Aggression

Question 1

What is aggression

Answer 1

Behaviour intended to hurt oneself/another/property = forceful verbal/physical action

Question 2

What drugs do you use in an acute setting of an aggressive patient?

Answer 2

1) Benzo’s
>lorazepam 2-4mg PO/SL/IMI (resus equipment available)
>diazepam 10mg IVI slowly over 5 mins (NOT IMI, resus facility available)

2) Antipsychotic
>haloperidol 5-10mg PO/IV/IM 4-6hrly
>Olanzapine 2,5-10mg PO/IMI
>risperidone 1-2mg PO

**Lorazepam and haloperidol can be given IMI at same time

Question 3

What intermediate term antipsychotics can you use in an aggressive patient after the acute phase?

Answer 3

Zuclopenthixol acetate (clopixol acuphase) 50-100mg IMI every 72hrs

Only when all else fails, allow 60 mins after previous drug before administering. NOT for combined use

Question 4

What drugs are used for long term aggression?

Answer 4

Antipsychotics
Anticonvulsants - valproate, carbamazepine
Antiandrogens
Lithium
Antidepressants
Beta blockers
Stimulants (children)
Benzo for children and adolescents

Question 5

How do you monitor the aggressive patient who you gave drugs? What do you look for?

Answer 5

Monitor vitals
Hypotension, irregular pulse, increased temperature

Decreased respiration = give flumazenil
Transfer to ICU for monitoring

Question 6

What does Post-aggressive counselling consist of?

Answer 6

Give alternative for conflict resolution that’s not aggressive
Identify precipitating factors with pt and family to avoid in future
Enhance treatment compliance
Close contact with health care workers and family

Question 7

What are the important legal aspects of a aggressive patient scenario?

Answer 7

Make good notes!!!
Form 1 = emergency admission
Form 48 = patient is secluded or restrained
Form 19,20 = Transfer to max security
Form 22 = Handing over by SAPS