Violent Behavior In Patients Research Articles

Pengaruh Pelaksanaan Terapi Spiritual Terhadap Kemampuan Pasien Mengontrol Perilaku Kekerasan

Perawat dapat mengontrol perilaku kekerasan pasien dengan melakukan tindakan salah satunya adalah terapi spiritual atau religius. Bentuk dari terapi spiritual dalam penelitian ini adalah dzikir dan mendengarkan bacaan Al-Qur’an surah Ar-Rahman. Penelitian ini bertujuan untuk mengetahui pengaruh pelaksanaan terapi spiritual terhadap kemampuan pasien mengontrol perilaku kekerasan di Ruang Kenari Rumah Sakit Khusus Daerah Dadi Provinsi Sulawesi Selatan. Desain penelitian yang digunakan dalam penelitian ini adalah metode Pre Experimental One Group Pretest-Posttest Design, yaitu design penelitian yang terdapat Pre-test sebelum diberi perlakuan dan Post-test setelah diberi perlakuan. Instrumen penelitian menggunakan lembar observasi tanda dan gejala yang muncul pada pasien sebelum dan sesudah diberikan terapi spiritual. Penentuan sampel dilakukan dengan menggunakan teknik purposive sampling dengan besar sampel sebanyak 20 pasien. Uji pengaruh dilakukan dengan menggunakan uji statistik Wilcoxon dengan nilai p < 0.05. Hasil penelitian menunjukkan bahwa ada pengaruh yang signifikan antara pelaksanaan terapi spiritual terhadap kemampuan pasien mengontrol perilaku kekerasan dimana dari hasil uji Wilcoxon diperoleh (p=0.003) α < 0.05. Kemampuan mengontrol perilaku kekerasan sebelum dilakukan terapi spiritual adalah sebanyak sembilan pasien, sedangkan sesudah dilakukan terapi spiritual adalah sebanyak sebelas pasien. Kesimpulan penelitian ini adalah ada pengaruh antara pelaksanaan terapi spiritual terhadap kemampuan pasien mengontrol perilaku kekerasan di Ruang Kenari Rumah Sakit Khusus Daerah Dadi Provinsi Sulawesi Selatan. Diharapkan bagi tenaga perawat untuk lebih meningkatkan lagi pemberian terapi spiritual terhadap kemampuan pasien mengontrol perilaku kekerasan.

Omega-3 fatty acids in cause, prevention and management of violence in schizophrenia: Conceptualization and application

Abstract Schizophrenia is a disabling neurological disorder. Patients with this disease are at higher risk to violence. This paper reviewed the recent literatures with respect to the heterogeneous nature of the abnormalities and pathophysiological and biological risk markers that link to violent behavior in patients with schizophrenia with a particular interest in lipid metabolism. We have focused on altered lipid profile including polyunsaturated fatty acids, which may have attributed to the development of aggressive behavior in patients with schizophrenia. We addressed questions on how aberrant lipid metabolism affects brain structure and function, and how lipids modulate neurotransmission activity during progression of this devastating disease. Many clinical studies have demonstrated that omega-3 fatty acids may reduce transition rate to psychosis and serve as additive to reduce the violence. We postulate that the beneficial effect of omega-3 fatty acid supplementation on violence may act through modulating neuronal membrane lipid structure and neurotransmission. A better understanding of the underlying mechanisms how these pathways modulate aggression may facilitate development of strategies to prevent, ameliorate or reduce the manifestation of violence.

Assessing the Risk of Inpatient Violence in Autism Spectrum Disorder.

The Historical Clinical and Risk Management scale (HCR-20) is a structured clinical judgment tool used to assess risk of violence in secure settings. But the scale does not account for difficulties typical of patients with autism spectrum disorder, which are thought to contribute to their engagement in violent behaviors. The present study is a preliminary investigation of the association between risk assessment and physical and verbal violence in patients with autism spectrum disorder in a secure psychiatric hospital. Scores from the third version of HCR-20 (HCR-20V3) and violent episodes at three and six months following the initial assessment were extracted from an electronic record. The results support the use of the HCR-20V3 to assess the risk of overall and physical violence but not verbal aggression. Future studies are needed to identify which factors are associated with violent behaviors in patients with autism spectrum disorder.

