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This seminar led by Dr. Michael P. Chan on June 6, 2012, explores the complex issue of violence in society, addressing various contributing factors like biological, neuropsychiatric, psychological, and environmental influences. The seminar discusses legal and clinical approaches to managing aggression, emphasizing clinician safety, patient interactions, and effective communication techniques. Recognizing warning signs, understanding countertransference, and planning for crisis situations are critical themes in this discourse aimed at enhancing safety and response strategies in clinical settings.
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AggressionResidents Seminar Dr. Michael P. Chan June 6, 2012
Issues • Violence in Society • Complex Interactions of Factors • Legal Approaches • Emotional Responses • Clinical Approaches
Formulation of Violence: Factors • Biological • Neuropsychiatric • Seizure, TBI • Neurotransmitter • Decreased 5HT, Impulsivity • Increased NE, DA • Genetic • Loading, Chromosome Abrnormality
Factors Cont’d • Psychological • Child Abuse • Witnessing Domestic Violence • Media Exposure • Social • Poverty, Deprivation, Unemployment • Family Breakdown • Subculture – Gang • Other Environmental • Overcrowding • Heat
Clinician Safety • Patient Attacks • Psychiatrist/Resident 40% • Nurse 80% • Inexperience • Limit Setting • Interview Setting • Counter Transference • Restrain or Talk • Clinical Approach • Categorize • Organic, Psychotic, PD/Other
Talk Approach • Calm Manner • Acknowledge the Affect • Respectful • Non-judgmental • Non-provocative • Physical Space, sit • Minimal Eye Contact • Listen Empathically • Controlled Manner • Offer Medication
Physical Setting • Furniture Layout • Exits • No Projectiles • Panic Button • Clothing, Jewelry
Physical Defence • Stand Facing Sideways • Arms for Defence • Deflect Kicks with Legs • Shields – Objects, Mattress • Grabbed – Thumb • Hair Pull – Control Hand • Choke Hold – Tuck Chin
Patient with Weapon • Expose Few Staff • Calm, Talk to Patient • Put Weapon Down • Do Not Go for Weapon • Plan – Hostage Situation
Intervene Before Attack • Staff Adequate and Trained • Staff Caring, Non-authoritarian, and in Control • Talk and Listen to Patient • Recognize Warning Signs • Staff Issues • Monitor Own Countertransference Feelings • Monitor Ward Dynamics • Staff Conflict
Intervention Cont’d • Defence Mechanisms • Denial • Projection and Overestimation • Displacement • Negative Reactions – Prejudice • Other Dynamics – Admin • Debriefing Meetings
Clinical Assessment: History Taking • Violence as Presenting Problem • Duration, Frequency, Target • Pattern • Injuries • Past Investigations • Impulsivity Features • Familial Violence • Developmental Insults • Medical
Clinical Assessment: Diagnostic Groups • Organic • Substances/Alcohol • Brain Disorders • Systemic Illness • O2 • Liver • Kidney • Metabolic/Endocrine • Metals • SLE • Porphyria • Vitamin • Electrolyte
Clinical Assessment:Psychiatric Disorders • Psychotic • P.D. Cluster B. • M.R. • ADHD • IED
Clinical Assessment:Investigations • Bloodwork • EKG CXR • Drug Screen • EEG • Other – Metals • MRI • Psychological
Summary • Violence in Society • Complex Interactions of Factors • Legal Approaches • Emotional Responses • Clinical Approaches
