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Diagnosis of psychiatric aggression

Three Part Question

In [adults suffering from agitation with a psychiatric cause] does [the Overt Aggression Scale][reduce interobserver and intraobserver variability when measuring agitation]?

Clinical Scenario

A patient enters the Accident and Emergency department. They are clearly distressed and do not respond to verbal pleas to calm down. They begin to act in a violent and threatening manner toward the staff, themselves or the other patients. You wonder how you should objectively assess this patient's level of agitation and aggression in order to best treat them.

Search Strategy

MEDLINE 1950 to June week 2 2010 using the OVID interface, EMBASE 1980 to week 24 2010 using the OVID interface, psycINFO 1806 to June week 3 2010 using the OVID interface
"Overt aggression scale".mp LIMIT to human and English language

Search Outcome

352 papers found, of which 1 was relevant

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Yudofsky SC et al
45 patients, (16 of which were children) at various psychiatric centres, involved in a total of 159 acute psychiatric episodesDiagnostic studyPearson correlation coefficient for verbal aggression+0.12No sample size calculation, small sample size Use of scale requires some staff training
Pearson correlation coefficient for physical aggression against objects+0.86
Pearson correlation coefficient for physical aggression against self+1.0
Pearson correlation coefficient for physical aggression against others+0.17


A simple, reliable, objective and simple method of rating aggression and hostility in an acute setting is vital for the efficient and safe treatment of psychiatric patients. Whilst this study is dated it does show that the Overt Aggression Scale is effective at objectively measuring and quantifying verbal and physical aggression in an acute setting. However, small sample sizes and alterations to the scale during the test mean that further study is warranted.

Clinical Bottom Line

Use of the Overt Aggression Scale is warranted but further research would be beneficial


  1. Yudofsky CS et al The Overt Aggression Scale for the Objective Rating of Verbal and Physical Aggression Am J Psychiatry Jan 1986, pp 35-39