الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
This is a cross sectional study conducted on 200 inpatients admitted to forensic wards of Alkhanka mental hospital, in the duration of January 2015 to January 2016.
The aim of the present work is to:
1. Estimate the prevalence rate of aggression in forensic psychiatry inpatients at Elkhanka mental hospital.
2. Determine patterns and precipitants of aggression among forensic psychiatric inpatients.
All subjects were evaluated by:
• Psychiatric assessment was done using DSM- 5 criteria,
• The Arabic version of the Overt Aggression Scale-Modified (OAS-M) was used to determine the prevalence and the type of aggression
• EPQ was done to determine the personality type.
The collected data were analysed using Chi-square test (X2), Monte carlo test (MCp), Fisher Exact test (FEp), Mann Whitney test (Z).
Results of this study were as follows:
- All the patients were males with age range from (from 18 to 50) years old with a mean
- As regard the residence, 87(43.5%) patients came from rural areas, while 113(56.5%) patients came from urban areas.:
- Among the sample, as regard to education 140(70%) were literate and 60(30%) were illiterate.
- As regard to occupation, 106(53%) were employed, 68(34%) were unemployed and 26(13%) had interrupted employment.
- As regard the marital status, 124 were single (56.4%), 82 were married (37.3%) and 14 were divorced (6.4%).
- All patients were involuntarily admitted by Law.
- One hundred and three (51.5%) patients were never hospitalized prior to incarceration,30(15%) patients were hospitalized only once and 67 (33.5%) patients were hospitalized more than once.
- Ninety six (48%) patients has history of previous aggressive incidents and 104(52%) patients had no history of previous aggressive incidences.
- Fifty nine (29.5%) had history of substance use and 141(70.5%). had no history of substance use.
- Duration of hospitalization of the studied sample ranged from 0.01 years to 37 years with a mean of 6.05 ± 7.0
- While age of onset of illness ranged from 14 to 50 years with a mean of 27.96 ± 7.56.
- One hundred and twenty one(60.5%) patients were incarcerated for homicide, 47(23.5%) were incarcerated because of committing violence against others, 17(8.5%) were incarcerated because of destruction of property and 15(7.5%) were incarcerated because of other causes (robbery, kidnapping, false pretenses, forgery, trespassing).
- Regarding diagnosis according to DSM 5, 128 (64%) patients were diagnosed with schizophrenia on admission, 44(22%) were diagnosed with bipolar disorder, 22(11%) were diagnosed with schizoaffective disorder, 1(0.5%) patient with major depression with psychotic features, and 5(2.5%) were diagnosed with other disorders (delusional disorder, impulse control disorder, obsessive compulsive disorder and intermittent explosive disorder)
- One hundred and six (53%) patients had active delusions and 94(47%) had no delusions. Regarding the type of delusion, 51(25.5%) patients had delusions of persecution, 24(12%) had delusions of grandiosity 7(3.5%) had delusions of influence and 24(12%) had more than one type of delusions.
- Thirty six (18%) patients had hallucinations all were auditory hallucinations 26(13%) were running commentary and 10 (5%) were commanding hallucinations, and 164 patients had no hallucinations (82%).
- Nineteen (9.5%) patients were insighted,133(66.5%) were not insighted and 48(24%) were partially insighted. The majority had poor judgement 151 (75.5%).
- Using the Arabic version of the Overt Aggression Scale-Modified (OAS-M), it was found that 72 patients of the studied sample showed aggression. This revealed the prevalence of aggression to be (36%) of the studied sample. The distribution of the 72 aggressive cases according to the four aggression subtypes of the scale (verbal, against objects, against others, against self) we could find that 62(86.1%) patients showing verbal aggression, 25(34.7%) patients showing physical aggression against others, 10(13.9%) patients showing aggression against property and 2(2.8%) patients showing aggression against self.
- Patients were distributed into two groups: Group I (128 patients who didn’t show aggression), and Group II (72 patients who showed aggression) as measured by the Arabic version of the Overt Aggression Scale- Modified (OAS-M).
- For aggressive patients, the age ranged from 20 to 50 with a mean age of 35.29 ± 8.0 compared to an age range of 38.96 ± 8.35 for non aggressive patients i.e. the aggressive group had a lower mean age. There was statistically significant difference between age among both groups with t=2.489and P= 0.014.
