Aggressive Behavior In Patients Research Articles

Job Satisfaction Analysis of Nurses, who Work in Neurology and Neurosurgery Units

Introduction. Satisfaction, facing problems and motivation are currently strategic points to be analysed in terms of nurses’ work. All positive or negative perceptions and attitudes towards work translate into commitment, identity creation, turnover and also status. The fit between the individual and the organisation draws attention. Both the complementary and supplementary dimensions show to what extent the employee’s needs are met and whether the recognised values of the two groups are the same. For the employee, this translates into identification with the workplace. A high degree of fit influences the status of the workplace, the involvement of employees in the tasks at hand increasing their quality. On the other hand, the existence of mismatches generates bad interpersonal relations, inappropriate division of responsibilities, loss of trust, and leads to conflicts.
 Aim. Comparative analysis of changes in the context of sense of job satisfaction of nurses working in neurological and neurosurgical wards in the Silesian province over the last decade.
 Material and Methods. The study was conducted in 2012 and 2022 among nurses working in neurological and neurosurgical wards of the N.M.P. Regional Specialist Hospital in Częstochowa and the Prof. K. Gibiński University Medical Centre in Katowice. The study used an original questionnaire containing 61 questions on various aspects of the work performed.
 Results. Among the respondents, the predominant age group is over 51 years old with a master’s degree, whereas in the earlier survey it was 31–40 years old with a secondary vocational education. The survey showed that 33% more respondents felt that their job involved a lot of physical exertion. The percentage of those able to cope with complex mental tasks has decreased significantly, the percentage of nurses who are overburdened with too many tasks has increased, 75% of them notice the impact of work on family life. Professional qualifications are being improved by 40% more of those surveyed than ten years ago, but 29% are attending fewer conferences and training courses, and 24% are introducing innovations into their workplace less than in 2012. A sense of meaningfulness and usefulness of the tasks performed at work is shared by 66% of respondents, previously 91% in 2012. The impact of the ward’s equipment on the work performed is now noted by 70% more nurses, and is considered by 66% of respondents as a factor giving greater job satisfaction, a decade ago it was 86% of respondents. Nursing staffing is considered sufficient by 34% more respondents than the previous survey showed. Far fewer respondents now perceive the impact of aggressive patient behaviour on their work. The percentage of respondents noticing conflicts with doctors increased by 72%. 77% more respondents feel they are treated fairly by their superiors than a decade ago. Low social prestige of the profession is noticed by only 6% of nurses.
 Conclusions. Nurses do not feel satisfaction with their work, even though they see a sense of purpose in the activities they undertake. This means that their need for development has been disrupted by low motivation both socially and economically, a sense of being undervalued and insufficient identification with the workplace. Most of the same people took part in the current survey as ten years ago, their attitude to their work has changed dramatically. Nurses are coping less well with their tasks. The work is associated with too much physical and mental strain. Relationships between nurses and patients and between nurses and other team members have changed. Nursing staffing in neurological and neurosurgical wards, where patients with severe conditions are often hospitalised, is insufficient. (JNNN 2022;11(3):114–123)

Aggressive behaviour in antipsychotic-naive first-episode schizophrenia patients, their unaffected siblings and healthy controls.

While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group. Patients (N=55), siblings (N=55) and healthy controls (N=71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group. The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p=.023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p=.010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p=.023) and non-planning (p=.004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β=.446, p=.0244) and psychopathy traits (β=.359, p=.010) helped predict AQ total scores among patients. Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis.

Correlation Analysis of Magnetic Resonance Imaging Characteristics and Prognosis of Invasive Pituitary Adenomas in Neurosurgery Hospitals.

The incidence of pituitary adenoma is second only to glioma and meningioma, and its incidence ranks third among intracranial tumors. Most pituitary adenomas are benign and noninvasive tumors, but invasive pituitary adenomas pose a great threat to human health. In order to explore the risk factors that affect the clinical aggressive behavior of patients with pituitary adenoma, analyze the correlation between different classification methods and clinical aggressive behavior, and lay the foundation for early judgment and individualized treatment of clinical aggressive behavior of patients with pituitary adenoma. We conducted statistical research on patients who were treated for pituitary adenomas in the city's Yangzhou Hongquan Hospital. The results of the study showed that six patients in this study showed aggressiveness in the clinical symptomatic outcome, six patients showed aggressiveness in the serological outcome, and seven patients showed aggressiveness in imaging. In the multimodal classification, the clinical aggressiveness of pituitary adenomas in the invasion + atypical group was significantly higher than that in other groups, and the difference was statistically significant (P < 0.05). The correlation analysis of magnetic resonance imaging features and prognosis of invasive pituitary adenomas were verified to be feasible for the treatment of patients.

