Characteristics of assaultive psychiatric patients: ten year analysis of the Assaulted Staff Action Program (ASAP)

Characteristics of American assaultive psychiatric patients: review of published findings, 2000-2012

Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.

A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression

OBJECTIVE

To combine the results of earlier comparison studies of in-patient aggression to quantitatively assess the strength of the association between patient factors and i) aggressive behaviour,ii) repetitive aggressive behaviour.

METHOD

A systematic review and meta-analysis of empirical articles and reports of comparison studies of aggression and non-aggression within adult psychiatric in-patient settings.

RESULTS

Factors that were significantly associated with in-patient aggression included being younger, male, involuntary admissions, not being married, a diagnosis of schizophrenia, a greater number of previous admissions, a history of violence, a history of self-destructive behaviour and a history of substance abuse. The only factors associated with repeated in-patient aggression were not being male, a history of violence and a history of substance abuse.

CONCLUSION

By comparing aggressive with non-aggressive patients, important differences between the two populations may be highlighted. These differences may help staff improve predictions of which patients might become aggressive and enable steps to be taken to reduce an aggressive incident occurring using actuarial judgements. However, the associations found between these actuarial factors and aggression were small. It is therefore important for staff to consider dynamic factors such as a patient's current state and the context to reduce in-patient aggression.

Characteristics of assaultive psychiatric patients: 20-year analysis of the Assaultive Staff Action Program (ASAP)

Empirical research demonstrates that patient assaults on staff are a worldwide occupational hazard. This study examined patient assailant characteristics in a 20-year longitudinal, retrospective study in one public health care system. Older male patients with schizophrenic illness and histories of violence toward others and substance use disorder and younger male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use disorder were the more frequent assailants. This was true at 10-, 15-, and 20-year periods. Specific clinical findings with regard to forensic patients, the violence triad, and victimization of women as well as methodological issues were discussed and the implications noted.

Forensic psychiatric inpatients and aggression: an exploration of incidence, prevalence, severity, and interventions by gender

BACKGROUND

Previous investigations suggest that women judged to be not criminally responsible on account of mental disorder (NCR-MD) differ markedly from their male counterparts in important ways, underscoring the necessity of subsequent study.

OBJECTIVE

The goal of the present study was to inform our understanding of the presenting profile of female forensic psychiatric patients and contrast their risk of inpatient aggression with their male counterparts.

METHOD

The population of patients assessed and/or treated at a secure Canadian forensic psychiatric hospital were available for study. In total, 527 patients had complete data and were part of intensive retrospective file reviews; inpatient aggression was evaluated using the Overt Aggression Scale.

RESULTS

Women were no less likely than men to have a violent index offence and to perpetrate inpatient aggression. Examining the range of aggressive behaviours and severity levels did little to increase the relevance of gender to inpatient risk.

DISCUSSION

Female forensic patients represent a highly selected subgroup of women with exceptional clinical and behavioural challenges and associated treatment needs.

Forensic psychiatric aspects of inpatient violence

Inpatient aggression jeopardizes the safety of psychiatric clinicians and patients. A minority of psychiatric inpatients is responsible for most of inpatient assaults; this subset of repetitively assaultive patients warrants greater attention in the form of systematic study. In developing treatment approaches for assaultive inpatients, it is important to characterize the primary motivation driving aggressive behavior. There are many pharmacologic agents and psychotherapeutic approaches available to address inpatients who engage in impulsive and psychotic violence, but the treatment of inpatients with antisocial or psychopathy personality remain limited, and further study is needed. To protect the safety of patients and staff, criminal prosecution of inpatient assaults is clinically justified if an assailant continues to be aggressive despite appropriate clinical interventions or commits an act of planned aggression so egregious that prosecution is the only reasonable alternative.

Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP)

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.

Aggression on a psychiatric acute ward: a three-year prospective study

The objectives of this 3-yr. prospective study of aggression on a Norwegian psychiatric acute ward serving a population of 170,000 were to monitor the rate and characteristics of aggressive behaviour, to identify possible interactional and situational precipitants to aggression, and to explore possible differences between aggressive and nonaggressive patients in terms of diagnosis, sex, age, numbers of admissions, admission type, and length of stay. Aggressive incidents were recorded on the Report Form for Aggressive Episodes (REFA). Severity of injuries was scored according to Fottrell's severity scale. Of the total 934 patients admitted, 98 (10.5%) accounted for a total of 981 aggressive episodes. About 55% of the aggressive incidents were assaults that resulted in 85 minor and 21 severe physical injuries. There was no evidence that diagnosis might be used to predict aggression in the clinical setting. Mean rate of admission per patient and length of stay was significantly higher in the aggressive group than in the nonaggressive group. However, several patients in the aggressive group also had admissions without being aggressive. About 13% of the aggressive patients accounted for nearly 50% of the aggressive incidents. There was no significant sex difference by total rate of aggression, but female patients tended to have higher rates of assaults and contributed to significantly more injuries than male patients. Nearly 20% of the aggressive episodes occurred during the first 24 hours of a stay and 54% during the first week. Limit setting, problems in communication, and physical contact, separately or in combinations, preceded nearly 90% of the aggressive episodes.