Aggressive Inpatients in a Community General Hospital

Patients who are aggressive and present with characteristics and behaviors associated with a significant risk for physical violence are not uncommon in the acute inpatient behavioral health units of general hospitals.Treating the aggressive patient challenges clinicians to safely, expeditiously, and effectively manage the needs of both the aggressive patient and the unit’s entire patient population.

Several factors contribute to the admission of aggressive patients to general hospitals’ psychiatric units, including the closing of state hospitals; insufficient housing for mentally ill, intellectually disabled, and addicted individuals; the recurrent problem of community treatment unsuccessfully managing aggressive patients; and controversy regarding if or when these patients’ actions necessitate incarceration. And, although staff may hope this trend of admitting aggressive patients abates, studies have stated that this population merely reflects society and will, therefore, continue to be present.

Research has shown that acts of aggression are most likely to occur within the first or second week of hospitalization. Predictors have frequently been utilized to identify which patients are most at risk for aggressive behavior while hospitalized and are typically grouped by categories such as demographics (eg, age, sex, history of violence, psychosocial factors), clinical characteristics (eg, diagnosis, substance use, personality disorders, symptoms, severity of illness), contextual factors (eg, unit environment), and staff contributors (eg, communication skills, aggression training).

The results of our prospective study on aggressive patients cited younger males with a history of previous violence, past psychiatric admissions, and severe symptoms of agitation (defined as excessive, purposeless motor activity) as being more at risk for aggressive behavior during acute psychiatric hospitalization than other patients. Additionally, our results suggested that positive psychotic symptoms, a diagnosis of bipolar disorder, and substance use also contributed to aggressive behavior. We also identified a relationship between the participants’ severity of illness and level of aggressiveness.

In study participants, paranoia was the symptom most successfully reduced/treated by medication. The medications we used for our study participants seemed efficacious, as significant improvements were seen in psychometric scale scores (CGI-S and MOAS) from baseline to last visit; however, the overall positive effects of the therapeutic inpatient environment and routine must also be considered as important contributors to patient improvement.

Our study showed high rehospitalization rates for aggressive patients, which suggests that patients with aggression issues are difficult to treat https://www.viagrageneric.org/ and difficult to keep in compliance with treatment on an outpatient basis. This finding highlights the need to strengthen community mental health centers through an increase in public-private partnerships.

Financial disclosure:Dr Mittal is a consultant for Janssen, Otsuka, and Teva. Ms Nourse had no relevant personal financial relationships to report.​