Volume 33, Issue 123 (April 2020)                   IJN 2020, 33(123): 62-72 | Back to browse issues page


XML Persian Abstract Print


1- Psychiatric Nursing, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
2- Nursing Care Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
3- Nursing Care Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 02143651814 Email: mardanihamoole.m@iums.ac.ir
4- Psychiatric Nursing, Iran Psychiatric Center, Iran University of Medical Sciences, Tehran, Iran
5- Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (5198 Views)
Background & Aims: In the bipolar disorder, the mood of the individual is damaged and constantly and abnormally changes from very good to very bad and depressed. Outbursts of explosive anger are one of the characteristics of patients with the bipolar disorder, which causes self-harm and harm to others. Aggression occurs in this population due to factors such as the lack of social support, frequent recurrence of the disease, and failure to use medication. The main consequence of aggression in this vulnerable population is that they are pushed toward substance abuse and alcohol consumption, which eventually disrupt their social functioning. Considering the adverse, debilitative effects of aggression on patients with the bipolar disorder, proper measures must be taken for effective management. Since patients with the bipolar disorder experience severe emotional fluctuations that could damage themselves, their families, other patients, and nurses, it is important to reduce the damages to others and replace aggressive behaviors with constructive interactions in the form of anger management programs. Anger management is a skill taught for the control of aggression in bipolar patients. In fact, anger management helps these individuals learn how to stay calm and control their negative emotions before the onset of anger. In other words, the purpose of this psychological training is to increase psychosocial abilities, effectively deal with the conflicts in life, prevent harmful behaviors to health, and promote the mental health of bipolar patients. The present study aimed to evaluate the effect of an anger management educational program on the aggression of individuals with bipolar disorders.
Materials & Methods: This single-group, quasi-experimental study was conducted at Iran Psychiatric Center in 2019 on 39 participants, who were selected via continuous sampling from the admitted patients with the bipolar disorder based on the inclusion and exclusion criteria of the study. Data were collected using a demographic questionnaire for the variables of age, gender, marital status, occupation status, education level, and history of admission due to bipolar disorders. In addition, the valid and reliable aggression scale by Buss and Perry was used for data collection, which consisted of for subscales, including physical aggression, verbal aggression, anger, and hostility. Initially, a pretest was performed on the participants. Afterwards, the anger management training program was presented to the participants. Notably, the contents of the educational program were prepared based on the available texts regarding anger management with an emphasis on the psychotherapeutic considerations regarding the aggression of patients with the bipolar disorder. The covered subjects in the program included ways to deal with anger and aggression, teaching effective anger management skills, playing a role in anger, teaching problem-solving skills, and decisiveness training for patients with the bipolar disorder. Following that, the validity of the educational contents was confirmed by psychiatric nursing professors. The training program was presented through lecture by the co-researcher with questions and answers between the researcher and the participants and expressing the experiences and roles played by the participants in the study. The program was implemented for four weeks with two 60-minute sessions each week. Due to the fact that it was not possible to gather all the participants in the training sessions, the sessions were held in small groups with gender segregation for 5-7 participants. The meetings were held after the hour of prayer and lunch in the visiting rooms of the inpatient wards. In addition, a 15-minute break was considered for each session. One month after the intervention, the participants were post-tested. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the participants and their voluntary participation. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (paired-t test).
Results: At the pretest, the mean score of aggression was 99.74±14.73, which reduced to 83.21±11.68 at the posttest. At the pretest and posttest stages, the mean scores of physical aggression, verbal aggression, anger, and hostility were 32.90±8.02 and 28.87±6.86 (P=0.042), 19.41±3.73 and 17.77±3.55 (P=0.814), 22.69±4.47 and 17.85±3.41 (P=0.010), and 24.74±7.55 and 18.72± 6.55 (P=0.032), respectively. In addition, the results of paired t-test indicated significant differences in the scores of aggression at the pretest and posttest in the patients with the bipolar disorder (t=-3.061; P=0.003). The anger management educational program affected all the dimensions of aggression, with the exception of verbal aggression (P=0.814).
Conclusion: According to the results, anger management training could reduce the aggression of the patients with the bipolar disorder in the subscales of physical aggression, anger, and hostility. Our findings could be a step toward the implementation of anger management training for this population of inpatients admitted to psychiatric centers in order to improve their aggression. Furthermore, it is recommended that nurses working in psychiatric wards become familiar with the educational contents of anger management for the subjects under study, so that they could perform the program at the bedside of these patients in appropriate situations in admission wards. In addition, the obtained results are useful for nursing managers and psychiatrists to better manage the care of individuals with the bipolar disorder. In the field of clinical education, the content of anger management could be provided to clinical nursing instructors to acquaint their students with such trainings, so that students could use the contents in their care plans for patients with the bipolar disorder.
