Academic journal article Hong Kong Journal of Psychiatry

Predicting Dangerousness of Schizophrenic Inpatients in Shanghai

Academic journal article Hong Kong Journal of Psychiatry

Predicting Dangerousness of Schizophrenic Inpatients in Shanghai

Article excerpt

SUMMARY

A sample of 134 consecutively admitted patients for schizophrenia or schizophrenic disorders was assessed by sociodemographic information, the BPRS, the 12-item Symptom Rating Scale, the BEP and the MMPI. The MOAS was administered to evaluate the dangerous behaviour during the first 15 days of hospitalization, Compared with the control goup, 41 patients with dangerous behaviour had longer duration and higher frequency of hospitalizations, more previous history of violent behaviour, higher scores on thought-disturbance, hostile-suspiciousness and activation of BPRS, more abnormalities of BEP, and higher scores on L, F, K, Pd, Ma of MMPI. The fully completed data of 82 patients were analyzed by logistic regression and a predicting model was developed. Six variables were identified, namely: hostile-suspiciousness and activation of BPRS, abnormality of BEP, F and Pd of MMPI, auditory hallucination of command- The model was validated with sensitivity of 86.7% and specificity of 92.3%.

Keywords: schizophrenia, Chinese, dangerousness, variables, logistic regression

INTRODUCTION

Mental health acts were issued in many countries, in which the legal basis for compulsory admission and detention of psychiatric patients were strictly provided. It is stated that the patients must be a danger to themselves or others because of mental disorders, and when the danger is removed, the patient should be discharged. Therefore, workers in mental health and forensic fields are facing a difficult problem, how to judge or predict the dangerousness of a psychiatric patient.

Towards the end of the 1970's, the prediction of dangerousness stepped into a new era called "the second generation of prediction." With the advances of statistical methods and instruments, research outcomes become more and more standardised and the accuracy of prediction has improved.

In the People's Republic of China, most of the researches conducted so far could only be part of the first generation of prediction, in which data were collected and the possible predictors descriptively analyzed. This study aims to probe into the feasibility of predicting dangerousness amongst Chinese psychiatric inpatients, and thus to find out the factors associated with dangerousness.

METHODOLOGY

SUBJECTS

The sample was selected from two wards in Shanghai Mental Health Centre, one for male and one for female. The subjects were those who were diagnosed as schizophrenia or schizophrenic disorders, according to Chinese Classification and Diagnostic Criteria of Mental Disorders, 2nd Edition, who were consecutively admitted to these two wards between Jan. 1 to Nov. 31, 1991. During the first 15 days of hospitalization, a Modified Overt Aggression Scale (MOAS) (Kay, 1988) was used to assess the dangerous behaviour occurred in each patient. Those patients, who got the weighted total scores of more than 4, were selected into "violent" group, while the rest entered the "nonviolent" control group.

PROCEDURES

Within the first seven days of hospitalization, the newly admitted patients were assessed by sociodemographic information (self-designed) and the Brief Psychiatric Rating Scale (BPRS). During the first fifteen days of hospitalization, each patient was assessed by MOAS according to the nursing records. In the first month of hospitalization, each patient was assessed by the "12-item Symptom Rating Scale, which was devised on the basis of PSE and SAPS, and each item consisted of three ratings. A Brain Evoked Potentials (BEP) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered before the patients were discharged. All the significant testings and logistic regression were made on the software of Biomedical Computer Programmes.

RESULTS

Among the sample of 134 (74 of male and60 of female), 82 patients finished all the examinations designed (46 of male and 36 of female). …

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