Presentation on theme: "MANAGEMENT OF aggressive PATIENT"— Presentation transcript:
1 MANAGEMENT OF aggressive PATIENT Dr. Rabie HawariConsultant PsychiatristClinical Assistant Professor
2 Usually the majority of Psychiatric patients are not Hostile, Dangerous or aggressive, BUT occasionally Psychiatric Illness presented in Aggressive Behavior
3 DEFINITIONS:-Aggression “ feeling of anger or antipathy resulting in hostile or violent behavior, readiness to attack or confront “The aggressive patient usually presents as a danger to others, to property and sometimes to himselfAggression could occur in the A/E, OPD either psychiatry or others, the hospital ground or the wards, therefore the policy applies to all these situations accordingly.
4 EXAMPLES OF AGGRESSIVE PTS.:- 1. Antisocial & Borderline Personality Disorder.2. Hypomania or mania >>> may beangry & hostile if they are obstructed3. Schizophrenia >> due to Delusionalbeliefs or in response to auditoryHallucination.Catatonic type >> outbursts of over activity &/or aggressive behavior.
5 Cont. examples of aggressive Pts. 4. Alcohol & Drugs:-Alcohol >> reduce self-control>> aggressionC.N.S. stimulants ( amphetamine ) >> over activity & over stimulation >>>Aggression.Heroin addicts during Withdrawal phase.
6 Cont. Examples of aggressive Pts.:- 5. Acute Confessional State >> clouding of consciousness >>> diminished comprehension, anxiety, perplexity, delusion of persecution >>>> Aggression.6. Epilepsy:- in the post-epileptic confessional state.
7 Cont. Examples of aggressive Pts. 7. Dementia:- cerebral damage >>>> decreased control >> aggressionCatastrophic Reaction:- when facing difficult tasks they become restless, disturbed, angry, aggressive, throw things & attack people mostly at night.
8 PREVENTION POLICY - Never attempt to evaluate an armed patient - Carefully search for any kind of offensive weapon ( by the security )- Anticipate possible violence from hostile, threatening behavior, & from restless, agitated abusive pts
9 - Keep the door open for an exit - No obstruction to exit for you or pt. - Do NOT bargain with a violent person. - Reassure the patient and encourage self control and cooperation.
10 MANAGEMENT OF AGGRESSIVE PT. - Doctors, Nurses, relatives should treat such pt. with understanding & gentleness as possible.- Adequate security.- Raise of alarm.- Availability of more staff.- Clear prevention policy to all.- Remain calm, non-critical.
11 Cont. Manage. Of aggressive pt. - Use minimum force with adequatenumbers of staff.- Talk pt. down- Do not argue with the pt.
12 PHYSICAL RESTRAIN :-- Assign one team member to each of the pts head and extremities. - Be humane but firm, don’t bargain. - Use minimum force. - Start together to hold the patient and accomplish restraint quickly.
13 SECLUSION:- Not as a punishment For the safety of pt., staff, property & others,On time-out bases,Regular check up on the pt.,Attend for the pt. basic needs,Evaluation of the condition by a Dr.,Monitor pt. through a screen.
14 MEDICATION:- Typical :- Major Tranquilizer . Chlorpromazine mg im. Droperidol 10-20mg im or iv.. Clopixol Aquaphase mg imAtypical - Risperidone 4mg- Zyprexia 10mg im.
15 Medication cont.:-Benzodiazepine:- Diazepam 5-10mg iv. In epilepsy, withdrawal of alcohol or barbiturates. ( may disinherit violence.)
16 HOSPITALIZATIONAdmission may be needed to a secured psychiatric ward for further assessment and treatment