Profiles of Aggression among Psychiatric Patients

Assessing and managing violence risk in outpatient settings

“…Clinical anger and agitation ratings were the best "postdictors" of prehospitalization violence (r ϭ .34 and r ϭ .27, respectively), and showed even higher correlations with prehospitalization violence than clinical ratings of factors such as antisocial behavior (r ϭ .18), suspiciousness (r ϭ .19), and delusional thinking (r ϭ .20). Similarly, Kay, Wolkenfeld, and Murrill (1988) reported anger, hostility, and excitability to be significantly associated with violence displayed by a sample of 208 psychiatric patients both during and subsequent to hospitalization. In a series of studies with psychiatric inpatients, Novaco (1994) reported that anger (as measured by various subscales of the Novaco Anger Scale) was significantly correlated with prior criminal convictions (.34), use of seclusion and restraint while hospitalized (.34), and hospital assaults (.26).…”

“…Not surprisingly, perhaps the single greatest risk factor for future violence is a history of violent behavior or criminal behavior more generally (Kay, Wolkenfeld, & Murrill, 1988;Mossman, 1994;Klassen & O'Connor, 1994;Bonta, Law, & Hanson, 1998). Persons who have contact with the juvenile justice system as minors are more likely to engage in violent and other criminal activities as adults, and adults with violence histories are more likely to engage in future violent behavior than persons without such histories.…”

Patient Aggression in Real Time on Geriatric Inpatient Units

“…Nursing staff were taught how to use the Modified Overt Aggression Scale (MOAS) (Kay, Wolkenfeld, & Murrill, 1988). The scale rates verbal aggression that seeks to inflict psychological harm through devaluation/degradation and threats of physical attack.…”

Construction of an Instrument to Evaluate Nurses' Decision Making in Relation to the Use of Restraint in Acute Care Psychiatry

“…Theory of aggression progression, including biological and behavioral components, and previous studies were identified (Kay, Wolkenfeld, & Murrill, 1988;Lange, 1966;Navis, 1987;Phillips & Nasr, 1983;Pisarcik, 1981;Silver & Yudofsky, 1987;Yudofsky et al, 1986). These authors documented that, although some aggressive incidents erupt spontaneously and others may resolve spontaneously, aggression in psychiatric patients most often follows a systematic pattern and the point at which actual violence occurs is predictable.…”

“…The Overt Aggression Scale (OAS; Silver & Yudofsky,1987) and the Modified Overt Aggression Scale (MOAS; Kay, Wolkenfeld, & Murrill, 1988) present levels of aggressive behavior as an objective measure for research purposes, legal purposes, and for use in investigating intervention methods. However, the aggressive actions are rated individually and the instrument is not intended for the assessment of ongoing progression of aggression as a guide for immediate intervention.…”