Risk factors for violence in schizophrenic patients at onset stage in community

Objective To investigate the prevalence, characteristics and influencing factors of violent behaviors in patients with schizophrenia during the onset stage of the disease in the community, and to provide targeted guidance for community and family when delivering care and rehabilitation for the patients. Methods From March to July in 2018, a total of 235 newly admitted schizophrenic patients in two specialized hospitals and one general hospital in Zhanjiang city were selected by convenience sampling. By the use of the self-designed questionnaire, the main caregivers were investigated directly about the patients' general information, patients factors, family factors and violent behaviors. The influences of the patients factors and family factors on the violent behaviors were analyzed. A total of 226 properly filled questionnaires were retrieved. Results Among the 226 patients, a total of 161 cases (71.24%) committed violence one week before admission in which 129 cases (57.08%) were general attack, and 32 cases (14.16%) were dangerous violence, 65 patients (28.76%) did not committed any violent behaviors. Ordinal Logistic regression analysis showed that the risk factors of the violence were the presence of conduct disorder before illness, previous verbal attacks, destruction of property, or personal attacks against others, as well as emotional vulnerability , verbal stimulation or behavior/action stimulation from surrounding environments (P<0.05) . Harmonious family relations and the main Guardians' good execution of doctors' advice were the protective factors (P<0.05) . Conclusions Patients who have previously had verbal attacks, property damage, physical attacks against others, and who have behavioral disorders before illness should be the focus of community and family care. Creating a harmonious family and rehabilitation environment in community should be an important part of family and community care for schizophrenic patients. Health education of mental illness for patients, primary caregivers and community should be strengthened. Key words: Schizophrenia; Community; Violence; Risk factors

Cannabis, a Significant Risk Factor for Violent Behavior in the Early Phase Psychosis. Two Patterns of Interaction of Factors Increase the Risk of Violent Behavior: Cannabis Use Disorder and Impulsivity; Cannabis Use Disorder, Lack of Insight and Treatment Adherence.

Background: Previous literature suggests that prevalence of cannabis use in the early phase of psychosis is high, and that early psychosis patients are at high-risk for violent behavior. However, the link between cannabis use and violent behavior in early psychosis patients is unclear. We carried out a study on a sample of early psychosis patients, in order to explore the impact of cannabis use on the risk of violent behavior (VB), while taking into account (1) potential confounding factors and, (2) interactions with other dynamic risk factors of VB.Method: In a sample of 265 early psychosis patients, treated at the Treatment and Early Intervention in Psychosis Program (TIPP) in Lausanne, we used logistic regression models to explore the link between various dynamic risk factors of VB [positive symptoms, substance use disorder (drugs including cannabis, alcohol and others drugs), insight, impulsivity, affective instability, and treatment adherence], and VB occurring during treatment. In order to understand hierarchical effects attributable to the combinations of risk factors on VB we conducted a Classification and Regression Tree (CART).Results: Our results show that cannabis use disorder is a risk factor for VB. The associations among risk factors suggest the presence of two patient profiles with an increased rate of VB: the first is composed of patients with cannabis use disorder and impulsivity, and the second of patients combining cannabis use disorder, absence of insight and non-adherence to treatment. The results also show the moderating role of insight and adherence to treatment on the rate of VB in patients with cannabis use disorder.Conclusion: This study suggests that cannabis use disorder is a significant risk factor for VB amongst early psychosis patients, particularly when combined with either impulsivity, lack of insight and non-adherence to treatment. These results suggest that preventive strategies could be developed on the basis of such patient profiles.

Patterns of Substance Abuse in Offenders With Schizophrenia- Illness-Related or Criminal Life-Style?

Objective: The impact of substance abuse on violent behavior in patients suffering from schizophrenia is well-known. However, the association between the pattern of substance abuse and certain aspects of criminal behavior like the severity of offense, the previous history of violence and the age at onset of the criminal career is still unclear.Method: To assess the relationship between substance abuse, schizophrenia and violent behavior we examined healthy non-offenders; healthy offenders; non-offenders suffering from schizophrenia; and offenders suffering from schizophrenia, with respect to different patterns of substance abuse (none, alcohol only, illicit drugs only, and multiple substances).Results: Healthy offenders as well as offenders and non-offenders suffering from schizophrenia are characterized by increased rates of alcohol and illicit drug abuse. Especially multiple substance abuse appears to lower the threshold of aggression and illegal behavior. This effect is more pronounced in subjects suffering from schizophrenia. In both offender groups the abuse of psychoactive substances is associated with an earlier onset of the criminal career, but has no impact on the severity of the offenses.Conclusion: Our results point to the need for a differentiated view on the contribution of substance abuse to the criminality of subjects suffering from schizophrenia.

