MANAGEMENT OF aggressive PATIENT Dr. Rabie Hawari Consultant Psychiatrist Clinical Assistant Professor

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.

EXAMPLES OF AGGRESSIVE PTS.:- 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.

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.

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.

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.

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

- 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.

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.

Cont. Manage. Of aggressive pt. - Use minimum force with adequate numbers of staff. - Talk pt. down - Do not argue with the pt.

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.

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.

MEDICATION:- Typical :- Major Tranquilizer . Chlorpromazine 50-100mg im . Droperidol 10-20mg im or iv. . Clopixol Aquaphase 50-100mg im Atypical - Risperidone 4mg - Zyprexia 10mg im.

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

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