aggression

Question 1

List out the stages of the assault cycle

Answer 1

1. Trigger
2. Escalation
3. Crisis
4. Recovery
5. Post-crisis depression

Question 2

Patient’s behaviour in the triggering phase

Answer 2

• Muscle tension
• Tapping of fingers
• Pacing about
• Repeated verbalisations
• Non-compliant
• Glaring
• Restlessness

Question 3

Patient’s behaviour in the escalation phase

Answer 3

• Pale/flushed face
• Screaming
• Hypersensitivity
• Threats/demands
• Readiness to retaliate
• Tautness
• Loss of reasoning ability
• Clenched fists

Question 4

Patient’s behaviour in the crisis phase

Answer 4

• Loss of self control
• Fighting
• Rage
• Scratching
• Throwing things

Question 5

Patient’s behaviour in the recovery phase

Answer 5

• Accusations
• Lowering of voice
• ↓ body tension
• Change in conversational content
• Relaxed posture

Question 6

Patient’s behaviour in the post-crisis depression phase

Answer 6

• Crying
• Apologies
• Reconciliatory interactions
• Repression of assaultive feelings (which may later appear as hostility passive aggression)

Question 7

Risk factors for violent behaviour (at least 5)

Answer 7

• Young age; male
• Lack of employment
• Limited education
• Violence to self or others and within family
• Antisocial behavior
• Arrests for criminal acts
• Aggressive childhood behaviour, including cruelty to animals
• Poor impulse control
• Escalating anger or agitation
• Coercive, exploitative interaction style
• Antisocial & criminal acts
• Statements of intent to harm self or others

Question 8

Drugs to treat aggression (for patients with non-psychotic context)

Answer 8

Anxiolytic:

Intermediate-acting BZP– Lorazepam (Ativan)

Question 9

Drugs to treat aggression (for patients WITH psychotic context)

Answer 9

1st gen/Typical:
- Haloperidol

OR 
2nd gen/Atypical:
- Risperidone drops or quicklets 
- Olanzapine 
(Lorazepam-Activan if needed)

Question 10

Possible cause of aggression

Answer 10

1. Health Care Worker
   - Own anger or frustration may intensify patients’ anger or aggression
   - Staff biases
   - Poor attitude
2. Environment
   - Excessive stimuli & overcrowding
   - Lack of space & resources
   - Lack of control of life & boredom
   - Lack of diversional activities
   - Rigid institution’s philosophies & policies
3. Patients
   - During changing of shift, meal-times, visiting hours & evening
   - No visitors: sad
   - On admission
   - Denied of discharge
   - During transportation to outside areas