Steinert T
Centre of Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ravensburg-Weissenau, Germany.
Acta Psychiatr Scand Suppl. 2002(412):133-41. doi: 10.1034/j.1600-0447.106.s412.29.x.
An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given.
To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence.
Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts.
The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.
对住院患者暴力行为的预测因素及预测准确性的研究进行综述。
由于样本特征不同、暴力行为的测量和定义不同以及观察时间框架不同，目前已发表的数据无法进行系统的荟萃分析。对已发表的关于住院患者暴力行为的重要预测因素的研究进行了综述。
机构环境中暴力行为的预测因素与社区中暴力行为的预测因素不同：性别、年龄、诊断和酒精滥用等变量作用较小，而临床和精神病理学变量较为突出。只有暴力史是一个可靠的静态预测因素。阳性和一般性精神病症状的总体水平似乎会增加住院患者的暴力风险，而由于样本选择不可避免的问题，关于妄想或命令性幻听等特定特征的结果相互矛盾。临床预测的准确性优于随机水平，但受到治疗干预和研究假象的影响。
作者认为，在机构中更精确地确定暴力风险将会失败，而且环境因素的作用常常被低估。
