Violence

Question 1

Predisposing Factors for Violence

Answer 1

Disorders and tumors of the limbic systems
Frontal lobe injury
Temporal lobe epilepsy
Low serotonin syndrome
Deliriums and Dementias
Alcohol/Drug Withdrawal

Question 2

Environmental-Social Models of Violence

Answer 2

Poverty
Unemployment
Gang involvement
Excessive TV 
Child abuse
Low educational attainment

Question 3

Managing Escalation

Answer 3

Depends on 3 skills:
Observation of changes from baseline
Assessment of the causes of behavioral change
Modification of communication based on the cause and degree of emotional arousal.
Voice should be low and slow

Question 4

Addressing the escalating patient

Answer 4

Address pt with respect
Give pt opportunity to change behavior but do not provide more than 1 option
Maintain your ability to relax by deep breathing and centering yourself

Question 5

Early Escalation

Answer 5

Changes in behavior: ascertain cause
First Technique:
-Offer self and use active listening techniques
-Discover the underlying emotion driving the behavior change
Second Technique:
-Supportive problem solving to alleviate distress
-Frustration: Identify source and practical ways to attain unmet needs
-Anger: Identify source and ways to reduce sense of threat or harm

Question 6

Late Escalation

Answer 6

Engage in crisis communication rather than problem solving
Respond to the emotion driving the escalation
Reduce words to a minimum and offer simple choices
Set enforceable limits and offer simple choices

Question 7

Escalated with fear and anxiety

Answer 7

Stand 5 to 8 feet away at an angle
Maintain a relaxed posture
Keep hands open and visible
Speak in a low but confident tone
Keep your facial expression neutral
Allow pt to determine eye contact
Offer help
Deny intent to harm
Ask pt what is needed to make him/her feel safe

Question 8

Escalated frustration and anger

Answer 8

Stand directly in front of the pt but just out of reach
Use pointed gestures and maintain a ready, non-aggressive posture
Speak in a soft, firm tone
Give simple 1 or 2 word commands
Repeat until directions followed

Question 9

Short-term goals when treating victims of abuse

Answer 9

A safe environment is established
Immediate injuries heal w/o complications
Client will be able to talk about abuse and feelings identified by abuse
Victims and/or abusers will be able to identify triggers for abuse and that the victim is not to blame

Question 10

Long-term goals for victims of abuse

Answer 10

Current victim will have no further injuries and family will not create any new abuse/neglect situations
Abusers will receive adequate treatment of any significant mental illness and will be maintained in a safe level of remission
Victims and witnesses will not develop long term emotional problems and will suffer no further developmental delays as a consequence of abuse.

Question 11

Violence

Answer 11

Criterion for involuntary treatment
Associated with anger, hostility, fear, manipulation, and intimidation
Aspect of aggression
Best predicted by a history of violence
Learned behavior that is reinforced by results and pleasurable arousal
Occurs in individuals in all diagnostic categories, and is not exclusively Manifested by individuals diagnosed with psychiatric disorders