الفهرس 
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Abstract
This work was intended to evaluate the accuracy of predictors of patient aggressive behavior in psychiatric wards (locked – unlocked).And, to screen aggression in the patient family. Also, to assess the severity and frequency of aggression and its relation to multiple variables among hospitalized patients with schizophrenia and bipolar I disorder.
The Theoretical Part
This part consisted of a review of the literature on aggression and its relation to bipolar and schizophrenia diagnosis, its management, its biology and impact on mental illness and admission, known correlated factors or predictors of aggressive patients.
The First Chapter
Starts with various definitions of aggression and its relation with psychiatry and psychology Then notes on the difference between aggression and violence, types and forms and prevalence of aggression, the biology of aggression and management of aggression in psychiatric patients with special emphasis on the non-pharmacological management and interventions(seclusion and restraint).
This chapter briefly concluded that theories of aggression are complex and invariably intertwined. And concluded that individuals behave aggressively due to a medical ‘‘abnormality’’, socialization or psychology is a debate that rages on. However, understanding such theories allows taking a more considered approach to dealing with aggression in the clinical area.
The Second Chapter
Discussed the predictors and factors related to aggression in patients with schizophrenia and bipolar disorder dividing them into demographic factors, contextual factors, clinical factors, staff factors. This chapter can be summarized by stating that a positive history of violent episodes is the strongest predictor minimizing the role of sex, age, diagnosis and alcohol abuse. The variables that most frequently correlated with episodes of aggression were past episodes of violence/aggression, the presence of impulsiveness/hostility, longer hospitalization, involuntary admission, and the same gender of aggressor and victim Alcohol/drug misuse, a younger age, and suicidal risk also increase the risk of aggression.
The Third Chapter
Discussed the historical debate of whether schizophrenic patients are more likely to be aggressive or not. Also, the epidemiology of aggression in schizophrenia, associated factors, Neuroimaging correlates, and its relation to comorbidity were discussed in this chapter. This chapter, in brief, resulted that increased risk of violence among patients with schizophrenia has been repeatedly confirmed and that many aggressive acts among patients with schizophrenia take place within the family or during inpatient treatment.
The Fourth Chapter
Discussed aggression in bipolar patients stating prevalence of aggression in bipolar patients and various associated factors from previous studies upon that subject, with a special focus on serotonin activity which is a major factor in aggression and impulsivity in mood disorders, were discussed , also focusing on the relation of aggression
in bipolar disorder and substance abuse as being an important comorbid act in bipolar disorder, it also included the important predictors of aggression in bipolar disorder from various previous studies. The chapter concluded that the connection between bipolar disorder and violence appears to be strongest during acute episodes of illness. In most cases, violence is random and not goal-directed. A specific target of aggression is rare. Early diagnosis and pharmacologic intervention are the most effective means of preventing violence in these patients. And that hostility and aggression have assumed particular importance as core features of manic and mixed states independent of psychosis, and often emerging as correlates of comorbid substance abuse and suicidality.
II.The Practical Part
Patients in this study were selected randomly from inpatients of Port Said Mental Health Hospital from the first of January to the end of June 2015. Patients who agreed to participate in this study and fulfilling the inclusion and exclusion criteria were subjected to a detailed psychiatric patient sheet; items were fulfilled through a semi-structured psychiatric interview and with special emphasis on certain points (socio-demographic data, data concerning clinical symptoms, aggressive episodes, premorbid personality, substance use or abuse, occupational activity, previous admissions and their causes, suicidality and contextual data concerning the present ward the patient is admitted into).
Patients were also subjected to The Modified Overt Aggression Scale (MOAS) used to assess the presence of aggressive episodes , their types in patients and their families, The modified structured clinical interview for DSM- IV Axis I disorders (SCIDI) to diagnose schizophrenia and bipolar I disorders according to DSM-IV-TR
classification after modification to match DSM-5 criteria, Positive and negative syndrome scale excited component (PANSS_EC) and YMRS to assess the severity of symptoms, plasma cortisol level &total cholesterol level, lastly SOAS to measure in patients aggression and assess its severity , frequency and measures used to stop aggression .
Results
In our study, the accuracy of prediction of aggression using the correlation between severity and frequency of aggression by SOAS-R and sociodemographic and clinical variables of aggression. In schizophrenic patients, 72% of aggressive patients committed acts of aggression (locked & unlocked) while 28% of aggressive patients didn’t commit aggressive attacks (risky) during hospitalization. Also, in bipolar I patients, 80% of aggressive patients committed acts of aggression (locked & unlocked) while 20% of aggressive patients didn’t commit aggressive attacks (risky) during hospitalization.
Results were subjected to statistical analysis using SPSS 17 and the following data was revealed:
I-Results of The Socio-Demographic Data
The mean age of the patients in our study was 34.92 years. there was no significant relation between aggression by SOA scale and age in schizophrenic patients. While a significant relation between aggression by SOA scale and age in bipolar I patients.
In our study sample, 68% of patients were males and (32%) were females. A higher percentage of a male found in the locked group
In our study, there was no significant difference between studied groups and marital status. single patients constituted 56
% of the study sample, divorced constituted 18 % and married were 26% of the study sample.
In our study, there was no significant difference between studied groups and Socioeconomic status. (SES) is often measured as a combination of education, income, and occupation. Low socioeconomic level constituted 28% of the sample, while patients with moderate socioeconomic level constituted 54% of this sample; and patients with high socioeconomic level were 18% of this sample.
In our study, patients with involuntary admission constituted 70 % of our sample, patients with voluntary admission constituted 30 % of the sample. in schizophrenic patients, there was a Significant relation between aggression by SOA scale and type of hospital admission, while in bipolar I patients, there was a highly significant relation between aggression by SOA scale and type of hospital admission.
In our study, 76% had a previous history of aggression, while Only 24 % of the patient didn’t have any history of aggression, patients who showed inpatient aggression (locked &unlocked) during hospitalization were more likely to have a previous history of aggression approximately 77.2%.
II-Results of The Clinical Assessment
In our study, there was no significant relation between studied groups and MOA scale of family,36% of patients showed positive MOAS of family half of them were schizophrenic and other half were bipolar I patients.
In our study, a total of 50% of the study sample were diagnosed with schizophrenia. The remaining 50% of the sample was diagnosed with bipolar disorder with manic features. the equally divided sample between schizophrenia and bipolar affective disorder was intentionally predetermined.
In our study, there was a significant relation between groups of schizophrenic patients by SOA scale and total PANSS-EC score & excitement &hostility & tension & poor impulse control & uncooperativeness.
In our study, there was a Significant relation between groups of bipolar patients by SOA scale and Young mania rating score & aggressive behavior.
III: Results of multivariate logistic regression for aggression by SOA scale in schizophrenic and bipolar I patients :
Considering aggressive behaviors, the type of hospital admission & previous aggression& hostility and excitement by PANSS scale & aggressive behavior of YMRS scale & low plasma cortisol level as the main predictors of inpatient aggression.
There was no significant difference between two groups(locked & unlocked) regarding different predictors as both groups carried out aggressive attacks during hospitalization. but they differ in the severity and frequency of attacks and measures used to stop attacks.