Assailant and Victim Behaviors Immediately Preceding Inpatient Assault

Crowner, Martha; Peric, Gordana; Stepcic, Franko; Lee, Seungyeoun

doi:10.1007/s11126-005-2977-2

Cited by 20 publications

(18 citation statements)

References 27 publications

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“…4 Analysis of 59 videotaped assaults occurring on an inpatient psychiatric ward showed that 60% were immediately preceded by at least one threatening, intrusive, or other provocative behavior. 6 Despite evidence indicating the importance of agitation as a predictor of ensuing violence, psychiatric inpatient staff often report that patient assaults occur without any observable warning or provocation and usually attribute violence to immutable factors, such as the patient's acute illness. [21][22][23][24] It is perhaps not surprising, then, that clinical judgment is a poor predictor of psychiatric inpatient violence, with an average positive predictive value of about 30% for both psychiatrists and psychiatric nurses.…”

Section: Predictors Of Psychiatric Inpatient Aggression and Violencementioning

confidence: 99%

Agitation in the Inpatient Psychiatric Setting

Hankin¹,

Bronstone²,

Koran

2011

Journal of Psychiatric Practice

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Agitation among psychiatric inpatients (particularly those diagnosed with schizophrenia or bipolar disorder) is common and, unless recognized early and managed effectively, can rapidly escalate to potentially dangerous behaviors, including physical violence. Inpatient aggression and violence have substantial adverse psychological and physical consequences for both patients and providers, and they are costly to the healthcare system. In contrast to the commonly held view that inpatient violence occurs without warning or can be predicted by "static" risk factors, such as patient demographics or clinical characteristics, research indicates that violence is usually preceded by observable behaviors, especially non-violent agitation. When agitation is recognized, staff should employ nonpharmacological de-escalation strategies and, if the behavior continues, offer pharmacological treatment to calm patients rapidly. Given the poor therapeutic efficacy and potential for adverse events associated with physical restraint and seclusion, and the potential adverse sequelae of involuntary drug treatment, these interventions should be considered last resorts. Pharmacological agents used to treat agitation include benzodiazepines and first- and second-generation antipsychotic drugs. Although no currently available agent is ideal, recommendations for selecting among them are provided. There remains an unmet need for a non-invasive and rapidly acting agent that effectively calms without excessively sedating patients, addresses the patient's underlying psychiatric symptoms, and is reasonably safe and tolerable. A treatment with these characteristics could substantially reduce the clinical and economic burden of agitation in the inpatient psychiatric setting.

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Section: Predictors Of Psychiatric Inpatient Aggression and Violencementioning

confidence: 99%

Agitation in the Inpatient Psychiatric Setting

Hankin¹,

Bronstone²,

Koran

2011

Journal of Psychiatric Practice

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“…Threat displays provide clues to the weapons used in fighting; these displays are usually the first step in a species' fighting technique that is used to threaten (Szamado, 2008;Walther, 1984). Thus, it is noteworthy that a number of researchers have suggested that the formation of a fist in response to stressful stimuli reflects a willingness to use physical force to resolve disputes (Darwin, 1899;Ekman, 1993;Schubert and Koole, 2009;Morris, 1977;Crowner et al, 2005). Human infants often use a 'closed hand' to express distress (Legerstee et al, 1990).…”

Section: Discussionmentioning

confidence: 99%

In vitrostrain in human metacarpal bones during striking: testing the pugilism hypothesis of hominin hand evolution

Horns

Jung

Carrier

2015

Journal of Experimental Biology

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The hands of hominins (i.e. bipedal apes) are distinguished by skeletal proportions that are known to enhance manual dexterity but also allow the formation of a clenched fist. Because male-male physical competition is important in the mating systems of most species of great apes, including humans, we tested the hypothesis that a clenched fist protects the metacarpal bones from injury by reducing the level of strain during striking. We used cadaver arms to measure in vitro strain in metacarpals during forward strikes with buttressed and unbuttressed fist postures and during side slaps with an open palm. If the protective buttressing hypothesis is correct, the clenched fist posture should substantially reduce strain in the metacarpal bones during striking and therefore reduce the risk of fracture. Recorded strains were significantly higher in strikes in which the hand was secured in unbuttressed and slapping postures than in the fully buttressed posture. Our results suggest that humans can safely strike with 55% more force with a fully buttressed fist than with an unbuttressed fist and with twofold more force with a buttressed fist than with an open-hand slap. Thus, the evolutionary significance of the proportions of the hominin hand may be that these are the proportions that improved manual dexterity while at the same time making it possible for the hand to be used as a club during fighting.

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“…Patient, der in eine psychiatrische Notaufnahme kommt, weist Symptome von Agitiertheit auf [4,52]. [23,56,63]. Wesentliches Ziel des akut agitierten Patienten ist nicht die Kausalbehandlung der zugrunde liegenden psychiatrischen Erkrankung, sondern vielmehr eine rasche und sichere Sedierung ("rapid tranquilisation"), um die mit der Störung verbundenen Verhaltensauffälligkeiten besser kontrollieren zu können [25,67].…”

Section: Agitiertheit Und Psychomotorische Unruhezuständeunclassified

Pharmakotherapie von psychiatrischen Akut- und Notfallsituationen

Messer¹,

Pajonk

Müller

2015

Nervenarzt

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The pharmacotherapy of psychiatric emergencies is essentially determined by the acuteness, the scene of the emergency, the diagnostic assessment and the special pharmacological profile of the drug used. As there are no specific drugs, syndromic treatment is carried out. For this, primarily antipsychotic drugs and benzodiazepines are available. This article gives an overview of the current state of treatment options for major psychiatric emergency syndromes, namely agitation, delirium, stupor and catatonia, anxiety and panic, as well as drug-induced emergencies.

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Assailant and Victim Behaviors Immediately Preceding Inpatient Assault

Cited by 20 publications

References 27 publications

Agitation in the Inpatient Psychiatric Setting

Agitation in the Inpatient Psychiatric Setting

In vitrostrain in human metacarpal bones during striking: testing the pugilism hypothesis of hominin hand evolution

Pharmakotherapie von psychiatrischen Akut- und Notfallsituationen

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