Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-hd9dq Total loading time: 0.407 Render date: 2022-09-30T22:37:44.301Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

Inpatient aggression in community hospitals

Published online by Cambridge University Press:  26 February 2015

Katalin A. Szabo
Affiliation:
Department of Psychiatry, San Mateo Health System, San Mateo, California, USA Behavioral Health and Recovery Services, San Mateo, California, USA
Christopher L. White
Affiliation:
Department of Psychiatry, San Mateo Health System, San Mateo, California, USA Behavioral Health and Recovery Services, San Mateo, California, USA
Stephen E. Cummings
Affiliation:
Department of Psychiatry, San Mateo Medical Center, San Mateo, California, USA
Raziya S. Wang
Affiliation:
Behavioral Health and Recovery Services, San Mateo, California, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
Cameron D. Quanbeck*
Affiliation:
Department of Psychiatry, San Mateo Health System, San Mateo, California, USA
*
*Address for correspondence: Cameron Quanbeck, MD, Medical Director, Cordilleras Mental Health Center, San Mateo Medical Center, Department of Psychiatry, 200 Edmonds Road, Redwood City, CA 94062, USA. (Email: cquanbeck@smcgov.org)

Abstract

Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients.

Type
Review Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Carr, VJ, Lewin, TJ, Sly, KA, et al. Adverse incidents in acute psychiatric inpatient units: rates, correlates and pressures. Aust N Z J Psychiatry 2008; 42(4): 267282.CrossRefGoogle ScholarPubMed
2. Dack, C, Ross, J, Papadopoulos, C, Stewart, D, Bowers, L. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand 2013; 127(4): 255268.CrossRefGoogle ScholarPubMed
3. Davis, S. Violence by psychiatric inpatients: a review. Hosp Community Psychiatry 1991; 42(6): 585590.Google ScholarPubMed
4. Irwin, A. The nurse’s role in the management of aggression. J Psychiatr Ment Health Nurs 2006; 13(3): 309318.CrossRefGoogle ScholarPubMed
5. Bowers, L, Stewart, D, Papadopoulos, C, et al, Inpatient violence and aggression: a literature review. Report from the Conflict and Containment Reduction Research Programme. London: Section of Mental Health Nursing, Health Service and Population Research, Institute of Psychiatry, Kings College London; 2011.Google Scholar
6. Khoshknab, MF, Tamizi, Z, Ghazanfari, N, Mehrabani, G. Prevalence of workplace violence in psychiatric wards, Tehran, Iran. Pak J Biol Sci 2012; 15(14): 680684.CrossRefGoogle ScholarPubMed
7. Kay, SR, Wolkenfeld, F, Murrill, LM. Profiles of aggression among psychiatric patients. I. Nature and prevalence. J Nerv Ment Dis 1988; 176(9): 539546.CrossRefGoogle ScholarPubMed
8. Benjaminsen, SE, Kjaerbo, T. [The staff’s experience of patient violence in a psychiatric department.] Ugeskr Laeger 1997; 159(12): 17681773.Google Scholar
9. Foster, C, Bowers, L, Nijman, H. Aggressive behaviour on acute psychiatric wards: prevalence, severity and management. J Adv Nurs 2007; 58(2): 140149.CrossRefGoogle ScholarPubMed
10. Flannery, RB Jr, Anderson, E, Marks, L, Uzoma, LL. The Assaulted Staff Action Program (ASAP) and declines in rates of assault: mixed replicated findings. Psychiatr Q 2000; 71(2): 165175.CrossRefGoogle ScholarPubMed
11. Johnson, ME. Violence on inpatient psychiatric units: state of the science. J Am Psychiatr Nurses Assoc 2004; 10(3): 113121.CrossRefGoogle Scholar
12. McNiel, DE, Binder, RL. The relationship between acute psychiatric symptoms, diagnosis, and short-term risk of violence. Hosp. Community Psychiatry 1994; 45(2): 133137.Google Scholar
13. McNiel, DE, Binder, RL, Greenfield, TK. Predictors of violence in civilly committed acute psychiatric patients. Am J Psychiatry 1988; 145(8): 965970.Google ScholarPubMed
14. Woods, P, Almvik, R. The Brøset violence checklist (BVC). Acta Psychiatr Scand Suppl 2002; 412: 103105.CrossRefGoogle Scholar
15. Woods, P, Ashley, C. Violence and aggression: a literature review. J Psychiatr Ment Health Nurs 2007; 14(7): 652660.CrossRefGoogle ScholarPubMed
