Pattern and characteristics of aggression among adults with psychosis during early inpatient stay in an open ward psychiatric facility: A cross-sectional study.

Abstract

Background: Psychiatric inpatient setting is commonly associated with hospital aggression, where it is often perpetrated by patients. An open ward system is less associated with aggression than a closed system. Aggression among inpatients is commonly associated with psychosis. Identifying aggression and its characteristics early can mitigate the negative outcomes of aggression.

Aims: To determine patterns and factors contributing to aggression among adult inpatients with psychotic disorders in a tertiary psychiatric open ward setting in the early part of stay.

Materials and methods: A cross-sectional study was conducted in a psychiatric inpatient facility in South India, following ethical research principles. Aggression was assessed using the Modified Overt Aggression Scale. Severity of psychosis and illness disability were recorded using the Brief Psychiatric Rating Scale and the Indian Disability Evaluation and Assessment Scale, respectively. Other relevant data were obtained using a clinical research form. Data were analyzed using SPSS 25.0.

Results: Of the 160 participants, 96% exhibited some form of aggression. Non-verbal aggression constituted 55%. In bivariate analysis, sex (P = 0.024) and severity of psychosis (P < 0.001) correlated with auto-aggression, while insight into illness (P = 0.004) and type of admission (P = 0.001) correlated with physical aggression. In multivariate analysis, non-verbal aggression retained a significant association with involuntary admission and markedly severe psychosis.

Conclusions: There is a high prevalence of aggression among psychiatric inpatients during the early part of hospitalization in this open ward system. Factors associated with aggression can help identify inpatients who may exhibit aggression early during inpatient stay.