Physical Assault in the Psychiatry Emergency Room

Lawrence, Ryan E.; Rolin, Stephanie A.; Looney, Diane V; Birt, Adriane R; Stevenson, Ellen M; Dragatsi, Dianna; Appelbaum, Paul S.; Dixon, Lisa B.

doi:10.1176/appi.focus.23022004

Cited by 6 publications

(4 citation statements)

References 36 publications

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“… 22 , 23 Moreover, physical violence is notoriously difficult to predict in clinical settings, and it may be difficult for staff to know what a patient is thinking or trying to do if the patient is intellectually disabled or motivated by an internal logic known only to themselves. 4 To help meet these challenges, we analyzed rapidly available clinical data to explore easily obtainable clinical markers of the risk of physical violence. Our findings may help develop a method for the timely assessment of the risk of physical violence in acute patients with BD-M.…”

Section: Discussionmentioning

confidence: 99%

“…Physical violence is considered a core characteristic of BD-M and refers to non-accidental physical assault that intimidates or harms others and is closely related to hostility and aggression. 4 , 5 Physical violence is common during manic episodes of BD, resulting in a higher rate of violent crime in patients with BD than in the general population and imposes a severe burden on the occupational, social, and family functioning of patients. 6 Patients with BD are eight times more likely to engage in physical violence than the general population and are even more likely to engage in physical violence than patients with schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States

Li,

Gao,

Liu

et al. 2023

RMHP

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Purpose Identifying patients with bipolar disorder (BD) in manic states (BD-M) who are at a high risk of physical violence is a matter of clinical concern. This retrospective institution-based study aimed to identify simple, rapid, and inexpensive clinical markers of physical violence in patients with BD-M. Patients and Methods The anonymized sociodemographic variables (sex, age, years of education, marital status) and clinical ones (weight, height, body mass index, blood pressure, the score of BRMS, number of BD episodes, psychotic symptoms, history of violence, biochemical parameters, and blood routine parameters) of 316 BD-M participants were collected, and the risk of physical violence was identified using the Brøset Violence Checklist (BVC). Difference tests, correlation analyses, and multivariate linear regression analysis were performed to identify clinical markers for the risk of physical violence. Results The participants were categorized into groups at low (49, 15.51%), medium (129, 40.82%), and high (138, 43.67%) risk of physical violence. The number of BD episodes, serum uric acid (UA), free thyroxine (FT4) levels, history of violence, and monocyte-to-lymphocyte ratio (MLR) differed significantly between groups (all P <0.05). The number of BD episodes ( r =0.152), FT3 ( r =0.131) and FT4 ( r =0.132) levels, history of violence ( r =0.206), and MLR ( r =−0.132) were significantly correlated with the risk of physical violence (all P <0.05). The existence of history of violence, number of BD episodes, UA, FT4, and MLR were identified as clinical markers of the risk of physical violence in patients with BD-M (all P <0.05). Conclusion These identified markers are readily available at initial presentation and may help in the timely assessment and treatment of patients with BD-M.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States

Li,

Gao,

Liu

et al. 2023

RMHP

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“…This correlation is likely related to the high levels of agitation, impulsivity, and lability among patients with mania. Notably, mania has also been identified as a risk factor for restraint/seclusion (Simpson et al, 2014) and physical violence (Lawrence et al, 2020) in emergency psychiatry settings. Emergency psychiatry training and policy development should highlight these patients as having increased risk for safety events.…”

Section: Discussionmentioning

confidence: 99%

Persons Who Engage in Self-Harm While in the Emergency Department

et al. 2022

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Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95-9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19-7.02), current manic episode (OR, 3.59; CI,, and a history of seizures (OR, 4.19; CI,. Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.

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“…Studies investigating the significant implication of patient aggression on the professional performance of nurses found that it negatively affects the quality of care provided (Stevenson et al 2015 ), contributes to increased levels of stress (Itzhaki et al 2018 ), anger, fear or anxiety, post-traumatic stress disorder symptoms (Jeffery and Fuller 2016 ; Cheung, Lee and Yip 2017 ), guilt, self-blame and shame (Lawrence et al 2020 ), reduces the mental and physical well-being (Maluleke and Van Wyk 2017 ), reduces the motivation of nurses (Dean, Butler and Cuddigan 2021 ), decreases job satisfaction (Joubert and Bhangan 2018 ), increases the intent to leave the organisation (Timor et al 2019 ) and lowers the health-related quality of life (Moylan et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa

Thandavhathu,

Maluleke,

Raliphaswa

et al. 2024

Health SA Gesondheid

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Background: Aggression of patients in hospital wards has become an endemic problem and professional nurses are particularly at high risk.Aim: This article presents the types of patient aggression experienced by professional nurses working in an acute psychiatric ward in Vhembe District, South Africa.Setting: Vhembe District, South Africa.Methods: A qualitative approach using exploratory, descriptive and contextual research design was used. Four hospitals were purposively selected and 10 professional nurses were conveniently sampled to participate in the study. Individual interviews were used to collect data, which were then analysed through Tesch Open Coding Method. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study.Results: This study shed some light on the professional nurses’ lived experiences regarding the types of aggression from patients in an acute psychiatric ward in Vhembe District. The types of aggression are physical aggression, destructive behaviour and verbal aggression.Conclusion: The findings show that the types of aggression to which professional nurses are exposed are overwhelming and the consequences are shocking. As a result, the health of professional nurses is compromised. Therefore, this study recommends further studies to determine the kind of support needed by professional nurses working in an acute psychiatric ward and to investigate the impact of aggression from patients in acute psychiatric ward with regard to the quality of care.Contribution: This article contributes to the body of knowledge regarding patients’ aggression in acute wards in Vhembe District, South Africa.

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Physical Assault in the Psychiatry Emergency Room

Cited by 6 publications

References 36 publications

Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States

Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States

Persons Who Engage in Self-Harm While in the Emergency Department

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa

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