16. Abderhalden, C, Needham, I, Miserez, B, et al. Predicting inpatient violence in acute psychiatric wards using the Broset-Violence-Checklist: a multicentre prospective cohort study. J Psychiatr Ment Health Nurs 2004; 11(4): 422427.CrossRefGoogle ScholarPubMed
17. Quanbeck, CD, McDermott, BE, Lam, J, Eisenstark, H, Sokolov, G, Scott, CL. Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatr Serv 2007; 58(4): 521528.CrossRefGoogle ScholarPubMed
18. Powell, G, Caan, W, Crowe, M. What events precede violent incidents in psychiatric hospitals? Br J Psychiatry 1994; 165(1): 107112.CrossRefGoogle ScholarPubMed
19. Crowner, ML, Peric, G, Stepcic, F, Lee, S. Assailant and victim behaviors immediately preceding inpatient assault. Psychiatr Q 2005; 76(3): 243256.CrossRefGoogle ScholarPubMed
20. Sheridan, M, Henrion, R, Robinson, L, Baxter, V. Precipitants of violence in a psychiatric inpatient setting. Hosp Community Psychiatry 1990; 41(7): 776780.Google Scholar
21. Ketelsen, R, Zechert, C, Driessen, M, Schulz, M. Characteristics of aggression in a German psychiatric hospital and predictors of patients at risk. J Psychiatr Ment Health Nurs 2007; 14(1): 9299.CrossRefGoogle Scholar
22. McNiel, DE, Gregory, AL, Lam, JN, Binder, RL, Sullivan, GR. Utility of decision support tools for assessing acute risk of violence. J Consult Clin Psychol 2003; 71(5): 945953.CrossRefGoogle Scholar
23. Harris, GT, Rice, ME. Risk appraisal and management of violent behavior. Psychiatr Serv 1997; 48(9): 11681176.Google ScholarPubMed
24. Steinert, T. Prediction of inpatient violence. Acta Psychiatr Scand Suppl 2002; 412: 133141.CrossRefGoogle Scholar
25. Cornaggia, CM, Beghi, M, Pavone, F, Barale, F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011; 189(1): 1020.CrossRefGoogle ScholarPubMed
26. Serper, MR, Goldberg, BR, Herman, KG, et al. Predictors of aggression on the psychiatric inpatient service. Compr Psychiatry 2005; 46(2): 121127.CrossRefGoogle ScholarPubMed
27. Fountoulakis, KN, Leucht, S, Kaprinis, GS. Personality disorders and violence. Curr Opin Psychiatry 2008; 21(1): 8492.CrossRefGoogle ScholarPubMed
28. McKinlay, WW, Brooks, DN, Bond, MR, Martinage, DP, Marshall, MM. The short-term outcome of severe blunt head injury as reported by relatives of the injured persons. J Neurol Neurosurg Psychiatry 1981; 44(6): 527533.CrossRefGoogle ScholarPubMed
29. Hare, RD. Psychopathy as a risk factor for violence. Psychiatr Q 1999; 70(3): 181197.CrossRefGoogle ScholarPubMed
30. Kanerva, A, Lammintakanen, J, Kivinen, T. Patient safety in psychiatric inpatient care: a literature review. J Psychiatr Ment Health Nurs 2013; 20(6): 541548.CrossRefGoogle ScholarPubMed
31. Pulsford, D, Crumpton, A, Baker, A, Wilkins, T, Wright, K, Duxbury, J. Aggression in a high secure hospital: staff and patient attitudes. J Psychiatr Ment Health Nurs 2013; 20(4): 296304.CrossRefGoogle Scholar
32. Duxbury, J, Whittington, R. Causes and management of patient aggression and violence: staff and patient perspectives. J Adv Nurs 2005; 50(5): 469478.CrossRefGoogle ScholarPubMed
33. Lavender MST. Putting aggression into context: an investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital. Journal of Mental Health 1999; 8(2): 159170.CrossRefGoogle Scholar
34. Flannery, RB Jr, Corrigan, M, Hanson, MA, Walker, AP. Past violence, substance use, and precipitants to psychiatric patient assaults: eleven-year analysis of the Assaulted Staff Action Program (ASAP). Int J Emerg Ment Health 2006; 8(3): 157163.Google Scholar
35. Cooper, AJ, Mendonca, JD. A prospective study of patient assaults on nurses in a provincial psychiatric hospital in Canada. Acta Psychiatr Scand 1991; 84(2): 163166.CrossRefGoogle Scholar
36. Rasmussen, K, Levander, S. Individual rather than situational characteristics predict violence in a maximum security hospital. Journal of Interpersonal Violence 1996; 11(3): 376390.CrossRefGoogle Scholar
37. Longo, DA, Bisconer, SW. Treatment of aggression for an adult diagnosed with schizophrenia at a public psychiatric hospital. Professional Psychology: Research and Practice 2003; 34(2): 177179.CrossRefGoogle Scholar
