Social, demographic, and clinical factors related to disruptive behaviour in hospital

Abstract

Objective: This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not.

Method: We completed a case-control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier.

Results: Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; chi2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model (R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95% CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital.

Conclusions: Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.