title: Frequency, characteristics and management of adolescent inpatient aggression.
abstract: BACKGROUND
  Inpatient aggression is a serious challenge in pediatric psychiatry.
  
  
  METHODS
  A chart review study in adolescent psychiatric inpatients consecutively admitted over 24 months was conducted, to describe aggressive events requiring an intervention (AERI) and to characterize their management. AERIs were identified based on specific institutional event forms and/or documentation of as-needed (STAT/PRN) medication administration for aggression, both recorded by nursing staff.
  
  
  RESULTS
  Among 408 adolescent inpatients (age: 15.2±1.6 years, 43.9% male), 1349 AERIs were recorded, with ≥1 AERI occurring in 28.4% (n=116; AERI+). However, the frequency of AERIs was highly skewed (median 4, range: 1-258). In a logistical regression model, the primary diagnosis at discharge of disruptive behavior disorders and bipolar disorders, history of previous inpatient treatment, length of hospitalization, and absence of a specific precipitant prior to admission were significantly associated with AERIs (R(2)=0.32; p<0.0001). The first line treatment of patients with AERIs (AERI+) was pharmacological in nature (95.6%). Seclusion or restraint (SRU) was used at least once in 59.4% of the AERI+ subgroup (i.e., in 16.9% of all patients; median within-group SRU frequency: 3). Treatment and discharge characteristics indicated a poorer prognosis in the AERI+ (discharge to residential care AERI+: 22.8%, AERI-: 5.6%, p<0.001) and a greater need for psychotropic polypharmacy (median number of psychotropic medications AERI+: 2; AERI-: 1, p<0.001).
  