38. Bowers, L, Allan, T, Simpson, A, Jones, J, Van Der Merwe, M, Jeffery, D. Identifying key factors associated with aggression on acute inpatient psychiatric wards. Issues Ment Health Nurs 2009; 30(4): 260271.CrossRefGoogle ScholarPubMed
39. Nijman, HL, Rector, G. Crowding and aggression on inpatient psychiatric wards. Psychiatr Serv 1999; 50(6): 830831.CrossRefGoogle ScholarPubMed
40. Ng, B, Kumar, S, Ranclaud, M, Robinson, E. Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatr Serv 2001; 52(4): 521525.CrossRefGoogle ScholarPubMed
41. Virtanen, M, Vahtera, J, Batty, GD, et al. Overcrowding in psychiatric wards and physical assaults on staff: data-linked longitudinal study. Br J Psychiatry 2011; 198(2): 149155.CrossRefGoogle ScholarPubMed
42. Barlow, K, Grenyer, B, Ilkiw-Lavalle, O. Prevalence and precipitants of aggression in psychiatric inpatient units. Aust N Z J Psychiatry 2000; 34(6): 967974.CrossRefGoogle ScholarPubMed
43. Hamrin, V, Iennaco, J, Olsen, D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues Ment Health Nurs 2009; 30(4): 214226.CrossRefGoogle ScholarPubMed
44. Bader, S, Evans, SE, Welsh, E. Aggression among psychiatric inpatients: the relationship between time, place, victims, and severity ratings. J Am Psychiatr Nurses Assoc 2014; 20(3): 179186.CrossRefGoogle ScholarPubMed
45. Mossman, D. Assessing predictions of violence: being accurate about accuracy. J Consult Clin Psychol 1994; 62(4): 783792.CrossRefGoogle ScholarPubMed
46. Douglas, KS, Ogloff, JR, Nicholls, TL, Grant, I. Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version. J Consult Clin Psychol 1999; 67(6): 917930.CrossRefGoogle ScholarPubMed
47. Wong, SCP, Gordon, A. The validity and reliability of the Violence Risk Scale: a treatment-friendly violence risk assessment tool. Psychology, Public Policy, and Law 2006; 12(3): 279309.CrossRefGoogle Scholar
48. Singh, JP, Fazel, S. Forensic risk assessment: a metareview. Criminal Justice and Behavior 2010; 37(9): 965988.CrossRefGoogle Scholar
49. Steadman, HJ, Silver, E, Monahan, J, et al. A classification tree approach to the development of actuarial violence risk assessment tools. Law Hum Behav 2000; 24(1): 83100.CrossRefGoogle ScholarPubMed
50. Allen, J. Assessing and managing risk of violence in the mentally disordered. J Psychiatr Ment Health Nurs 1997; 4(5): 369378.CrossRefGoogle ScholarPubMed
51. Palmstierna, T, Wistedt, B. Risk factors for aggressive behaviour are of limited value in predicting the violent behaviour of acute involuntarily admitted patients. Acta Psychiatr Scand 1990; 81(2): 152155.CrossRefGoogle ScholarPubMed
52. Almvik, R, Woods, P, Rasmussen, K. The Brøset Violence Checklist: sensitivity, specificity, and interrater reliability. Journal of Interpersonal Violence 2000; 15(12): 12841296.CrossRefGoogle Scholar
53. Elbogen, EB, Tomkins, AJ, Pothuloori, AP, Scalora, MJ. Documentation of violence risk information in psychiatric hospital patient charts: an empirical examination. J Am Acad Psychiatry Law 2003; 31(1): 5864.Google Scholar
54. Gardner, W, Lidz, CW, Mulvey, EP, Shaw, EC. Clinical versus actuarial predictions of violence of patients with mental illnesses. J Consult Clin Psychol 1996; 64(3): 602609.CrossRefGoogle ScholarPubMed
55. Abderhalden, C, Needham, I, Dassen, T, Halfens, R, Haug, HJ, Fischer, JE. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry 2008; 193(1): 4450.CrossRefGoogle ScholarPubMed
56. Ogloff, JRP, Daffern, M. The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law 2006; 24(6): 799813.CrossRefGoogle ScholarPubMed
57. Almvik, R, Woods, P. Predicting inpatient violence using the Brøset Violence Checklist (BVC). Int J Psychiatr Nurs Res 1999; 4(3): 498505.Google Scholar
58. Chu, CM, Daffern, M, Ogloff, JRP. Predicting aggression in acute inpatient psychiatric setting using BVC, DASA, and HCR-20 Clinical scale. Journal of Forensic Psychiatry & Psychology 2013; 24(2): 269285.CrossRefGoogle Scholar
