Aggression in psychiatry: prevention, epidemiology & treatment
Margo Faay
AIM: To contribute to the body of knowledge concerning aggression in psychiatry.
METHOD: Five studies were conducted covering three overarching themes: prevention, epidemiology and treatment.
FINDINGS: Related to the theme of ‘prevention’, we investigated common changes in children’s’ behaviour prior to aggression in psychiatric facilities. Sixteen warning signs were found. The most prevalent were: ‘restlessness’, ‘not listening’ and ‘feelings of anger’. In adolescent and adult psychiatry, we evaluated an instrument (Kennedy Axis V) utilized by nurses to perform clinical risk assessment. This instrument appeared to be useful and interrater reliability was found to be substantial. Related to the theme ‘epidemiology’, the annual incidence of aggression in patients with psychotic disorders was about 2%. Symptoms such as impulsivity, excitement and lack of cooperation, but also childhood trauma, increased the risk for aggression. Concerning the theme ‘treatment’, not all antipsychotics were found equally effective against aggression. Atypical antipsychotics, specifically clozapine, were most effective. While clozapine was suited for patients with persistent illness, amisulpride was found to be effective against aggression during a first episode of psychosis.
DISCUSSION and CONCLUSION: Aggression is a complex concept and more research is needed. These findings help to understand, assess and treat aggression within psychiatry.
Keywords: Aggression, violence, hostility, psychiatry, nursing
Agressie is een groot probleem binnen de psychiatrie. Het kan het zorgproces ernstig verstoren en voor alle betrokkenen zijn er nadelige gevolgen. Zorgprofessionals hebben risico op verwondingen of een burn-out (1-3), en patiënten krijgen te maken met verlengde opnameduur, gedwongen behandeling met risico op traumatische gevolgen, fysieke verwondingen, justitiële gevolgen en lager sociaal functioneren (4-6).&ellipsis;
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