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Clinical Trial
. 2019 Nov 21;9(1):17228.
doi: 10.1038/s41598-019-52940-w.

Detection of Impending Aggressive Outbursts in Patients with Psychiatric Disorders: Violence Clues from Dogs

Uriel Bakeman  1 , Hodaya Eilam  2 , Clara Moray Schild  3 , Dan Grinstein  4 , Yuval Eshed  4 , Morris Laster  1 , Ester Fride, Sharon Anavi-Goffer  5
Affiliations
Clinical Trial

Detection of Impending Aggressive Outbursts in Patients with Psychiatric Disorders: Violence Clues from Dogs

Uriel Bakeman et al. Sci Rep. .

Abstract

Aggression in psychiatric wards is a continuing matter of concern for both patients and medical staff. Here we have tested the hypothesis that the frequency of such incidents can be reduced with a new strategy of using trained alert dogs that warn of impending violent outbursts. Dogs were positioned among patients in psychiatric wards. Analyses show that the dogs warned of impending aggressive outbursts, responding to signals from a specific patient out of a group of unfamiliar psychotic patients. Their alerts were not a response to stress as canine cortisol levels were not significantly changed. Visual glance was the preferred method used by young dogs to respond to patient. Until a similar electronic technology is developed, trained alert dogs can help caregivers to protect both the patient and those around them from injuries that may otherwise result from aggressive outbursts in psychiatric patients.

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Conflict of interest statement

H.E.,C.M.S., D.G., Y.E., E.F. and S.A.G. have no financial or non-financial interests that may be relevant to the submitted work. Y.E. (Yoad Eshed Ltd) is an independent consultant who contributed to the design of this study. He has nofinancial or non-financial interests and he is not funded by Mind Print Ltd. U.B. (Mind Print Ltd) and M.L. (MindPrint Ltd) have financial and non-financial interests in the company Mind Print Ltd and in training alert dogs. This does not alter our adherence to a high academic integrity and sharing policies of data and materials.

Figures

Figure 1
Figure 1
Schematic illustration of the visible area of the ward. During a session, the trainer was located at a fixed position in the ward (i.e. recreation area).
Figure 2
Figure 2
Trained-alert dogs identify violent outbursts in advance. A significant association was found between positive alerts and true outbursts when dogs were (A) at pre-puberty or (B) adult. ***p < 0.0001, Chi square (total N 293) or Fisher’s exact tests, respectively.
Figure 3
Figure 3
A comparison of cortisol level in dogs’ saliva before alerts and after alerts. A total of 24 samples were collected. (A) In the ‘baseline’ group, 18 samples were collected before the dogs started their sessions (17 samples analysed, one sample was below kit sensitivity). The mean cortisol level before alerts (‘Baseline’ group) was not significantly different from the mean cortisol level after alerts (‘Alert’ group). Results are expressed as means ± SEM, unpaired, two-tailed, Student’s t test p = 0.45. (B) Out of all samples, 3 pairs of samples (before/after alert) per each dog (a total of 6 pairs) were compared. Mean cortisol levels of the paired samples was not significantly different. Results are expressed as means ± SEM, two-way analyses of variance (ANOVA), matched values, p = 0.26, F(1,1) = 5.52.
Figure 4
Figure 4
‘Outbursts’ vs. ‘Physical restraints’. The number of outbursts was significantly higher than the number of physical restraints at the wards. Results are expressed as means per hour (±95% CI). * p < 0.05 by confidence intervals.
Figure 5
Figure 5
Physical restraints. The number of physical restraints per day in the ward for each month in the years (A) 2010 and (B) 2011. (C) The mean of physical restraints per day was calculated from the data in A and B.
Figure 6
Figure 6
‘Focused’ vs. ‘Unfocused’ alerts. (A) Adult dogs produce significantly less ‘focused’ alerts and significantly more ‘unfocused’ alerts. (B) Adult dogs alert more frequently. (C) The number of working hours by each dog. (D) The frequency that each dog started a session. * vs. ‘focused’ and # vs. ‘unfocused’ at pre-puberty, p < 0.05, Wald method for 95% confidence intervals of ratios.
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