Article Title: Psychiatric In-Patient Violence: Use Of Chemical And Physical Restraint At A University Hospital In Karachi, Pakistan

Author(s): Saman Iqbal, Haider Naqvi, Naim Siddiqi

Institute(s): Department of Psychiatry, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi 74800

Journal: Journal of Pakistan Psychiatric Society, 2006, Vol. 3, No. 1, p. 35–38

Correspondence Address: E-mail: saman.zuberi@aku.edu; Tel: 493 0051 ext 4692/ Fax: 493 4294

Abstract

Objective: To study the frequency of inpatient-violence and use of physical and chemical restraints in its management.

Design: Prospective observational study.

Place and duration of study: The Department of Psychiatry, Aga Khan University Hospital, Karachi between January 2004 and December 2004.

Subjects and Methods: Information on socio-demographic characteristics, psychiatric diagnoses, routine and as required psychotropic medications was collected for all patients admitted to psychiatric unit. An incidence reporting form was filled for each patient requiring physical restraint.

Result: Out of all the patients admitted (n=393) over the one-year period, 44% (n=175) patients required P.R.N. psychotropic medication. Intramuscular anti-psychotic medication was used in 50% cases, benzodiazepines in 33% while 16% required both. 14% (n=57) required physical restraints. 4-point restrain was used in 31 (54%) cases while 2-point restrain was used in 23 (40%) cases. No serious injury was noticed in any case. According to these two proxy indicators the frequency of violence in this in patients psychiatric setting is estimated to be 14%.

Conclusion: Incidence figures of inpatient violence in our psychiatric setting are alarmingly high. This requires systematic research related to the risk factors and determinants of inpatient violence.

Key words: Violence, Chemical restrain, Physical Restrain, Pakistan.