Purpose: Violence in psychiatric hospital wards in Japan is not well understood, and the risk factors for identification of violent patients have not been established. The goal of this study was to develop strategies for short-term prediction of violence based on behavioral profiles. Methods: Demographic characteristics, diagnoses, psychiatric symptoms and social skills were analyzed in 534 inpatients in seven closed wards of four psychiatric hospitals. The behavior of these subjects was observed using the Brøset Violence Checklist (BVC). Results: Ninety-two subjects were involved in 164 incidents of violence. Logistic regression analysis suggested that a past history of violence, significant dysthymia, and a BVC score of 1 or higher were risk factors for violence. Discussion and Conclusion: Violence in psychiatric wards can be predicted using background factors including a past history of violence, a lack of negative symptoms, and dysphoria, in combination with a BVC score of 1 or more. Prevention of violence may be achieved with careful attention to the identified risk factors.
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January 1997
The case notes of all the inpatients (n=107) committing assaults during their stay at Government Hospital for Psychiatric Diseases, Lahore in the year 1992 were analyzed. The most common victims were ward attendants followed by other patients and doctors. More doctors were assaulted than nurses and other patients. The violent patients were more likely to be schizophrenics, deluded (persecutory),
... [Show full abstract] hallucinated and to have undergone repeated admissions. Violence tended to be repetitive, and the violent patients were usually identifiable from previous aggressive disturbed behaviour. These patients tended to be younger, psychotic and more seriously sick. They were particularly treated in a closed ward. Read more March 2007 · Aggressive Behavior
As aggressive behavior has a negative impact in general psychiatry, its influence specifically from a gender-related point of view in an in-patient population of a psychiatric clinic was assessed at the time of admission. A group of 521 successively admitted psychiatric in-patients was investigated at admission with the help of the "Social Dysfunction and Aggression Scale". A slightly higher
... [Show full abstract] frequency and intensity of "verbal aggressive behavior" was observed in males. Within the other categories of aggressive behavior ("tension", "physical violence to things", and "assaults"), however, the percentages and intensities of gender-related aggressive behavior did not differ significantly. Furthermore, under the covarying impact of various psychiatric diagnoses, the gender-related differences concerning the intensity of "verbal aggressive behavior" disappeared. When comparing male and female subgroups, it was notable that male schizophrenic patients were younger than female patients when displaying comparable risks of showing at least one kind of aggressive behavior. In addition, in the female subgroup, "self-injurious behavior" was more strongly correlated to the category "tension" than in the male subgroup. Although there are some methodological shortcomings, the present results show that there are small qualitative differences in gender-related aggressive behavior in addition to minimal quantitative differences in the frequency and intensity of "verbal aggressive behavior" at admission. Read more February 2002 · Acta psychiatrica Scandinavica. Supplementum
Research of the determinants of inpatient aggression indicates that certain environmental hospital variables play a role in triggering aggression in psychiatric hospitals. Yet, how patient, staff and ward variables interact in eliciting aggression is not well understood.
On the basis of earlier findings, a model was proposed in which psychopathology and distorted cognitions of the patient are
... [Show full abstract] combined with environmental and communicational stressors that are specific for psychiatric wards.
The proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence.
Although tentative, the model may shed light on the mechanisms that lead to (repeated) violence. Read more Article
Full-text available
September 2015 · International Journal of Nursing Studies
Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both.
To test the efficacy of these interventions.
A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation.
... [Show full abstract] The main outcomes were rates of conflict and containment.
Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals.
For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.6-23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% CI 9.9-34.3%).
Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment.
IRSCTN38001825.
Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved. View full-text October 1994 · Law and Human Behavior
Developed a screening checklist for assessing the risk of violence at the time of psychiatric hospitalization. Checklist items and a cutoff point for low vs high risk of violence were selected based on a previous study of statistical prediction of violence. Application of the checklist to a new sample of 338 adult patients admitted to a university-based inpatient unit revealed promising results
... [Show full abstract] in identifying patients who later displayed aggressive behavior in the hospital, as indicated by its positive predictive value (59.0%), negative predictive value (70.6%), sensitivity (57.2%), specificity (70.0%), total predictive value (65.4%), and likelihood ratio (1.97). Results suggest the potential value of incorporating actuarial methods in the evaluation of violence risk. (PsycINFO Database Record (c) 2014 APA, all rights reserved) Read more Article
Full-text available
August 2008 · The British journal of psychiatry: the journal of mental science
There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care.
To assess whether such risk assessments decrease the incidence of violence and coercion.
A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The
... [Show full abstract] intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients.
Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease.
Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards. View full-text August 2007 · The Lancet
Recent changes to mental-health services have taken their toll on inpatient care in the UK. Acute psychiatric wards have lost experienced staff and money to community mental-health teams, and, as a result, some have become untherapeutic and unsafe. Udani Samarasekera reports.