- There was no statically significant differences between the two groups as regard the other items of demographic data.
- Patients who showed aggression, 30(41.7%) were never hospitalized before, 11(15.3%) were only hospitalized once and 31(43.1%) were admitted to the hospital more than once, while in the non aggressive group 73(57%) were never hospitalized, 19(14.8%) were only hospitalized once and 36(28.1%) were hospitalized more than once with no statistical significance ( = 5.184 and P= 0.075).
- Regarding history of violence during hospital stay, among the group that showed aggression 60(83.3%) patients had history of violence and 12(16.7%) patients had no history of violence , while among the non aggressive group 36(28.1%) patients had history of violence and 92(71.9%) patients had no history of violence with a statistically significant difference ( = 56.270 and P <0.001).
- The aggressive group had a higher prevalence of substance use (44.4%) compared to lower prevalence in non aggressive group (29.9%).There was a statistically significant difference ( = 12.081 and P= 0.001).
- The group that showed aggression had a lower mean of 5.25 ± 6.27 years than the non aggressive group which had a mean of 6.50 ± 7.37 years but this difference had no statistical significance (P=0.075)
- Patients who showed aggression had a lower mean age of 26.54 ± 7.41 years than patients who showed no aggression who had a mean age of onset of illness of 28.91 ± 8.0 years. The difference had a statistical significance (t =2.060 and P=0.041)
- There was no statistical significance regarding cause of incarceration both groups which had the same order of frequency. The most common cause was homicide followed by violence against others, destruction of property and lastly, other causes like robbery, kidnapping, false pretenses, forgery, trespassing.
- Among both groups; the most common diagnosis was schizophrenia followed by bipolar disorder and schizoaffective disorder, respectively. There was a statistically significant difference (= and P= 0.001).
- The aggressive group has a higher frequency of active delusions, 48(66.7%) patients compared to non aggressive group 58(45.3%). The difference was statistically significant (= 8.435 and P=0.004). Hallucinations were higher among the aggressive group with 15(20.8%) but the difference was not statistically significant.
- Persecutory delusions being the most common type wit 21 (43.75%) in the aggressive group and 30 (51.72) in the non aggressive group. However the type of delusion had no statistical significance.
- The majority of aggressive group scored high on different subscales of EPQ 61(84.7%) compared to 31(24.2%) in non aggressive group. Followed by criminality in aggressive group 17(23.6%) and neuroticism in non aggressive group 18(14.1%)The result was statistically significant ((= 86.263 and P< 0.001).
- The duration of hospitalization for the group that showed aggression had a lower mean of 5.25 ± 6.27 years than the non aggressive group which had a mean of 6.50 ± 7.37 years but this difference had no statistical significance (P=0.075)
- Patients who showed aggression had a lower mean age of 26.54 ± 7.41 years than patients who showed no aggression who had a mean age of 28.91 ± 8.0 years. The difference had a statistical significance (t =2.060 and P=0.041)
- No statistical significant differences could be found by comparing the four aggression subtypes as measured by the Overt aggression scale modified (OAS-M) in relation to demographic data, type and number of admissions, insight to illness, diagnosis, history of aggression, family history of psychiatric illness and family history of aggression and time of occurrence of the aggressive event.
- Regarding ward environment, only dangerous fixtures(unsecured tables, unsecured seats, waste bins, sharp corners) showed significant risk in increased aggression ( =25.521 and P=<0.001).
- A negative correlation was found between the age of the patient and the score on OAS-M with rs =-0.205 and P= 0.084. Also, there was a negative correlation between the age of onset of illness and the score of OAS-M with rs =-0.136 and P=0.255. However, the correlation sowed no statistical significance.
- There was a positive relation between increased mean score of OAS-M and history of substance use , diagnosis of schizophrenia and bipolar disorder, the presence of active delusions lack of insight and poor judgement, however none was statistically significant.
- A statistically significant positive relation was present between history of violence during hospital stay and increased mean score of OAS-M (Z=3.113, P=0.002)..
- The positive relation between personality type according to EPQ and increased OAS-M score that was statistical significant (KWχ2=31.882, P<0.001).
- Again, a positive relation was found between presence of dangerous fixtures(unsecured tables, unsecured seats, waste bins, sharp corners) in the ward and increase in OAS-M that was not statistically significant .