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

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