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Aggressive disruptive behaviour

Introduction

These are agitated and acutely disturbed patients, who may or may not have a psychiatric condition. Many acute medical conditions and substance abuse can also present with agitation.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• Agitation
• Aggressive behaviour

Investigations

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Managemet

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  • Non-pharmacological

    • Ensure the safety of the patient and those caring for them.
    • Caution is needed with elderly and frail patients as they are vulnerable to falls and further injury if sedated.
    • The use of physical restraint should only be employed when there is a need to protect the patient and surrounding people in an acute setting and it should be for as short time as possible with a constant monitoring of patients safety
    • Assess for sign of delirium.

    De-escalation Techniques should be Attempted first:

    • Calm the patient
    • Manage in a safe environment
    • Ensure the safety of all staff members

  • Pharmacological

    • Diazepam, 10 mg (PO) stat
    OR
    • Lorazepam, 4 mg, (PO) stat
    If oral treatment fails after 30–60 minutes, OR If there is significant risk to the patient and others give

    Parenteral treatment as follows:

    • Haloperidol 5 mg (IM) repeat in 30–60 minutes, if required. (Max dose: 20 mg within 24 hours)
    AND
    • Diazepam 10 mg (IV), stat. Repeat after 30–60 minutes if needed.
    OR
    • Promethazine 25–50 mg (deep IM). Repeat after 30–60 minutes if needed.
    OR
    • Lorazepam 4 mg (IM), stat. Repeat after 30–60 minutes if needed 3.
    If haloperidol is unavailable,

    • Chlorpromazine 25–50 mg (deep IM). May be repeated as necessary 4 times in 24 hours.
    If patient is known to suffer from schizophrenia and is not neuroleptic naïve give:
    • Zuclopenthixol acetate 50–150 mg (IM) Repeat after 2–3 days, if necessary
    If patient develops acute dystonia give:
    • Promethazine deep IM 25–50 mg. In the elderly 25 mg.
    OR Anticholinergic agent, e.g.: S: Biperiden, IM/IV, 2 mg. Repeat as necessary.

    Note: repeated doses of high potency antipsychotics may lead to the development of the life-threatening neuroleptic malignant syndrome, characterized by hyperthermia, muscle rigidity, autonomic dysfunction and alterations in consciousness. Serum CK is typically markedly elevated. If suspected, stop antipsychotic, and institute supportive care. *Always monitor vital signs of sedated patients 23.2

Prevention

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Updated on,

20 Novemba 2020, 07:30:19

References

    1. STG
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