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Aggression and counteraggression during child psychiatric hospitalization
W T Garrison1, B Ecker, M Friedman
1Department of Psychiatry, Baystate Medical Center, Springfield, Massachusetts.
Summary
Patient aggression in child psychiatry units is predictable and linked to patient/environmental factors. Staff interventions like seclusion and restraint are best for acute management, not long-term therapy.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Science
- Clinical Psychology
Background:
- Aggressive incidents are a significant challenge in child psychiatry inpatient units.
- Understanding the patterns and predictors of aggression is crucial for effective management.
- Current counteraggression strategies require evaluation for their therapeutic efficacy.
Purpose of the Study:
- To descriptively study aggressive incidents in child/adolescent psychiatric inpatients over one year.
- To examine the relationship between patient aggression and staff counteraggressive strategies.
- To evaluate the predictive patterns of patient aggression based on person and environmental variables.
Main Methods:
- A 1-year descriptive study of 99 child/adolescent patients in an inpatient unit.
- Documentation of 887 aggressive incidents.
- Analysis of seclusion, activity restriction, physical restraint, and PRN medication use in relation to aggression.
Main Results:
- Patient aggression within clinical contexts showed predictable patterns related to person and environmental variables.
- Counteraggression strategies, including seclusion and restraint, were primarily effective in acute management.
- These interventions demonstrated limited long-term therapeutic function for aggressive children.
Conclusions:
- Patient aggression in child psychiatry settings is often predictable.
- Staff counteraggression strategies are most valuable for immediate crisis intervention.
- Further research and refined clinical applications of these methods are recommended.