Management of aggressive behaviour

Box 5.5 summarises the conditions in which unpredictable outbursts of aggression may occur.

Patients who are potentially violent should not be interviewed in an isolated room; when the risk is particularly high the doctor should not be alone with such patients. Adequate staff should be available nearby. The immediate aims are to control the risk of violence, to diagnose the underlying disorder, and to administer specific treatment. A detailed history and full physical and mental state assessment are rarely possible; immediate treatment has to be arranged until complete information is available.

Every effort should be made to calm patients by sympathetic understanding and reassurance. Violence is often a response to paranoid experiences and patients can be pacified if they believe that the doctor appreciates the reasons for their behaviour. If this can be achieved medication may be accepted voluntarily; otherwise compulsory treatment becomes unavoidable if patients are endangering themselves or others. Physical restraint should be applied with the assistance of security staff; the safety of all involved is best ensured by having more than a sufficient number of staff available. At least one person should restrain each limb while another administers medication.60,61 Haloperidol 10-20 mg intramuscularly is the preferred drug, except for cases of alcohol or drug misuse or patients with serious physical illness. Benzodiazepines should then be given instead; for example diazepam 10 mg by slow intravenous injection or lorazepam 2 mg intramuscularly. Once the risk of aggression

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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