Department of Clinical Psychiatry, University of Milano-Bicocca, Monza, Italy; Organic Psychiatry Unit, Zucchi Clinical Institute, Carate Brianza, Italy.
Psychiatry Res. 2011 Aug 30;189(1):10-20. doi: 10.1016/j.psychres.2010.12.024. Epub 2011 Jan 13.
Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses.
尽管在精神科住院患者中相当常见，但攻击/暴力事件主要限于言语攻击，但报告“频繁”接触暴力事件的护士的总体健康水平明显较低，并且患者和工作人员对这些事件的预测因素存在分歧。我们在 PubMed、Embase 和 PsychInfo 数据库中，以英文、意大利文、法文或德文检索了 1990 年 1 月 1 日至 2010 年 3 月 31 日期间发表的论文，关键词为“aggress*”（攻击或攻击性）“violen*”（暴力或暴力）和“in-patient”或“psychiatric wards”，纳入标准为成年人群（排除所有特定样本的研究，如除精神病以外的特定精神病诊断、青少年或老年人、仅男性/女性、人格障碍和智力迟钝）。在 66 项针对未选择的精神科人群的研究中，与攻击或暴力最常相关的变量是先前发作的存在、冲动/敌意的存在、住院时间较长、非自愿入院以及相同性别的攻击者和受害者；证据较弱的是酒精/药物滥用、精神病诊断、年龄较小和自杀风险。在 12 项精神病人研究中，酒精/药物滥用、敌意、偏执思维和急性精神病是最常涉及的因素。与精神病病房中使用的其他一些策略（如男护士的存在）相比，工作人员之间的和谐（良好的工作氛围）似乎更有助于预防攻击。