Full-Text [PDF 864 kb]   (1290 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2020/01/15 | Accepted: 2020/04/18 | Published: 2020/04/18

References
1. olfaei AG, Ataei S, Ghayoomi R, Shabani A. High Frequency of Bipolar Disorder Comorbidity in Medical Inpatients. Iranian journal of psychiatry. 2019;14(1):60-66.
2. Findling RL, Stepanova E, Youngstrom EA, Young AS. Progress in diagnosis and treatment of bipolar disorder among children and adolescents: an international perspective. Evid-based Ment Health. 2018;21(4):177-81. [DOI:10.1136/eb-2018-102912] [PMID]
3. Marangoni C, De Chiara L, Faedda GL. Bipolar disorder and ADHD: comorbidity and diagnostic distinctions. Current psychiatry reports. 2015;17(8):67. [DOI:10.1007/s11920-015-0604-y] [PMID]
4. Masand P, Correll CU, Yu X, Xiang Y, Kane JM. Biological treatment of acute agitation or aggression with schizophrenia or bipolar disorder in the inpatient setting. Annals of clinical psychiatry. 2017;29(2):92-107.
5. Roberts J, Canales AG, Blanthorn-Hazell S, Boldeanu AC, Judge D. Characterizing the experience of agitation in patients with bipolar disorder and schizophrenia. BMC psychiatry. 2018;18(1):1-8. [DOI:10.1186/s12888-018-1673-3] [PMID] [PMCID]
6. Genovese T, Dalrymple K, Chelminski I, Zimmerman M. Subjective anger and overt aggression in psychiatric outpatients. Comprehensive psychiatry. 2017;73:23-30. [DOI:10.1016/j.comppsych.2016.10.008] [PMID]
7. Dib JE, Adams CE, Kazour F, Tahan F, Haddad G, Haddad C, Hallit S. Managing acutely aggressive or agitated people in a psychiatric setting: a survey in Lebanon. Medical journal of the Islamic Republic of Iran. 2018;32:60. [DOI:10.14196/mjiri.32.60] [PMID] [PMCID]
8. Belete H, Mulat H, Fanta T, Yimer S, Shimelash T, Ali T, Tewabe T. Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study. BMC psychiatry. 2016;16(1):443. [DOI:10.1186/s12888-016-1151-8] [PMID] [PMCID]
9. Luo C, Chen H, Zhong S, Guo H, Li Q, Cai W, de Girolamo G, Zhou J, Wang X. Manic episode, aggressive behavior and poor insight are significantly associated with involuntary admission in patients with bipolar disorders. PeerJ. 2019;7:e7339. [DOI:10.7717/peerj.7339] [PMID] [PMCID]
10. Verdolini N, Perugi G, Samalin L, Murru A, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Barbuti M, Guiso G. Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features. Acta Psychiat Scandin. 2017;136(4):362-72. [DOI:10.1111/acps.12777] [PMID]
11. Perugi G, Angst J, Azorin JM, Bowden CL, Mosolov S, Reis J, Vieta E, Young AH. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiat. 2015;76(3):e351-8. [DOI:10.4088/JCP.14m09092] [PMID]
12. Drange OK, Vaaler AE, Morken G, Andreassen OA, Malt UF, Finseth PI. Clinical characteristics of patients with bipolar disorder and premorbid traumatic brain injury: a cross-sectional study. Int J Bipol Disord. 2018;6(1):19. [DOI:10.1186/s40345-018-0128-6] [PMID] [PMCID]
13. Alnıak İ, Erkıran M, Mutlu E. Substance use is a risk factor for violent behavior in male patients with bipolar disorder. J Affect Disord. 2016;193:89-93. [DOI:10.1016/j.jad.2015.12.059] [PMID]
14. Khalsa HM, Baldessarini RJ, Tohen M, Salvatore P. Aggression among 216 patients with a first-psychotic episode of bipolar I disorder. Int J Bipol Disord. 2018;6(1):18. [DOI:10.1186/s40345-018-0126-8] [PMID] [PMCID]
15. Van Meter A, Youngstrom E, Freeman A, Feeny N, Youngstrom JK, Findling RL. Impact of irritability and impulsive aggressive behavior on impairment and social functioning in youth with cyclothymic disorder. J Child Adoles Psychopharmacol. 2016;26(1):26-37. [DOI:10.1089/cap.2015.0111] [PMID] [PMCID]
16. Bragazzi NL, Pezzoni F, Del Puente G. Investigating aggressive styles and defense mechanisms in bipolar patients and in their parents. Health psychology research. 2014;2(3):1546. [DOI:10.4081/hpr.2014.1546] [PMID] [PMCID]
17. Dolenc B, Dernovšek MZ, Sprah L, Tavcar R, Perugi G, Akiskal HS. Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder. J Affect Disord. 2015;174:13-8. [DOI:10.1016/j.jad.2014.11.007] [PMID]
18. Sher L, Rice T, World Federation of Societies of Biological Psychiatry (Wfsbp) Task Force on Men's Mental Health. Prevention of homicidal behaviour in men with psychiatric disorders. World J Biolog Psychi. 2015;16(4):212-29. [DOI:10.3109/15622975.2015.1028998] [PMID]
19. Reich R, Gilbert A, Clari R, Burdick KE, Szeszko PR. A preliminary investigation of impulsivity, aggression and white matter in patients with bipolar disorder and a suicide attempt history. J Affec Disord. 2019;247:88-96. [DOI:10.1016/j.jad.2019.01.001] [PMID]
20. Yu X, Correll CU, Xiang YT, Xu Y, Huang J, Yang F, Wang G, Si T, Kane JM, Masand P. Efficacy of atypical antipsychotics in the management of acute agitation and aggression in hospitalized patients with schizophrenia or bipolar disorder: results from a systematic review. Shanghai archives of psychiatry. 2016;28(5):241-52.
