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Fortschr Neurol Psychiatr 2001; 69(10): 443-452
DOI: 10.1055/s-2001-17560
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Aggressives Verhalten psychisch Kranker im stationären Bereich: Häufigkeit, Risikofaktoren, Prävention

Inpatient Violence: Frequency, Risk Factors, Preventive StrategiesH.  Schanda1 , Pamela  Taylor2
  • 1Justizanstalt Göllersdorf (Ärztl. Leiter: Univ.-Prof. Dr. H. Schanda), Österreich
  • 2Department of Forensic Psychiatry, Section of Special Hospital Psychiatry (Head: Prof. P. J. Taylor, MD), Institute of Psychiatry, London, England
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Publication Date:
02 October 2001 (online)

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Zusammenfassung

Im Gegensatz zu angloamerikanischen und skandinavischen Ländern, in denen aggressives Verhalten psychisch Kranker während stationärer Behandlung seit längerem als Problem angesehen wird, findet im deutschsprachigen Raum erst seit einigen Jahren eine Auseinandersetzung mit diesem Thema statt, wobei die bisher vorliegenden Ergebnisse deutliche Parallelen zur internationalen Entwicklung zeigen. In der vorliegenden Arbeit wird nach der Erörterung methodologischer Probleme (unterschiedliche Definitionen, Informationsquellen und Registrierungsmöglichkeiten) anhand der vorhandenen Literatur der aktuelle Wissensstand dargestellt:

Generell wird die Häufigkeit, vor allem bei Frauen, unterschätzt; relativ wenige Patienten sind für die Mehrzahl der Übergriffe verantwortlich; Opfer werden eher Mitglieder des Betreuungspersonals als Mitpatienten; es besteht eine Diskrepanz zwischen den meist geringfügigen körperlichen und den erheblichen emotionalen Folgen für die Opfer, dementsprechend werden die negativen Auswirkungen auf das Stationsklima oft unterschätzt. Neben statischen/aktuarischen Risikofaktoren, wie soziale Schicht, aggressives Verhalten in der Vorgeschichte, dissoziale Persönlichkeitsmerkmale und (teilweise) Diagnosen haben vor allem dynamische Risikofaktoren, wie akute Intoxikation, Substanzmissbrauch, mangelnde Krankheitseinsicht bzw. Compliance sowie produktiv-psychotische Symptome Einfluss auf Frequenz und Schweregrad von einschlägigen Vorfällen, an externen Faktoren Personaldichte, Stationsgröße und -struktur, vor allem aber Haltung und Einstellung des Betreuungspersonals sowie dessen Fähigkeit, Risikosituationen und Frühwarnzeichen zu erkennen bzw. adäquat damit umzugehen. Für Behandlung und Prävention sind - abgesehen von medikamentösen Interventionen - vor allem die erwähnten personalbezogenen Maßnahmen von Bedeutung. Sie stellen die grundsätzliche Basis für die suffiziente Versorgung hospitalisierter Patienten auch jenseits des Phänomens Aggression dar.

Abstract

In contrast to Angloamerican and Scandinavian countries inpatient violence was not regarded as a problem in German-speaking countries for a long time. Only recently it has become a topic of increasing interest for clinical practice and research, whereby the present data exhibit significant parallels to the international development. After the discussion of methodological problems (e. g. varying definitions, sources of information, ways of registration) the paper presents the current state of knowledge about inpatient violence:

Underestimation in general, mainly with respect to female patients; only a few patients are responsible for the majority of assaults; victims are rather staff members than fellow patients; discrepancy between the mostly minor physical, though major emotional consequences for victims; considerably negative effects on patient-staff interactions and ward climate. Aside from patient-related actuarial and dynamic risk factors (social origin, previous history of aggressive behaviour, dissocial personality traits and - partly - diagnoses, acute intoxication, substance abuse, lack of insight and compliance, psychotic symptoms) external/contextual factors as patient-staff ratio, ward size, structure and climate, staff-attitudes, recognition of early warning signs and handling of risk situations are of major importance for the frequency and severity of incidents. Intervention and prevention strategies are focussing - aside from medication - on the aforementioned staff-related factors and patient-staff interactions. They are the principal basis for sufficient inpatient treatment beyond the problem of violence.

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Univ.-Prof. Dr. Hans Schanda

Justizanstalt Göllersdorf

2013 Göllersdorf 17

Österreich