Transcript Lecture Title : Aggressive Patient

Lecture Title :
Aggressive Patient
Level : 4th year Medical Students
Course : 462 Psych.
Lecturer :
Prof. Mohammed Alsughayir
Consultant Psychiatrist
‫أد محمد بن عـبدهللا‬
‫الصغـيّر‬
Aggressive patient 462Psych Prof. Alsughayir
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Lecture Objectives
Knowledge
Aggression:
Substance-Induced
AttitudePsychosis.
Skills
Personality Disorders related to psychosis.
Positive attitude toward
Terminology : aggression> meaning
How to deal with an
aggressive patient.
1. Patients.
Clinical Presentation.
Causes.
2. Treatment.
Management.
Aggressive patient 462Psych Prof. Alsughayir
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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.
Aggressive patient 462Psych Prof. Alsughayir
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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).
Aggressive patient 462Psych Prof. Alsughayir
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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.
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Medications
• E.g. Olanzapine5-10mg Im,
• Haloperidol 5 - 10 mg IM or
• Chlorpromazine 50 - 100 mg IM.
Hospitalization:
For further assessment and treatment.
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