21. Hayes JF, Pitman A, Marston L, Walters K, Geddes JR, King M, Osborn DP. Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: a UK population-based electronic health records study. JAMA psychiatry. 2016;73(6):630-7. [DOI:10.1001/jamapsychiatry.2016.0432] [PMID]
22. Belete H. Use of physical restraints among patients with bipolar disorder in Ethiopian Mental Specialized Hospital, outpatient department: cross-sectional study. Int J Bipol Disord. 2017;5(1):17. [DOI:10.1186/s40345-017-0084-6] [PMID] [PMCID]
23. Gaynes BN, Brown CL, Lux LJ, Brownley KA, Van Dorn RA, Edlund MJ, Coker-Schwimmer E, Weber RP, Sheitman B, Zarzar T, Viswanathan M. Preventing and de-escalating aggressive behavior among adult psychiatric patients: a systematic review of the evidence. Psychiatric services. 2017;68(8):819-31. [DOI:10.1176/appi.ps.201600314] [PMID]
24. Karimi H, Hemmati SA, Haghighi M, Ahmadpanah M, Mohammad BH. Comparing the effectiveness of group anger management and communication skills training on aggression of marijuana addicted prisoners. J Res Behav Sci. 2013;11(2):129-38.
25. Kwak EY, Choi DJ, Kim SJ, Choi EJ, Yeom EK, Kim JY, Shin JW, Jang SJ. The Effects of Anger Management Programs on Anger Expression in Psychiatric Inpatients. Korean Journal of Stress Research. 2014;22(3):159-97. [DOI:10.17547/kjsr.2014.22.3.159]
26. Buss AH, Perry M. The aggression questionnaire. J Person Soc Psychol. 1992;63(3):452-9. [DOI:10.1037/0022-3514.63.3.452]
27. Mohammadi N. A perliminary study of the psychometric properties of Buss and Perry's aggression questionnaire. Journal of social sciences and humanities of Shiraz University, 2007;25(4):135-51.
28. Mirzaei R, Meimandi NI, Mousavi E, Raesi Z, Masoudi S. Effectiveness of training problem solving and anger management on improve of problem solving ability and aggression control ability in prisoners. J Appl Environ Biolog Sci. 2016;6(5):167-72.
29. Bahrami E, Mazaheri MA, Hasanzadeh A. Effect of anger management education on mental health and aggression of prisoner women. J Educ Health Prom. 2016;5. [DOI:10.4103/2277-9531.184563] [PMID] [PMCID]
30. Zarshenas L, Baneshi M, Sharif F, Sarani EM. Anger management in substance abuse based on cognitive behavioral therapy: An interventional study. BMC psychiatry. 2017;17(1):1-5. [DOI:10.1186/s12888-017-1511-z] [PMID] [PMCID]
31. Lök N, Bademli K, Canbaz M. The effects of anger management education on adolescents' manner of displaying anger and self-esteem: A randomized controlled trial. Arch Psych Nurs. 2018;32(1):75-81. [DOI:10.1016/j.apnu.2017.10.010] [PMID]
32. Alijanzadeh M, Makvand HS, Kianersi F. The Effectiveness of Group Dialectical Behavior Therapy (Based on Skills Training) on Aggression in Adolescents. Journal of Clinical Psychology. 2014;6(3):23-33.
33. Branco LD, Cotrena C, Ponsoni A, Salvador-Silva R, Vasconcellos SJ, Fonseca RP. Identification and perceived intensity of facial expressions of emotion in bipolar disorder and major depression. Arch Clin Neuropsychol. 2018;33(4):491-501. [DOI:10.1093/arclin/acx080] [PMID]
34. Mneimne M, Fleeson W, Arnold EM, Furr RM. Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personality Disorders: Theory, Research, and Treatment. 2018;9(2):192-6. [DOI:10.1037/per0000255] [PMID] [PMCID]
35. Johnson SL, Carver CS. Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder. J Affec Disord. 2016;189:169-75. [DOI:10.1016/j.jad.2015.07.050] [PMID]

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.