Inpatient aggression in community hospitals

K, Szabó; White, Christopher L.; Cummings, Stephen; Wang, Raziya S; Quanbeck, Cameron

doi:10.1017/s1092852914000820

Cited by 17 publications

(15 citation statements)

References 79 publications

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“…The seven-point BARS assesses behavioral activities in agitated patients with high reliability and convenience, with results ranging from sedation, to normal activity, to agitation [25]. Agitation is an established short-term factor associated with physical aggression [26]. The assessment of behavioral activities in agitated patients at an early stage may help to identify the risk of aggression and suggest specific treatment interventions.…”

Section: Discussionmentioning

confidence: 99%

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Zhang

Liu

et al. 2019

BMC Psychiatry

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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. Electronic supplementary material The online version of this article (10.1186/s12888-019-2192-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Zhang

Liu

et al. 2019

BMC Psychiatry

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“…Neurons Away group binds on existing evidence of high reports of agitation during nursing shift change. [19] It focuses on distracting and redirecting the attention of the inpatients to a more playful, favorable environment, from a nursing shift change, a chaotic environment. It encouraged and helped build and practice the use of mature defense mechanisms of using humor, sublimation, altruism, and distraction, as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

“…Medication times and mealtimes were also associated with an increased incidence of agitation. [18,19] We decided to implement a novel form of art -based recreational therapy that focuses on completing creative questions and activities that encourage mental flexibility and imaginative thinking as a means to develop new coping skills, decrease the incidence of agitation, and improve mood amongst patients on an acute inpatient psychiatry unit. We implemented this new group called Neurons Away during the critical period of nursing shift change.…”

Section: Introductionmentioning

confidence: 99%

On importance of new group therapy for decrease of agitation during the critical period of nursing shift changes on an acute psychiatric inpatient floor

Leontieva

Safadi²,

Jain

et al. 2020

JHA

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Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change.Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session.Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984).Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration.Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.

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“…Several studies have investigated the presence of violent behaviors among inpatients of psychiatric wards. 21,24,[33][34][35][36][37][38] In contrast with a large amount of data reported for inpatients, studies with Italian 39,40 and international 41 outpatients are lacking.…”

Section: Discussionmentioning

confidence: 99%

Aggressiveness and violence in psychiatric patients: a clinical or social paradigm?

et al. 2019

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ObjectivePsychiatric disorders are often considered the leading cause of violence. This may be due to a stereotype created by media and general opinion.MethodThe Modified Overt Aggression Scale (MOAS) was used to evaluate the severity of aggressive and violent behaviors in 400 patients who attended a post-acute psychiatric service in Milan from 2014 to 2016 and suffered from different psychiatric disorders. The psychopathological clinical picture was evaluated by Clinical Global Impression (CGI). The study also assessed the possible correlation between epidemiologic and sociodemographic factors, clinical variables, and aggression and violence.ResultsOf the total number of subjects, 21.50% showed a MOAS score >0, 11.50% presented mild aggression (0–10 MOAS weighted score), 9% moderate aggression (11–20), and 1% severe aggression (MOAS >20). With respect to violent behaviors, 16% of patients showed a score >0 in one MOAS subscale other than verbal aggression according to violence definition. The severity of clinical picture seemed to be related to higher weighted MOAS score. Multivariate testing of different sociodemographic and clinical variables showed that violence was related to unemployment status, and significantly correlated to compulsory admission (TSO), suicide attempts (TS), and personality disorders, while the severity of clinical psychiatric picture seemed to play a secondary role.ConclusionResults have shown that personality disorders and sociodemographic factors, including economic factors, seem to be major determinants of violence among patients diagnosed with mental disorders.

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Inpatient aggression in community hospitals

Cited by 17 publications

References 79 publications

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

On importance of new group therapy for decrease of agitation during the critical period of nursing shift changes on an acute psychiatric inpatient floor

Aggressiveness and violence in psychiatric patients: a clinical or social paradigm?

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