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Presentation on theme: "MANAGEMENT OF aggressive PATIENT"— Presentation transcript:

Dr. Rabie Hawari Consultant Psychiatrist Clinical 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 himself Aggression 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.

1. Antisocial & Borderline Personality Disorder. 2. Hypomania or mania >>> may be angry & hostile if they are obstructed 3. Schizophrenia >> due to Delusional beliefs or in response to auditory Hallucination. Catatonic type >> outbursts of over activity &/or aggressive behavior.

5 Cont. examples of aggressive Pts.
4. Alcohol & Drugs:- Alcohol >> reduce self-control>> aggression C.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 >> aggression Catastrophic 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.

- 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 adequate numbers 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 im Atypical - Risperidone 4mg - Zyprexia 10mg im.

15 Medication cont.:- Benzodiazepine:- Diazepam 5-10mg iv. In epilepsy, withdrawal of alcohol or barbiturates. ( may disinherit violence.)

16 HOSPITALIZATION Admission may be needed to a secured psychiatric ward for further assessment and treatment

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