Assessment of aggressive

patient

DR.NOOR AL_MODIHESHLECTURER , 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.MDDBrief psychotic disorder\ schz.

Cognitive dis. ( Delirium\dementia)1st 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 1st 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:For further assessment.Restraint might be needed.