AVERSIVE-STIMULATION BY STAFF AND VIOLENCE BY PSYCHIATRIC-PATIENTS

This study investigated the frequency with which violence by psychiatr ic in-patients was preceded by aversive interpersonal stimulation. The precursors of 63 assaults by psychiatric patients on nurses were stud ied using semi-structured interviews conducted within 72 hours of the assault. Reliability data were collected from staff witnesses and assa ultive patients in a subgroup of assaults. Eighty-six per cent of the assaults were immediately preceded by the assaulted nurse having deliv ered an aversive stimulus to the patient, e.g. frustration, activity d emand or physical contact. There were significant associations between diagnosis and the type of aversive stimulation which preceded assault s. Interpersonal factors and diagnosis therefore seem to play a signif icant role in most violence in psychiatric hospitals and only a minori ty of patients behave aggressively in the absence of aversive stimulat ion. An explanation of the link between psychosis and aggressive behav iour in terms of distorted social cognition is discussed.