title: Predictors of violent behavior among acute psychiatric patients: clinical study.
abstract: OBJECTIVE
  Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients.
  
  
  METHODS
  The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated.
  
  
  RESULTS
  Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical.
  
  
  CONCLUSIONS
  A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.
authors.affiliation: Division of Psychiatry, Department of Neurosciences, University of Parma, Parma, Italy. mario.amore@unipr.it
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.forename: Marco
authors.initials: M
authors.lastname: Menchetti
authors.forename: Cristina
authors.initials: C
authors.lastname: Tonti
authors.forename: Fabiano
authors.initials: F
authors.lastname: Scarlatti
authors.forename: Eva
authors.initials: E
authors.lastname: Lundgren
authors.forename: William
authors.initials: W
authors.lastname: Esposito
authors.forename: Domenico
authors.initials: D
authors.lastname: Berardi
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D010054:Brief Psychiatric Rating Scale; D017028:Caregivers; D003430:Cross-Sectional Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D008297:Male; D008487:Medical History Taking; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010343:Patient Admission; D010348:Patient Care Team; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011567:Psychiatric Department, Hospital; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012308:Risk Management; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012565:Schizophrenic Psychology; D012637:Security Measures; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D014754:Violence / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data