NCJ Number
196849
Journal
Aggression and Violent Behavior Volume: 7 Issue: 5 Dated: September-October 2002 Pages: 477-497
Date Published
2002
Length
21 pages
Annotation
This literature review summarizes the available research on psychiatric inpatient aggression to assist in the development of a framework for examining aggression that emphasizes functional relationships.
Abstract
The techniques most often used in the immediate management of the aggressive inpatient -- seclusion, one-to-one supervision, and provision of prn (as required) medication -- may act as positive or negative reinforcers for some patients (Drinkwater and Gudjonsson, 1989). Further, these strategies may precipitate or model aggressive behavior, thereby contributing to the maintenance of aggressive behavior rather than its elimination. A distinction can be made between structural-assessment approaches to inpatient aggression, which focus on the correct classification of the form of a particular behavior, and functional-assessment approaches, which emphasize the purpose of the behavior. Research on inpatient aggression has largely drawn upon structural-assessment approaches and has typically focused on intrapersonal factors. Despite inconsistencies and individual patient variation, the literature reveals a number of clinical characteristics of schizophrenic patients that increase the likelihood of inpatient aggression. Of these characteristics, hallucinations, in the absence of delusions, do not appear to contribute directly to aggression; however, delusions, particularly those of a persecutory nature, may have a significant and direct influence. Further characteristics of the ward environment are neglected contributors to inpatient aggression. An alternative approach to the examination of inpatient aggression is through functional analysis, which Haynes and O'Brien (1990) define as the "identification of important, controllable, causal functional relationships applicable to a specified set of target behavior for an individual client." Functional analyses attempt to identify the purpose of behavior. Research on the functional analysis of inpatient aggression has been sparse. An excessive reliance on the immediate and direct contributor to aggression with an exclusive focus on intrapersonal factors promotes simplistic, linear models of aggression. The development of recording systems capable of reliably classifying the purpose of aggression and intervention guidelines that correspond to the functional needs of the aggressive inpatient may assist treatment, risk management, and risk assessment. 83 references