An increase in violence on an acute psychiatric ward: a study of associated factors

Article Abstract:

A study of a 12-bed acute care psychiatric ward in a London hospital examined the level of violence on the ward, compared characteristics of violent patients with non-violent patients, and looked for hospital-related factors associated with the violence. The ward chosen for the study contained newly admitted patients who required close supervision, and incidents were ascertained from standard ward incident forms. Violent incidents decreased when permanent nursing staff predominated on the ward, and increased when temporary or new staff were on the ward. Over the 15-months of study period, 102 violent incidents were recorded. There were 44 incidents of violence against the staff and 24 incidents against other patients, ranging from fist fights to one case of rape. Incidents of self-violence included four poisonings, six cutting incidents, and four attempted suicides by hanging, while incidents of violence against property included 15 episodes of destroying furniture and fabric and five fires were set. Sixty-four of the 280 patients admitted to the ward during the study were responsible for violent incidents. Sixty-six percent of the violent patients were white and 61 percent were schizophrenic. However, when the high number of schizophrenics among the non-violent patients was taken into account, no significant differences were detected with regard to diagnostic category. However, all incidents of self-harm involved schizophrenics, which supports previous evidence indicating that this group as a high potential for suicide. The violent population was primarily under 25 years of age, and most had been admitted involuntarily. Patients with a diagnosis of depression (with or without psychosis), were significantly less likely to be violent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Observations, Violence in hospitals, Hospital violence, Violence in psychiatric hospitals

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Psychiatric screening of admissions to an accident and emergency ward

Article Abstract:

A high prevalence of psychiatric disorders among general hospital medical inpatients has been reported by several studies. Despite this, most medical staff do not readily detect psychiatric disorders in their patients. To better understand the prevalence and the possible variables involved in detection, a study was conducted over a 30-day-period, during which all patients seen in a general hospital's emergency ward were screened for psychiatric disorders. Sociodemographic data was obtained for each of the 144 patients, and 100 agreed to an interview, completed the General Health Questionnaire (GHQ), and the Hospital Anxiety and Depression Scale (HAD). Of the 100 study patients, 37 were diagnosed with psychiatric disorder, of which 30 were correctly identified by the GHQ. Factors that significantly correlated with psychiatric disorder included lower social class, single, unemployed, and homeless. Not having a regular primary care physician was a factor as well. Fourteen patients in the study patients had overdosed, and they constituted most of the psychiatric referrals made by house physicians. However, this group was no more likely to be diagnosed with a psychiatric disorder than the others in the sample. It was also found that medical personnel tended to neglect inquiry into emotional problems upon evaluation in the emergency room. These results suggest that proper evaluation of psychosocial issues is necessary in general medical emergency rooms; that physicians need to be more aware of objective evidence of psychiatric disorder; and that standard questionnaires may be a useful aid in diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Diagnosis, Hospital patients, Mental illness, Hospitals, Hospital emergency services, Psychiatric diagnosis

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Suicidal ideation as a presenting complaint: associated diagnoses and characteristics in a casualty population

Article Abstract:

Psychiatric practice includes assessment of suicide risk. In 1971, the British National Institute for Mental Health task force classified suicidal individuals into three types: suicidal ideators, suicide attempters, and suicide completers. Though it was estimated in one study that 8.9 percent of the population had experienced suicidal ideation, relatively little is known about this group. Over a one-year period, 53 people who complained of suicidal ideation, but had no history of self-harm, were studied along with 369 controls referred for other psychiatric complaints (excluding those who had an episode of self-harm). Data were collected by an interviewer and psychiatric diagnosis was made for each patient. The average age of patients with suicidal ideation was 38.6 years. Most were single, unemployed, men. Thirteen percent were homeless. Forty percent of the study patients were diagnosed with personality disorders, 15 percent had alcohol dependence, and 13 percent had formal depressive illness. In contrast, more controls received a diagnosis than study patients. The patients complaining of suicidal ideation were also more likely to have a criminal record. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Suicide

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