59. Beck, JC, White, KA, Gage, B. Emergency psychiatric assessment of violence. Am J Psychiatry 1991; 148(11): 15621565.Google Scholar
60. Allen, M, Forster, P, Zealberg, J, et al, Report and recommendations regarding psychiatric emergency and crisis services: a review and model program descriptions. American Psychiatric Association Task Force. 2002. http://www.emergencypsychiatry.org/data/tfr200201.pdf. Accessed September 1, 2014.Google Scholar
61. Huf, G, Coutinho, ESF, Adams, CE. Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ 2007; 335: 869.CrossRefGoogle Scholar
62. Raveendran, NS, Tharyan, P, Alexander, J, Adams, CE. Rapid tranquillisation in psychiatric emergency setting in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ 2007; 335(7625): 865869.CrossRefGoogle ScholarPubMed
63. Powney, MJ, Adams, CE, Jones, H. Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation). Cochrane Database Syst Rev 2012; 11: CD009377.Google Scholar
64. Baldaçara, L, Sanches, M, Cordeiro, DC, Jackoswski, AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Rev Bras Psiquiatr 2011; 33(1): 3039.CrossRefGoogle ScholarPubMed
65. Bosanac, P, Hollander, Y, Castle, D. The comparative efficacy of intramuscular antipsychotics for the management of acute agitation. Australas Psychiatry 2013; 21(6): 554562.CrossRefGoogle ScholarPubMed
66. Kinon, BJ, Stauffer, VL, Kollack-Walker, S, Chen, L, Sniadecki, J. Olanzapine versus aripiprazole for the treatment of agitation in acutely ill patients with schizophrenia. J Clin Psychopharmacol 2008; 28(6): 601607.CrossRefGoogle ScholarPubMed
67. Gillies, D, Sampson, S, Beck, A, Rathbone, J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev 2013; 4: CD003079.Google Scholar
68. Wallace, PS, Taylor, SP. Reduction of appeasement-related affect as a concomitant of diazepam-induced aggression: Evidence for a link between aggression and the expression of self-conscious emotions. Aggress Behav 2009; 35(2): 203212.CrossRefGoogle ScholarPubMed
69. Wilson, MP, MacDonald, K, Vilke, GM, Feifel, D. Potential complications of combining intramuscular olanzapine with benzodiazepines in emergency department patients. J Emerg Med 2012; 43(5): 889896.CrossRefGoogle ScholarPubMed
70. Keating, GM. Loxapine inhalation powder: a review of its use in the acute treatment of agitation in patients with bipolar disorder or schizophrenia. CNS Drugs 2013; 27(6): 479489.CrossRefGoogle ScholarPubMed
71. Citrome, L. Aerosolised antipsychotic assuages agitation: inhaled loxapine for agitation associated with schizophrenia or bipolar disorder. Int J Clin Pract 2011; 65(3): 330340.CrossRefGoogle ScholarPubMed
72. Currier, G, Walsh, P. Safety and efficacy review of inhaled loxapine for treatment of agitation. Clin Schizophr Relat Psychoses 2013; 7(1): 2532.CrossRefGoogle ScholarPubMed
73. Sheehan, B, Burton, E, Wood, S, Stride, C, Henderson, E, Wearn, E. Evaluating the built environment in inpatient psychiatric wards. Psychiatr Serv 2013; 64(8): 789795.CrossRefGoogle ScholarPubMed
74. Southard, K, Jarrell, A, Shattell, MM, McCoy, TP, Bartlett, R, Judge, CA. Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu? J Psychosoc Nurs Ment Health Serv 2012; 50(5): 2834.CrossRefGoogle ScholarPubMed
75. Ulrich, RS, Zimring, C, Zhu, X, et al. A review of the research literature on evidence-based healthcare design. HERD 2008; 1(3): 61125.CrossRefGoogle ScholarPubMed
76. Ulrich, RS, Berry, LL, Quan, X, Parish, JT. A conceptual framework for the domain of evidence-based design. HERD 2011; 4(1): 95114.CrossRefGoogle ScholarPubMed
77. Douglas, CH, Douglas, MR. Patient-centred improvements in health-care built environments: perspectives and design indicators. Health Expect 2005; 8(3): 264276.CrossRefGoogle ScholarPubMed
11
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Inpatient aggression in community hospitals
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Inpatient aggression in community hospitals
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Inpatient aggression in community hospitals
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *