Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-27T21:16:58.237Z Has data issue: false hasContentIssue false
  • English
  • Français

Violent patients within Psychiatric Intensive Care Units: treatment approaches, resistance and the impact upon staff

Published online by Cambridge University Press:  15 September 2005

Paul Dawson ,
Marc Kingsley  and
Stephen Pereira
Paul Dawson
Affiliation:
Research Psychologist
Marc Kingsley
Affiliation:
Specialist Clinical Psychologist/Adult psychotherapist
Stephen Pereira
Affiliation:
Consultant Psychiatrist

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

It has become evident that Psychiatric Intensive Care Units (PICU) accept aggressive, violent patients often with criminal histories and personality disorders. This paper aims to document the effects that this patient group can have on a PICU and the significant role that psychotherapy can offer this complex patient group. The conclusions have been drawn from psychotherapeutic work on a PICU (Pathways on Tagore, NELMHT). Such patients present unique therapeutic and emotional challenges to staff. As a result staff need to recognise and address these issues. This paper identifies and discusses a number of central themes, challenges and practical skills that may be important in enabling the successful treatment of such patients within a PICU setting.

Keywords

Anger managementviolencePICUs
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 1 , September 2005 , pp. 45 - 53
Copyright
© 2005 NAPICU

References

Adler, A. (1925) Individual Psychology and Crime. In: The Practice and Theory of Individual Psychology. Routledge & Kegan, London.
Adler, G. (2000) Borderline personality disorders in the emergency room: current perspectives. Emergency Psychiatry. 6: 119–122.Google Scholar
Atakan, Z. (1995) Violence on psychiatric inpatient units: what can be done? Psychiatric Bulletin. 19: 593–596.Google Scholar
Atakan, Z. (2001) The Complex Needs Patient. In: Beer, D., Paton, C., Pereira, S. (eds) Psychiatric Intensive Care. pp. 170–196. Greenwich Medical Media.
Barlow, K., Grenyer, B. and Ilkiw-Lavalle, O. (2000) Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry. 34: 967–974.Google Scholar
Beck, J.C. (1995) Forensic psychiatry in Britain. Bulletin of the Academy of Psychiatry and the Law. 23: 249–259.Google Scholar
Becker, M., Love, C.C. and Hunter, M.E. (1997) Intractability is relative: behaviour therapy in the elimination of violence in psychoticforensic patients. Legal & Criminological Psychology 2, pp.103–116. British Psychological Society, England.
Beer, D., Paton, P. and Pereira, S. (1997) Hot beds of general psychiatry. Psychiatric Bulletin. 21: 142–144.Google Scholar
Beer, D., Pereira, S. and Paton, C. (2001) Psychiatric Intensive Care- Development and Definition. In: Beer, D., Paton, C., Pereira, S. (eds) Psychiatric Intensive Care. Greenwich Medical Media, pp. 2–11.
Birnie, W.A. (1988) The psychiatric acute observation unit in a general hospital. Canadian Journal of Psychiatry 33: 707–710.Google Scholar
Blomhoff, S., Seim, S. and Friis, S. (1990) Can prediction of violence among psychiatric inpatients be improved? Hospital & Community Psychiatry. 41: 771–775.Google Scholar
Britton, P. (1997) The Jigsaw Man. Corgi Books.
Britton, P. (2000) Picking Up the Pieces. Corgi Books.
Carsen, R.C., Butcher, J.N. and Mineka, S. (1998) Abnormal Psychology and Modern Life. Longman Press.
Clarke, R.V. and Cornish, D.B.(1987) Modelling offender's Decisions: A Framework for Research and Policy. In: Tonry, M., Morris, N. (eds) Crime and Justice: An Annual Review of Research. University of Chicago Press, 7, pp. 147–185.
Coid, J.W. (1991) A survey of patients from five health districts receiving special care in the private sector. Psychiatric Bulletin. 15: 257–262.Google Scholar
Cordall, J. (1999)Angry women mentally disordered offenders: a need to do more? British Journal of Nursing. 8: 658–663Google Scholar
Department of Health and Social Services (1974) Revised Report for the Working Party on Security in NHS Psychiatric Hospitals (Glancy Report). DHSS, London.
Eastman, N. (1999) Who should take responsibility for antisocial personality disorder? British Medical Journal. 318: 206–207.Google Scholar
Egan, V., Charlesworth, P., Richardson, C., Blair, M. and McMurran, M. (2001) Sensational interests and sensation seeking in mentally disordered offenders. Personality and Individual Differences. 30: 995–1007.Google Scholar
Ekblom, B. (1970) Acts of Violence by Patients in Mental Hospitals. Svenska Bokforalaget, Uppsala.
Goldney, R. (1985) The PICU. British Journal of Psychiatry. 146: 50–54.Google Scholar
Goldstein, M.J. (2001) Psychological Approaches to the Acute Patient. In: Beer, D., Paton, C., Pereira, S. (eds) Psychiatric Intensive Care. Greenwich Medical Media, pp. 94–106.
Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Inc., Englewood Cliffs, NJ.
Howells, K. and Watt, B. (1997) Developing programmes for violent offenders. Legal and Criminological Psychology. 2: 117–128.Google Scholar
Kho, K., Sensky, T., Mortimer, A. and Corcos, C. (1998) Prospective study into factors associated with aggressive incidents in psychiatric acute admission wards. British Journal of Psychiatry. 172: 38–43.Google Scholar
Koenberg, O.F. (1975) Borderline Conditions and Pathological Narcissism. Jason Aronson, New Jersey.
Koerner, B.I. (1999) It may be all the rage, but does it work. US NEWS and World Report, April 12, pp. 44–45.
Mayne, T.J. and Ambrose, T.K. (1999) Research review on anger in psychotherapy. Journal of Clinical Psychology. 3: 353–363.Google Scholar
McGuire, J. (ed) (1995) What Works: Reducing re-offending — Guidlelines from Research and Practice. Chicester, Wiley.
McMurran, M., Charlesworth, P., Duggan, C. and McCarthy, L. (2001) Controlling angry aggression: a pilot group intervention with personality disordered offenders. Behavioural & Cognitive Psychotherapy. 29: 473–483.Google Scholar
Michalon, M. and Richman, A. (1990) Factors affecting length of stay in a PICU. General Hospital Psychiatry. 12: 303–308.Google Scholar
Mitchell, G.D. (1992) A survey of psychiatric intensive care units in Scotland. Health Bulletin. 50: 228–232.Google Scholar
Miller, A. (1990) For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence. Farrar Straus Giroux, New York.
Novoco, R.W. (1997) Remediating anger and aggression with violent offenders. Legal and Criminological Psychology. 2: 77–88.Google Scholar
Pereira, S., Beer, D. and Paton, C. (1999) Good practice issues in psychiatric intensive care units: Findings from a national survey. Psychiatric Bulletin. 23: 397–399.Google Scholar
Renwick, S.J., Black, L. and Ramm, M. (1997) Anger treatment with forensic hospital patients. Legal and Criminological Psychology. 2: 103–116.Google Scholar
Robins, R. and Novaco, R.W. (1999) Systems conceptualisation and treatment of anger. Psychotherapy in Practice. 55: 325–337.Google Scholar
Savage, L. and Salib, E. (1999) Seclusion in psychiatry. Nursing Standard. 13: 34–37.Google Scholar
Saverimuttu, A. (2000) Aggressive incidents on a PICU. Nursing Standard. 12: 33–36.Google Scholar
Serin, R.C. and Kuriychuk, M. (1994) Social and cognitive processing deficits: Implications for treatment. International Journal of Law and Psychiatry. 17: 431–441.Google Scholar
Sheridan, M., Henrion, R., Robinson, L. and Baxter, V. (1990) Precipitants of violence in a psychiatric inpatient setting. Hospital and Community Psychiatry. 7: 776–780.Google Scholar
Smith, A.D. (1997) Characteristics of inpatients transferred to a locked ward in a Scottish psychiatric hospital. Health Bulletin. 55(2): 77–82.Google Scholar
Spergal, I. (1964) Racketville, Slumtown, Haulberg: An Exploratory Study of Delinquant Subcultures. Chicago University Press.
Steels, M., Roney, G., Larkin, E., Jones, P., Crudace, E. and Duggan, C. (1998) Discharged form special hospital under restriction: a comparison of the fates of psychopaths and the mentally ill. Criminal Behaviour and Mental Health. 8: 39–55.Google Scholar
Stermac, L. (1986)Anger control treatments for forensic patients. Journal of Interpersonal Violence. 1: 446–457.Google Scholar
Walsh, E., Buchanan, A. and Fahy, T. (2001) Violence and schizophrenia: examining the evidence. British Journal of Psychiatry. 180: 490–495.Google Scholar
Whyte, L. (2001) Working with a MDT team in secure psychiatric environments. Journal of Psychosocial Nursing. 39(9): 26–34.Google Scholar
Widiger, T.A. and Trull, T.J. (1994) Personality Disorders and Violence. In: Monahan, J., Steadman, H.J. (eds) Violence and Mental Disorder: Developments in Risk Assessment. University of Chicago Press, Chicago, IL.
Winnicott, D.W. (1951) Hate in the counter transference. International Journal of Psychoanalysis. 30: 69–75.Google Scholar
Wolferdorf, M., Keller, F. and Kaschka, W. (1997) Suicide of psychiatric inpatients 1970–1993 in Baden-Wurttemberg (Germany). Archives of Suicide Research. 3: 303–311.Google Scholar