Characteristics of Patients Involved in Physical Assault in an Acute Inpatient Psychiatric Setting

Abstract

Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault.

Risk Factors and Triggers That May Result in Patient-Initiated Violence on Inpatient Psychiatric Units: An Integrative Review

“…The three themes demonstrate that patient characteristics, staff approach, and the ward environment are risk factors and triggers that may result in patient-initiated violence in various ways. Previous research has acknowledged the association between patient characteristics and the emergence of violent incidents (Dack et al, 2013;Iozzino et al, 2015;Sanghani et al, 2017), thus confirming our findings (Barlow et al, 2000;Bilgin, 2009;Chou et al, 2002;Grassi et al, 2001;Ketelsen et al, 2007;Newton et al, 2012;Omérov et al, 2004;Scanlan, 2010;Soliman & Reza, 2001). Moreover, we showed that the explanatory model cannot be restricted to patient characteristics.…”

“…Based on quantitative research, it has been possible to find associations between patient variables and violence. For example, some studies have found an association between violent behavior and age (Dack, Ross, Papadopoulos, Stewart, & Bowers, 2013), sex (Iozzino et al, 2015), diagnosis (Iozzino et al, 2015), history of violence (Sanghani et al, 2017), use of alcohol and substances (Bowers et al, 2009), and marital status (Dack et al, 2013). Several risk assessment scales have been developed, for example, the HCR-20 (Webster, Douglas, Eaves, & Hart, 1997) and the Violence Risk Appraisal Guide (VRAG) (Harris, Rice, & Quinsey, 1993).…”

Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit

“…; Sanghani et al . ; Van Dorn et al . ), quantitative research has predominantly focused on the binarity of the presence or absence of violence, and to a large extent concerned itself with the patients’ characteristics.…”

Medication use and physical assaults in the psychiatric emergency room

“…Alternatively, although medications (especially antipsychotics, benzodiazepines, and mood stabilizers) are a potentially important tool for modifying violence risk, few studies have analyzed the relationship between medication and violence risk (3,9,13,14,16,17). Studies that did report a relationship offered limited conclusions: non-adherence can be a risk factor for violence (15,18,19), clinicians often respond to aggressive or violent behavior by administering medication (11,20,21), violent patients undergo more medication changes (12), and may receive more medication during their hospital course including higher average daily dose of antipsychotics and benzodiazepines, and multiple antipsychotics (4,7,8,12). However, these studies did not address the central clinical question of whether a particular medication, given at particular moment, may be associated with reduced risk of subsequent violence.…”

“…Physical assaults are a persistent problem in hospital psychiatry, causing physical injuries, psychological distress, and increased costs (1–3). Although by some metrics these events are quite rare (1.98 events per 1000 patient days at one acute psychiatric hospital (4)), other analyses suggest this prevalence is unacceptably high. A recent publication by the Joint Commission (2018) highlighted that 75% of 25,000 workplace assaults reported annually to the Occupational Safety and Health Administration occurred in healthcare and social service settings; workers in healthcare settings are four times more likely to be assaulted than workers in private industry and violence-related injuries are four times more likely to cause healthcare workers to take time off from work.…”