Psychological medicine

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Interviewing Aggressive Patients

  • Understanding why they are aggressive is important:
    • Poor anger control
    • Inappropriately managed
    • Overwhelmingly afraid
    • Most clients are afraid/confused by their own feelings
  • Aggressive patients often try to change the „rules‟ of the relationship between professional and client by trying to dominate. The interviewer must maintain the boundaries. If „rules‟ are broken (eg threats, etc) ® terminate the interview
  • Interviewing tips:
    • Is it wise to interview them at all?
    • Get as much information about their history and current state before you start
    • Patients home most difficult environment
    • Ensure you and the client have direct access to a door
    • Appear confident!
    • Ensure there are no missiles (tea cups, ash trays)
    • Don‟t sit eyeball to eyeball.  Have the client in a low, soft chair
    • Have someone else sit in
    • Remain aware of clients body language
    • Negotiate breaks with the client – take a walk in the corridor
  • Responses:
    • Set limits: “I can‟t help you if you keep shouting”
    • Demanding patients: “Perhaps I need to know a bit more before I decide to…”
  • Reflection: “I can see that made you very angry”
  • Evaluation: 
    • Diagnose psychiatric disorder and assess mental state – especially paranoid states, command hallucinations, intoxicated, delirium, manic, depressed
    • History of violence, abuse, neglect
    • Who are intended victims
    • Emotional stressors
    • Quality of self control
    • External constraints on behaviour
    • Physical exam: old and new injuries
  • Sedation: if drug sedation is necessary: 
    • Haloperidol 2.5 – 5 mg PO/IV and Clonazepam 2 mg PO/IM. Effect takes up to 20 – 30 minutes. Repeat at 30 minute intervals to maximum of 3 doses 
    • If you forcibly restrain or medicate someone, should initiate Mental Health Act (otherwise iT constitutes common assault)