Characteristics of Repeatedly Aggressive Incidents in an Acute Psychiatric Ward

精神科急性病房重覆攻擊事件特徵

張正辰(Cheng-Chen Chang) ； 張淑桂(Shu-Kuei Chang)

《台灣精神醫學》 22卷2期 (2008/06) Pp. 115-124

https://doi.org/10.29478/TJP.200806.0005

摘要

目的：精神科急性病房重覆攻擊事件是常見而且迫切的議題，卻較少提出討論。目前文獻多強調攻擊者與非攻擊者的臨床差異。本研究旨在探討精神科急性病房重覆攻擊事件的臨床特徵。方法：回溯收集從民國93年三月至94年二月急性病房內暴力事件，針對單次攻擊者和重覆攻擊者，分析比較相關的危險因子。結果：總共603次住院中，發生199次攻擊事件。住院病人共485名，81位病人曾攻擊他人，發生比例為16.7%。其中32名病人(39.51%)為單次攻擊者，49名病人(60.49%)發生兩次以上攻擊。單次攻擊者和重覆攻擊者在年齡、性別、教育程度、婚姻，發病年齡並無差異。利用邏輯式回歸可歸納出以下幾點為攻擊危險因子：躁症(OR=4.16, 95%CI=1.37-12.68)，住院前攻擊史(OR=2.25, 95% CI=1.26-4.02)和較長住院日(OR=1.03, 95%CI=1.01-1.04)。住院前兩週內曾發生攻擊事件與住院後重覆攻擊事件呈正相關。結論：住院重覆攻擊常因特定病人造成。注意監測特別的危險因子可幫助發現高度危險性的病人，採取必要防範措施。

關鍵字

暴力 ； 重覆攻擊 ； 精神科住院病人

並列摘要

Objective: Repeatedly aggressive incidents by psychiatric inpatients pose an imperative yet seldom discussed issue. Most of the articles focused on the clinical differences between aggressors and nonaggressors in psychiatric wards, the factors associated with repeated aggression are often overlooked. The aim of this study was to examine the clinical characteristics of repeated aggression among patients admitted to an acute psychiatric unit. Methods: Data on aggressive incidents in an acute psychiatric unit were retrospectively collected from March 2003 to February 2004. Patients responsible for repeated aggression and transient aggression were compared in terms of socio-demographics and the nature of the incident. Results: Out of 603 total admissions of 485 patients, 199 aggressive incidents were recorded during this one-year period. Among the 485 patients included in the study, 81 patients had at least one aggressive incident, rate of aggression was 16.7%. Of the 81 aggressive patients, 32(39.51%) had a transient episode, while 49(60.49%) had two or more episodes (167 episodes, 3.41 incident/patient). Patients with transient and repeated aggressive episodes had comparable socio-demographics, onset age and number of admissions. Logistic regression analysis revealed three major risk factors for aggression: diagnosis of mania (OR=4.16, 95%CI=1.37-12.68), pre-admission aggression (OR=2.25, 95%CI=1.26-4.02) and duration of hospitalization (OR=1.03, 95%CI=1.01-1.04). Conclusions: Diagnosis of mania, pre-admission aggression and duration of hospitalization were risk factors for inpatient aggression. Repeated aggression was also more common among patients with previous aggression. Careful monitoring of these factors may help physicians recognize the potential for and takes steps to prevent violence among acute psychiatric inpatients.

並列關鍵字

violence ； repeated aggression ； psychiatric inpatient

參考文獻

Barlow K,Grenyer B,Ilkiw-Lavalle O(2000).Prevalence and precipitants of aggression in psychiatric inpatient tient units.Aust N Z J Psychiatry.34,967-974.

Bensley L,Nelson N,Kaufman J,Silverstein B,Shields JW(1995).Patient and staff views of factors influencing assaults on psychiatric hospital employees.Issues Ment Health Nurs.16,433-446.

Blomhoff S,Seim S,Friis S(1990).Can prediction of violence among psychiatric inpatients be improved?.Hosp Community Psychiatry.41,771-775.

Chang JC,Lee CS(2004).Risk factors for aggressive behavior among psychiatric inpatients.Psychiatr Serv.55,1305-1307.

Chou KR,Lu RB,Mao WC(2002).Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan.Arch Psychiatr Nurs.16,187-195.