Pengaruh Relaksasi Progresif Terhadap Penurunan Perilaku Kekerasan Pada Pasien Skizofrenia Di Rumah Sakit Jiwa Daerah Klaten

Abstract: Violent Behavior, Schizophrenia, Progressive Relay Therapy. Management or treatment of violent behavior is necessary and can be done in three ways, namely prevention programs, anticipation and restraint. Progressive relaxation is part of the anticipatory program. The progressive relaxation technique is to focus on a muscle activity, by identifying the tense muscles and then decreasing the tension by performing relaxation techniques to get relaxed feelings (Murphy, 1996). The purpose of this study is to determine the effect of progressive relaxation on the risk of violent behavior in patients with schizophrenia RSJD Klaten. The type of research is Quasi experiment with research design using One Group Pre and Post test Design. Sampling using non probability sampling technique by purposive sampling which amounted to 30 respondents in RSJD Klaten. Sample is done pre test fill out questionnaire BPRS (General Response Function Adaptif) which include behavioral response, verbal response, emotional response, and physical response with scale 1-14 .. Data analysis used is Paired t-test with the help of computer SPSS for Windows version 18.0. The results of research on progressive relaxation implant dillakuakn in RS Klaten Klaten, after analyzed with bivariate showed that there is a decrease of average between before and after given progressive relaxation action from before action 2.07 to after action 1.63 (t count 0.44) and P value 0,000 &lt;  (0.05). Interpretation of this research that progressive relaxation therapy is very influential in reducing the level of perilakukan violence in schizophrenic patients.

14. VIOLENCE IN SCHIZOPHRENIA: PREVALENCE, MEASUREMENT, PREDICTION AND PREVENTION

Overall : Most patients with schizophrenia and bipolar disorders (severe mental illness, SMI) are not violent in their lifetimes, however, a minority of patients are violent at some points in the course of their illness. As the illness appears relatively early in life, and typically runs a chronic course, the number of violent incidents caused by patients can be considerable in some cases. Due to the stigma toward SMI, the media often emphasize reporting of these incidents, which fuel the stigma even more. Although violent behavior is a common cause of concern for patients, their families and clinicians, it is not often discussed in scientific meetings. The purpose of this symposium is to bring this relatively neglected, but very important topic into the spotlight in SIRS, in order to summarize the latest evidence for clinicians and researchers, and to foster new work on reducing these risks of violence.Dr. Weiser will present an overview of the prevalence of violent behavior in patients with SMI, and will present a population-based, case-control study from Israel, showing increased rates of violent crime in patients with SMI, particularly in female patients and patients who abuse drugs. Secondary analyses will show increased rates of violent behaviour in siblings of patients as well.Dr. Fazel will present a systematic review on the prognostic (or predictive) accuracy of structured ways to assess violence risk in patients with severe mental illness, and present new work on a scalable and potentially useful predictive model of violent behaviour based on 75,000 patients in Sweden.Dr. Nijman will present a model based on patient, ward and staff variables focused on the causes and triggers of aggressive behavior on (locked) psychiatric wards. Based on this model, a number of preventive measures can be formulated. At 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 as well as 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.Dr. Torrey will present data on rates of re-arrest in patients with SMI, showing that the average five-year re-arrest rate is approximately 40% for those released from psychiatric hospitals and 60% for those released from jails or prisons, and will present comparison data from other countries. He will then present data on the effect of extended conditional release, Forensic Assertive Community Treatment (FACT) teams, and Psychiatric Security Review Boards on re-arrest rates.