The Attitudes of Nurses Towards Inpatient Aggression And Selected Staff Characteristics: a Cross-sectional Study

Introduction: The attitude of nurses to the patient aggression may also reflect how they interpret its function or what meaning they attribute to aggressive patient behaviour. These attitudes are subsequently manifested in the way, in which nurses behave towards aggressive patients and manage aggression. Methods: The study aimed to identify the attitudes of nurses from various clinical areas to the inpatient aggression and to reveal differences in attitudes based on selected staff characteristics. The study has a quantitative cross-sectional design. Nurses’ attitudes towards the inpatient aggression were identified by means of the Attitude Towards Aggression Scale (ATAS©) distinguishing five types of attitudes represented by five domains named as offensive, destructive, intrusive, communicative, and protective domains. The prevalence of patient aggression towards nurses was determined using the Violence and Aggression of Patients Scale (VAPS). The sample consisted of 1220 nurses from nine selected faculty or university hospitals in the Slovak Republic. Results: The highest scores were identified in the ATAS© domains representing a negative perception of patient aggression in terms of destruction, offensive, or intrusion; on the other hand, nurses were open also to a positive perception of patient aggression. Conclusion: The results of our study point to the need for a deeper investigation into the issue of nurses’ attitudes towards aggressive patients. Nurses’ negative attitudes towards patient aggression can have an adverse effect on the quality of care provided to aggressive patients, thus it is crucial to identify these attitudes and implement lifelong-learning interventions to reduce them.

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations.

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.

The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

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.

The efficacy of antipsychotics in the treatment of physical aggressive behavior in patients with dementia in nursing homes.

Patients with dementia often suffer from behavioral changes. A common behavioral change is acute physical aggressive behavior which is the most distressing change. This can lead to harm, which is especially problematic in nursing homes. Despite the serious safety concerns, antipsychotics are often prescribed to combat this problem. This article is aimed to review the evidence of the efficacy of utilizing antipsychotics in acutely treating physical aggressive behavior in patients with dementia in nursing homes. Therefore, a systematic literature search was performed. The results demonstrated that a meta-analysis confirmed statistically significant reduction in physical aggression when risperidone was compared to placebo. However, a randomized controlled trial showed no change in physical aggressive behavior between quetiapine and placebo. More research is needed to fully investigate the benefits of physical aggressive behavior and safety concerns of all the antipsychotics in patients with dementia in nursing homes.

Long-Acting Injectable Antipsychotics: an option for treating aggressive behavior in patients with developmental disorders?

Long-Acting Injectable Antipsychotics: an option for treating aggressive behavior in patients with developmental disorders?

A Comparison of Incidence of Patient Aggression in the University Psychiatric Clinic Ljubljana and at the Department of Psychiatry of the University Medical Centre Maribor

Purpose: Management of aggressive behaviour in patients with psychiatric diagnoses presents a challenge and burden for health staff. The present study compared two psychiatric institutions (the Department of Psychiatry of the University Medical Centre Maribor and the University Psychiatric Clinic Ljubljana) in terms of frequency and consequences of patient aggression. We compared frequencies of aggression between male and female patients, patients diagnosed with schizophrenia and other diagnoses, previously aggressive patients and patients who were aggressive for the first time. We also compared the use of special protective measures in both institutions.&#x0D; Methods: This study was retrospective and included the analysis of documentation of patients who were hospitalised at both institutions from 1 January 2012 to 31 June 2012. We identified patients with aggressive behaviour and acquired their sociodemographic data, diagnosis, number of hospitalisations, presence of alcohol or psychoactive substances and presence of aggressive behaviour. For assessment of aggressive behaviour, the Overt aggression scale was used. &#x0D; Results: One-hundred and forty-seven patients met the criteria for aggressive behaviour. There was no statistically significant difference in the frequency of aggression between genders or diagnoses. However, there was a statistically significant difference (p ≤ 0.01) in the frequency of aggression in patients who had previously been aggressive compared to those patients who had not exhibited such behaviour. There was no statistically significant difference in the use of special protective measures between the two institutions.&#x0D; Conclusions: Two hypotheses were confirmed: patients who had exhibited previous aggression were more frequently aggressive than those with no previous aggressive behaviour while the use of special protective measures between the two institutions was similar.

