A ten-year prospective study of aggression in a special secure unit for dangerous patients

In a 10-year prospective study inpatient aggression was investigated in a Norwegian special secure unit covering a well-defined catchment area with a population of 240,000. The seven bed special secure unit receives dangerous, psychotic patients for long-term treatment. Only 19 patients were treated during the ten-year study lasting from 1 April 1987 to 1 April 1997. Incidents of aggressive behavior were recorded on the Report Form for Aggressive Episodes by the nursing staff. The study aimed to identify, classify and measure the occurrence of aggressive behavior, as well as the relative frequency of events preceding such behavior. A total of 2021 incidents of aggressive behavior were recorded. Seventy-five per cent of the aggressive acts were verbal or physical threats, while the remaining 25% were physical assaults directed at other persons. Four patients accounted for about 80% of the aggressive encounters. Nursing staff were victims in about 90% of the incidents. Serious physical injury was extremely rare. Situations pertaining to limit-setting and problems of communication accounted for approximately 90% of the precipitants of aggressive behavior. There were no sex differences regarding the occurrence of aggressive behavior.