Association of homicide attempts with childhood traumatic experiences in patients with schizophrenia

Objective: It has been reported that childhood traumatic experiences have various adverse effects on the clinical course of schizophrenia and increases the tendency to violent behavior. In this study, it was aimed to investigate whether childhood traumatic experiences increase homicide, which is a special subtype of violent behavior in patients with schizophrenia. Methods: Thirty patients with schizophrenia with a history of homicide, 30 patients with schizophrenia without a history of homicide and 30 healthy controls equivalent to patients in terms of age, sex and education were included in study. After diagnostic interview all subjects were given Sociodemographic Data Form and Childhood Trauma Questionnaire. Brief Psychiatric Rating Scale applied to patient groups. Results: Emotional abuse and emotional neglect and physical abuse subscales points of patients with a history of homicide were significantly higher than control group, no statistically significant difference was found between the patient groups with and without a history of homicide. There was no statistical significance in terms of any subscale score between the patients without homicidal history and control group. Conclusion: Childhood traumatic experiences may in-crease homicidal behavior with schizophrenia patients. In clinicians' daily practice, questioning childhood abuse in patients with schizophrenia may help to anticipate the risk of violence.

Brain structure differences among male schizophrenic patients with history of serious violent acts: an MRI voxel-based morphometric study

BackgroundThe biological underpinnings of serious violent behaviors in patients with schizophrenia remain unclear. The aim of this study was to identify the characteristics of brain morphometry in patients with schizophrenia and a history of serious violent acts, who were being treated under relatively new legislation for offenders with mental illness in Japan where their relevant action should be strongly associated with their mental illness. We also investigated whether morphometric changes would depend on types of serious violent actions or not.MethodsThirty-four male patients with schizophrenia who were hospitalized after committing serious violent acts were compared with 23 male outpatients or inpatients with schizophrenia and no history of violent acts. T1-weighted magnetic resonance imaging (MRI) with voxel-based morphometry was used to assess gray matter volume. Additionally, patients with violent acts were divided based on whether their relevant actions were premeditated or not. The regional volumes of these two groups were compared to those of the control patient group.ResultsPatients with schizophrenia and a history of serious violent acts showed significantly smaller regional volumes of the right inferior temporal area expanded to the middle temporal gyrus and the temporal pole, and the right insular area compared to patients without a history of violence. Patients with premeditated violent acts showed significantly smaller regional volumes of the right inferior temporal area, the right insular area, the left planum polare area including the insula, and the bilateral precuneus area including the posterior cingulate gyrus than those without a history of violence, whereas patients with impulsive violent acts showed significantly smaller volumes of only the right inferior temporal area compared to those without a history of violence.ConclusionsPatients with schizophrenia and a history of serious violent acts showed structural differences in some brain regions compared to those with schizophrenia and no history of violence. Abnormalities in the right inferior temporal area were relatively common but did not depend on whether the violent actions were premeditated or not, and abnormalities in a wider range may be attributed to not only planning the violent action against others but also to maintaining that plan.Trial registrationUMIN.ac.jp UMIN000008065. Registered 2012/05/31.

Substance use is a risk factor for violent behavior in male patients with bipolar disorder

BackgroundTo determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD). MethodsA sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss–Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior. ResultsCurrent substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior. LimitationsThe sample was limited to male patients. Data on some participants’ recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis. ConclusionsCSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.

Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder.

An increasing number of states have approved posttraumatic stress disorder (PTSD) as a qualifying condition for medical marijuana, although little evidence exists evaluating the effect of marijuana use in PTSD. We examined the association between marijuana use and PTSD symptom severity in a longitudinal, observational study. From 1992 to 2011, veterans with DSM-III/-IV PTSD (N = 2,276) were admitted to specialized Veterans Affairs treatment programs, with assessments conducted at intake and 4 months after discharge. Subjects were classified into 4 groups according to marijuana use: those with no use at admission or after discharge ("never-users"), those who used at admission but not after discharge ("stoppers"), those who used at admission and after discharge ("continuing users"), and those using after discharge but not at admission ("starters"). Analyses of variance compared baseline characteristics and identified relevant covariates. Analyses of covariance then compared groups on follow-up measures of PTSD symptoms, drug and alcohol use, violent behavior, and employment. After we adjusted for relevant baseline covariates, marijuana use was significantly associated with worse outcomes in PTSD symptom severity (P < .01), violent behavior (P < .01), and measures of alcohol and drug use (P < .01) when compared with stoppers and never-users. At follow-up, stoppers and never-users had the lowest levels of PTSD symptoms (P < .0001), and starters had the highest levels of violent behavior (P < .0001). After adjusting for covariates and using never-users as a reference, starting marijuana use had an effect size on PTSD symptoms of +0.34 (Cohen d = change/SD), and stopping marijuana use had an effect size of -0.18. In this observational study, initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior, and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.

