Aggression in Psychiatry: prevention, epidemiology & treatment

Abstract

Introduction Aggression is a major problem within psychiatry. The aim of this thesis is to contribute to the current knowledge about aggression in psychiatry with clinically relevant results and insights. This thesis consists of five different studies with three overarching themes: prevention, epidemiology and treatment.

Prevention We investigated common changes in children’s behavior prior to aggression in psychiatric facilities. 16 warning signs were found, of which ‘restlessness’, ‘not listening’ and ‘anger’ were most prevalent. In adolescent and adult psychiatry, we evaluated an instrument (the Kennedy Axis V) that assists nurses in clinical risk assessment. This instrument is useful in clinical practice. The interrater reliability, meaning the level of agreement between nurses, was substantial.

Epidemiology We found that 1 in 5 patients with a psychotic disorder had a history of previous assault. The yearly incidence of aggression in this population is about 2%. Symptoms such as impulsivity, excitement and lack of cooperation, increase the risk for aggression. Childhood trauma also is an important risk factor for aggression.

Treatment Antipsychotics can decrease aggression in patients with psychotics disorders. We found that not all antipsychotics are equally effective against aggression. Atypical antipsychotics, specifically clozapine, are most effective. While clozapine is suited for patients with persistent illness, amisulpride could be effective against aggression in first episode psychosis.

Conclusion Aggression is a complex concept and more research is needed. The findings of this thesis help to understand, assess and treat aggression within psychiatry.