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Wednesday, October 5, 2011

Relationship between violent behavior and mental illnesses

Most people who do not know about mental illnesses think mentally ill patients can become easily violent. But the truth is little different. Most people with mental illnesses are not violent. According to the MacArthur Violence Risk Assessment Study, “the prevalence of violence among those with a major mental disorder who did not abuse substances was indistinguishable from their non-substance abusing neighborhood controls (normal people)”.

In addition, schizophrenia shows lowest incidence of violence. Bipolar affective disorder and major depression patients are more violent than schizophrenic patients. Patients with substance abuse issues are the most violent.

Who are at risk?
According to the above study and the personal experience of this author, close relatives of the mentally ill are at most risk. Risk to general public is much less than expected. In fact incidence of violence is almost similar to non-mentally ill people.

What are the predictions of violence in mentally ill?


One of the best predictor is past violence. Past unprovoked violence carries the greatest risk. In addition, substance abuse issues increase the violence of mentally ill patients. Other factors that are thought to increase violence are command hallucinations, and severe prosecutory delusions. In addition, people with severe depression may harm their dependents. E.g. severely depressed mother may kill her young children just to save them from her imagined misery.

How to control violence in a mentally ill?


Even the risk of violence is low, they do occur and most people who deal with mentally ill patients need to know how to tackle them.
  Conversation between patient and doctor

1. Talking to the patient calmly will alleviate most of the violence. Most people with mental illnesses become violent because they do not get their basic needs. In fact for some of the reasons even the most normal sane people could get violent. For an example, one of the patients who really got violent and try to break the door of the seclusion room became so because he could not contact his mother. Contacting his mother stopped his violence completely.

2. Even most patients can be calmed down by talking, some do need drugs. First option is oral antipsychotics with sedating properties such as Olanzapine.

3. Third option is intramuscular sedative drugs such as Olanzapine, Haloperidol and Midazolam. These drugs will quickly calm down a patient but they can cause side effects such as abnormal movements and respiratory depression (Midazolam).

In extreme rare cases patients need to be physically restrained. Usually it is to allow an intramuscular injection. When the patient is sedated physical restrain should be removed.

Sources


Violence and mental illness: an overview
Violence and Mental Illness — How Strong is the Link?

Link of this post
Relationship between violent behavior and mental illnesses



First published in
Mental health information blog





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