Categorization of aggressive acts committed by chronically assaultive state hospital patients.
OBJECTIVE
This study examined factors motivating inpatient aggression in a sample of chronically assaultive state hospital patients.


METHODS
Inpatients who had committed three or more assaults over a one-year period were identified by using an incident report database. Aggressive episodes were categorized as impulsive, organized, or psychotic by using a procedure for classifying assaultive acts based on record review. Each assault type was further subcategorized. The relationship between assault type, victim (staff or patient), and legal status of the assaulter was also assessed.


RESULTS
A total of 839 assaults committed by 88 chronically aggressive patients were reviewed. Although most patients had a primary psychotic disorder, the most common type of assault was impulsive (54%), rather than psychotic or organized. Staff were most often victimized by impulsive assaults in situations involving attempts to change a patient's unwanted behavior and refusal of a patient request. Organized and psychotic assaults occurred less frequently (29% and 17%, respectively) and were more likely to target other patients. Organized assaults were most often motivated by a desire to seek revenge. Psychotic assaults were most often committed by an assailant acting under the influence of paranoid ideations. Civilly committed patients were overrepresented in the sample. Criminally committed patients committed more acts of organized aggression, although this finding did not reach significance.


CONCLUSIONS
These findings indicate that assaultive behavior among state hospital inpatients is complex and heterogeneous. Because each type of assault requires a different management approach, characterizing aggressive behavior may be important in determining which institutional programs and treatment-plan interventions to implement when addressing inpatient aggression.
Quanbeck
Cameron David
CD
Department of Psychiatry, Division of Psychiatry and the Law, University of California-Davis, 2230 Stockton Blvd., Sacramento, CA 95817, USA. cameron.quanbeck@ucdmc.ucdavis.edu
McDermott
Barbara E
BE
Lam
Jason
J
Eisenstark
Howard
H
Sokolov
Gregory
G
Scott
Charles L
CL
D000328:Adult; D000374:Aggression / Q000523:psychology*; D002140:California; D002908:Chronic Disease; D003415:Crime / Q000523:psychology / Q000706:statistics & numerical data; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010259:Paranoid Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data; D014754:Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*