Aggression in psychiatry wards: A systematic review

Cornaggia, C; Beghi, Massimiliano; Pavone, Fabrizio; Barale, Francesco

doi:10.1016/j.psychres.2010.12.024

Cited by 260 publications

(213 citation statements)

References 109 publications

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“…These findings are unsurprising given that younger age is a well-established risk factor for violence in psychiatric inpatient settings (Cornaggia et al 2011;Dack et al 2013;Iozzino et al 2015). However, the fact that we adjusted for multiple behavioural precursors suggests that this finding is not entirely explained by the fact that younger patients are more likely to be aggressive.…”

Section: Demographic and Clinical Predictors Of Treatmentmentioning

confidence: 88%

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Cullen

Bowers

Khondoker

et al. 2016

Epidemiol Psychiatr Sci

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Aims. Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods. Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results. PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions. Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.

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Section: Demographic and Clinical Predictors Of Treatmentmentioning

confidence: 88%

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Cullen

Bowers

Khondoker

et al. 2016

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

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“…Women displayed proportionally more aggressive behavior than did men in the initial 4 weeks of inpatient treatment, 5,6,28 whereas during longer hospitalization this difference disappears. 4,6 This gender effect of the early inpatient period could contribute to the poor treatment response in women observed in our study. Furthermore, men might be more compliant in these emergencies.…”

Section: Y13mentioning

confidence: 75%

Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized controlled study with oral haloperidol, risperidone, and olanzapine

Walther¹,

Moggi²,

Horn³

et al. 2013

Pharmacopsychiatry

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“…When it occurs as an impulsive reaction, the manifestation of aggressiveness has the role to release the tension, to psychologically defuse an individual with an excessively high psychoenergetic burden. In some cases, the planned hetero-aggressiveness can indicate the presence of psychopathic traits of personality and self-aggression could be an indicator of depression [10].Also, certain sources of aggression are related to the personality traits of the individual, while others to external conditions, such as frustration, which is one of the most common triggers of aggression along with the attack or direct provocation, verbal and physical, pain, in its physical and moral forms, heat and crowds. The most common and well-known forms of aggressive behaviour that have a social and community impact are particularly delinquency and crime.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Short Review on the Aggressive Behaviour: Genetical, Biological Aspects and Oxytocin Relevance

Pădurariu

Prepelita

Ciobîcă

et al. 2016

ILNS

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Abstract.In this mini-review we were interested in describing the main genetic, biological and mechanistic aspects of the aggressive behaviour in human patients and animal models. It seems that violent behaviour and impulsive traits present a multifactorial substrate, which is determined by genetic and non-genetic factors. Thus, aggressivity is regulated by brain regions such as the amygdala, which controls neural circuits for triggering defensive, aggressive or avoidant behaviour. Moreover, other brain structures such as the anterior cingulate cortex and prefrontal cortex regions could modulate circuits involved in aggression. Regarding the genetic aspects, we could mention the mutations in the monoamine oxidase or the polymorphisms of the genes involved in the metabolism of serotonin, such as tryptophan hydroxylase. Also, besides the low levels of serotonin metabolites, which seem to be associated with impulsive and aggressive traits, there are good evidences that deficiencies in glutamate transmission, as well as testosterone, vasopressin, hypochloesterolemia or oxytocin modifications could be related to the aggressive behaviour. Regarding oxytocin we present here in the last chapter the controversial results from the current literature regarding the various effects exhibited by oxytocin administration on the aggressive behavior, considering the increased interest in understanding the role of oxytocin on the main neuropsychiatric disorders. Introducing the concept of aggressionBased on the etymological analysis, the word aggression comes from Latin, from aggressio, signifying attack, and also from the verb aggredior, which can be translated as "to go against something or someone", "to approach someone with a purpose ", or "to assault" [1]. Thus, aggression basically describes a state of the psychophysiological system that allows the individual to respond with a set of hostile behaviours in the conscious, unconscious, or phantasy plan towards the destruction, coercion, degradation, humiliation of a meaningful thing or being, that the abuser perceives as such and represent a challenge for him/her [2].Moreover, according to a general dictionary of psychology, the term aggression is defined as: 1. the tendency to display hostility by manifestation of aggressive acts; 2. the tendency to overcome any encountered oppositions; 3. the tendency of self-assertion by unswerving manifesting of self interests; 4. hiperenergy in one's attitudes and reactions; 5. the constant tendency of domination within the social group or community [3].In addition, from a psycho-sociological perspective, the aggressiveness as physical expression of the aggressive impulses is perceived by the existence of the behavioural intent to cause moral or psychological suffering to others. The human aggressive behaviour has on one hand an innate feature and, on the other hand, is acquired during the course of anthropogenic evolution. Also, if in the primitive societies the aggression consisted only in physical attacks as violence, in modern society ...

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Aggression in psychiatry wards: A systematic review

Cited by 260 publications

References 109 publications

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized controlled study with oral haloperidol, risperidone, and olanzapine

Short Review on the Aggressive Behaviour: Genetical, Biological Aspects and Oxytocin Relevance

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