A study on prevalence and risk factors of aggression among psychiatric inpatients in a tertiary hospital in India

Introduction. Mental illness and aggression are often seen as inextricably linked. There is a growing body of evidence on aggressive behavior towards others by people with schizophrenia. Even though there is no study conducted in this study area, this study will help to identify the factors associated with aggressive behavior to be dealt early and as a base line for further study. Therefore, this study was designed to determine the prevalence of aggressive behavior and associated factors among people with schizophrenia. Method An institutional-based cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital from May 6 to 31, 2019, among 403 participants who were selected by a systematic random sampling technique. Data was collected by an interview technique by using the Modified Overt Aggression Scale, entered and analyzed by using EPI-INFO version 3.5.3 and Statistical Package for Social Science version 20, respectively. The association between variables was analyzed using bivariate and multivariate logistic regression analyses, and the level of significance of association was determined at a P value < 0.05. Results A total of 403 schizophrenia patients were included making the response rate 95.4%. The prevalence of aggressive behavior was 26.6%. Significant associated factors for aggressive behavior were being male (AOR = 2.61, 95% CI (1.21, 5.61)), unemployment (AOR = 8.03, 95% CI (3.08, 25.95)), previous history of aggression (AOR = 6.22, 95% CI (2.75, 14.10)), psychotic symptoms (AOR = 8.12, 95% CI (3.11, 21.14)), drug nonadherence (AOR = 6.41, 95% CI (3.02, 13.63)), poor social support (AOR = 3.11, 95% CI (1.35, 7.17)), and alcohol use (AOR = 2.40, 95% CI (1.02, 5.66)). Conclusion Prevalence of aggressive behavior is high among schizophrenia patients. Professionals have to identify clearly predictors of aggressive behavior giving special emphasis when treating male schizophrenia patients, who are unemployed, lack social support, with previous history of aggression, and alcohol users.

Personality Disorders and Unmet Needs Among Psychiatric Inpatients

BackgroundAggressive behavior is a challenging behavior among bipolar patients that causes poor social interaction and hospitalization. But, there is no information regards of the magnitude and contributing factors for aggressive behaviour among bipolar patients in Ethiopia. Therefore, this study was designed to assess the prevalence and associated factors of aggressive behaviour among patients with bipolar disorder.MethodAn institutional based cross sectional study was conducted at Amanual Mental Specialized Hospital from May 1 to June 1, 2015 among 411 participants who were selected by systematic random sampling technique. Data was collected by interview technique by using Modified Overt Aggression Scale, entered and analyzed by using Epi Data 3.1 and Statistical Package for Social Science version 20, respectively. Adjusted Odd Ratio (AOR) with 95% Confidence Interval (CI) were used to show the odd and P-value <0.05 was considered as statistically significant.ResultsA total of 411 bipolar patients were included in the study and the prevalence of aggressive behaviour was 29.4%. Significant associated factors for aggression were, having two or more episode [AOR = 2.35 95% CI (1.18, 4.69)], previous history of aggression, [AOR = 3.72, 95% CI (1.54, 8.98)], depressive symptoms [AOR = 3.63, 95% CI (1.89, 6.96)], psychotic symptoms [AOR = 5.41,95% CI (2.88, 10.1)], manic symptoms [AOR = 3.85,95% CI (2.06, 7.19)], poor medication adherence [AOR = 3.73 95% CI (1.71, 8.13)], poor social support [AOR = 2.99 95% CI (1.30, 6.91)] and current use of substance[AOR = 2.17 95% CI (1.16, 4.06)].ConclusionPrevalence of aggression is high among bipolar patients and associated with many factors. So it needs public health attention to decrease aggression among bipolar patients.

Delusion, excitement, violence, and suicide history are risk factors for aggressive behavior in general inpatients with serious mental illnesses: A multicenter study in China

BackgroundThe identification of genetic variants that differentiate PsA from psoriasis has the potential to help us understand the underlying biological pathways that lead to the development of PsA. Associations to...

IntroductionViolence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.ObjectivesThe objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.MethodsIt is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.We used SPSS 15 to analyse resultsResultsSixty-five case files were selected during the study month. The average age was 35.3 (19;64).The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic levelImage:Image 2:ConclusionsIn the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.Disclosure of InterestNone Declared

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: Variables affecting aggressive behavior, such as male gender, involuntary admission, and a history of aggression, might aid in the early detection of patients who may exhibit more severe aggressive behavior.

