Past Issues

Objective: Repeatedly aggressive incidents by psychiatric inpatients pose an imperative yet seldom discussed issue. Most of the articles focused on the clinical differences between aggressors and nonaggressors in psychiatric wards, the factors associated with repeated aggression are often overlooked. The aim of this study was to examine the clinical characteristics of repeated aggression among patients admitted to an acute psychiatric unit. Methods: Data on aggressive incidents in an acute psychiatric unit were retrospectively collected from March 2003 to February 2004. Patients responsible for repeated aggression and transient aggression were compared in terms of socio-demographics and the nature of the incident. Results: Out of 603 total admissions of 485 patients, 199 aggressive incidents were recorded during this one-year period. Among the 485 patients included in the study, 81 patients had at least one aggressive incident, rate of aggression was 16.7%. Of the 81 aggressive patients, 32(39.51%) had a transient episode, while 49(60.49%) had two or more episodes (167 episodes, 3.41 incident/patient). Patients with transient and repeated aggressive episodes had comparable socio-demographics, onset age and number of admissions. Logistic regression analysis revealed three major risk factors for aggression: diagnosis of mania (OR=4.16, 95%CI=1.37-12.68), pre-admission aggression (OR=2.25, 95%CI = 1.26-4.02) and duration of hospitalization (OR=1.03, 95%CI=1.01-1.04). Conclusions: Diagnosis of mania, pre-admission aggression and duration of hospitalization were risk factors for inpatient aggression. Repeated aggression was also more common among patients with previous aggression. Careful monitoring of these factors may help physicians recognize the potential for and takes steps to prevent violence among acute psychiatric inpatients.