Assessment of aggressive patient DR.NOOR AL_MODIHESH LECTURER, CHILD PSYCHIATRY UNIT

What is the difference between aggression & agitation?

Aggression: Verbal or physical attack on other living creature or things. Aggressiveness: readiness to be aggressive (Scharfetter,1980)

Agitation: Mental disturbance causing physical restlessness & increased arousal. It is phenomenologically a description of a subjective mood state associated with and resulted in physical expression.

Common presentation to psychiatric emergency. It can be shown with any psychiatric condition, NOT necessary with the illness BUT may be an expression of individual ’s underlying personality.

Risk factors: History of violence. Significant psychomotor agitation or anger. Hx of impulsive behavior or fantasies of violence. Hx of childhood abuse. Frequently visualizing abuse. Presence of weapons. School failure, truancy.

Cont. Risk factors: Psychiatric disorders:  Manic phase.  MDD  Brief psychotic disorder\ schz. Cognitive dis. ( Delirium\dementia) 1 st psychiatric hospitalization < 18. Substance abuse. Personality dis. MR. Abuse by parents.

Cont. Risk factors: Physical health related issues:  Head inj.(frontal & temporal)  ictal & post ictal. Demographic data:  Male>female.  Young>old.  Lower socioeconomic status.  Few social support.

Management : In ER: Safety is the first consideration ( always stay beside gate) Few people. Avoid confrontation. Take precautions ( armed patients)

 Verbal communication can de-escalate the potential for violence & is a logical 1 st choice. Do not bargain with a violent person about the need for restraints, medication or admission

Show of force !!

Medication: Antipsychotics ( haloperidol, olanzapine) Can be given orally or parentally. BZD ( lorazepam) Hospitalization Hospitalization: For further assessment. Restraint might be needed.