Abstract
Aggressive and disruptive behavior in inpatient settings poses a serious challenge for clinical staff and fellow patients. Hence, the aim of this study was to identify different aspects of aggressive and disruptive behavior in the context of an aberrant self-esteem or clinically manifested depression as potentially influencing factors. We collected self-reported data from 282 psychiatric patients [ICD-10 diagnoses for alcohol dependency, schizophrenia or major depressive disorder (MDD)] and compared it to healthy norm groups. As expected, all three patient groups scored higher in the aggression questionnaires than the norm group. Specifically, patients with MDD exhibited significantly higher externally directed aggression, reactive aggression, and irritability compared to controls. Patients with schizophrenia displayed higher irritability, while all three groups showed distinctly higher self-aggressiveness than healthy persons. We found a lower inhibition of aggression in alcohol dependent subjects compared to both the patient groups and the norm sample. Yet, the higher the self-esteem among alcohol dependent and MDD patients, the lower were their aggression scores; similarly, a lower self-esteem among patients diagnosed with schizophrenia resulted in heighten self-aggressiveness. Thus, our data suggests that therapeutic interventions for strengthening self-esteem in patients with a diagnosis of MDD, alcohol dependency or schizophrenia could reduce certain aspects of aggressive behavior. Therefore, it seems conceivable that strengthening self-esteem in psychiatric patients could contribute to the prevention of violence in clinical practice.
Highlights
Several studies have highlighted the negative impact of aggressive behavior and violent acts among psychiatric patients in inpatient settings [1, 2]
In addition to the serious direct implications of aggression and violence for fellow patients, staff, and environment, frequent disruptive behavior and verbal or physical aggression of patients can genuinely endanger the general goals of psychiatric inpatient care [3]
Whereas some authors draw particular attention to the high rates of aggression in inpatients experiencing their first episode of psychosis [17,18,19] or the effects of comorbid substance use [20, 21], there is an ongoing debate about a broader range of clinical variables and specific patient factors associated with aggression
Summary
Several studies have highlighted the negative impact of aggressive behavior and violent acts among psychiatric patients in inpatient settings [1, 2]. Whereas some authors draw particular attention to the high rates of aggression in inpatients experiencing their first episode of psychosis [17,18,19] or the effects of comorbid substance use [20, 21], there is an ongoing debate about a broader range of clinical variables and specific patient factors associated with aggression. Such factors are being younger or male, having been admitted involuntarily and having a greater number of previous admissions or a history of violence or self-destructive behavior or both [22]. Rund [25] showed that insight, impulsivity, psychopathy, motor speed and a global measure of cognition have strong empirical evidence for an association with violence
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