Predictors of violent behavior among acute psychiatric patients: Clinical study

Abstract

Aim: Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. Methods:The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated.Results: Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. Conclusion:A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

Aggression in Psychiatry Wards

“…demografik özellikler, çocuklukta kötüye kullanım/şiddet öyküsü, yatış öncesi şiddet öyküsü, hastalığın aşaması), yani, hemşirelik girişimleriyle giderilmesi pek mümkün olmayan faktörler yer almaktadır. [8,13,19,27,39,40,[53][54][55][56][57][58][59][60] Agresyonun yönetilmesi açısından, bu model hemşirelerin, dış model (çevre ve çalışana ait faktörler) ya da durumsal/etkileşimsel modele göre, geleneksel yaklaşımları (tespit, izolasyon vb.) daha fazla kullanmalarına neden olabilmektedir.…”

The Predictive Validity of Clinical Ratings of the Short-Term Assessment of Risk and Treatability (START)

“…Another strength of this research was that past behavior was controlled for in the multilevel logistic models. Despite the adage that past behavior is the best predictor of future behavior and that this has been replicated in research done with the severely mentally ill (Amore et al, 2008), many studies do not take it into account in a systematic manner (e.g., HCR-20, Webster et al, 1997).…”

Drugs of abuse among acute psychiatric and medical admissions: laboratory based identification of prevalence and drug influence

“…Still, recent intake of substances may result in severe medical conditions (31) and increase the risk of violence and suicide (57,186). Even small amounts of a drug may pose problems for people with mental illness (59).…”