BEHAVIOUR EMERGENCIES

Dr Mohd Jamil Yaacob, Associate Prof & Head, Dept of Psychiatry

Content
Definition Why patients become violent? Assessing and predicting violent behaviour Assessment the risk of violence General Strategy in Evaluating the Patient Signs and Symptoms of Suicidal Risk Behaviour Prevention Drugs Physical Restraint
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Definition
Behaviour Refers to actions or reactions of an object or organism usually in relation to environment Conscious or unconscious Overt or covert Voluntary or involuntary Complexity of behaviour is related to the complexity of its nervous system Human evaluate the complexity of behaviour using social norm Regulation of behaviour is done by means of social control
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Definition
Emergency Is a situation which poses an immediate risk to health, life, property or environment Most emergency requires urgent intervention to present worsening of the situation
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Behaviour emergency
Human actions or reactions that lead to a situation which could pose an immediate risk to health, life, property or environment.

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In the workplace
Violent acts, including physical assaults and threats of assault or intimidation and harassment including sexual harassment, directed toward persons at work or on duty where an employee is verbally or physically attacked, harassed, injured or killed
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Another Side of Video Games

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.When I was a kid, I was obsessed with video games. I saved my allowance to buy new games every month. I read Nintendo magazines for tips about solving the Super Mario Brothers adventures. I played so many hours of Tetris that I used to dream about little blocks falling perfectly into place. There were physical effects, too. My thumbs turned into machines, quick and precise. During especially difficult levels of play, my palms would sweat. My heart would race. I'd have knots in my stomach from anxiety. It was the same feeling I'd sometimes get from watching scary movies or suspenseful TV shows.
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 "If you've ever watched young children watching kickboxing," says child psychologist John Murray, "within a few minutes they start popping up and pushing and shoving and imitating the actions." Murray is at Kansas State University in Manhattan, Kansas.
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 In his most recent study, eight boys and girls between the ages of 8 and 12 watched a series of video clips. Some clips showed violent fighting scenes of Sylvester Stallone from the movie Rocky IV. Other clips were full of action, but no violence. Others were just blank screens. During the experiment, each kid lay inside a special brain-imaging machine. Such a machine takes pictures of the brain and shows which parts of the brain are working at different times.
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Murray and his colleagues found that exposure to violent video clips activated the amygdala, a thumbnailsized area in the brain. The right side was particularly active.
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The amygdala is best known as the "fight or flight" organ. It senses danger and prepares you to either go to battle or run away. You become hyper-aware of movements in the environment. And blood rushes to your brain's core, among other effects
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Why patients become violent?

Patients may become violent for many reasons Drug abuse Antisocial personality disorder Mental illness (schizophrenia) Tumour Infection Poor Impulse control Alcohol epilepsy
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Assessing and predicting violent behavior

Signs of impending violence Very recent acts of violence Verbal or physical threats Carrying weapons Progressive agitation Alcohol or drug intoxication Paranoid patient Hearing voices (auditory hallucination): commanding in nature Personality disorder patients prone to violent
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Assessment the risk of violence

Take serious note on Violent idea Wish Intention Plan Availability of means Implementation of plan Wish for help
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Assessment the risk of violence

Seriously study the distribution like: Sex (male) Age (15-24) Socioeconomic status (low) Social support (few)
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Assessment the risk of violence

Look back at the past history of: Violence Nonviolent antisocial act Impulse dyscontrol (gambling, substance abuse, suicide, self-injury, mental illness)
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Assessment the risk of violence

Consider seriously the stress factors: Marital crisis Loss financial crisis

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General Strategy in Evaluating the Patient

Self-protection Know as much as possible about the patients before meeting them Leave physical restraint procedures to those who are trained Be alert to risks of impending violence
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General Strategy in Evaluating the Patient

Attend to the safety of the physical surroundings (door access) Have others present during the assessment Have others in the vicinity Attend to developing an alliance with the patient
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General Strategy in Evaluating the Patient

Prevent harm Prevent self-injury and suicide Prevent violence toward others

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General Strategy in Evaluating the Patient

Assess patient for the risk of violence. If the risk is deemed significant, consider: Inform the patient that violence is not acceptable Approach the patient in a non-threatening manner Reassure, calm, or assist the patient judgment Offer medication Inform the patient that restraint or seclusion will be used if necessary Have teams ready to restraint the patient

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General Strategy in Evaluating the Patient

When patients are restrained, closely observe them, check their vital signs. Isolate them from surrounding agitation stimuli Plan for further approach-medical evaluation and medication

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Signs and Symptoms of Suicidal Risk

Previous attempt of suicide Anxiety, depression, exhaustion Availability of means of suicide Concern for effect of suicide on family members Verbalized suicidal ideation
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Signs and Symptoms of Suicidal Risk

Preparation of will Proximal life crisis (grief or impending surgery) Family history of suicide Pervasive pessimism or hopelessness

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Behaviour Prevention

Behaviour Prevention
Empathy Thorough understanding such as in marital conflict Counseling Psychotherapy

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Drugs

Drugs

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Example of drugs

Haloperidol Benzodiazepine

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Restraint

Type
Geographical restraint Moving pt to a quieter place, a more secure ward or seclusion Chemical restraint Physical restraint

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Physical Restraint
Any action that is used for the purpose of restricting the free movement of another person Should be used as a last resort or when other measures have failed or in acutely dangerous situation

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Purpose
To prevent clear, imminent harm to patient or others To prevent the pts treatment from being significantly disrupted To prevent damage to the physical surroundings

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Methods
Minimum 4-5 persons should be used to retrain the pt Explain why the pt is going to be restraints A staff member should always be visible & reassuring the pt who is being restrained. Reassurance helps to elevate the pt fear of helplessness & loss of control. Restraint in leg spread angles. One arm to one side and the other arm over the pts head
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 Pt head is raised slightly to decrease feeling of vulnerability & reduce the possibility of aspiration Check periodically for safety & discomfort After restraint, begins treatment After pt is under control, one restraint at a time should be removed at 5 minutes interval until the pt has only 2 restraints on.
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 Both of the remaining restraints should be removed at the same time, bec it is inadvisable to keep a pt in only 1 restraint. Always thoroughly document the reason for the retraints, the course of treatment, the pts response to treatment while in restraints.
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Physical Restraint

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Physical Restraint

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