The Violence Triad and Common Single Precipitants to Psychiatric Patient Assaults on Staff: 16-Year Analysis of the Assaulted Staff Action Program

Flannery, Raymond B.; Staffieri, Andrea; Hildum, Susan; Walker, Andrew P.

doi:10.1007/s11126-010-9155-x

Cited by 24 publications

(28 citation statements)

References 16 publications

(52 reference statements)

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“…19 In a 16-year observational study, acute psychosis precipitated 19% of physical and verbal assaultive behaviors by psychiatric inpatients. 20 Contrary to the common belief that patient violence occurs without warning, [21][22][23][24] most violent episodes are preceded by specific behavioral warning signs and cues, 1-6 such as explosive or unpredictable anger, intimidation, restlessness, pacing and excessive movement, physical or verbal self-abusiveness, verbally demeaning or hostile behavior, uncooperative or demanding behavior, and impulsiveness and impatience. 9 In 1992, Morrison observed that psychiatric inpatients' aggressive and violent behaviors occurred along a hierarchy of eight levels (Table 1), with higher levels indicating more severe aggression.…”

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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“…Secondly, this study's findings again document high levels of violence toward others, personal victimization, and substance use disorder as all being present in many assaultive patients. Previous research [24] has demonstrated that the presence of these three clinical variables taken together is highly associated with subsequent assault and care givers should be alert, when these variables are present in patients. Thirdly, these present findings continue to document unacceptable levels of violence committed against women in society [1,16].…”

Section: Specific Clinical Findingsmentioning

confidence: 99%

Characteristics of Assaultive Psychiatric Patients: 20-Year Analysis of the Assaultive Staff Action Program (ASAP)

et al. 2010

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Empirical research demonstrates that patient assaults on staff are a worldwide occupational hazard. This study examined patient assailant characteristics in a 20-year longitudinal, retrospective study in one public health care system. Older male patients with schizophrenic illness and histories of violence toward others and substance use disorder and younger male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use disorder were the more frequent assailants. This was true at 10-, 15-, and 20-year periods. Specific clinical findings with regard to forensic patients, the violence triad, and victimization of women as well as methodological issues were discussed and the implications noted.

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“…Thus, the estimates of prevalence and risk of violent behavior in the community are lowered by a constant removal of the most violent schizophrenia patients to hospitals and jails. In many cases, violent behavior continues inside these institutions [30,31]. Furthermore, it is important to point out that only some incidents of aggressive behavior lead to prosecution.…”

Section: Prevalence Of Violent Behavior In Schizophreniamentioning

confidence: 99%

Aggression in Psychoses

Volavka

2014

Advances in Psychiatry

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Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.

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The Violence Triad and Common Single Precipitants to Psychiatric Patient Assaults on Staff: 16-Year Analysis of the Assaulted Staff Action Program

Cited by 24 publications

References 16 publications

Agitation in the Inpatient Psychiatric Setting

Agitation in the Inpatient Psychiatric Setting

Characteristics of Assaultive Psychiatric Patients: 20-Year Analysis of the Assaultive Staff Action Program (ASAP)

Aggression in Psychoses

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