Aggressive behavior during the first 24 hours of psychiatric admission

Vitor Crestani Calegaro; Amanda Bolson Dotto; Denise Freitas; Anderson Barcellos Brum; Andrei Garziera Valerio; Christina Chitolina Schetinger; Angelo B. M. Cunha

doi:10.1590/2237-6089-2014-0016

Original Article

Aggressive behavior during the first 24 hours of psychiatric admission

Comportamento agressivo durante as primeiras 24 horas de internação psiquiátrica

Vitor Crestani Calegaro; Amanda Bolson Dotto; Denise Freitas; Anderson Barcellos Brum; Andrei Garziera Valerio; Christina Chitolina Schetinger; Angelo B. M. Cunha

http://dx.doi.org/10.1590/2237-6089-2014-0016 Trends Psychiatry Psychother, vol.36, n3, p.152-159, 2014

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Abstract

OBJECTIVE: To investigate the association between aggression in the first 24 hours after admission and severity of psychopathology in psychiatric inpatients.METHODS: This cross-sectional study included psychiatric patients admitted to Hospital Universitário de Santa Maria, in Santa Maria, southern Brazil, from August 2012 to January 2013. At their arrival at the hospital, patients were interviewed to fill in the Brief Psychiatric Rating Scale (BPRS) form, and any aggressive episodes in the first 24 hours after admission were recorded using the Overt Aggression Scale (OAS). The Mann-Whitney U test was used to compare patients according to aggressiveness: aggressive versus non-aggressive, hostile versus violent, and aggressive against others only versus self-aggressive.RESULTS: The sample was composed of 110 patients. Aggressive patients in general had higher BPRS total scores (p = 0.002) and individual component scores, and their results showed more activation (p < 0.001) and thinking disorders (p = 0.009), but less anxious-depression (p = 0.008). Violent patients had more severe psychomotor agitation (p = 0.027), hallucinations (p = 0.017) and unusual thought content (p = 0.020). Additionally, self-aggressive patients had more disorientation (p = 0.011) and conceptual disorganization (p = 0.007).CONCLUSIONS: Aggression in psychiatric patients in the first 24 hours after admission is associated with severity of psychopathology, and severity increases with severity of patient psychosis and agitation.

Keywords

Aggression, psychopathology, psychiatric emergency services, Brief Psychiatric Rating Scale

Resumo

OBJETIVO: Avaliar a relação entre agressividade nas primeiras 24 horas após admissão e a gravidade da psicopatologia de pacientes psiquiátricos.MÉTODOS: Este estudo transversal foi realizado no Hospital Universitário de Santa Maria, na região sul do Brasil, com pacientes admitidos entre agosto de 2012 e janeiro de 2013. Ao chegar ao hospital, os pacientes foram entrevistados para completar a Escala Breve de Avaliação Psiquiátrica (BPRS), e todos os episódios de agressão nas primeiras 24 horas após a admissão foram registrados usando a Escala de Agressividade Declarada (OAS). O teste U de Mann-Whitney foi usado para as comparações entre pacientes agressivos e não-agressivos, hostis e violentos, e agressivos contra outros apenas ou autoagressivos.RESULTADOS: A amostra tinha 110 pacientes. Em geral, pacientes agressivos tiveram escores mais altos na escala BPRS (p = 0.002) e nos itens individuais, e exibiram mais ativação (p < 0.001) e distúrbios de pensamento (p = 0.009), mas menos ansiedade-depressão (p = 0.008). Os pacientes violentos tiveram escores mais altos para excitação (p = 0.027), comportamentos alucinatórios (p = 0.017) e alteração de conteúdo do pensamento (p = 0.020). Além disso, os pacientes autoagressivos mostraram maior desorientação (p = 0.011) e desorganização conceitual (p = 0.007).CONCLUSÕES: A agressão em pacientes psiquiátricos nas primeiras 24 horas da admissão é relacionada a gravidade da psicopatologia, a qual aumenta à medida que a gravidade da psicose e a excitação do paciente aumentam.

Palavras-chave

Agressão, psicopatologia, serviços de emergência psiquiátrica, Escala Breve de Avaliação Psiquiátrica

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Aggressive behavior during the first 24 hours of psychiatric admission

Comportamento agressivo durante as primeiras 24 horas de internação psiquiátrica

Vitor Crestani Calegaro; Amanda Bolson Dotto; Denise Freitas; Anderson Barcellos Brum; Andrei Garziera Valerio; Christina Chitolina Schetinger; Angelo B. M. Cunha

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