Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward

Overview

Journal Neuropsychiatr Dis Treat

Publisher Dove Medical Press

Specialty Psychiatry

Date 2023 Apr 3

PMID 37007613

Authors

Ping-Ying Chang

Jian-Hong Chen

Hui-Wen Cheng

Yen-Chin Wang

Affiliations

Soon will be listed here.

Abstract

Objective: Prevention, de-escalation, and management of violence in the acute psychiatric ward is essential. Few studies have focused on differences in the duration of high-violence risk between different profiles of high-violence risk. This study aimed to analyze the data of high-violence patients and duration of high-violence risk to provide a new perspective on violence prevention, de-escalation and management.

Methods: This retrospective observational cohort study included 171 patients who were treated in the acute psychiatric ward of Keelung Chang Gung Memorial Hospital between January 2016 and June 2020, and who were assessed daily as having high violence risk. All patient data were collected from electronic hospital records (eg, age, gender, diagnosis, violence history, self-harm history, and admission condition (involuntary admission, discharged against medical advice). Between-group differences in disease severity, use of antipsychotics and benzodiazepine, and duration of high violence risk were analyzed using regression analysis.

Results: Only patients' age was significantly associated with duration of high-violence risk (P = 0.028), making it predictive of longer duration of high-violence risk. In patients with schizophrenia spectrum disorder or bipolar disorder, higher severity was significantly associated with longer duration of high-violence risk (P = 0.007, P = 0.001, respectively).

Conclusion: Only age is a predictor of longer duration of violence risk in psychiatric patients, although higher severity is associated with higher violence risk. Study results may help management and healthcare staff better understand how quickly or slowly violence risk will decrease and may improve efficient use of healthcare resources and individualized patient-centered care.

References

Gaynes B, Brown C, Lux L, Brownley K, Van Dorn R, Edlund M . Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence. Psychiatr Serv. 2017; 68(8):819-831. DOI: 10.1176/appi.ps.201600314. View

Moberg T, Stenbacka M, Tengstrom A, Jonsson E, Nordstrom P, Jokinen J . Psychiatric and neurological disorders in late adolescence and risk of convictions for violent crime in men. BMC Psychiatry. 2015; 15:299. PMC: 4657257. DOI: 10.1186/s12888-015-0683-7. View

Odes R, Chapman S, Harrison R, Ackerman S, Hong O . Frequency of violence towards healthcare workers in the United States' inpatient psychiatric hospitals: A systematic review of literature. Int J Ment Health Nurs. 2020; 30(1):27-46. DOI: 10.1111/inm.12812. View

Roca R, Charen B, Boronow J . Ensuring Staff Safety When Treating Potentially Violent Patients. JAMA. 2016; 316(24):2669-2670. DOI: 10.1001/jama.2016.18260. View

Leucht S, Engel R, Davis J, Kissling W, Meyer Zur Capellen K, Schmauss M . Equipercentile linking of the Brief Psychiatric Rating Scale and the Clinical Global Impression Scale in a catchment area. Eur Neuropsychopharmacol. 2012; 22(7):501-5. DOI: 10.1016/j.euroneuro.2011.11.007. View

Young R, Biggs J, Ziegler V, Meyer D . A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133:429-35. DOI: 10.1192/bjp.133.5.429. View

Gao Y, Oberhardt M, Vawdrey D, Lawrence R, Dixon L, Luo S . Medication Use and Physical Assaults in the Psychiatric Emergency Department. J Clin Psychiatry. 2021; 83(1). PMC: 8682673. DOI: 10.4088/JCP.21m13970. View

Fazel S, Gulati G, Linsell L, Geddes J, Grann M . Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009; 6(8):e1000120. PMC: 2718581. DOI: 10.1371/journal.pmed.1000120. View

Urheim R, Palmstierna T, Rypdal K, Gjestad R, Senneseth M, Mykletun A . Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward. BMC Psychiatry. 2020; 20(1):200. PMC: 7201664. DOI: 10.1186/s12888-020-02524-0. View

10.

Cowman S, Bjorkdahl A, Clarke E, Gethin G, Maguire J . A descriptive survey study of violence management and priorities among psychiatric staff in mental health services, across seventeen european countries. BMC Health Serv Res. 2017; 17(1):59. PMC: 5248457. DOI: 10.1186/s12913-017-1988-7. View

11.

Cornaggia C, Beghi M, Pavone F, Barale F . Aggression in psychiatry wards: a systematic review. Psychiatry Res. 2011; 189(1):10-20. DOI: 10.1016/j.psychres.2010.12.024. View

12.

Volavka J . The neurobiology of violence: an update. J Neuropsychiatry Clin Neurosci. 1999; 11(3):307-14. DOI: 10.1176/jnp.11.3.307. View

13.

Fazel S, Smith E, Chang Z, Geddes J . Risk factors for interpersonal violence: an umbrella review of meta-analyses. Br J Psychiatry. 2018; 213(4):609-614. PMC: 6157722. DOI: 10.1192/bjp.2018.145. View

14.

Dupre K, Dawe K, Barling J . Harm to Those Who Serve: Effects of Direct and Vicarious Customer-Initiated Workplace Aggression. J Interpers Violence. 2014; 29(13):2355-2377. DOI: 10.1177/0886260513518841. View

15.

Sailas E, Fenton M . Seclusion and restraint for people with serious mental illnesses. Cochrane Database Syst Rev. 2000; (2):CD001163. PMC: 6669266. DOI: 10.1002/14651858.CD001163. View

16.

Amore M, Menchetti M, Tonti C, Scarlatti F, Lundgren E, Esposito W . Predictors of violent behavior among acute psychiatric patients: clinical study. Psychiatry Clin Neurosci. 2008; 62(3):247-55. DOI: 10.1111/j.1440-1819.2008.01790.x. View

17.

Senior M, Fazel S, Tsiachristas A . The economic impact of violence perpetration in severe mental illness: a retrospective, prevalence-based analysis in England and Wales. Lancet Public Health. 2020; 5(2):e99-e106. PMC: 7025880. DOI: 10.1016/S2468-2667(19)30245-2. View

18.

Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T . Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One. 2021; 16(10):e0258346. PMC: 8500453. DOI: 10.1371/journal.pone.0258346. View

19.

Large M, Nielssen O . Assessing risk of suicide and aggression in hospitals: same but different. Acta Psychiatr Scand. 2013; 128(1):101. DOI: 10.1111/acps.12127. View

20.

Steinert T, Birk M, Flammer E, Bergk J . Subjective distress after seclusion or mechanical restraint: one-year follow-up of a randomized controlled study. Psychiatr Serv. 2013; 64(10):1012-7. DOI: 10.1176/appi.ps.201200315. View