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Aggression patterns and clinical predictors of inpatient aggression in a mental health low secure unit population

Published online by Cambridge University Press:  01 December 2008

Anandamurugan Muthukumaraswamy
Specialist Registrar, Bracton Centre, Oxleas NHS Foundation Trust
M Dominic Beer*
Consultant Psychiatrist, Oxleas NHS Foundation Trust and Honorary Senior Lecturer Institute of Psychiatry, University of London
Kalaanithi Ratnajothy
Research and Development Manager, Oxleas NHS Foundation Trust
Correspondence to: Dr Dominic Beer, Bracton Centre, Oxleas NHS Trust, Bracton Lane, Dartford, Kent, DA2 7AF. E-mail:
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Aims: To describe the pattern of aggressive incidents, compare clinical characteristics of aggressive and non aggressive inpatients and determine predictors of inpatient aggressive behaviours in a low secure mental health unit population.

Method: Clinical data were extracted from inpatient records and a critical incident database for a low secure unit population. Clinical variables between those with inpatient aggressive behaviours (inpatient aggressors) and those without inpatient aggressive behaviours (inpatient non aggressors) were compared. Statistical analysis was carried out on the differences to establish predictors of inpatient aggression.

Results: 80 admissions resulted from 78 patients during a 6½ year period. 44% of patients presented with inpatient aggressive incidents. 64% of aggressive incidents resulted from 15% of patients. 54% of aggressive incidents were directed towards staff, 16% towards property and 15% towards other patients. 8% and 4% contributed to disturbed behaviour (non-directed aggression) and sexually inappropriate behaviour respectively. Most aggressive incidents are perpetrated by males and directed towards staff though a larger proportion of females (compared to males) were aggressive. On univariate analysis, clinical variables of more than one previous psychiatric admission, auditory hallucinations and delusions of control and persecution were significantly higher in patients displaying inpatient aggression. Logistic regression analysis identified the former two as predictors of inpatient aggression.

Conclusion: In a low secure inpatient population, the majority of aggressive incidents are perpetrated by a minority of patients. Clinical variables such as history of more than one previous psychiatric admission and psychopathological symptoms such as presence of auditory hallucinations and delusions of control and persecution can influence inpatient aggression.

Original Paper
Copyright © NAPICU 2008

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