  
  CONCLUSIONS
  Despite high rates of pharmacological interventions, SRU continue to be used in adolescent inpatient care. As both of these approaches lack a clear evidence base, and as adolescents with clinically significant inpatient aggression have increased illness acuity/severity and service needs, structured research into the most appropriate inpatient aggression management is sorely needed.
authors: Child and Adolescent Psychiatry and Psychology Department, CIBERSAM IDIBAPS, Hospital Clinic i Universitari, Barcelona, Spain.
authors: Immaculada
authors: I
authors: Baeza
authors: Christoph U
authors: CU
authors: Correll
authors: Ema
authors: E
authors: Saito
authors: Dinara
authors: D
authors: Amanbekova
authors: Meena
authors: M
authors: Ramani
authors: Sandeep
authors: S
authors: Kapoor
authors: Raja
authors: R
authors: Chekuri
authors: Marc
authors: M
authors: De Hert
authors: Maren
authors: M
authors: Carbon
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology / Q000628:therapy; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010356:Patient Isolation; D010359:Patient Readmission / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012149:Restraint, Physical; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives
references: Bipolar Disord. 2010 Mar;12(2):116-41
references: 20402706
references: Soc Psychiatry Psychiatr Epidemiol. 2010 Sep;45(9):889-97
references: 19727530
references: Aust N Z J Psychiatry. 2011 Aug;45(8):638-45
references: 21714722
references: J Am Acad Child Adolesc Psychiatry. 1991 Nov;30(6):982-8
references: 1757448
references: Psychiatry (Edgmont). 2010 Feb;7(2):32-40
references: 20376274
references: Curr Opin Psychiatry. 2012 Jul;25(4):271-6
references: 22569307
references: J Am Acad Child Adolesc Psychiatry. 2009 Jun;48(6):636-642
references: 19454919
references: J Am Acad Psychiatry Law. 2011;39(2):170-9
references: 21653259
references: J Psychiatr Pract. 2009 May;15(3):193-201
references: 19461392
references: Aust N Z J Psychiatry. 2008 Jun;42(6):536-43
references: 18465381
references: Am J Psychiatry. 2011 Feb;168(2):129-42
references: 21123313
references: Psychopharmacol Bull. 1997;33(1):161-4
references: 9133769
references: J Child Adolesc Psychopharmacol. 2011 Dec;21(6):505-15
references: 22196314
references: J Clin Psychiatry. 2007 Dec;68(12):1876-85
references: 18162018
references: J Am Acad Child Adolesc Psychiatry. 2005 Mar;44(3):213-35
references: 15725966
references: Eur Child Adolesc Psychiatry. 2006 Aug;15(5):277-81
references: 16583125
references: J Am Acad Child Adolesc Psychiatry. 2004 Jan;43(1):37-45
references: 14691359
references: J Am Acad Child Adolesc Psychiatry. 1990 Nov;29(6):919-24
references: 2273021
references: J Clin Psychol. 2011 Apr;67(4):368-82
references: 21254060
references: J Child Adolesc Psychiatr Nurs. 2011 Feb;24(1):11-5
references: 21272110
references: J Interpers Violence. 2011 Feb;26(3):567-79
references: 20237391
references: J Am Acad Child Adolesc Psychiatry. 1990 Mar;29(2):242-50
references: 2324065
references: Arch Gen Psychiatry. 2007 Sep;64(9):1032-9
references: 17768268
references: Aust N Z J Psychiatry. 2010 May;44(5):443-9
references: 20397786
references: J Clin Psychopharmacol. 2006 Aug;26(4):419-25
references: 16855463
references: Can J Psychiatry. 2003 Jun;48(5):330-7
references: 12866339
references: Psychiatr Serv. 2003 Jul;54(7):987-93
references: 12851435
references: Acta Psychiatr Scand Suppl. 2002;(412):133-41
references: 12072145
references: Hosp Community Psychiatry. 1989 May;40(5):520-4
references: 2722150
references: Biol Psychiatry. 2007 Jul 15;62(2):107-14
references: 17306773
references: Bipolar Disord. 2010 Mar;12(2):205-12
references: 20402713
references: Eur Child Adolesc Psychiatry. 2011 May;20(5):221-30
references: 21298305
references: Br J Psychiatry. 2011 Dec;199(6):473-8
references: 22016437
references: J Child Adolesc Psychiatr Nurs. 2001 Jul-Sep;14(3):128-40
references: 11814079
references: Eur Child Adolesc Psychiatry. 2002 Aug;11(4):162-7
references: 12444425
references: Psychiatr Serv. 2011 Nov;62(11):1310-7
references: 22211210
references: Psychiatr Serv. 2008 Oct;59(10):1198-202
references: 18832507
references: Adm Policy Ment Health. 2008 May;35(3):198-203
references: 18058220
references: J Clin Psychiatry. 1991 Dec;52(12):499-501
references: 1752851
references: Psychiatry Res. 2011 Aug 30;189(1):10-20
references: 21236497
references: J Psychosoc Nurs Ment Health Serv. 2008 Feb;46(2):21-4
references: 18293780
references: Aust N Z J Psychiatry. 2001 Apr;35(2):155-9
references: 11284895
references: Psychiatr Serv. 2005 Sep;56(9):1105-8
references: 16148325
references: Eur Neuropsychopharmacol. 2011 Aug;21(8):600-20
references: 21550212
references: Cochrane Database Syst Rev. 2000;(2):CD001163
references: 10796606
references: Child Psychiatry Hum Dev. 2009 Dec;40(4):621-36
references: 19568928
references: Child Psychiatry Hum Dev. 2005 Winter;36(2):177-93
references: 16228146
references: Arch Psychiatr Nurs. 2010 Feb;24(1):15-26
references: 20117685
references: J Can Acad Child Adolesc Psychiatry. 2006 Feb;15(1):27-39
references: 18392193
references: J Child Psychol Psychiatry. 1993 Sep;34(6):975-89
references: 8408379
references: Aust N Z J Psychiatry. 2008 Apr;42(4):283-92
references: 18330770
references: J Child Adolesc Psychopharmacol. 2009 Jun;19(3):281-8
references: 19519263
references: Psychiatr Serv. 2004 Jun;55(6):665-70
references: 15175464
references: Psychiatr Q. 2010 Jun;81(2):167-75
references: 20165915
references: Am J Orthopsychiatry. 1995 Apr;65(2):238-44; discussion 245-8
references: 7611341
references: J Clin Psychiatry. 2011 May;72(5):655-70
references: 21658348
references: Bull Am Acad Psychiatry Law. 1989;17(2):165-9
references: 2758118