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Physical Assault in the Psychiatry Emergency Room. 2020

Ryan E Lawrence, and Stephanie A Rolin, and Diane V Looney, and Adriane R Birt, and Ellen M Stevenson, and Dianna Dragatsi, and Paul S Appelbaum, and Lisa B Dixon
Dr. Lawrence is Assistant Professor of Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Dr. Rolin is Research Fellow, Division of Law, Ethics, and Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Ms. Looney is Administrator for Psychiatry, Department of Psychiatry, New York Presbyterian Hospital, New York, NY. Dr. Birt is Assistant Professor of Psychiatry, Department of Psychiatry, Columbia University, New York, NY. Dr. Stevenson is Associate Professor of Psychiatry and Director of Psychiatry, Department of Psychiatry, Columbia University, New York, NY. Dr. Dragatsi is Associate Professor of Psychiatry, Columbia University and Associate Clinical Director, Department of Psychiatry, Rockland Psychiatric Center, Orangeburg, NY. Dr. Appelbaum is the Dollard Professor of Psychiatry, Medicine, and Law, and Directory of the Center for Law, Ethics, and Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. Dr. Dixon is the Edna L. Edison Professor of Psychiatry and Director, Division of Behavioral Health Services and Policy Research, Department of Psychiatry, New York State Psychiatric Institute, New York, NY. rel2137@cumc.columbia.edu.

Previous studies of physical assaults in hospitals focused primarily on inpatient psychiatric units, leaving unanswered questions about the extent to which findings generalize to psychiatric emergency rooms. Assault incident reports and electronic medical records from one psychiatric emergency room and two inpatient psychiatric units were reviewed. Qualitative methods were used to identify precipitants. Quantitative methods were used to describe characteristics of each event, as well as demographic and symptom profiles associated with incidents. During the five-year study period, there were 60 incidents in the psychiatric emergency room and 124 incidents on the inpatient units. Precipitating factors, incident severity, means of assault, and interventions were similar in both settings. Among patients in the psychiatric emergency room, a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder with manic symptoms (Adjusted Odds Ratio (AOR) 27.86) and presenting with thoughts to harm others (AOR 10.94) were associated with an increased likelihood of having an assault incident report. Similarities between assaults in the psychiatric emergency room and inpatient psychiatric units suggest that the broader literature from inpatient psychiatry can be generalized to the psychiatric emergency room setting, although some differences exist.

UI MeSH Term Description Entries
D007297 Inpatients Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. Inpatient
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D004636 Emergency Service, Hospital Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient. Emergency Outpatient Unit,Emergency Services Utilization,Hospital Emergency Room,Hospital Emergency Service,Hospital Emergency Services Utilization,Accident and Emergency Department,Emergency Departments,Emergency Hospital Service,Emergency Room,Emergency Units,Emergency Ward,Hospital Service Emergency,Service, Hospital Emergency,Department, Emergency,Departments, Emergency,Emergencies, Hospital Service,Emergency Department,Emergency Hospital Services,Emergency Outpatient Units,Emergency Room, Hospital,Emergency Rooms,Emergency Rooms, Hospital,Emergency Services, Hospital,Emergency Unit,Emergency Wards,Emergency, Hospital Service,Hospital Emergency Rooms,Hospital Emergency Services,Hospital Service Emergencies,Hospital Service, Emergency,Hospital Services, Emergency,Outpatient Unit, Emergency,Outpatient Units, Emergency,Room, Emergency,Room, Hospital Emergency,Rooms, Emergency,Rooms, Hospital Emergency,Service Emergencies, Hospital,Service Emergency, Hospital,Service, Emergency Hospital,Services Utilization, Emergency,Services Utilizations, Emergency,Services, Emergency Hospital,Services, Hospital Emergency,Unit, Emergency,Unit, Emergency Outpatient,Units, Emergency,Units, Emergency Outpatient,Utilization, Emergency Services,Ward, Emergency,Wards, Emergency
D005260 Female Females
D006778 Hospitals, Psychiatric Special hospitals which provide care to the mentally ill patient. Mental Hospitals,Hospitals, Mental,Mental Institutions,Psychiatric Hospitals,Hospital, Mental,Hospital, Psychiatric,Institution, Mental,Institutions, Mental,Mental Hospital,Mental Institution,Psychiatric Hospital
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001523 Mental Disorders Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. Mental Illness,Psychiatric Diseases,Psychiatric Disorders,Psychiatric Illness,Behavior Disorders,Diagnosis, Psychiatric,Mental Disorders, Severe,Psychiatric Diagnosis,Illness, Mental,Mental Disorder,Mental Disorder, Severe,Mental Illnesses,Psychiatric Disease,Psychiatric Disorder,Psychiatric Illnesses,Severe Mental Disorder,Severe Mental Disorders
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor

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