Analisys of violent behaviour on a population of psychiatric patients in Puglia and Basilicata

Abstract

A retrospective study has been conducted on the clinical files of four public psychiatric facilities in the South of Italy of all patients who were continuously treated in the period of 1995-1999. The sample under consideration is made up of 1,582 subjects, mostly adults (48.4% between the ages of 30 and 49), divided almost equally between males (49%) and females (51%), with a quite low level of education. The most representative diagnoses are those of mood disorder (41.2%), psychotic disorders (27.3%), and disorders in the anxiety spectrum (17.6%); 11.4% of our sample have used drugs. Patients with long clinical histories, more than 10 years in 70% of the cases, predominate. After first contact with the facility, almost all patients began psychopharmacological treatment (84%), and about a third (35.8%) of patients taken into care by the facility required hospitalisation over time: in 39.5% of cases, the reason for admission was the result of self- and other-directed aggression. A positive correlation between the presence of a clinical history of admissions and the occurrence of violent episodes (OR 9.0, IC 95% 7.1 - 11.5; χ2 = 373.7, p <0.05) has emerged. Violent behaviour emerges in the clinical histories of more than a third (36.3%) of the patients in our sample, mostly males. In the majority of cases, was exclusively other-directed (76.7%); violent behaviour which was either self- or other-directed occurred 9.2% of the time, and that which was exclusively self-directed, 14.1%. Psychotic disorder is the most statistically common diagnosis in patients with violent behaviour. Psychotic patients (27.3% of the total sample) make up 43.3%. In the subgroup of patients with violent behaviour, “suspension of therapy” seems to be correlated with episodes of other-directed violence (57.5%) (χ2 = 5.8 with p < 0.05; OR = 1.8 with IC 95% 1.1 – 2.9), and against people (58.1%) (χ2 = 5.5 with p < 0.05; OR = 1.6 with IC 95% 1.1 – 2.4). The existence of substance abuse constitutes a specific risk factor. Occurring in only a minority (11.4%) of the general sample of 1,582 patients, 79.55% of subjects that abuse substances exhibit violent behaviour (OR = 8.7 with IC 95% 5.8 – 12.9; χ2 = 162.7 with p < 0.05), especially that of the other-directed type (63.1%). A significant correlation exists with a positive family case history for both substance abuse (OR = 13.4, IC 95% 5.2 – 34.3, χ2=48.2) and violent behaviour (OR = 7.9, IC 95% 4.0 – 15.2, χ2 = 50.3). Beginning at first contact with the psychiatric facility, adequate psychopharmacological treatment seems to be an important protective factor: only one third of patients under constant psychopharmacological treatment (35.0%) have, in fact, a positive clinical history of violent behaviour. A good level of compliance to treatment also seems to correlate positively. In this group of patients, only 11.95% of violent behaviour episodes had emerged. An other important protective factor against committing a violent act is a “good” level of psychosocial adaptation. Among those who possess this (15.73% of the entire sample of 1,582 patients), there is a low incidence of it (8.83%); violent behaviour is markedly higher (70.8%), in contrast, among patients with an adaptation level of “fair” or “poor” (8,65% of the entire sample). The extra-familial relationships constitute an important protective factor against committing a violent act. It has been pointed out that charges have been brought in only 8% of cases where violent behaviour has occurred: 3% by relatives and 5% by other people, in particular, neighbours. A total of 20 convictions for episodes of violent behaviour have been reported (3.5%).