Hostility and violence of acute psychiatric inpatients

Raja Michele, Azzoni, Azzoni Antonella

Description

Objective The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit. Methods Retrospective analysis of data prospectively collected in a 6-year period. Results No hostility was observed in 56.1%, hostility in 40.9%, and violence in 3.0% of the admitted cases. Seclusion was never used. Six cases (2,5‰) required physical restraint. Risk factors associated with violence were younger age, suicidal risk, and diagnosis of schizophrenia. Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder, being single, having no children, lower GAF scores, higher BPRS hostility, SAPS, and CGI scores, lower BPRS anxiety-depression score, higher doses of psychoactive drugs, more frequent use of neuroleptics, diagnosis of mania, personality disorder, substance and alcohol related disorders, no diagnosis of depression. Conclusion The study confirms the low rate of violence among Italian psychiatric in-patients, the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior, the possibility of a no seclusion-no physical restraint policy, not associated either with higher rates of hostility or violence or with more severe drug side effects.

Sujets

• Hostility
• Violence
• Psychiatry
• Emergency
• Psychosis
• Schizophrenia
• Mood

Informations

• Publié par: biomed
• Publié le: 01 janvier 2005
• Nombre de lectures: 52
• Langue: English

Extrait

Clinical Practice and Epidemiology in Mental Health

Research Hostility and violence of acute psychiatric inpatients Michele Raja* and Antonella Azzoni

BioMedCentral

Open Access

Address: Università degli Studi di Roma "La Sapienza". Scuola di Specializzazione in Psichiatria. Servizio Psichiatrico di Diagnosi e Cura, Ospedale Santo Spirito, Rome, Italy Email: Michele Raja*  [e-mail]; Antonella Azzoni  [e-mail] * Corresponding author

Published: 29 July 2005Received: 15 June 2005 Accepted: 29 July 2005 Clinical Practice and Epidemiology in Mental Health2005,1:11 doi:10.1186/ 1745-0179-1-11 This article is available from: http://www.cpementalhealth.com/content/1/1/11 © 2005 Raja and Azzoni; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

hostilityviolencepsychiatryemergencypsychosisschizophreniamooddisorders

Abstract Objective:The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit. Methods:Retrospective analysis of data prospectively collected in a 6-year period. Results:No hostility was observed in 56.1%, hostility in 40.9%, and violence in 3.0% of the admitted cases. Seclusion was never used. Six cases (2,5‰) required physical restraint. Risk factors associated with violence were younger age, suicidal risk, and diagnosis of schizophrenia. Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder, being single, having no children, lower GAF scores, higher BPRS hostility, SAPS, and CGI scores, lower BPRS anxiety-depression score, higher doses of psychoactive drugs, more frequent use of neuroleptics, diagnosis of mania, personality disorder, substance and alcohol related disorders, no diagnosis of depression. Conclusion:The study confirms the low rate of violence among Italian psychiatric in-patients, the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior, the possibility of a no seclusion-no physical restraint policy, not associated either with higher rates of hostility or violence or with more severe drug side effects.

Introduction Hostility and violence have long been a matter of concern in inpatient psychiatry. Violence of inpatient psychiatric units is a distinct character from outpatient violence. Of inpatients, 18% to 25% exhibit violent behavior while in the hospital [1,2]. Of violent acts, 78% are directed to nurses, with other targets being (in descending order of frequency) fellow patients, property, self, physicians, psy chologists, family members, and housekeeping staff [3]. Ten to 45% of patients with schizophrenia exhibit aggres

sive or threatening behavior during hospitalization [47]. Since violence is a complex behavior related to clinical as well as social components and approaches of psychiatric care, it is particularly important to investigate the aggres sive and violent behavior of psychiatric patients in differ ent settings and countries in order to find out risky or protective factors. In Italy, reported rates of psychiatric inpatients' violent behavior tend to be lower than in other countries [810]. The reasons are unknown. The aim of the present study was to find out the extent of hostility

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