Gewalttätiges Verhalten von Patienten in Institutionen

Zusammenfassung

Anliegen: Die Beurteilung des Risikos gewalttätiger Verhaltensweisen bei psychiatrischen Patienten ist nicht nur in der forensischen Psychiatrie bedeutsam, sondern hat auch in der Allgemeinpsychiatrie wichtige Implikationen für klinische Entscheidungen. Im letzten Jahrzehnt wurden zahlreiche Studien zu dieser Problematik publiziert, deren Ergebnisse allerdings teilweise Fehlinterpretationen unterliegen. Methode: Es wird ein zusammenfassender Literaturüberblick zum Thema gegeben. Ergebnisse: Es zeigt sich, dass strikt zu trennen ist zwischen „Gewalt in der Gemeinde” und „Gewalt in Institutionen”. Während Prädiktoren für gewalttätiges Verhalten in der Gemeinde weitgehend identisch sind mit denjenigen für Gewalttaten bei nicht psychisch erkrankten Personen und psychopathologische und klinische Variablen von untergeordneter Bedeutung sind, ist in psychiatrischen Kliniken aggressives Verhalten eng mit psychopathologischen Variablen korreliert. Der Versuch einer genaueren Differenzierung klinischer Risikovariablen endet allerdings regelmäßig mit widersprüchlichen Befunden, was auf unvermeidbare Probleme der Stichprobenselektion zurückzuführen ist. Schlussfolgerungen: Gewalt in Institutionen und außerhalb derselben in der Gemeinde geschieht unter völlig unterschiedlichen Rahmenbedingungen und Risikokonstellationen. Entsprechende Befunde dürfen nicht übertragen werden. Personenbezogene Vorhersagemöglichkeiten sind grundsätzlich begrenzt, weil situativen Faktoren eine bedeutende Rolle zukommt.

Abstract

Objective: The assessment of violence risk has impact on psychiatrists' decisions not only in forensic psychiatry but concerns many aspects of civil psychiatric units, too. Within the last decade, many studies on violence have been published. The results are misinterpreted sometimes. Method: A review about studies on in-patient violence is given. Results: In-patient violence and violence in the community should strictly be separated concerning predictors and predictions. Predictors of community violence both for persons with major mental disorders and persons without mental illness are criminal history, male gender, younger age, and substance abuse. Psychopathological and clinical variables play a minor role. In contrast, in-patient violence is closely related to the severity of psychopathological symptoms. More detailed determinations of risk-related symptoms yield conflicting results due to inevitable problems of sample selection. Conclusions: The assessment of violence risk has to consider the different risk constellations for violence in institutions and in the community. Predictions of violence by individual risk variables are limited because situation-related factors are important, too.

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