Lecture Title : Aggressive Patient Level : 4 th year Medical Students Course : 462 Psych. Lecturer : Prof. Mohammed Alsughayir Consultant Psychiatrist أد محمد بن عـبدالله الصغـيّر Aggressive patient 462Psych Prof. Alsughayir 1

2 Lecture Objectives Substance-Induced Psychosis. Personality Disorders related to psychosis. SkillsAttitudeKnowledge How to deal with an aggressive patient. Positive attitude toward 1. Patients. 2. Treatment. Aggression: Terminology : aggression> meaning Clinical Presentation. Causes. Management.

A 34-year-old married man was brought to Emergency because he was potentially assaultive, physically abusive, and threatened to kill his father. -Aggressive patients are frequently seen in Emergency /Wards. - Causes: Brief psychosis /schizophreniform disorder /acute schizophrenia. Substance abuse (intoxication / withdrawal). Acute organic brain syndrome (delirium). Personality disorders (e.g. borderline personality disorder). Mood disorders; mania - severe agitated depression. 3 Aggressive patient 462Psych Prof. Alsughayir

Approach - Arrange for adequate help & appear calm and helpful. - Avoid confrontation, aim to save patient and others & take precautions: # Never attempt to evaluate an armed patient. # Carefully search for any kind of offensive weapon. # Anticipate possible violence from hostile, threatening behavior. & from restless, agitated abusive patient. # Other persons should be present (security guards or police officers). # Keep the door open for an unavoidable exit. # Restraints if needed (adequate number of people / the minimum of force). 4 Aggressive patient 462Psych Prof. Alsughayir

Approach Do not bargain with a violent person about the need for restraints, medication or admission. Reassure the patient and encourage self-control and cooperation. Restraint Technique: Enough staff should be available. If restraint becomes necessary, assign one team member each to the patient’s head and to each extremity. Be humane but firm, and do not bargain, start together to hold the patient and accomplish restraint quickly. 5 Aggressive patient 462Psych Prof. Alsughayir

Medications E.g. Olanzapine5-10mg Im, Haloperidol mg IM or Chlorpromazine mg IM. Hospitalization: For further assessment and treatment. 6 Aggressive patient 462Psych Prof. Alsughayir