The phenomenon of patient aggression according opinion of medical practitioner

The article considers the problem of patient aggression during medical care provision. The purpose of the study was to estimate factual prevalence of patient aggressive behavior versus medical practitioners (with emphasis on primary health care) and specification of such manifestations. The anonymous survey of 508 physicians practicing in Moscow and the Moscow Region was carried out. The original questionnaire included 9 items regarding particular forms of patient aggression, its frequency and personal harm received. The feeling of personal safety at workplaces was evaluated according to 10-point scale. The study revealed that 412 respondents (81.1%) reported about episodes of patient aggressive behavior during performance of professional duties. In the year prior to the survey 66 respondents (16.0%) regularly experienced aggression from patients, 85 respondents (20.6%) recalled more than 5 such cases, 176 respondents (42.8%) - from 2 to 5 cases and 85 respondents (20.6%) - 1 case. The forms of aggression and damage suffered due to the aggressive behavior of patients were described. The physicians do not feel themselves safe at their workplaces regardless of their gender, professional experience, medical specialty and practice setting. The respondents assess their average feeling of safety in 5.4±2.5 points. The study established that 251 respondents (40.6%) considered patient aggressive behavior as manifestation of specific features developed in response to impact of present somatic disease. The study results demonstrated that physicians are exposed to aggressive actions from their patients more often than this is commonly considered and prefer to conceal such kind of incidents. The most common form of patient aggression was verbal abuse though physical aggression also took place. The application of preventive measures and management of conflict are key practical skills for any physician.

Effectiveness of a Home Based Training Program on Caregivers Knowledge in Managing Aggressive Behavior of Patients With Mental Illness

In India, more than 90% of the patient with chronic mental illness stayed with their family members. Approximately 77.4% of caregivers experience moderate to severe levels of aggression. The purpose of this study was to evaluate the effectiveness of caregiver-training program on knowledge in managing aggressive behavior of mentally ill at home. Research design was pre-experimental. Seventy two caregivers were recruited using purposive sampling technique. The caregivers knowledge was assessed at 3 time points with regard to training program; before, immediately (post-test 1), and after 1 month (±1 week; post-test 2). The baseline knowledge was reflective of the deficiencies existing in the management of aggression of the mentally ill by caregivers. The knowledge of caregivers regarding the management of aggressive behavior of mentally ill, increased after caregiver training program, from the pre-test score of 17.63 ± 3.3 to post-test 1 score of 23.26 ± 2.9, and slightly decreased post-test 2 score of 21.01 ± 3.3 at p &lt; .05. Repeated measure analysis of variance (ANOVA) was done to compare the differences in knowledge score over time with Bonferroni adjustment. This home based caregiver training program helped caregivers to identify etiological factors of aggression, warning signs of aggression and use of de-escalation strategies to manage aggressive behavior of mentally ill. Training caregivers regarding aggression management will make caregiver proficient in practicing safe approach during handling of aggressive patient which will ensure the physical safety of the caregiver as well as of the patient and let the patient stay at home.

Sansoninto attenuates aggressive behavior and increases levels of homovanillic acid, a dopamine metabolite, in social isolation-reared mice

Background and aimEarly-life stress is thought to affect aggressive behavior in humans and rodents. Laboratory experiments have demonstrated that Sansoninto (SST; 酸棗仁湯 suān zǎo rén tāng), a traditional herbal medicine, attenuates stress-induced abnormal behavior in rodents. However, it is unknown whether SST attenuates stress-induced aggressive behavior. The current study examined the effects of SST on aggressive behavior of mice who suffered from social isolation (SI) stress in adolescence. Experimental procedureFive-week old mice were socially isolated for 6 weeks, and SST administration was started at 4 weeks after starting SI. Aggressive behavior and locomotor activity were examined in SST-treated mice. The content of dopamine and its metabolites in the hypothalamus were examined using high-performance liquid chromatography analysis. Gene expression analyses of monoamine oxidase-B (MAO-B), catechol-O-methyltransferase (COMT), and tyrosine hydroxylase in the hypothalamus were performed using quantitative reverse transcription polymerase chain reaction. Results and conclusionSST attenuated SI-induced aggressive behavior and increased levels of homovanillic acid, a metabolite of dopamine. However, SST did not affect dopamine levels. SI enhanced locomotion in a novel environment and increased COMT mRNA levels. In contrast, SST-treated mice showed no significant enhancement of locomotion. SST attenuated the increase in COMT mRNA levels. Given that the dopaminergic system has been implicated in aggressive behavior, these findings suggest that SST toned down dopaminergic signaling, resulting in amelioration of aggression. SST may be useful for treatment of aggressive behavior in patients with neurotic symptoms.

