The treatment of behavioral disorders usually begins at the same time as the examination, especially when diagnosing possible somatic disorders (see Medical Assessment of Patients with Mental Disorders Medical Assessment of Patients with Mental Disorders Patients with complaints or mental health problems, or behavioral disorders go to various clinical facilities, including primary care and urgent care centers... Read more info ). It is erroneous to assume that the cause of abnormal behavior is only a mental disorder or intoxication, even in patients with a psychiatric diagnosis or odor of alcohol. Since patients are often unable or unwilling to talk about themselves, any other available means of obtaining information (e.g., family, friends, co-workers, medical records) should be used.
The physician must be aware that patient violence may be directed at the staff treating the patient and at other patients.
Agitated and aggressive patients should be immobilized with:
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Physical means
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Medications (chemical restraint)
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Both.
Such interventions are provided to prevent harm to patients; they also allow adequate examination of the patient to ascertain the cause of this behavior (e.g., through assessment of vital functions and blood samples for tests). Once a patient's mobility is physically restricted, ongoing monitoring, often involving an experienced caregiver, is required. Medically stable patients can be placed in a safe, isolated room. Physicians should be well versed in the legal issues of involuntary treatment Legal issues Patients who are experiencing severe changes in mood, thoughts or behavior, or who develop severe, life-threatening side effects after taking medications need emergency evaluation... Read more (see also Legal Issues of Physical Restraint in Violent Aggressive Patients Legal Issues of Physical Restraint in Violent Aggressive Patients ), such measures should not postpone life-saving interventions.
Preventive measures should be used for violent patients. Measures that can help reduce agitation and aggression include:
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Transferring the patient to a quiet environment (e.g., isolation ward, if possible)
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Removing dangerous items that can be used to harm yourself or others
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Expressing sympathy for the patient and genuine concern for his complaints
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Respond to the patient in a confident but calm tone
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Ask what can be done to eliminate the cause of anxiety or aggression
Speaking directly to the patient, noting that they seem angry or upset, asking them directly about their intent to hurt someone can allow you to gain the patient's trust and get them to open up.
Unproductive methods include the following:
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Doubting the truth of the patient's fears and complaints
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Make threats against the patient (e.g., call the police, put the patient in a psychiatric hospital)
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Speaking to a sick person in a condescending tone
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Misleading the patient (e.g., hiding medications in food, promising not to use mobility restraints)
When interviewing aggressive patients, care should be taken to ensure staff safety. It is customary in most hospitals to search behaviorally disturbed patients for weapons (hand searches and/or metal detectors). Whenever possible, patient evaluations should be conducted in a room with security features such as video cameras, metal detectors, and rooms with staff surveillance.
Patients with a hostile mood, but without a clear propensity for violence, do not usually attack staff members; rather, they attack staff members who are hostile or pose a threat to them. Doors to the premises should be kept open. Having staff sit on the same level as the sick will help avoid a threatening impression. Staff can avoid the patient's anger by not responding to their hostility by not arguing loudly in an angry tone. If, however, the patient shows signs of growing restlessness and aggression, the staff should simply leave the room and call enough colleagues for help to demonstrate their strength, which sometimes discourages patients. As a rule, 4 to 5 people (preferably young men) may be present in the room. However, you should not bring straitjackets into the room without the intention of using them, as the sight of a straitjacket may provoke patients.
Verbal threats must be taken seriously. In the United States, in most states, if a patient expresses intent to harm a particular person, the doctor must warn the potential victim and notify the police. Some requirements vary from state to state. Generally, local laws require the reporting of suspected abuse of children, the elderly, and family members.
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