The Violent Patient - Questions

Question 1

Name two characteristics of the violent patient and define each (

Answer 1

• Irritability is a state of being easily annoyed and provoked to anger.
• Anger is an emotion characterized by antagonism toward someone or something you feel has deliberately done you wrong

Question 2

Outline the acute management of a violent patient in the form of the ABC (0.5 + 0.5 + (0.5 x6)

Answer 2

Assessment (0.5)
Identify the underlying issue
Back-up (0.5)
security, staff and resource must be available
Containment (0.5 x 6)
Initiate non-pharmacological measure to at first to better handle the situation
Calm – Try and be calm, calm the patient and those around you.
Control – Take control of the situation or at least appear to.
Confidently manage your staff according to the prearranged plan suitable for your setting.
Contain the patient in a smaller room etc.
Control with physical or pharmacological measures

Question 3

Name the 4 categories considered in risk assessment and an example of each. (4)

Answer 3

• Dispositional: age and gender.
• Historical: previous history of violence as a perpetrator or as a victim that could have modeled violent behavior.
• Contextual: sex, weapon availability, substance use, victim characteristics.
• Clinical: comorbid substance use, psychotic thoughts or perceptions, mania, personality disorders.

Question 4

List 2 neurological causes (0.5 x2 marks each) and 2 non-neurological causes (0.5 x 2 marks each) of violence in a medical setting. List 2 common causes of violence in a psychiatry setting (2 marks) - Total 4 marks

Answer 4

Neurological causes (any 2 of the following options)
* Head injuries (0.5)
* Epilepsy (0.5)
* Encephalitis (0.5)
* Meningitis (0.5)
* Strokes (0.5)
* Space-occupying lesions (0.5)

Non-neurological causes (any 2 of the following options)
* Electrolyte imbalances (0.5)
* Metabolic imbalances (0.5)
* Infections (i.e. HIV) (0.5)

Common causes in a psychiatric setting (any 2 of the following options)
* Psychotic disorders (1)
* Mood disorders (1)
* Intellectual disability (1)
* Personality disorder (Antisocial, borderline) (1)
* Anxiety disorders (1)
* Dementia (1)

Question 5

List the forms used for the following scenarios. (1 x3)

Answer 5

This form is used to report any exploitation, physical abuse, neglect, or degrading treatment of a mental health care user.
FORM 2
When the head of a health establishment grants an application for involuntary care, this form records the 72-hour assessment and findings by a medical or mental health care practitioner.
FORM 6
This form is used in cases where the South African Police Services hand over custody of a person suspected of being mentally ill or severely intellectually disabled.
FORM 22

Question 6

Give two examples of de-escalation techniques (0.5 x2 marks)

Answer 6

• Active listening techniques; validation of feelings; redirection; offering
• reassurance; showing empathy and understanding

Question 7

How can triage staff help to prevent further escalation of violence (1 mark)

Answer 7

Triage staff can be authorized to jump queue to examine patients who are likely to become violent shortly if not managed

Question 8

What does setting boundaries mean in the context of managing a violent patient in the imminent violence stage (1 mark)

Answer 8

• means setting limits to unacceptable behaviour and using negotiation techniques that may prevent aggression process to further escalate.