Psychiatric nurses’ experiences of patient aggression

Abstract Introduction. Employees of psychiatric hospitals, especially the closed wards, experience aggression almost every day. Aggression in psychiatry is a particularly complex problem and is the subject of numerous studies. In this field of medicine, aggressive behavior of hospitalized patients is treated by the staff as an understandable, but undesirable component of work. The personnel’s confrontation with the above phenomenon is treated as a part of professional duties determined by the place of their performance. Aim. The aim of the study was to determine the frequency of aggressive behaviors in patients and to assess their impact on nursing staff employed in psychiatric departments. Material and methods. The study was conducted in 2017 in a group of nursing staff employed at the Clinical Hospital Dr Joseph Babinski in Cracow. The number of 196 nurses participated in the study. It was a cross-sectional study and consisted of one stage – the completion of the research tool by participants. Results. The results showed that 94.39% of the respondents were a victim of aggressive behavior on the part of patients. The most common verbal aggression experienced by the respondents were: verbal taunts, the use of vulgar words by the hospitalized, using offensive nicknames and shouting at the staff, while physical were: destroying hospital property, attempting to hit, throwing objects and destroying own belongings. Conclusions. The scale of the phenomenon of experiencing aggression on the part of patients in the group of nurses working in psychiatric departments indicates the need to conduct research into this subject and also to conduct staff training taking into account coping with aggressive behavior of patients.

Impact of a Mechanism-Based Anti-Aggression Psychotherapy on Behavioral Mechanisms of Aggression in Patients With Borderline Personality Disorder.

Introduction: Aggressive behavior is highly prevalent in patients with borderline personality disorder (BPD) and represents a major burden for patients and their environment. Previous studies have hypothesized threat hypersensitivity, among other mechanisms, as a biobehavioral mechanism underlying aggressive behavior in patients with BPD. The effects of a 6-week mechanism-based anti-aggression psychotherapy (MAAP) for the group setting were tested in comparison to the effects of a non-specific supportive psychotherapy (NSSP) on this hypothesized mechanism and their relation to the effects on aggressive behavior.Methods: To assess mechanisms of reactive aggression, 38 patients with BPD (20 in MAAP and 18 in NSSP) and 24 healthy controls participated in an emotion classification task before and after therapy or at a similar interval of 7 weeks for controls, respectively. In addition, current reactive aggressive behavior was assessed by the externally directed overt aggression score of the Overt Aggression Scale Modified (OAS-M) at both time points. Mixed linear models were used to test for group differences and differential treatment effects.Results: Consistent with previous findings, patients showed longer response latencies and misclassified faces as angry more often than healthy controls. Comparing pre- and post-treatment measurements, the MAAP group showed an increase in response latency in classifying angry faces, whereas the NSSP group showed a decrease in latency. Furthermore, the difference between pre- and post-treatment response latencies in classifying emotional faces correlated with the reductions in reactive aggression in the MAAP group, but not in the NSSP group or healthy controls.Conclusion: The results suggest an impact of MAAP on threat sensitivity as well as cognitive control, which has also been previously hypothesized as a biobehavioral mechanism underlying reactive aggression in patients with BPD. In addition, our findings shed light on the importance of these two biobehavioral mechanisms underlying reactive aggression as mechanisms of change addressed by MAAP. Further studies are needed to determine whether the behavioral change is stable over time and to what extent this change is related to a stable reduction in reactive aggression in a larger group of patients with BPD.

PROBLEMS OF MAINTAINING NURSING STAFF PRODUCTIVITY IN CONNECTION WITH AGGRESSIVE PATIENT BEHAVIOR

The article is devoted to the results of a study of the problems of nursing staff performance maintenance in connection with aggressive behavior of patients. We studied the opinions of 413 nurses concerning the aggressive behavior of patients in medical organizations of the Central Federal District. The paper reveals the problems of patient aggression and its interaction with nursing staff productivity.

Effectiveness of educational interventions for health care staff to prevent and manage aggressive behaviors in patients admitted to an acute hospital: a systematic review protocol.