Literature Synthesis: Patient Aggression Risk Assessment Tools in the Emergency Department

Multiple risk assessment tools have been developed to prevent violent behavior of patients. The purpose of a risk assessment tool is to prevent injury to health care workers, prevent suicide, and de-escalate a patient before a violent act occurs. A risk assessment tool can be used by nurses to identify interventions and to protect themselves or their organization from potential poor decision making and poor outcomes when a violent event occurs. 1 Brown S Langrish M Evaluation of a risk assessment tool to predict violence behaviour by patients detained in a psychiatric intensive care unit. J Psychiatr Intensive Care. 2011; 8: 35-41https://doi.org/10.1017/S1742646411000264 Crossref Scopus (6) Google Scholar Natalie Calow, Member, Indy Roadrunners Chapter, is LEAN Facilitator, Indiana University Health Methodist Hospital, Indianapolis, IN. Angie Lewis is Staff RN, Indiana University Health West Hospital, Indianapolis, IN. Scott Showen is Staff RN, Riley Hospital for Children, Indiana University Health, Indianapolis, IN. Norma Hall is Assistant Professor of Nursing, University of Indianapolis, Indianapolis, IN.

Violent behavior of patients living in psychiatric residential facilities: A comparison of male patients with different violence histories

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs.To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors.This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out.The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.

910 – Schizophrenia and violence at home

Introduction There is good evidence from epidemiological studies that the diagnosis of schizophrenia is associated with an increased risk of violence.Some studies have linked the presence of positive symptoms, first psychotic episode, duration of untreated psychosis and lack of insight with violent behavior. Objective The primary objective was to identify factors related to violent behavior in patients diagnosed with psychotic disorder attended by our group, a multidisciplinary mobile outreach team (EMSE). Methodology We evaluated a total of 249 patients diagnosed with psychotic disorder between 2007 and 2012. We administered the following scales: PANSS, GAF (Global Assessment of Functioning), CGI (Clinical Global Impression), GEP (Severity of psychiatric illness scale, AVAT (Instrument to assess violent behavior in mental illness) and SUMD (Scale unawareness of mental disorders). To study the correlation between the scales and the score of the AVAT instrument we used the Pearson correlation. Clinical variables were also compared between aggressive and non-aggressive patients using Chisquare and Student's. Results There is a positive correlation between AVAT and PANSS-P (r = 0.544), ICG (r = 0.472), GEP (r = 0.515) and a negative correlation between AVAT and GAF (r = -0357). The correlation between AVAT and SUMD is positive (r = 0.119) but not statistically significant. Conclusion The presence of positive symptoms and clinical severity has been linked to increased aggressiveness and to predict the occurrence of violent behavior in the course of psychotic disorder. Unlike other studies, no correlation was observed with the lack of insight.

2124 – Assessment and treatment of patients with violent behaviors in emergency psychiatry. The HCR-20 violence risk assessment scheme

Introduction Violent behavior of patients is a common problem in emergency psychiatry and evaluation, diagnosis, management and treatment of which is very difficult.The absence of a test that could be used to predict violent behavior hampers proper decision in the case of emergency admissions, as well as discharge from the hospital. The application of such a test would upgrade assessment offering solve this problem. Objective To identify risk and protective factors of violent behaviors : to establish the degree to which the HCR-20 predicts the frequency and severity of violent behavior; to examine the predictive validity of the scales of the HCR-20. Goal Improve assessment, management and treatment of patients with violent behaviors in the psychiatric ward. Method Prospective cohort study, during 24 weeks. Psychiatric evaluation based on structural clinical interviews and questionnaires related to violent behaviors and risk factors were conducted to patients admitted in psychiatric hospital on UHC “Mother Tereza” Tirana. Results According to our data, the relationship between violence and mental illness vary considerably across different diagnoses. The highest rate of violence is reported in subjects with substance abuse disorder and antisocial personality disorder followed by Bipolar disorder and psychotic patients. Among the risk factors verified so far, the past violence behaviors reported show the highest predictive value. Conclusions HCR-20 tool has currently shown good results to roughly estimate probability of future violence and taking appropriate measures in order to prevent unwanted consequences.

