Staff and Patient Views of the Reasons for Aggressive Incidents: A Prospective, Incident-Based Study

Nolan, Karen; Shope, Constance; Citrome, Leslie; Volavka, Jan

doi:10.1007/s11126-009-9104-8

Cited by 21 publications

(20 citation statements)

References 15 publications

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“…54 In two studies, about 20%-45% of nurses who suffered an assault by a patient on a psychiatric ward missed work as a result of the incident, 41,55 with a mean of 5.2 sick days. 41 Although most aggressive incidents in the inpatient psychiatric setting do not result in physical injury, 41,44,56 the frequent and everpresent potential for patient aggression has negative emotional effects on staff. 57,58 Among inpatient psychiatric staff who were physically assaulted by a patient, 65% required more than a week to recover emotionally from the assault, 55 61% reported symptoms of posttraumatic stress disorder (PTSD), 59 and up to 17% satisfied diagnostic criteria for PTSD.…”

Section: Situational Antecedentsmentioning

confidence: 99%

Agitation in the Inpatient Psychiatric Setting

Hankin¹,

Bronstone²,

Koran

2011

Journal of Psychiatric Practice

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Agitation among psychiatric inpatients (particularly those diagnosed with schizophrenia or bipolar disorder) is common and, unless recognized early and managed effectively, can rapidly escalate to potentially dangerous behaviors, including physical violence. Inpatient aggression and violence have substantial adverse psychological and physical consequences for both patients and providers, and they are costly to the healthcare system. In contrast to the commonly held view that inpatient violence occurs without warning or can be predicted by "static" risk factors, such as patient demographics or clinical characteristics, research indicates that violence is usually preceded by observable behaviors, especially non-violent agitation. When agitation is recognized, staff should employ nonpharmacological de-escalation strategies and, if the behavior continues, offer pharmacological treatment to calm patients rapidly. Given the poor therapeutic efficacy and potential for adverse events associated with physical restraint and seclusion, and the potential adverse sequelae of involuntary drug treatment, these interventions should be considered last resorts. Pharmacological agents used to treat agitation include benzodiazepines and first- and second-generation antipsychotic drugs. Although no currently available agent is ideal, recommendations for selecting among them are provided. There remains an unmet need for a non-invasive and rapidly acting agent that effectively calms without excessively sedating patients, addresses the patient's underlying psychiatric symptoms, and is reasonably safe and tolerable. A treatment with these characteristics could substantially reduce the clinical and economic burden of agitation in the inpatient psychiatric setting.

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Section: Situational Antecedentsmentioning

confidence: 99%

Agitation in the Inpatient Psychiatric Setting

Hankin¹,

Bronstone²,

Koran

2011

Journal of Psychiatric Practice

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“…Differential diagnosis of agitated behavior in a person with known schizophrenia or bipolar disorder can be complex as there can be multiple causes, any of which can be present at the same time and can also differ from episode to episode 3–7. There may be co-occurring substance use or intoxication, intrusive hallucinations or paranoid delusions, neuropsychiatric deficits that result in overall poor impulse control, a chaotic environment that lends itself to behavior dyscontrol, or frank psychopathy.…”

Section: Introductionmentioning

confidence: 99%

Addressing the need for rapid treatment of agitation in schizophrenia and bipolar disorder: focus on inhaled loxapine as an alternative to injectable agents

Citrome¹

2013

TCRM

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Agitation (excessive motor or verbal activity) can be associated with schizophrenia or bipolar mania, and can further escalate into aggressive behavior and potentially lead to injuries in patients and staff. Medications used to treat agitation include antipsychotics and benzodiazepines, usually administered intramuscularly when rapid action is desired. Loxapine, a first-generation antipsychotic, has recently been reformulated into an inhaled powder that allows for direct administration to the lungs, resulting in rapid absorption into the systemic circulation. Administered via a single-use device, inhaled loxapine was tested in randomized controlled trials in agitation associated with schizophrenia or bipolar mania; doses of 5 mg and 10 mg were found to be efficacious, with an apparent dose response. In the Phase III studies, number needed to treat versus placebo for a ≥40% reduction from baseline on the Positive and Negative Syndrome Scale – Excited Component (PANSS-EC) at 2 hours was three for patients with bipolar disorder, and five for 5 mg and four for 10 mg for patients with schizophrenia, with effect sizes comparable to what has been observed in analogous studies of intramuscular injection of antipsychotics or lorazepam. Separation from placebo on the PANSS-EC was as early as 10 minutes postinhalation, the first time point where this was measured. Dysgeusia was the most commonly encountered spontaneously reported adverse event. Adverse events related to extrapyramidal symptoms and akathisia were relatively rare. Spirometry studies identified the potential for bronchospasm particularly in persons with asthma. Because of concerns over pulmonary safety, inhaled loxapine is restricted to use in hospitals and patients need to be prescreened for the presence of pulmonary disease, as well as monitored for signs and symptoms of bronchospasm for 1 hour postdose administration, as per a Food and Drug Administration-mandated Risk Evaluation and Mitigation Strategy.

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“…Developing rapport, through therapeutic interactions, is complex and requires effective communication from HCPs (Priebe et al., ). Therapeutic rapport in the inpatient psychiatric setting is challenging and not always achieved (Nolan, Shope, Citrome, & Volavka, ).…”

Section: Background/significance Of the Problemmentioning

confidence: 99%