Characteristics of heteroaggressive behavior in patients admitted to an acute psychiatric ward

Abstract

Aggression is a common cause of acute psychiatric admission. In the National Institute of Mental Health, Neurology and Neurosurgery a new, high security psychiatric unit was started.

The aim of this study was to observe and evaluate the occurrence and change over time of aggressive behavior among patients admitted to an acute psychiatric ward, and defining that patient population who should be potentially transferred to the high security unit. The study included those patients who were admitted to the acute psychiatric ward of the Department of Psychiatry and Psychiatric Rehabilitation of Jahn Ferenc South-Pest Hospital in a 5 months period. Data about aggressive behavior appeared during the first week of inpatient treatment has been processed. Evaluation of the occurrence of aggressive behavior was part of the routine nursing care. Aggressive behavior was assessed by the 7-item Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) with two additional items evaluating the presence of physical aggression and physical assault. DASA-IV questionnaire was completed by the nursing staff at the end of each 12-hours shift for a whole week. During the study period there were altogether 290 acute admissions. 60% (N=174) of the patients showed at least low level of aggression. Among these patients, men had significantly higher scores of aggression than women (p=0.008). The level of aggression observed in the first 12 hours following admission significantly correlated with higher level of aggression during the first week of treatment (p <0.001). Furthermore, appearance of physical threat and physical assault also had a significant predictive effect on the higher DASA-IV score during the observational period (p <0.001). Considering the diagnostic groups, any form of aggression occurred most frequently in patients with mental retardation, paranoid disorders, bipolar disorders and dementia. DASA-IV score decreased at the earliest in patients with adjustment disorder, and at the latest in patients with mental retardation during the first week of treatment. As a result of effective therapy, till the fourth day of treatment occurrence of aggressive behavior significantly decreased in all diagnostic groups, except mental retardation. Our results show that after the first 3 days of inpatient treatment most acutely admitted patients do not need to be transferred to a special high security unit due to persistent aggressive behavior, except some patients with mental retardation.