Obesity and asthma: An association modified by age of asthma onset

Psychiatric disorders are often considered the leading cause of violence. This may be due to a stereotype created by media and general opinion. The Modified Overt Aggression Scale (MOAS) was used to evaluate the severity of aggressive and violent behaviors in 400 patients who attended a post-acute psychiatric service in Milan from 2014 to 2016 and suffered from different psychiatric disorders. The psychopathological clinical picture was evaluated by Clinical Global Impression (CGI). The study also assessed the possible correlation between epidemiologic and sociodemographic factors, clinical variables, and aggression and violence. Of the total number of subjects, 21.50% showed a MOAS score >0, 11.50% presented mild aggression (0-10 MOAS weighted score), 9% moderate aggression (11-20), and 1% severe aggression (MOAS >20). With respect to violent behaviors, 16% of patients showed a score >0 in one MOAS subscale other than verbal aggression according to violence definition. The severity of clinical picture seemed to be related to higher weighted MOAS score. Multivariate testing of different sociodemographic and clinical variables showed that violence was related to unemployment status, and significantly correlated to compulsory admission (TSO), suicide attempts (TS), and personality disorders, while the severity of clinical psychiatric picture seemed to play a secondary role. Results have shown that personality disorders and sociodemographic factors, including economic factors, seem to be major determinants of violence among patients diagnosed with mental disorders.

The Modified Overt Aggression Scale (MOAS) has been validated for use in the study of aggression in the developed world; unlike in the undeveloped world. The aim of this study therefore is to ascertain the discriminant validity of the MOAS for use in this part of the world using psychiatric in-patients at the Jos University Teaching Hospital. Forty aggressive psychiatric patients and 40 non-aggressive healthy subjects were randomly selected for this study. The psychiatric patients were enlisted after fulfilling the ICD-10 (World Health Organization, 1993) criteria for a specific clinical diagnosis. The 40 non-aggressive subjects were mainly medical students and hospital staff. The MOAS was subsequently used to assess aggression in the entire cohort. The males had higher mean global weighted score than the females in both the aggressive and nonaggressive categories. The mean global weighted scores of the aggressive and non-aggressive categories were 13.70 +/- 7.25 and 0.65 +/- 1.01 respectively. The difference in means is statistically significant; hence the MOAS has discriminant validity. Therefore, the modified overt aggression scale is a valid instrument in this environment for the study of aggression.

Background. Multiple myeloma (MM) is the most common hematologic malignancy affecting African Americans, with a younger age of onset and standardized incidence and mortality rates that are twofold higher compared to European Americans despite the presence of clinical features, which are consistent with milder clinical course. The basis for this paradox remains poorly understood. However, evidence suggests a shared genetic susceptibility. Methods. Using 720 participants (259 confirmed MM cases; 461 age-, sex-, ancestry-matched controls) enrolled in the Molecular and Genetic Epidemiology (iMAGE) study of myeloma, we examined the risk of MM associated with a positive family history of cancer and the excess risk observed among AA patients. Family history of cancer was obtained from structured interviews and risk estimates were calculated using odds ratios (OR) and corresponding 95% confidence intervals (CI) from logistic regression stratified by ancestry and median age of MM onset (65 years). Results. Of the total participants included (42% African American), the majority reported a positive family history of cancer (80%), including solid tumors (75%), hematologic malignancies (17%) and MM (4%). A positive family history of any cancer in any relative was strongly associated with an increased risk of MM overall (OR=1.73, 95% CI 1.14-2.60; P=0.008), as well as among African Americans (P=0.03) and participants less than 65 years of age (P=0.0005). MM risk was markedly increased for participants who reported any relative with MM overall (OR=3.06, 95% CI 1.42-6.58; P=0.004) and among participants less than 65 years of age (OR=4.06, 95% CI 1.44-11.5; P=0.005). The magnitude of this effect was greater in African Americans (OR=18.6, 95% CI 2.32-148; P=0.0002) compared to European Americans, and was notable among first-degree relatives (OR=9.90, 95% CI 1.14-85.9; P=0.01). In contrast, MM risk was not significantly elevated for participants who reported relatives with any hematologic malignancy other than MM (OR=1.47, 95% CI 0.96-2.27; p=0.08) nor a positive family history of solid tumors (OR=1.36, 95% CI 0.95-1.95; P=0.09), and these estimates did not differ by ancestry, age of onset or degree of relative. Conclusions. Our observations suggest that the excess risk of MM observed among African Americans and among those with early age of onset may be attributed to shared susceptibility including underlying heritable genetic and environmental factors. Future studies are warranted to examine the relationship between family history of MM with clinical and cytogenetic factors, which are known to differ by ancestry. Citation Format: Gwendolyn I. Pruitt, Howard W. Weiner, Racquel D. Innis-Shelton, Donna Salzman, Kelly N. Godby, Vishnu B. Reddy, Fady M. Mikhail, Andrew J. Carroll, Elizabeth E. Brown. Effect of family history of cancer on the risk of multiple myeloma: Differences by ancestry and age of onset. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1299. doi:10.1158/1538-7445.AM2014-1299