The assessment and management of the violent patient in critical hospital settings

ObjectivePatient violence and aggression is prevalent in critical care settings, yet clinicians are often inadequately trained to assess and respond to these types of behaviors. Targeted toward trainees as well as seasoned clinicians, this articles provides an updated review of the literature regarding the management of violence in the emergency department. MethodsThis narrative review is largely derived from research articles and reviews published since 2000. We conducted a systematic search of electronic databases for review articles or studies examining patient violence and aggression in critical care settings. Electronic searches were supplemented by manual searches of reference lists. ResultsCurrent statistics, risk factors and imminent signs of violent patient behavior are presented. We conclude with recommendations for pharmacological and psychological interventions that can help manage aggressive behavior in the emergency department. ConclusionsThe relatively high frequency of aggressive and violent behavior in critical care settings increases the likelihood that clinicians working in this environment will encounter this situation. It is our hope that providing additional information about the factors associated with and techniques for managing violent patient behavior will reduce the occurrence of injuries in health care professionals in emergency departments.

The epidemiology of violent behavior in patients with a psychotic disorder: A systematic review of studies since 1980

Since the 19th century, it has been widely acknowledged that persons with a psychotic disorder are more often involved in violent crimes than those without mental problems, which is confirmed by several recent review papers and meta-analytic studies. However, the caveats and limitations of these studies have been largely neglected. In the present systematic review paper, the epidemiological studies that were published since 1980 on the link between psychosis and violent behavior were critically reviewed. Electronic databases were searched to initially identify 5756 articles. A total of 26 articles were eventually selected as they met all selection criteria. Studies were categorized according to their research design (i.e., birth cohort, community, register/record-based). Although schizophrenia and other related psychotic disorders seem to be undoubtedly associated with violent behavior (with OR's between 2 and 28), it should be kept in mind that underlying variables or risk factors (e.g., family history of violence, emotions such as anger and anxiety, impulsivity, childhood problems), the study design, and conceptual problems (i.e., definitions of violence/aggression and schizophrenia/psychosis) might be particularly relevant when interpreting the link between violence and psychosis.

The Association between Schizophrenia and Violent or Homicidal Behaviour: The Prevention and Treatment of Violent Behaviour in These Patients

This review article aims to discuss and evaluate the risk factors for the development of violence and homicidal behaviour and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed. Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes. Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine. In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.

Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia

Background: Violence is a significant clinical and public concern and is a frequent occurrence in patients with schizophrenia. The relationship between insight and violence remains controversial. In addition, there is a lack of research on insight, cognitive insight, demographic and psychopathologic variables in violent versus nonviolent schizophrenia patients. Aim: We aimed to compare insight, cognitive insight, psychopathological and demographic variables in violent and nonviolent subjects suffering from schizophrenia. In addition, we aimed to determine the demographic and clinical predictors of violent behaviour in patients with schizophrenia. Method: We recruited 133 schizophrenic patients without concomitant substance abuse or axis II disorder. Diagnoses were based on the SCID-I and SCID-II. Violent behaviours were assessed using the Overt Aggression Scale. Insight and cognitive insight were assessed with the Scale to Assess Unawareness of Mental Disorder and the Beck Cognitive Insight Scale, respectively. Results: We compared 47 patients with violent schizophrenia with 86 nonviolent patients. Non-violent patients had more severe depression, lower scores on positive symptoms, better clinical insight, more self-reflectivity and higher R-C index scores than did violent patients. In addition, history of violence, lower self-reflectiveness, worse clinical insight and delusion severity were significant predictors of violence in schizophrenia. Conclusion: The present study suggests that the inclusion of insight and cognitive insight may increase the prediction of violence in this population. In addition, clinicians should consider using non-pharmacological techniques that are based on cognitive behaviour therapy and enhance insight, particularly cognitive insight, among patients with schizophrenia who exhibit violent behaviour.