MANAGEMENT OF aggressive PATIENT Dr. Eman abahussain Consultant Psychiatrist Clinical Assistant Professor King Saud University College of Medicine

Usually the majority of Psychiatric patients are not Hostile, Dangerous or aggressive, BUT occasionally Psychiatric Illness presented in Aggressive Behavior

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.

Predisposing causes of violence 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.

Alcohol >> reduce self-control>> aggression 4. Alcohol & Drugs:- Alcohol >> reduce self-control>> aggression C.N.S. stimulants ( amphetamine ) >> over activity & over stimulation >>> Aggression. Heroin addicts during Withdrawal phase.

7. Dementia:- cerebral damage , decreased control aggression 5. delirium: clouding of consciousness , diminished comprehension, anxiety, perplexity, delusion of persecution , Aggression. 6. Epilepsy:- in the post-epileptic confessional state 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. .

Positive predictors of violence: Male gender Prior history of violence Psychiatric illness Drug or ethanol abuse

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 - Doctors, Nurses, relatives should treat such pt with understanding & gentleness as possible. - Adequate security. - Raise of alarm. - Availability of more staff.

- 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 Remain calm, non-critical

Management Options: Verbal de-escalation Physical restrains Chemical restrains.

Verbal de-escalation Calm, slow talking Be firm and assertive Avoid argumentative or condescending language.

Physical restrains - 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.

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.

Chemical restrains. antypsychotic medication Typical . Chlorpromazine 50-100mg im . Droperidol 10-20mg im or iv. . Clopixol Aquaphase 50-100mg im Atypical - Risperidone 4mg - Zyprexia 10mg im.

Benzodiazepine:- Diazepam 5-10mg po or iv Benzodiazepine:- Diazepam 5-10mg po or iv. In epilepsy, withdrawal of alcohol or barbiturates.

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

Thank you