Staff and patient views of the reasons for aggressive incidents: a prospective, incident-based study

Aggression is a serious problem in psychiatric hospitals. It is not clear whether reasons for aggression guide which therapeutic interventions are selected. Aggression was monitored in participants in a randomized clinical trial of the antiaggressive efficacy of adjunctive valproate in patients with schizophrenia. The Overt Aggression Scale was used to record aggression type and severity, reasons given by patients and staff, and interventions delivered. Forty two patients caused 317 aggressive incidents. Patients reported more often than staff that aggression was provoked by external factors (e.g., interpersonal conflict, limit-setting). Staff cited internal factors (e.g., psychotic symptoms, tension) more often than patients. Interventions administered were related to type and severity of aggression but not to either staff or patients' reasons. Responses to aggressive events do not take causes into account. It is possible that consideration of the reasons for the aggressive behavior might yield more targeted interventions.