Psychiatric Quarterly

, Volume 85, Issue 3, pp 303–317

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2000–2012

  • Raymond B. FlanneryJr.
  • Grace Wyshak
  • Joseph J. Tecce
  • Georgina J. Flannery
Original Paper

Abstract

In international reviews of psychiatric inpatient violence, one study of all types of patient violence found hostility, involuntary admission, and longer hospital stays associated with violence. A second study of comparison-group papers of patient assaults found younger males with schizophrenia, past violence, and substance abuse assaultive. The present review of raw assault data studies assessed characteristics of assaultive patients worldwide. It was hypothesized that patients with schizophrenia would present greatest assault risk. There were three analyses: International/no American studies (reviewed earlier), European studies, and merged International/American studies. Results revealed that male and female patients with schizophrenia, affective disorders, personality disorders, and other diagnoses presented greatest worldwide risk. Results partially support earlier findings. Given that individual institutional studies in this review reported significant assailant characteristics, a second finding is the absence of most of these institutional characteristics in this international review. Possible explanations for findings and a detailed methodological review are presented.

Keywords

Assaults Assault characteristics Community settings Inpatient setting International psychiatric patients Repetitive assaults 

References

  1. 1.
    Cornaggia CM, Beghi M, Pavone F, et al.: Agression in psychiatry wards : A systematic review. Psychiatry Research 189:10–20, 2011PubMedCrossRefGoogle Scholar
  2. 2.
    Ross DC, Papadopoulos C, Stewart D, et al.: A review and meta-analysis of the patient factors associated with psychiatric impatient aggression. Acta Psychiatrica Scandinavica 127:255–268, 2013PubMedCrossRefGoogle Scholar
  3. 3.
    Flannery RB Jr, Wyshak G, Tecce J, et al.: Characteristics of American Assaultive Psychiatric Patients: Review of Published Findings, 2000–2012. Psychiatric Quarterly, 2014 (in press)Google Scholar
  4. 4.
    Weizmann-Henelius G, Suutala H: Violence in a Finnish forensic psychiatric hospital. Nordic Journal of Psychiatry 54:269–273, 2000CrossRefGoogle Scholar
  5. 5.
    Barlow K, Grenyer B, Iukiw-Lavalle O: Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry 34:967–974, 2000PubMedCrossRefGoogle Scholar
  6. 6.
    Saverimuttu H, Lowe T: Aggressive incidents on a psychiatric intensive care unit. Nursing Standard 14:33–36, 2000PubMedCrossRefGoogle Scholar
  7. 7.
    Soliman A, Reza H: Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatric Services 52:75–80, 2001PubMedCrossRefGoogle Scholar
  8. 8.
    Chou K, Lu R, Chang M: Assaultive behavior by psychiatric in-patients and its related factors. Journal of Nursing Research 9:139–151, 2001PubMedCrossRefGoogle Scholar
  9. 9.
    Manfredini R, Vanni A, Peron L, et al.: Day-night variation in aggressive behavior among psychiatric inpatients. Chronobiology International 18: 503–511, 2001PubMedCrossRefGoogle Scholar
  10. 10.
    Grassi L, Peron L, Marangoni C, et al.: Characteristics of violent behavior in acute psychiatric in-patients: A 5-year Italian study. Acta Psychiatrica Scandinavia 104:273–279, 2001PubMedCrossRefGoogle Scholar
  11. 11.
    Ehmann TS, Smith GN, Yamamoto A, et al.: Violence in treatment resistant psychiatric inpatients. The Journal of Nervous and Mental Disease 189:716–721, 2001PubMedCrossRefGoogle Scholar
  12. 12.
    Green B, Robinson L: A further 12-month study of violent incidents within a medium secure psychiatric unit (and a comparison with the previous 12 months). The British Journal of Forensic Practice 3:13–22, 2001CrossRefGoogle Scholar
  13. 13.
    Chou K, Lu R, Mao W: Factors relevant to patient assaultive behavior and assaults in acute inpatient units in Taiwan. Archives of Psychiatric Nursing 16:187–195, 2002PubMedCrossRefGoogle Scholar
