BB-30-b-1
*Dangerous patient – Assault to cause injury or disfigurement.
Can we predict – The patient in EAU – we overpredict. You must tell the person you think he is dangerous.
You also have to warn that you were going to commit them (& may lie to you). Ex-prisoner are more apt to be dangerous.
Early TRIAD – FIGHTING – TANTRUMS – school truancy
Drugs – PCP, speed + violent (especially schizo’s). Schizo’s like to take this shit. So get drug history. Their prognosis off dope is better than other (schizo’s) who don’t use them.
Eroh also cause violence.
Violence in Environment is a prerequisite, especially of unpredictable beatings – lead to sudden unpredictable violence on the child’s part later. Developer ego-syntonic acceptance of violence (USA common).
Perceived environmental stress – Parents & Spouses are afraid of the patient & doc’s don’t believe this. Don’t let tragedy happen, doc! It is sometimes not provoked!
Case: Boy shot his mother. He had subtly told about Mom’s invasion of his privacy, & how he could not tolerate this.
Take it seriously, even if 14% says it.
* 7% who threaten to kill – either kill or suicide
Predatory aggression – (usually for food). But some people totally dehumanize others pathologically. Most dangerous folk see others as [illegible word] only. We should check the patient’s capacity to see other people as humans & if he thinks violence is acceptable = dangerous. “Only me & the world” Narcissistic
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BB-30-b-2
Affective – Aggressive – overwhelmed with rage
Biochemically determined?
(Still must dehumanize & have acceptance of violence)
often: sex = violence
they attack “bad (nonhuman) homosexuals”
Li+ may be of use with these folk
look at: our own affective responses:
take your own fears seriously [added note: “is their pathology”]
take your own anger seriously [added note: “are significant in diagnosis of potential for aggression”
some schiz, make us feel motherly; this is their path (we hope?)
* Control the violent only with sufficient backup support!!
* Men should be handled by [symbol for man] – call in more than one security guard!
* Meet them in the waiting room, don’t wait in the office; greet them in waiting room, if look explosive – hosp not as outpatient
“you may say what you like you may not do [what] you like”
“you do not have permission to behave violently”!