The Difference Between Aggression and Agitation in Psychiatry
Assessment of
aggressive patient
D
D
R
R
.
.
N
N
O
O
O
O
R
R
A
A
L
L
_
_
M
M
O
O
D
D
I
I
H
H
E
E
S
S
H
H
LECTURER , CHILD
LECTURER , CHILD
PSYCHIATRY UNIT
PSYCHIATRY UNIT
W
h
a
t
i
s
t
h
e
d
i
f
f
e
r
e
n
c
e
b
e
t
w
e
e
n
a
g
g
r
e
s
s
i
o
n
&
a
g
i
t
a
t
i
o
n
?
A
g
g
r
e
s
s
i
o
n
:
Verbal or physical attack on other living
creature or things.
Aggressiveness: readiness to be aggressive
(Scharfetter,1980)
A
g
i
t
a
t
i
o
n
:
Mental disturbance causing physical
restlessness & increased arousal.
It is phenomenologically a description of a
subjective mood
state associated with
and resulted in physical expression.
Common presentation to psychiatric
emergency.
It can be shown with any psychiatric
condition ,
NOT
necessary with the
illness
BUT
may be an expression of
individual
’
s underlying personality.
R
i
s
k
f
a
c
t
o
r
s
:
History of violence.
Significant psychomotor agitation or
anger.
Hx of impulsive behavior or fantasies of
violence.
Hx of childhood abuse.
Frequently visualizing abuse.
Presence of weapons.
School failure , truancy.
C
o
n
t
.
R
i
s
k
f
a
c
t
o
r
s
:
Psychiatric disorders:
Manic phase.
MDD
Brief psychotic disorder\ schz.
Cognitive dis. ( Delirium\dementia)
1
st
psychiatric hospitalization < 18.
Substance abuse.
Personality dis.
MR.
Abuse by parents.
C
o
n
t
.
R
i
s
k
f
a
c
t
o
r
s
:
Physical health related issues:
Head inj.(frontal & temporal)
ictal & post ictal.
Demographic data:
Male>female.
Young>old.
Lower socioeconomic status.
Few social support.
M
a
n
a
g
e
m
e
n
t
:
In ER:
Safety is the first consideration ( always
stay beside gate)
Few people.
Avoid confrontation.
Take precautions ( armed patients)
Verbal communication can
Verbal communication can
de-escalate
de-escalate
the
the
potential for violence & is a logical 1
potential for violence & is a logical 1
st
st
choice.
choice.
Do not bargain with a violent person about the
Do not bargain with a violent person about the
need for restraints, medication or admission
need for restraints, medication or admission
S
S
h
h
o
o
w
w
o
o
f
f
f
f
o
o
r
r
c
c
e
e
!
!
!
!
M
M
e
e
d
d
i
i
c
c
a
a
t
t
i
i
o
o
n
n
:
:
Antipsychotics (
haloperidol
, olanzapine)
Can be given orally or parentally.
BZD ( lorazepam)
Hospitalization
Hospitalization
:
For further assessment.
Restraint might be needed.
Aggression involves verbal or physical attacks, while agitation is a state of mental disturbance leading to physical restlessness and increased arousal. Both can be common presentations in psychiatric emergencies with various risk factors and management strategies involved, including verbal communication to de-escalate violence.
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Presentation Transcript
DR.NOOR AL_MODIHESH LECTURER , CHILD PSYCHIATRY UNIT
What is the difference between aggression & agitation?
Aggression: Verbal or physical attack on other living creature or things. Aggressiveness: readiness to be aggressive (Scharfetter,1980)
Agitation: Mental disturbance causing physical restlessness & increased arousal. It is phenomenologically a description of a subjective mood state associated with and resulted in physical expression.
Common presentation to psychiatric emergency. It can be shown with any psychiatric condition , NOT necessary with the illness BUT may be an expression of individual s underlying personality.
Risk factors: History of violence. Significant psychomotor agitation or anger. Hx of impulsive behavior or fantasies of violence. Hx of childhood abuse. Frequently visualizing abuse. Presence of weapons. School failure , truancy.
Cont. Risk factors: Psychiatric disorders: Manic phase. MDD Brief psychotic disorder\ schz. Cognitive dis. ( Delirium\dementia) 1stpsychiatric hospitalization < 18. Substance abuse. Personality dis. MR. Abuse by parents.
Cont. Risk factors: Physical health related issues: Head inj.(frontal & temporal) ictal & post ictal. Demographic data: Male>female. Young>old. Lower socioeconomic status. Few social support.
Management : In ER: Safety is the first consideration ( always stay beside gate) Few people. Avoid confrontation. Take precautions ( armed patients)
Verbal communication can de-escalate the potential for violence & is a logical 1stchoice. Do not bargain with a violent person about the need for restraints, medication or admission
Medication: Antipsychotics ( haloperidol , olanzapine) Can be given orally or parentally. BZD ( lorazepam) Hospitalization: For further assessment. Restraint might be needed.