Atypical antipsychotics for disruptive behaviour disorders in children and youths.

To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. The transmission rate was 9.16% (95% CI: 7.4-10.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.1-15); vaginal delivery (OR: 2.02; 95% CI: 1.2-3.4); prematurity (OR: 2.5; 95% CI: 1.3-4.7); and breastfeeding (OR: 2.6; 95% CI: 1.4-4.6). This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.

This study examined usage patterns of restraint and seclusion before and after the implementation of collaborative problem solving (CPS), a manualized therapeutic program for working with aggressive children and adolescents. The clinical setting was a 15-bed psychiatric inpatient unit for school-age children. A total of 755 children were hospitalized for a total of 998 admissions from fiscal years 2003 to 2007 (median age=11 years; 64% boys). Data were collected for three years before and 1.5 years after the six-month implementation of the CPS model of care. There were 559 restraint and 1,671 seclusion events during the study period. After implementation of the CPS model there was a reduction in the use of restraints (from 263 events to seven events per year, representing a 37.6-fold reduction, slope [beta]=-.696) and seclusion (from 432 to 133 events per year, representing a 3.2-fold reduction, beta=-.423). The mean duration of restraints decreased from 41+/-8 to 18+/-20 minutes per episode, yielding cumulative unitwide restraint use that dropped from 16+/-10 to .3+/-.5 hours per month (a 45.5-fold reduction, beta=-.674). The mean duration of seclusion decreased from 27+/-5 to 21+/-5 minutes per episode, yielding cumulative unitwide seclusion use that dropped from 15+/-6 to 7+/-6 hours per month (a 2.2-fold reduction; p for trend .01 or better for all slopes). During the early phases of implementation there was a transient increase in staff injuries through patient assaults. CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

BackgroundMouse studies have recently compared the age-onset patterns of cancer between different genotypes. Genes associated with earlier onset are tentatively assigned a causal role in carcinogenesis. These standard analyses ignore the great amount of information about kinetics contained in age-onset curves. We present a method for analyzing kinetics that measures quantitatively the causal role of candidate genes in cancer progression. We use our method to demonstrate a clear association between somatic mutation rates of different DNA mismatch repair (MMR) genotypes and the kinetics of cancer progression.MethodsMost experimental studies report age-onset curves as the fraction diagnosed with tumors at each age for each group. We use such data to estimate smoothed survival curves, then measure incidence rates at each age by the slope of the fitted curve divided by the fraction of mice that remain undiagnosed for tumors at that age. With the estimated incidence curves, we compare between different genotypes the median age of cancer onset and the acceleration of cancer, which is the rate of increase in incidence with age.ResultsThe direction of change in somatic mutation rate between MMR genotypes predicts the direction of change in the acceleration of cancer onset in all 7 cases (p ˜ 0.008), with the same result for the association between mutation rate and the median age of onset.ConclusionMany animal experiments compare qualitatively the onset curves for different genotypes. If such experiments were designed to analyze kinetics, the research could move to the next stage in which the mechanistic consequences of particular genetic pathways are related to the dynamics of carcinogenesis. The data we analyzed here were not collected to test mechanistic and quantitative hypotheses about kinetics. Even so, a simple reanalysis revealed significant insights about how DNA repair genotypes affect separately the age of onset and the acceleration of cancer. Our method of comparing genotypes provides good statistical tests even with small samples for each genotype.