Read more April 2015 · CNS spectrums
Existing literature on aggression within psychiatric hospitals suggests that treating an aggressive patient's symptoms could be complemented by (a) milieu environments that mitigate violence and (b) hospital-wide policies and procedures that focus on creating a safe environment. Described as an ecological approach, examples of how this broader, situational approach can reduce inpatient violence
... [Show full abstract] in psychiatric settings are provided throughout. The authors identify potential barriers to focusing on wards and institutional rules as well as patient treatment. Last, details of how this ecological approach has been implemented at one state hospital in California are provided. Read more February 2007 · Journal of Psychiatric and Mental Health Nursing
This study investigated the aggressive behaviour of all mentally ill patients within a whole psychiatric hospital with a catchment area of 325 000 inhabitants over a 1-year period (i) to assess the 1-year prevalence and characteristics of aggressive episodes and index inpatients, and (ii) to identify predictors of patients at risk by a multivariate approach. Staff Observation of Aggression Scale
... [Show full abstract] was used to assess aggressive behaviour. Characteristics of index inpatients were compared with those of non-index inpatients. Logistic regression analysis was applied to identify risk factors. A total of 171 out of 2210 admitted patients (7.7%) exhibited 441 aggressive incidents (1.7 incidents per bed per year). Logistic regression analyses revealed as major risk factors of aggression: diagnoses (organic brain syndromes OR = 3.6, schizophrenia OR = 2.9), poor psychosocial living conditions (OR = 2.2), and critical behaviour leading to involuntary admission (OR = 3.3). Predictors of aggressive behaviour can be useful to identify inpatients at risk. Nevertheless, additional situational determinants have to be recognized. Training for professionals should include preventive and de-escalating strategies to reduce the incidence of aggressive behaviour in psychiatric hospitals. The application of de-escalating interventions prior to admission might be effective in preventing aggressive behaviour during inpatient treatment especially for patients with severe mental disorders. Read more January 1984
Thesis (D.N.S.)--University of California, San Francisco, 1984. Includes bibliographical references. Microfiche.
Read more July 2011 · Der Nervenarzt
In order to identify psychiatric patients who have a higher risk of being aggressive towards others, a risk checklist, the "Bremen Risk Assessment Scale for General Psychiatry" (BRAS-GP) was developed. The results of the first trial are described in this article.
In this prospective study all in-patients who were treated in the last quarter of 2006 were included. The BRAS-GP was applied on
... [Show full abstract] discharge to patients who were treated involuntarily. In a 1-year follow-up all patients who had been readmitted were analyzed to assess if any aggressive incident had occurred to confirm or refute the prognoses.
On evaluation of the readmissions data, we calculated sensitivity of 0.72 and specificity of 0.71 as well as an "area under the curve" of 0.74. Especially during the first months after discharge readmissions linked with aggressive behavior were observed.
The BRAS-GP is a useful prognostic instrument with high predictive validity. It can be easily applied in general psychiatric wards to help identify risk patients. After detecting risk patients special treatment strategies can then be offered. Read more February 2016 · Law and Human Behavior
The present study examined risk for inpatient aggression, including treatment-related changes in risk, using a battery of 5 forensic instruments. The relative contributions of different types of risk factors to the assessment of risk for inpatient outcomes were also assessed. The Historical-Clinical-Risk Management-20V3, Short-Term Assessment of Risk and Treatability, Violence Risk Scale,
... [Show full abstract] Violence Risk Appraisal Guide-Revised, and Psychopathy Checklist-Revised were rated from archival information sources on a sample of 99 adult forensic inpatients from a Canadian psychiatric hospital. Pretreatment and posttreatment ratings were obtained on all dynamic study measures; associations between risk and change ratings with inpatient aggression were examined. Significant pretreatment-posttreatment differences were found on the HCR-20V3, START, and VRS; pretreatment scores on these measures each demonstrated predictive accuracy for inpatient aggression (AUC = .68 to .76) whereas the PCL-R and VRAG-R did not. HCR-20V3, VRS, and START dynamic scores demonstrated incremental predictive validity for inpatient aggression to varying degrees after controlling for static risk factors. Dynamic change scores from these 3 measures also demonstrated incremental concurrent associations with reductions in inpatient aggression after controlling for baseline risk. Several instruments demonstrated predictive validity for inpatient aggression and clinical/dynamic risk and change scores had unique associations with this outcome. The present findings suggest that risk assessments using the HCR-20V3, START, and VRS may inform the management and reduction of inpatient aggression, as well as assessments of dynamic risk more generally. (PsycINFO Database Record Read more Last Updated: 05 Jul 2022
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