The objective of this review is to determine the most effective strategies for educating health care staff to manage or prevent aggressive patient behaviors within an acute care setting. Health care workers in acute settings are frequently at risk of being injured by aggressive patients. Staff are often ill-prepared to de-escalate such behaviors and, therefore, are at greater exposure to verbal or physical injury. This protocol outlines methods for a systematic review on the effectiveness of educational strategies to manage and/or prevent aggressive patient behaviors in hospitals. Quantitative studies that report on programs used to educate or train hospital staff in managing or preventing an episode of aggressive behavior by an adult patient while in an acute health care facility will be included. Individual, program, and organizational outcomes, such as confidence, behavior, knowledge, or attitudes, as well as recorded rates of injury, sick leave, stress, anxiety, or detection/prevention of aggression before and/or after the intervention will be analyzed. Psychiatric patients or settings are excluded from this review. Two reviewers will independently select and appraise eligible studies and extract data following methods outlined by JBI for systematic reviews of effectiveness. Multiple databases will be searched for studies in English and Chinese from 2008 to the present. The JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) will be used to manage studies and, where possible, meta-analysis will be undertaken. Results will be presented in a Summary of Findings following the GRADE approach. PROSPERO CRD42020190538.

ДИСКРИМИНАНТНЫЙ АНАЛИЗ АГРЕССИВНОГО ПОВЕДЕНИЯ ЗАВИСИМЫХ ОТ АЛКОГОЛЯ ЛИЦ

The article analyzes the results of the authors' own research on the influence of a number of factors on the aggressive behavior of patients with alcohol dependence syndrome in a state of intoxication. The comparison was made between groups of patients suffering from alcohol dependence, with and without objectively proven cases of aggressive behavior. The influence of education, profession, family functioning, social intelligence, personality structure, anosognosia is considered within the framework of a single model. Discriminant analysis used as a tool for constructing a generalized model of aggressive behavior of alcohol addicts.

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals-An Exploratory Study.

Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes

Use of psychotropic agents to treat agitation and aggression in Brazilian patients with Alzheimer's disease: A naturalistic and multicenter study

We assessed psychotropic prescribing patterns in the clinical treatment of agitation and aggressive behavior in patients with Alzheimer's disease (AD) treated at specialist outpatient clinics in the Federal District of Brazil. This was a naturalistic, observational, multicenter study of a convenience sample of patients with AD (according to DSM-5) who had behavioral symptoms of aggression and/or agitation at outpatient visits, as assessed by the Neuropsychiatric Inventory (NPI), and required pharmacologic intervention. Participants were recruited in 2018-2019 from 11 AD treatment centers. Sociodemographic and clinical data were collected during routine visits. The sample consisted of 369 older adults with a mean age of 82.3 (SD, 7.7) years. The medications most commonly used in patients with behavioral disorders were antidepressants (79.1%), antipsychotics (70.2%), benzodiazepines (10.6%), and mood stabilizers (9.5%). Quetiapine was the most frequently prescribed antipsychotic medication (48.5%), at a mean dose of 57.4 (SD, 40.7) mg. Citalopram was the most widely used antidepressant medication (32.0%), at a mean daily dose of 24.1 (SD, 8.1) mg. In this sample, two or more pharmacologic agents were frequently used together to control aggression and agitation. Benzodiazepine was not frequently used.

Understanding aggressive behaviour in patients with schizophrenia through social cognitive theory: a narrative literature review

Background/AimsStudies have shown that some people diagnosed with schizophrenia are more predisposed to distress than others because of positive and negative symptoms of schizophrenia, leading to aggressive and violent behaviour. Moreover, there is no conclusive evidence to substantiate the reasons for the causes of aggression and what suitable interventions can be used. The aim of this study was to explore evidence-based literature through social cognitive theory to find effective strategies to manage aggression among patients with a diagnosis of schizophrenia.MethodsA background literature review search was conducted from the following databases: Medline, Cinhal and PsychInfo. The Boolean operator OR was used to search for Aggression OR Violence OR Cognitive theory OR Interventions OR Mental illness OR Schizophrenia OR Self-control OR Self-efficacy OR Social learning theory. Suitable papers were hand searched and seven papers were selected.ResultsResearch studies are in favour of social cognitive interventions to manage aggression in patients with schizophrenia as they have fewer side effects and can be used alongside other pharmacological interventions as the second line of treatment. However, findings from these studies should be viewed with caution, resulting from the contradiction that still exists in whether psychotic symptoms are correlated to aggression and violent behaviours among patients with schizophrenia.ConclusionsSocial cognitive models can enable health care professionals to explore the causes of aggression from a broad perspective, using appropriate risk assessment tools to design appropriate strategies.