  14. 14.
    Omerov M, Edman G, Wistedt B: Incidents of violence in psychiatric inpatient care. Nordic Journal of Psychiatry 56:207–213, 2002PubMedCrossRefGoogle Scholar
  15. 15.
    Nijman H, Merckelbach H, Evers C, et al.: Prediction of aggression on a locked psychiatric admissions ward. Acta Psychiatrica Scandinavica 105:390–395, 2002PubMedCrossRefGoogle Scholar
  16. 16.
    Winstanley S, Whitttington R: Violence in a general hospital: Comparison of assailant and other assault-related factors on accident and emergency and inpatient wards. Acta Psychiatrica Scandinavica 106:144–147, 2002CrossRefGoogle Scholar
  17. 17.
    Mellesdal L: Aggression on a psychiatric acute ward: A three-year perspective study. Psychological Reports 92:1229–1248, 2003PubMedCrossRefGoogle Scholar
  18. 18.
    Daffern M, Mayer M, Martin T: A preliminary investigation into patterns of aggression in an Australian forensic psychiatric hospital. The Journal of Forensic Psychiatry and Psychology 14: 67–84, 2003CrossRefGoogle Scholar
  19. 19.
    Rutter S, Gudjonsson G, Rabe-Hesketh S: Violent incidents in a medium secure unit: The characteristics of persistent perpetrators of violence. The Journal of Forensic Psychiatry and Psychology 15: 293–302, 2004CrossRefGoogle Scholar
  20. 20.
    Chang J, Chau-Shoun L: Risk factors for aggressive behavior among psychiatric inpatients. Psychiatric Services 55: 1–4, 2004CrossRefGoogle Scholar
  21. 21.
    Foley SR, Kelly BD, Clarke M, et al.: Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis. Schizophrenia Research 72: 161–168, 2005PubMedCrossRefGoogle Scholar
  22. 22.
    Raja M, Azzoni A: Hostility and violence of acute psychiatric inpatients. Clinical Practice and Epidemiology in Mental Health 29: 1–11, 2005Google Scholar
  23. 23.
    Odawara T, Narita H, Yamada Y, et al.: Use of restraint in a general hospital psychiatric unit in Japan. Psychiatry and Clinical Neurosciences 59: 605–609, 2005PubMedCrossRefGoogle Scholar
  24. 24.
    Fresan A, Apiquian R, de la Fuente-Sandoval C, et al: Violent behavior in schizophrenic patients: Relationship with clinical symptoms. Aggressive Behavior 31: 511–520, 2005CrossRefGoogle Scholar
  25. 25.
    Verna S, Poon L, Subramaniam M, et al.: Aggression in Asian patients with first-episode psychosis. International Journal of Social Psychiatry 51:365–371, 2005CrossRefGoogle Scholar
  26. 26.
    Abushua’leh K, Abu-Akel A: Association of psychopathic traits and symptomatology with violence in patients with schizophrenia. Psychiatry Research 143: 205–211, 2006PubMedCrossRefGoogle Scholar
  27. 27.
    Dean K, Walsh E, Moran P, et al.: Violence in women with psychosis in the community: Prospective study. The British Journal of Psychiatry 188: 264–270, 2006PubMedCrossRefGoogle Scholar
  28. 28.
    Grassi L, Biancosino B, Marmai L, et al.: Violence in psychiatric units: A 7-year Italian study of persistently assaultive patients. Social Psychiatry and Psychiatric Epidemiology 41: 698–703, 2006PubMedCrossRefGoogle Scholar
  29. 29.
    James A, Madeley R, Dove A: Violence and aggression in the emergency department. Emergency Medicine Journal 23:431–434, 2006PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    El-Badri SM, Mellsop G: Aggressive behavior in an acute general adult psychiatric unit. Psychiatric Bulletin 30:166–168, 2006CrossRefGoogle Scholar
  31. 31.
    Ketelsen R, Zechert C, Driessen M, et al.: Characteristics of aggression in a German psychiatric hospital and predictors of patients at risk. Journal of Psychiatric and Mental Health Nursing 14:92–99, 2007PubMedCrossRefGoogle Scholar
  32. 32.
    Abderhalden C, Needham I, Dassen T, et al.: Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland. Clinical Practice and Epidemiology Mental Health 4:3–30, 2007Google Scholar
  33. 33.
    Grube M: Gender differences in aggressive behavior at admission to a psychiatric hospital. Aggressive Behavior 33:97–103, 2007PubMedCrossRefGoogle Scholar
  34. 34.
