Aggressive Behaviors due to Psychosis - Background and Significance

Aggressive Behaviors due to Psychosis - Background and Significance 
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Abstract
In most clinical settings, it is not correct to state that all patients diagnosed with psychotic episodes and mental illnesses are aggressive and violent. However, some patients with mental illnesses commit to violent acts due to their condition. A research was conducted where articles that were published between 1980 and 2019 were searched with specific keywords such as "schizophrenia," "aggression," "psychosis," and "violence." In the results, one article titled, article “Are patterns of violence and aggression at a presentation in patients with first-episode psychosis temporally stable? A comparison of 2 cohorts" was chosen. The article was published in 2019, and in comparison with the previous texts on the topic in the overall population, there is a significant escalation in aggression and assaults among patients with psychosis and schizophrenia. The review of the article has proven the importance of non-pharmacological methods of treatment on patients exhibiting violent acts due to psychoses and schizophrenia.
Introduction
The public believes that patients with mental illness are dangerous. This way, the fear of violence and the belief that they could cause injuries, permanent damages, and even death has led to the isolation and stigma of the patients. Nevertheless, an analysis of most psychiatric units has shown the existence and prevalence of violent and aggressive behavior among patients with psychotic episodes. The practice has placed healthcare personnel and other workers at considerable risk of the impacts of such acts. It is equally significant to stress the lack of adequate management of violent encounters and their tremendous implications on the health care services and communities. The chosen article outlines several methodological difficulties of the behaviors, including a poor definition of the challenges and lack of proper assessment tools that quantify the effects of violence in the context. The analysis of the article and the specific notion that violence, aggressive behavior, schizophrenia, and psychosis pose an unmitigated danger to the health care system is what led to the selection of the clinical problem. This paper seeks to examine the capacity of violence, aggressive behavior, schizophrenia, and psychosis and the underlying mechanisms of their management in a health care setting.
Assessment of the Phenomena
There are two classifications of aggressive behavior: impulsive and premeditated aggression. Impulsive aggression is triggered by environmental provocation and an abnormal response to a sudden or gradual change in the environment. This type of assault comprises a significant loss of control in behavior. On the other hand, intentional aggression is an organized act of aggression that is not spontaneous and does have agitation or loss of behavioral control. The definition of violence is offered by the MacArthur Community, which divides the act into two dependent upon its levels of severity: minor and significant force (Junginger, 2016). Premeditated violence is an act of violence characterized by mere and straightforward assaults without the use of weapons or severe injuries. In contrast, extreme violence is the cause of harm with the use of lethal weapons or any form of sexual assault. In different clinical settings, the various kinds of aggression and violence may be experienced by nurses and doctors on account of psychosis and schizophrenia and the absence of their treatment.
There is a similar prevalence of violence and aggressive behavior among patients suffering from psychotic episodes and schizophrenia. However, the media and the general population have portrayed patients who have schizophrenia to be unpredictably more dynamic and involved in robust violent activities (Volavka, 2019). There are detailed research and adequate investigation evidence that manifest that individuals suffering from the condition are at a significantly elevated risk of being charged and taken action upon cases of small criminal activities and a great risk of being charged with certain criminal cases and even homicides, as compared to the general population. The phenomenon has increased numerous accounts of stigmatization and poor treatment in health care settings because of the nurses' and doctors' fear of violence from the patients (Douglas, Guy & Hart, 2019). The forms of aggression are a result of multiple factors, including insufficient social and emotional support, drug and substance abuse, and the failure of healthcare practitioners to treat schizophrenic patients, among others.
There is a significant need for change in the current state of gaps in evidence on the context of primary care for patients who have schizophrenia and psychosis. The problem has escalated because of the inadequate attention given to the matter and even complete negligence of the patients with the condition. Clinical evidence is essential in the decision-making process and for the benefit of the patient. Therefore, practitioners should ensure that they practice intense planning, conduction, and evaluation of numerous clinical trials that conform to the right clinical practice (Rueve & Welton, 2018). Other methods of addressing the phenomenon would be the use of technological review models, organizational change models, and deliberate practice of guidelines before the application, provision, and presentation of evidence-based reviews before a decision is arrived upon and holding of consensus conferences when deciding on how to manage mental illness. Additionally, primary care should comprise incentive models, creation, and development of trust between mild and even aggressive patients with the doctors, practice-oriented analyses, and collaboration in the study of case studies on the matter (Volavka, 2019).
Historical and Societal Perspective
Psychosis and schizophrenia are dated back to 1841 when Canstatt coined the idea of psychic neurosis into the overall psychiatric literature. Before this, a supernatural obsession was another term for brain diseases, but Canstatt stated that the term would also be used to define issues and disorders of the brain. Years later, Feuchtersleben used the word as a synonym of psychopathy, and together with Canstatt, they received influences by Schneider, who included the annotation in his research of abnormal personalities of the brain in an individual (Volavka, 2019). The analysis was later advanced, and schizophrenia was introduced in 1910 by the Swiss psychiatrist, Paul Eugen Bleuler. He created the word from a derivation of “schizo," a Greek word for "split" and "phren" for "mind." There were numerous inventions as treatment methods for the symptoms of schizophrenia and psychosis. Some of the methodologies include fever therapy, which was composed of the injection of Sulphur, gas therapy, genocide, amputation of affected areas in the brain, sleep therapy, and electroconvulsive therapy.
The advent of antipsychotic medication and the sudden change of care in the community have given hope to patients who have schizophrenia because today, they have a chance at leading a healthy, productive, prolonged, and satisfactory life. The invention of Chlorpromazine drug in the 1950s was a breakthrough all over the world as schizophrenic patients were treated and allowed to have families and continue with their careers. During this time, there were no biomedical and physical defects associated with psychosis, schizophrenia, and any other form of mental illness, other than the highest aggressiveness and violence (Volavka, 2019). However, doctors found strong evidence that interconnected the disorder and its violent impacts to several genetic factors in the contribution of the advancement of the disease. Similar to the results of 1977 and 2019, social factors play a smaller role in the aggression and violence among the patients, and that is why the combination of pharmacological and non-pharmacological methods of treatment has been deemed successful in all contexts of the condition.
Incidence and Prevalence
This section narrows down to the incidence and prevalence of violent behaviors examined and collected on patients who have schizophrenia. The National Institute of Mental Health (NIMH) performed a survey in the United States in support of the Epidemiological Catchment Area (ECA) surveys to study the incidence and prevalence of mental disorders and their effects in the country. This survey was different from the ones that had been carried out before because it was based on orchestrated household interviews throughout five states in the United States, including prisoners. The questions asked in the investigations comprised a history of violence. The final analysis of the data collected showed an 8.5% one-year prevalence of assault practice on individuals suffering from schizophrenia and 2.1% of people who are not suffering from any mental disorder (Swanson et al., 2017). The results yielded that males show higher violent behaviors than females, and concurrent drug and alcohol abuse considerably increased prevalence of violent and aggressive behavior in schizophrenia.
The table below gives a small number of data collected by writers and researchers around the world and tabulated on the incidence and prevalence of violence and aggressive behaviors on patients who have schizophrenia and other mental disorders. The information on the table was retrieved from a peer-reviewed journal in the bibliography by Fazel et al. (2018).
Study

No. Scz Violence

No. Scz Patients

No. Pop Violence

No. Population