Aggression

Question 1

What is the definition of aggression? (You need to know this)

Answer 1

Any behaviour directed toward another individual that is carried out
with the proximate intent to cause harm.

In addition, the perpetrator must believe that the behaviour will harm the target, and
that the target is motivated to avoid the behaviour
(Anderson & Bushman, 2002)

Question 2

Why does the standard definition of aggression not suit psychiatric patients?

Answer 2

Aggression definition (in psychiatric research) = Any verbal, non-verbal or physical behaviour that was threatening or physical behaviour that actually did harm (to self, others or property).

There is not always an intent to cause harm, but the patient can still show aggressive behaviour

Question 3

Why are there so many different numbers of reported incidents in psychiatry/year?

Answer 3

very differing numbers among studies. Bc of definition, in/excluding verbal aggression, type of ward, ..

Question 4

What are the current treatment options against aggression?

Answer 4

Pharmacotherapy
* Antipsychotics
* Antidepressants (e.g., fluoxetine)
Psychotherapy
* Emotion Regulation
De-escalating programs for staff

Question 5

What percentage of patients cause these incidents?

Answer 5

10%

Question 6

Neurobiology of aggression: what biomarkers are increased?

Answer 6

Inflammation (IL-6, TNF-alfa, CRP (c-reactive protein)
HPA axis
Serotonin (deficiency)

Question 7

Supplying aggression-cases with sufficient nutrients: what is a summary of previous studies?

Answer 7

• Reductions in aggression
• Low nutrient concentrations benefit the most
• Randomization or blinding not always successful
• Children and adolescents
• Medication excluded

Question 8

Rationale PSYVA & PSYVB (maybe need to look into this more)

Answer 8

was the population of previous studies really a population at risk? Did they have a lower nutritional status compared to the rest of the population?

Question 9

Aim of PSYVA vs PSYVB?

Answer 9

PSYVA:

assess whether multivitamin, mineral and n-3 FA supplementation reduces aggressive incidents among long-stay psychiatric in-patients

PSYVB:

…. among people with intellectual disabilities

Question 10

Design of PSYVA?

Answer 10

randomization of two groups: supplement (two multivitamin, one omega-3) + placebo

Both:
Baseline (blood samples, questionnaires: about incidents, nurses have to fill it in)
2 weeks (questionnaires)
2 months (questionnaires)
6 months (blood samples, questionnaires)

continuous monitoring incidents

Multisite setting

Question 11

Results PSYVA?

Answer 11

 No difference in number of incidents, no differences in type of incidents
 Difference in patients that did not take psychotics

Question 12

Challenges PSYVA?

Answer 12

• Multisite setting
• Selection supplement
• Recruiting patients
• Preventing dropout

Question 13

What are explanations for the fact that there was no effect found in PSYVA?

Answer 13

• Different population
• Antipsychotics may have induced a ceiling effect
• Different forms of aggression may have been included
• COVID pandemic
• No info on dietary intake (PSYVA)
• High dropout rates (PSYVB)