Violence and threats of violence within psychiatric care--a comparison of staff and patient experience of the same incident.

This study compared staff members' and psychotic patients' experiences of one and the same violent incident. The staff exposed to the violence completed the Staff Observation Aggression Scale (SOAS). The patients who had exhibited the violent behaviour were interviewed prior to discharge from the ward. When comparing the SOAS data with the patient interviews, it was found that the staff members were able to identify less than 50% of the provocations that the patient experienced. According to the patient interviews, giving the patient medication was far more often experienced as a provocation, resulting in violence, than the staff perceived. Knowledge about how to interpret the patients' body language and other signals, and how patients perceive the staff's behaviour, must be understood for an efficient prevention of violence in psychiatric care.

Effect of citalopram treatment on relationship between platelet serotonin functions and the Karolinska scales of personality in panic patients.

Using the Karolinska Scales of Personality (KSP), we investigated the effect of the selective serotonin reuptake inhibitor citalopram on personality traits and the relationship between personality traits and peripheral indexes for central serotonergic function in patients with panic disorder at baseline and after 6 months of treatment. The degree of anxiety and depression was assessed using the Beck Anxiety Inventory, the Beck Depression Inventory, the Clinical Anxiety Scale, and the Montgomery Asberg Depression Rating Scale. A reduction in anxiety and depression scores of 75% was observed after treatment in two thirds of the patients. Mean changes of 12% in the direction of normalization were observed in all KSP anxiety-related items (Somatic Anxiety, Muscular Tension, Psychic Anxiety, and Psychasthenia), the aggression and hostility related items (Inhibition of Aggression, Irritability, and Guilt) and the item of Socialisation. A positive correlation was found between Vmax for the platelet [14C]-serotonin uptake and Inhibition of Aggression before treatment, and a negative correlation was found between the affinity of serotonin uptake and Inhibition of Aggression after treatment. Negative childhood experiences influenced enhanced scores on some KSP items but not the serotonergic function. In panic patients treated with citalopram, effects were seen on personality traits, confirming an association between serotonergic activity and aggression.

Incidents of violence in psychiatric inpatient care.

During a period of 18 months a systematic inventory of aggressive incidents was made on two psychosis wards at the psychiatric department of Danderyd Hospital, Stockholm, Sweden. The Staff Observation Aggression Scale (SOAS) for recording and assessing aggressive incidents was used. Staff subjected to violence or threat of violence was interviewed using a semi-structured questionnaire. In one part of the study, a somewhat reduced variant of the same questionnaire was used but this time staff answered anonymously. Aggressive incidents were distributed over the 24 h, but had two distinct peaks - morning and evening. Aggressive incidents most often occur with patients with some kind of a psychotic diagnosis, most often schizophrenic psychoses. The female staff was more exposed to violence than male. Female patients are also more violent to female staff than to male staff. There is a significant difference in the emotional reactions of female and male staff after aggressions. In the staff, men are more often frightened while women tend to get surprised. Still, staff members of both genders feel insulted and angry. The "research" interviews were experienced as therapeutic discussions by the staff.