatient psychiatric staff can decrease the potential for violence by using therapeutic relationship strategies such as using good communication skills, advocating for clients, being available, having strong clinical assessment skills, providing patient education, and collaborating with patients in treatment planning. Cultural improvements include providing meaningful patient activities and appropriate levels of stimulation and unit staffing.
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Affiliation(s)
- Vanya Hamrin
- Yale University, New Haven, Connecticut 06536, USA.
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Pompili M, Innamorati M, Lester D, Akiskal HS, Rihmer Z, Casale AD, Amore M, Girardi P, Tatarelli R. Substance Abuse, Temperament and Suicide Risk: Evidence from a Case-Control Study. J Addict Dis 2009; 28:13-20. [DOI: 10.1080/10550880802544757] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Inferior frontal white matter volume and suicidality in schizophrenia. Psychiatry Res 2008; 164:206-14. [PMID: 19008082 DOI: 10.1016/j.pscychresns.2007.12.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 10/08/2007] [Accepted: 12/22/2007] [Indexed: 11/21/2022]
Abstract
The neurobiology of suicidality in schizophrenia is largely unknown. We therefore assessed gray and white matter volumes associated with past suicidality and current self-aggression in schizophrenia. Fifty-five outpatients with schizophrenia (n=55) and healthy controls (n=55), matched for age, gender and handedness, were recruited. Ten patients had a life-time history of one or more suicide attempts. Current self-aggression was assessed using the Modified Overt Aggression Scale. High resolution structural magnetic resonance images were analyzed by voxel-based morphometry. We found significantly larger inferior frontal white matter volumes bilaterally in patients with a previous suicide attempt as compared with those patients without a history of suicidality. No other significant white or gray matter volume differences were observed. White matter volume in these regions did not differ between healthy controls and those patients without a previous suicide attempt. Furthermore, among patients, the level of current self-aggression showed a significant positive correlation with white matter volume in the same regions. Inferior frontal white matter alterations in fronto-temporo-limbic circuits may be associated with suicidality and self-aggression in schizophrenia.
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McDermott BE, Edens JF, Quanbeck CD, Busse D, Scott CL. Examining the role of static and dynamic risk factors in the prediction of inpatient violence: variable- and person-focused analyses. LAW AND HUMAN BEHAVIOR 2008; 32:325-38. [PMID: 17597388 DOI: 10.1007/s10979-007-9094-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 05/04/2007] [Indexed: 05/16/2023]
Abstract
Although the construct of psychopathy is related to community violence and recidivism in various populations, empirical evidence suggests that its association with institutional aggression is weak at best. The current study examined, via both variable-level and group-level analyses, the relationship between standard violence risk instruments, which included a measure of psychopathy, and institutional violence. Additionally, the incremental validity of dynamic risk factors also was examined. The results suggest that PCL-R was only weakly related to institutional aggression and only then when the behavioral (Factor 2) aspects of the construct were examined. The clinical and risk management scales on the HCR-20, impulsivity, anger, and psychiatric symptoms all were useful in identifying patients at risk for exhibiting institutional aggression. These data suggest that factors other than psychopathy, including dynamic risk factors, may be most useful in identifying forensic patients at higher risk for exhibiting aggression.
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Affiliation(s)
- Barbara E McDermott
- Department of Psychiatry, UC Davis School of Medicine, Sacramento, CA 95817, USA.
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Carr VJ, Lewin TJ, Sly KA, Conrad AM, Tirupati S, Cohen M, Ward PB, Coombs T. Adverse incidents in acute psychiatric inpatient units: rates, correlates and pressures. Aust N Z J Psychiatry 2008; 42:267-82. [PMID: 18330769 DOI: 10.1080/00048670701881520] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. METHOD Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). RESULTS The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital stays; 47.6% were involuntary; 25-30% involved adverse incidents; bed occupancy averaged 88.4%; median length of stay was 8 days (mean=14.59 days); and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization. CONCLUSIONS By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources.
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Affiliation(s)
- Vaughan J Carr
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.
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Serper M, Beech DR, Harvey PD, Dill C. Neuropsychological and symptom predictors of aggression on the psychiatric inpatient service. J Clin Exp Neuropsychol 2008; 30:700-9. [PMID: 18608673 DOI: 10.1080/13803390701684554] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neuropsychological assessment of executive dysfunction may identify psychiatric patients who may be at high risk for aggressive behavior because impairment of the prefrontal cortex has been indicated as a possible anatomical correlate of aggression. No consensus, however, has been reached on the extent that executive dysfunction contributes to the formation of psychopathology and to aggressive behavior in psychiatric inpatients. We hypothesized a mediating model wherein patients' executive-functioning deficits contribute to the formation of psychopathological symptoms, which then underlies aggressive behavior. To test this model, we examined the relationship between executive functioning, psychiatric symptomatology, and aggressive behavior in 85 psychiatric inpatients presenting over an acute hospital admission using structure equation modeling techniques. The results revealed that psychiatric inpatients' executive function impairment significantly predicted the formation of psychiatric symptomatology, which in turn significantly contributed to the manifestation of aggressive behavior. Executive dysfunction also directly predicted inpatient aggressive behavior. Combining the indirect and direct effects, 59% of our inpatient aggression measure factor variance was accounted for by our measures of executive dysfunction and clinical symptom severity. These findings suggest that neurocognitive deficits underlie both psychiatric symptom formation and aggression. Patients with executive dysfunction may not possess the behavioral inhibition skills needed to cope with the presence of symptoms and other stressful events that accompany acute psychosis and hospitalization that may result, consequently, in increased manifestations of aggressive behavior.
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Affiliation(s)
- Mark Serper
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
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Abstract
This paper reports the results of a literature review that was undertaken to provide background for a small pilot study that introduced violence measurement instruments that was to assist the development of nursing practice on an acute psychiatric unit. Multiple databases were searched, focusing on publications since 1994: CINAHL, Ovid Healthstar, Ovid MEDLINE (R), EMBASE, and PsycINFO. The search used the following four groups of key word alternatives (used in truncated form to allow for ending permutations) in combination with each other: violence, aggression, dangerous; prediction, assessment, factor, risk, issue, cause, reason; mental, psychiatric; inpatient, short-term, acute, admission. Searching was supplemented with footnote chasing of those papers retrieved and existing resources of the first author. Consequently, the synthesis of the results discussed cannot be considered a systematic review of the literature and is a reflection of some of the key issues found in the literature.
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Affiliation(s)
- P Woods
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada.
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Goldberg BR, Serper MR, Sheets M, Beech D, Dill C, Duffy KG. Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits. J Nerv Ment Dis 2007; 195:436-42. [PMID: 17502810 DOI: 10.1097/01.nmd.0000253748.47641.99] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.
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Affiliation(s)
- Brett R Goldberg
- Department of Psychology, Hofstra University, Hempstead, New York 11549-1350, USA.
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