Abstract

BackgroundPatients with schizophrenia and other psychotic disorders have an increased likelihood of engaging in violent behavior. These increased risks of dangerous and aggressive behavior, in combination with a lack of insight in their own illness, relatively often make involuntary admission of acutely disturbed psychotic patients on locked psychiatric admissions wards often inevitable. On these locked psychiatric admissions wards, aggression from psychotic patients against staff and fellow patients is a prevalent phenomenon, with the mean in the Netherlands being about 18 aggressive incidents per bed per year on locked psychiatric admissions wards.MethodsIn the lecture, a model of what causes or triggers aggressive behavior on (locked) psychiatric wards is presented. In this model, patient, ward and staff variables are integrated to explain why, and in what specific situations, psychotic patients particularly run a high risk of engaging in aggressive behavior.ResultsBased on the presented model, a number of preventive measures can be formulated.On the patient level, the administration of anti-psychotic medication is used to reduce the negative cognitive schemes and delusional thoughts that are depicted in the center of the model. A more novel intervention at the patient level may be the additional administration of nutritional supplements with (among others) high levels of omega 3 fatty acids. The results of two Dutch studies on this topic will be briefly presented in the lecture, among which a RCT on the effects of the use of nutritional supplements on aggressiveness.On the staff level, the use of short-term (daily) risks assessments by the ward nursing staff, among others by means of the six item BrØset Violence Checklist (BVC), has been found to reduce aggressiveness and the use of coercive measures on psychiatric wards in two cluster randomized RCTs.On the ward level, studies indicate that aggression on psychiatric wards can be reduced by preventing overcrowding on psychiatric wards, and by providing more space and privacy to the patients.DiscussionThe proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence.

Highlights

  • Patients with schizophrenia and other psychotic disorders have an increased likelihood of engaging in violent behavior

  • Patient, ward and staff variables are integrated to explain why, and in what specific situations, psychotic patients run a high risk of engaging in aggressive behavior

  • A more novel intervention at the patient level may be the additional administration of nutritional supplements with high levels of omega 3 fatty acids

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Summary

Background

For individuals who have a psychiatric disorder and have committed a major crime, the rate of re-offending is twice as high in the US compared to nine other countries for which there is comparable data. For such individuals the average five-year rearrest rate is approximately 40% for those released from psychiatric hospitals and 60% for those released from jails or prisons. Methods: All 50 states were surveyed to assess how they were doing in providing follow-up treatment for such individuals. Results: Sixteen states were found to be making a moderate effort to provide follow-up treatment, and another 13 states are making a minimal effort. Discussion: Using proven treatment approaches the re-arrest rate of individuals with serious mental illness can be reduced from 40–60% to 10% or less

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