psych: aggressive client

Anger

- A normal human behavior or emotion
- A strong and uncomfortable emotional response to a real or perceived provocation
- Positive force leading to problem solving and productive change when appropriately handled
- Potentially destructive and life-threatening when inappropriately channeled (denial, suppression)

• Catharsis
o Expression of anger through aggressive but safe means like hitting a punching bag and yelling
o Increases anger rather than alleviating

• Assertive Communication
o Use of word “I” in accepting one’s anger
 Example
• I am angry about your constant nagging.

Anger Control versus Anger Suppression

Anger Control
• Utilizing Assertive communication
• Use of non-aggressive means like walking or talking

Anger Suppression
• Common in women
• Prevents the expression of anger and keeping it
• Prone to somatic and psychological complications


Hostility

- Also known as verbal aggression
- An emotion expressed through verbal abuse, uncooperativeness, threatening behaviors, and lack of concern for laws and norms
- Expressed when threatened or powerless
- Intended to intimidate


Passive Aggressiveness/ Passivity

- Indirect and subtle expression of anger toward others
- People who are afraid of rejection or punishment


Intermittent Explosive Disorder

- Aggression as its main symptom
- An impulse control disorder
- Failure to resist aggressive impulses
- Aggressive episodes are out of proportion
- Behavior is not caused by a physiologic effect or drugs


Etiology

- Serotonin, GABA, and Dopamine derangements
- Brain Damages and trauma
- Alzheimer’s
- Hormonal Imbalances
- Dementia
- Alcohol or Drug Abuse
- Nutritional Deficiencies
- Medication Non-Compliance


Best Predictors of Potential Violent Behavior:
1. Excessive alcohol intake
2. History of violent acts, with arrests or criminal activity
3. History of childhood abuse.

Signs of Impending Violence:
1. Recent acts of violence inc. property violence
2. Verbal and physical threats.
3. Carrying weapons or other objects that may be used as weapons.
4. Progressive psychomotor agitation.
5. Alcohol or other substance intoxication.
6. Paranoid features in a psychotic patient.
7. Command violent auditory hallucinations.
8. Brain diseases
9. Catatonic excitement
10. Certain manic episodes
11. Certain agitated depressive episodes
12. Personality disorders

PSYCHOTHERAPY

 Empathy is critical to healing.
 Note vulnerability of selected close relatives.
 No single approach is appropriate for all persons in similar situations.


When you don’t know what to say, the best approach is to LISTEN.
PHARMACOTHERAPY

 Major indications for the use of psychotropic medication:
1. violent and assaultive behavior
2. massive anxiety/panic

Onset and Clinical Course

- Sudden and explosive
- Often in 5 stages known as the assault or aggression cycle
- Triggering and Escalation Phases are the most critical stages for preventing physical aggression


Use of Restraints:
 Preferably five or a minimum of four persons should be used to restrain the patient. Leather restraints are the safest and surest type of restraint.
 Explain to the patient why he or she is going into restraints.
 A staff member should always be visible and reassuring the patient who is being restrained.
 Patients should be restrained with legs spread-eagled and one arm restrained to one side and the other arm restrained over the patient's head.
 Restraints should be placed so that intravenous fluids can be given, if necessary.
 The patient's head is raised slightly to decrease the patient's feelings of vulnerability and to reduce the possibility of aspiration.
 The restraints should be checked periodically for safety and comfort.
After the patient is in restraints, the clinician begins treatment, using verbal intervention.
 Even in restraints, most patients still take antipsychotic medication in concentrated form.
 After the patient is under control, one restraint at a time should be removed at 5-minute intervals until the patient has only two restraints on. Both of the remaining restraints should be removed at the same time, because it is inadvisable to keep a patient in only one restraint.
 Always thoroughly document the reason for the restraints, the course of treatment, and the patient's response to treatment while in restraints.