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Aggression Residents Seminar

Aggression Residents Seminar. Dr. Michael P. Chan June 6, 2012. Issues. Violence in S ociety Complex Interactions of Factors Legal Approaches Emotional R esponses Clinical Approaches. Formulation of Violence: Factors. Biological Neuropsychiatric Seizure, TBI Neurotransmitter

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Aggression Residents Seminar

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  1. AggressionResidents Seminar Dr. Michael P. Chan June 6, 2012

  2. Issues • Violence in Society • Complex Interactions of Factors • Legal Approaches • Emotional Responses • Clinical Approaches

  3. Formulation of Violence: Factors • Biological • Neuropsychiatric • Seizure, TBI • Neurotransmitter • Decreased 5HT, Impulsivity • Increased NE, DA • Genetic • Loading, Chromosome Abrnormality

  4. Factors Cont’d • Psychological • Child Abuse • Witnessing Domestic Violence • Media Exposure • Social • Poverty, Deprivation, Unemployment • Family Breakdown • Subculture – Gang • Other Environmental • Overcrowding • Heat

  5. Clinician Safety • Patient Attacks • Psychiatrist/Resident 40% • Nurse 80% • Inexperience • Limit Setting • Interview Setting • Counter Transference • Restrain or Talk • Clinical Approach • Categorize • Organic, Psychotic, PD/Other

  6. Talk Approach • Calm Manner • Acknowledge the Affect • Respectful • Non-judgmental • Non-provocative • Physical Space, sit • Minimal Eye Contact • Listen Empathically • Controlled Manner • Offer Medication

  7. Physical Setting • Furniture Layout • Exits • No Projectiles • Panic Button • Clothing, Jewelry

  8. Physical Defence • Stand Facing Sideways • Arms for Defence • Deflect Kicks with Legs • Shields – Objects, Mattress • Grabbed – Thumb • Hair Pull – Control Hand • Choke Hold – Tuck Chin

  9. Patient with Weapon • Expose Few Staff • Calm, Talk to Patient • Put Weapon Down • Do Not Go for Weapon • Plan – Hostage Situation

  10. Intervene Before Attack • Staff Adequate and Trained • Staff Caring, Non-authoritarian, and in Control • Talk and Listen to Patient • Recognize Warning Signs • Staff Issues • Monitor Own Countertransference Feelings • Monitor Ward Dynamics • Staff Conflict

  11. Intervention Cont’d • Defence Mechanisms • Denial • Projection and Overestimation • Displacement • Negative Reactions – Prejudice • Other Dynamics – Admin • Debriefing Meetings

  12. Clinical Assessment: History Taking • Violence as Presenting Problem • Duration, Frequency, Target • Pattern • Injuries • Past Investigations • Impulsivity Features • Familial Violence • Developmental Insults • Medical

  13. Clinical Assessment: Diagnostic Groups • Organic • Substances/Alcohol • Brain Disorders • Systemic Illness • O2 • Liver • Kidney • Metabolic/Endocrine • Metals • SLE • Porphyria • Vitamin • Electrolyte

  14. Clinical Assessment:Psychiatric Disorders • Psychotic • P.D. Cluster B. • M.R. • ADHD • IED

  15. Clinical Assessment:Investigations • Bloodwork • EKG CXR • Drug Screen • EEG • Other – Metals • MRI • Psychological

  16. Summary • Violence in Society • Complex Interactions of Factors • Legal Approaches • Emotional Responses • Clinical Approaches

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