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Assessment of aggressive patient

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).

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Assessment of aggressive patient

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

  2. What is the difference between aggression & agitation?

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

  4. 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.

  5. 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.

  6. 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.

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

  8. 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.

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

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

  11. Show of force !!

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

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