Functional Deficits and Aggressive Behaviors in an Inpatient Psychiatric Hospital: Description and Clinical Implications.

The primary goals of compulsory, inpatient, psychiatric treatment are to decrease dangerous behaviors and help improve functioning so that a safe discharge to a less restrictive environment can be obtained. This study examined the aggression rates, levels of functioning, and treatment adherence for persons treated for schizophrenia (N = 506) compared with persons treated for borderline personality disorder (BPD) (N = 98) in an inpatient psychiatric facility. Over half of persons engaged in at least one incident of aggressive behavior during hospitalization. Differences in the types of aggression and functional deficits between these two clinical sub-groups were found. In addition, overall impairment increased the likelihood of aggressive behavior for persons diagnosed with schizophrenia, whereas irritability and social dependence increased the risk of aggression for persons diagnosed with BPD. Treatment interventions that target the improvement of these deficits may help reduce the intensity and severity of aggressive behaviors and help improve functioning and discharge readiness.

Anatomy of a transformation: a systematic effort to reduce mechanical restraints at a state psychiatric hospital.

OBJECTIVE: The authors describe efforts to reduce use of mechanical restraints at a state psychiatric hospital. METHODS: Data were collected for individuals admitted to the acute adult unit (AAU) (N=2,910) and the community transition unit (CTU) (N=334) over three years. Two strategies aimed to reduce mechanical restraint use. First, staff were trained in deescalation techniques, and a response team was formed for crisis situations. Second, a policy change required prior approval for use of mechanical restraint. RESULTS: Mechanical restraint was significantly reduced on both units after the first strategy. After the second, additional reduction was noted on AAU (98% total reduction) but not on CTU, where the practice had already been eliminated. No increase in assaults or injuries was noted. CONCLUSIONS: Reduction in mechanical restraint use is possible through deescalation skills training, use of a response team, and policy changes. Strong leadership, staff buy-in, provision of feedback, and quality monitoring were also instrumental.