Predictors of violent behavior among acute psychiatric patients: Clinical study

Psychiatry and Clinical Neurosciences (Impact Factor: 1.63). 05/2008; 62(3):247 - 255. DOI: 10.1111/j.1440-1819.2008.01790.x


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.

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Available from: Marco Menchetti, Oct 26, 2014
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    • ") that play an important role in inpatient aggression and its management, including: alcohol or substance use (Amore et al., 2008; Biancosino et al., 2009; Bowers et al., 2009; Steadman et al., 1998); diagnoses of schizophrenia, bipolar or personality disorder (Biancosino et al., 2009; Ketelsen et al., 2007); a history of prior violence (Cornaggia et al., 2011); poor psychosocial living status (Ketelsen et al., 2007); high levels of hostility– suspiciousness (Amore et al., 2008; Biancosino et al., 2009); and younger age, male gender, being unmarried and longer hospitalisation (Amore et al., 2008; Biancosino et al., 2009). "
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    ABSTRACT: A retrospective case-control study was conducted examining relationships between patients’ socio-demographic, clinical and admission characteristics and inpatient aggression. Patients aged 18–64 years with a recent offence episode, who were admitted to a regional acute mental health unit, were included as cases (N = 82), while controls comprised the next available admission, matched for age and gender (N = 82). The prototypical patient was a young, single male, with a diagnosis of schizophrenia, a history of substance use and previous psychiatric admissions. The majority of cases had a history of aggression and recent offences against public order. They also revealed a higher likelihood of involvement in ‘less serious’ aggressive incidents (e.g. verbal threats or demands) during the index admission. Clinically, knowledge of each patient’s recent offence history, arrival mode and observed characteristics on admission (including any verbal aggression) may be important in the management of subsequent inpatient aggression.
    Full-text · Article · Apr 2014 · Journal of Forensic Psychiatry and Psychology
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    • "Discussing a trial of medication discontinuation requires a clear articulation of the risks and costs of relapse. A second episode of schizophrenia may be experienced as a major setback for patients who have made a good recovery from their FEP; it can lead to losses in hard-won social and vocational gains, and may increase the risk of violence and suicide (Amore et al., 2008; Hor and Taylor, 2010; Llorca, 2008; Masand et al., 2009). Tragically, some patients are not able to achieve a remission following their second episode and develop chronic treatment resistant symptoms (Lieberman, 1993; Wiersma et al., 1998). "
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    • "Sur les 471 résumés initiaux identifiés, 41 répondaient aux critères d'inclusion [7,8,14,17–53]. Après examen, 27 ont e ´té exclus car l'homicide n'e ´tait pas spécifiquement exploré (n = 10) [17,19–21,29,39,41,44–46], le design de l'e ´tude ne répondait pas exactement aux critères d'inclusion (n = 12) [18] [25] [26] [32] [33] [35] [38] [40] [43] [50] [51] [54] ou encore l'e ´tude e ´tait non prospective (n = 5) [8] [36] [37] [42] [47]. Six revues de la littérature ou méta-analyses [7] [14] [24] [31] [52] [55] et huit e ´tudes longitudinales [22] [23] [27] [28] [30] [34] [49] [53] ont e ´té retenues. "
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