RESIDENT: Inpatient Aggression in Psychiatry: Risk Management and Treatment

Presenting Author(s): Ahmed Ben Mabrouk, BSc

Co-Author(s): Maryana Kravtsenyuk

Date and time: 21 Mar 2025 from 14:05 to 14:20

Location: Hawthorn C  

Abstract

This abstract reviews the current literature on inpatient aggression in psychiatric settings, focusing on risk management and treatment strategies. Inpatient aggression is a significant contributor to the use of seclusion and restraint, major coercive elements of psychiatric care, which can have adverse impacts on both patients and staff. Aggression prevalence varies, with physical violence reported in 2.1-24.4% of inpatients and verbal aggression in 5.9-37.6% . Key risk factors include younger age, male gender, diagnoses such as schizophrenia or bipolar disorder, substance abuse, and prior aggressive behavior. Environmental factors, such as ward atmosphere and staff-patient interactions, also contribute significantly.

Risk assessment tools like the Dynamic Appraisal of Situational Aggression (DASA) help predict violence and guide intervention planning. Management strategies are both pharmacological and nonpharmacological. Pharmacological interventions include antipsychotics (e.g., clozapine, olanzapine) and mood stabilizers, which are particularly effective in psychotic disorders. Non-pharmacological approaches involve de-escalation techniques.

A multidisciplinary program-wide approach is essential to managing aggression effectively. Individualized care, combining evidence-based pharmacological and behavioral interventions, and fostering a safe and supportive ward environment are key. Continuous research is vital to refining these strategies and improving patient and staff safety.

Learning Objectives

1. Evaluate evidence-based and emerging strategies for the effective treatment and management of inpatient aggression;

2. Identify and mitigate factors of aggression, including environmental and interpersonal factors to foster safer settings;

3. Compare the effectiveness of pharmacological and behavioral interventions across diverse patient populations;

4. Exploring long-term outcomes of seclusion and restraint on both staff and patients; and

5. Examining current protocols for mental health staff to determine their effectiveness in inpatient aggression management.

Literature References

1. Girasek, H., Nagy, V. A., Fekete, S., Ungvari, G. S., & Gazdag, G. (2022). Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World journal of psychiatry, 12(1), 1.

2. Inacker, P. M. (2018). Aggression Management Curriculum for Acute, Non-psychiatric Medical Units Within a General Hospital (Doctoral dissertation, University of Pennsylvania).

3. Moscovici, M., Farrokhi, F., Vangala, L., Simpson, A. I., Kurdyak, P., & Jones, R. M. (2024). Violence risk prediction in mental health inpatient settings using the Dynamic Appraisal of Situational Aggression. Frontiers in Psychiatry, 15, 1460332.

4. Smith, J. (2024). Mitigating Patient Violence Within Inpatient Psychiatric Facilities (Doctoral dissertation, Walden University).