Reduced frequency of aggressive behavior in forensic patients in a social learning program

An Analysis of the Correlates of Aggression in a Social Learning Program for Severely and Persistently Mentally Ill Inpatients

PURPOSE

This study aimed to examine the relationship between behavioral variables and aggression among severely and chronically mentally ill inpatients in a Social Learning Program (SLP) at a state psychiatric facility.

METHODS

Using archival data over a 24-month period, a total of 23 severely and chronically mentally ill inpatients comprised the sample in this study. The predictor variables included length of current hospitalization; length of stay on SLP; basic activities of daily living (ADLs); instrumental ADLs; attendance in programming; participation in programming; and the number of minor, major, and intolerable infractions received. The criterion variable was number of aggressive episodes (e.g., hitting persons or objects).

RESULTS

Results of a standard multiple regression analysis indicated an overall model of two predictors (intolerable infractions and instrumental ADLs) that significantly predicted number of aggressive episodes. Findings suggested that SLP patients who have a tendency to be aggressive are able to adequately and concurrently complete daily hygiene needs and participate in scheduled treatment groups and activities.

DISCUSSION

Our findings provide valuable information regarding aggressive tendencies that can inform treatment planning. Specifically, our results suggested there are not necessarily obvious warning signs for aggression among severely and persistently mentally ill inpatients. Rather, other individualized patient factors may be at play in the expression of aggressive impulses, emphasizing the importance of adequate staff-to-patient ratios so that care planning and implementation can be appropriately individualized.

Traitement multimodal de l’agressivité et de la violence chez des personnes souffrant de psychose

Dans cet article, les auteurs décrivent les traitements non pharmacologiques qui ont fait preuve d’efficacité pour réduire l’agressivité et la violence chez les personnes souffrant de psychose. Ils présentent ensuite une approche de formulation/planification du traitement qui aborde les influences étiologiques complexes, et les facteurs multiples qui jouent sur le maintien du comportement agressif chez ces patients. Finalement, ils présentent en exemple un cas où l’on se sert de cette approche.

Behavioral rehabilitation and the reduction of aggressive and self-injurious behaviors with cognitively impaired, chronic psychiatric inpatients

Aggressive behavior has been identified as a significant concern and occupational hazard in psychiatric inpatient settings. Several factors, including lax or unclear ward structure, have been identified as contributing to the exhibition of aggressive behavior. Token economies are effective in increasing ward structure and reducing aggressive behavior. This study evaluated the effects of rehabilitation programming, based on Gordon Paul's social learning approach (SLA), on rates of aggressive and self-injurious behaviors in a group of cognitively impaired, chronic psychiatric inpatients, compared to three long-term wards of similar patients. While no differences were found between the two groups prior to implementing SLA procedures, lower rates of aggression and self-injurious behavior were observed at one and two years on the Paul-derived ward. These results support the use of Paul's approach with multiply-impaired psychiatric inpatients in reducing patient aggression.