    Dolan M, Fullam R, Logan C, et al.: The violence risk scale second edition (VRS-2) as a predictor of institutional violence in a British forensic inpatient sample. Psychiatry Research 158:55–65, 2008PubMedCrossRefGoogle Scholar
  35. 35.
    Abderhalden C, Needham I, Dassen T, et al.: Structural risk assessment and violence in acute psychiatric wards: Randomized controlled trial. The British Journal of Psychiatry 193:44–50, 2008PubMedCrossRefGoogle Scholar
  36. 36.
    Amore M, Menchetti M, Tonti C, et al.: Predictors of violent behavior among acute psychiatric patients: Clinical study. Psychiatry and Clinical Neurosciences 62:247–255, 2008PubMedCrossRefGoogle Scholar
  37. 37.
    Bobes J, Fillat O, Arango C: Violence among schizophrenia out-patients compliant with medication: Prevalence and associated factors. Acta Psychiatrica Scandinavica 119:218–225, 2009PubMedCrossRefGoogle Scholar
  38. 38.
    Nicholls TL, Brink J, Greaves C, et al.: Forensic psychiatry inpatients and aggression: An exploration of incidence, prevalence, severity, and interventions by gender. International Journal of Law and Psychiatry 32:23–30, 2009PubMedCrossRefGoogle Scholar
  39. 39.
    Biancosino B, Delmonte S, Grassi L, et al.: Violent behavior in acute psychiataric inpatient facilities: A national survey in Italy. The Journal of Nervous and Mental Disease 197: 772–782, 2009PubMedCrossRefGoogle Scholar
  40. 40.
    Young C, Brady J, Iqbal N, et al.: Prosecution of physical assaults by psychiatric in-patients in Northern Ireland. Psychiatric Bulletin 33:416–419, 2009CrossRefGoogle Scholar
  41. 41.
    Kruger C, Rosema D: Risk factors for violence among long-term psychiatric inpatients: A comparison between violent and non-violent patients. African Journal of Psychiatry 13:366–375, 2010PubMedGoogle Scholar
  42. 42.
    Roaldset JO, Bjorkly S: Patients’ own statements of their future risk for violent and self-harm behavior: A prospective inpatient and post-discharge follow-up study in an acute psychiatric unit. Psychiatry Research 178:153–159, 2010PubMedCrossRefGoogle Scholar
  43. 43.
    Amoo G, Fatoye FO: Aggressive behavior and mental illnesss: A study of inpatients at Aro Neuropsychiatric Hospital, Abeokuta. Nigerian Journal of Clinical Practice 13: 351–355, 2010Google Scholar
  44. 44.
    Chukwujekwu D, Stanley P: Prevalence and correlates of aggression among psychiatric in-patients at Jos University Teaching Hospital. Nigerian Journal of Clinical Practice 14:163-167, 2011PubMedCrossRefGoogle Scholar
  45. 45.
    Roaldset JO, Bakken AM, Bjorkly S: A prospective study of lipids and serotonin as risk markers of violence and self-harm in acute psychiatric patients. Psychiatry Research 186: 293–299, 2011PubMedCrossRefGoogle Scholar
  46. 46.
    Vaaler AE, Iversen VC, Morken G, et al.: Short-term prediction of threatening and violent behaviour in an acute psychiatric intensive care unit based on patient and environment characteristics. Biomedcentral 11:44–51, 2011Google Scholar
  47. 47.
    Doyle M, Carter S, Shaw J, et al.: Predicting community violence from patients discharged from acute mental health units. Social Psychiatry and Psychiatric Epidemiology 47:627–637, 2012PubMedCrossRefGoogle Scholar
  48. 48.
    Roaldset JO, Hartvig P, Linaker OM, et al.: A multifaced model for risk assessment of violent behaviour in acutely admitted psychiatric patients. Psychiatry Research 200: 773–778, 2012PubMedCrossRefGoogle Scholar
  49. 49.
    Palmstierna T, Wistedt B: Staff Observation Aggression Scale, SOAS: Presentation and evaluation. Acta Psychiatrica Scandinavica 76:657–673, 1987PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Raymond B. FlanneryJr.
    • 1
    • 4
  • Grace Wyshak
    • 1
  • Joseph J. Tecce
    • 2
  • Georgina J. Flannery
    • 3
  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Boston CollegeChestnut HillUSA
  3. 3.Newton Free LibraryNewtonUSA
  4. 4.Department of PsychiatryCambridge Health AllianceCambridgeUSA

Personalised recommendations