Transcript Psychopharmacology and Other Biologic Treatments

Management of Aggression and
Violence
Chapter 34
Anger
• Affective state experienced as the
motivation to act in ways that warn,
intimidate or attack those who are
perceived as challenging or threatening
• Targets
– Others
– Impersonal objects/life situations
– Oneself
Experience of Anger
• Anger is a signal that something is wrong.
• It is a normal human emotion.
• It is inappropriate expression of anger that
may be threatening to the self or others.
• Difficulties expressing anger are associated
with psychiatric problems.
• Behavioral expressions of anger may vary.
Aggression vs. Violence
• Aggression
– Verbal statements that are intended to threaten
– Does not occur in a vacuum
– Must consider the context
• Violence
– A physical act of force intended to cause harm to a
person or an object
– Conveys a message that the perpetrator’s point of
view is correct, not the victim’s
Models
Biological
– Cognitive neuroassociation
– Neurostructural model - emotional circuit
– Neurochemical model -  serotonin
Models
Psychological
– Psychoanalytic
– Behavioral theories
– Drive
– Social learning
– Cognitive
Models
Social
– Western society’s values competitive, individualistic
– Interactional theory - Morrison
Nursing Management
Psychosocial Assessment
Biologic Assessment
•
Exposure to toxic chemicals
•
Thought processing
•
Missed doses of medications
•
Perception
•
Intoxication and withdrawal
•
Sensory impairment
•
Characteristics
•
Social factors, such as home,
family or community problems
– History or evidence of CNS
lesion or dysfunction
– Sudden onset and unprovoked
– Outburst less controlled
– Episode with clear beginning
and end
– Expression of remorse after
episode
– Financial
– Legal
Nursing Diagnosis
• Risk for self-directed violence
• Risk for other-directed violence
Planning Interventions
• Development of a partnership between nurse and
patient, who work together to find solutions to prevent
the recurrence of explosive episode
• Guidelines for reducing risk:
• Using non-threatening body language
• Respecting patient’s personal space and boundaries
• Positioning for immediate access to door
• Leaving door open when talking to patient
• Knowing where colleagues are, let colleagues know where you
are
• Removing clothing or accessories that could be harmful
Biologic Interventions
Administering and Monitoring Medications
• Atypical antipsychotics
• SSRIs
• Beta-adrenergic receptor blockers
• Lithium carbonate
• Divalproex sodium and carbamazepine
Psychological Interventions
Affective Interventions
– Validating
– Listening to patient’s illness experience
– Exploring beliefs
Psychological Interventions
Cognitive Interventions
– Giving commendations
– Offering information
– Providing education
– Contracting
Psychological Interventions
Behavioral Interventions
– Using bibliotherapy
– Interrupting patterns
– Providing choices
Social Interventions
• Reducing stimulation
• Anticipating needs
• Interactional processes
Nurses’ Responses to Assault
•
•
Affective
–
Irritability
–
Depression
–
Anger
–
Anxiety
–
Apathy
Cognitive
–
•
Behavioral
–
•
Suppressed or intrusive thoughts of assault
Social withdrawal
Physiologic
–
Disturbed sleep
–
Headaches
–
Stomach aches
–
Tension