Main cause is drug intoxication especially alcohol in severe behavioral disturbances

SEVERE BEHAVIORAL DISTURBANCES

Patients with aggressive or violent behavior cause understandable apprehension in all staff,and are most commonly seen in the accident and emergency department.Information from anyone accompanying the patient ,including police or carers ,can help considerably.

Emotional and behavioral disturbances represent marked behavioral excesses or deficits. Many entries describe the abnormal  deviant behavior; these labels include: emotionally handicapped or disturbed, behaviorally disordered, socially maladjusted, criminals, mentally ill, psychotic, and schizophrenic. Each of these terms refers to patterns of behavior that deviates makedly from the expectations of others. In recent decades, "behavioral disorders" has gained favor over "emotional disturbance" as a more accurate indicator that is more  objective decision-making and fewer negative connotations.

MAIN CAUSES OF DISTURBED BEHAVIOR

Drug intoxication (especially alcohol )

Delirium ( acute confusional state )

Acute psychosis

Personality disorder

MANAGEMENT OF THE SEVERELY DISTURBED PATIENT

The primary aims of management are control of dangerous behavior and establishment of a provisional diagnosis.Three specific strategies may be necessary when dealing with the violent patient.

Reassurance and explanation

Physical restraint

Medication

The majority of disturbed patients are themselves frightened,as well as frightening ,and may feel threatened by those around them,misinterpreting the actions of others.Staff should always explain the situation and their intentions.This simple strategy may calm a patient sufficiently to be interviewed and allow an appropriate examination.

If the behavior remains severely disturbed ,it may be necessary to restrai patients from harming themselves or others.If planned ,this should be done with sufficient numbers of trained staff,at least one person per limb and another two in charge or delivering medication.Once brought under physical control,the patient should be held in the prone position ,in order to protect the airway and allow access for intramuscular medication.

In these circumstances it is usually necessary to administer medication while the patient is restrained and they should not be released until they are visibly calmed.Management depends on the provisional diagnosis 'Rapid tranquilization "should be employed when the patient has a psychosis ,so long as the Mental Health Act has been or the situation is so dangerous that the doctor is acting under common law.Moderate doses of a neuroleptic or benzodiazepine should be given at regular ,comparatively short intervals (30-60 ) minutes intramuscularly,if oral administration is not possible .I most situation a single dose of medication should be enough to allow more definitive management to take place.Both neuroleptic drugs and benzidiazepines may be used as tranquillizers.

Used in comination they have a synergistic action and it has been shown to reduce the total amount of neuroleptic required to treat acute psychosis.A simple regimen of an intramuscular butyrophenon may be used in most situations.Haloperidol ( 5-10mg ) may be used in patients under 60 years old.This dose should be reduced in the elderly and those with known cardiac or hepatic disease.The patient should be observed for upto 1 hour before a further dose is administered.In the case of continuing disturbance,it may be preferable to administer an adjunctive intramuscular benzodiazepine ( lorazepam 2mg ) rather than a further dose of neuroleptic.Breathing ,pulse rate and blood pressure should be monitored for hypotension,arrhythmias and respiratory difficulty.

In some cases you may not realize that you have personality disorder symptoms

Because your way of thinking and behaving seems natural to you and you blame others for your circumtances

PERSONALITY DISORDER
These  disorders comprise deeply ingrained and lasting patterns of activity which manifest themselves as adamantine responses to a panoptic range of individualized and ethnic situations.Personality disorders are developmental conditions that appear in childhood or adolecence and move into adult life. They are not secondary to another medicine modify or bain disease,although they haw antecede or coexist with another disorders.In oppositeness ,personality change is acquired,usually in adult life,following severe or prolonged stress,extreme enviormental deprivation,serious medicine modify or brain trauma or disease.

Personality disorders are commonly subdivided according to clusters of traits that equal to the most frequent or manifest activity manifestations.

THREE MAJOR CATEGORIES OF PERSONALITY DISORDERS

CLUSTER "A" PERSONALITY DISORDER
Affected patients are ofttimes defined as 'wild ' or 'mad' .
The PARANOID personality is suspicious ,hypersensitive ,guarded ,hostile ,and can occasionally embellish threatening or dangerous.Litigiousness ,a tendency to excessive self-importance ,and a preoccupation with unsubstantiated conspirational explanations of events.
The SCHIZOID personality is interpersonally isolated,cold and thoughtless ,a limited power to express emotions,an almost constant preference for solitary activities,lack of near friendships,and a marked insensivitybto current ethnic norms and conventions.
While the SCHIZOTYPAL personality is eccentric and superstitious ,with magical thinking and unusuall belief's resembling schizophrenia.

CLUSTER " B" PERSONALITY DISORDER
Patients with these disorders are ofttimes 'wild'or 'bad'.
The  BORDERLINE  personality is impulsive and manipulative ,with unpredictable and fluctuating intense moods and unstable relationships,a fear of abandonment,and occasional rage episodes.They exposit  chronic  interior worthlessness with frequent self-harm,self-abuse ( eating disorders, substance expend ) and they haw develop transient psychotic features of doubtful significance.There is ofttimes a strong family history of feeling disorder.

The HISTRIONIC patients is dramatic,engaging ,seductive ,and attention-seeking.Shallow and labile emotions.

The NARCISSISTIC patient is self-centered and has an inflated significance of self-importance compounded with tendency to cheapen or demean others, While patients with ANTISOCIAL personality modify use another people to attain their possess ends and vow in exploitative and manipulative activity with no significance of remorse,a very low tolerance of frustration,an incapacity to undergo guilt and to acquire from undergo ,and a marked proneness to alter and blame others.Some aspects of Cluster B personality disorders appear related  to feeling disorders.

CLUSTER " C " PERSONALITY DISORDER
Patients with these disorders are ofttimes 'whiny'or'sad'.

The DEPENDENT patients fears separation,tries to vow others to assume responsibility,and ofttimes has a help-rejecting style.They encourage others to make their individualized decisions,subordinate their needs to others on whom they are dependent ,feel unable to care for themselves,are preoccupied with fears of existence abandoned.Such patients hit a limited power to make routine decisions without an excessive amount of advice and reaassurance from others.

Patients with COMPULSIVE personality modify are meticulous and perfectionistic but also adamantine and indecisive,while those who are PASSIVE-DEPRESSIVE request help,appear willing on the surface,but undo or baulk every efforts aimed at change.

AVOIDENT patients are uneasy about ethnic occurrence and hit difficulty forward domain for their isolation.The parsonality disorders share whatever features with the anxiety disorders.

Many individuals with disturbed personalities do not fit neatly into much categories ,but manifest a mixture of features.

These activity patterns in personality disorders are typically associated with nonindulgent disturbances in the activity tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable individualized and ethnic disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large conception to the fact that such activity is ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, detected to be appropriate by that individuals...... read more

In Borderline personality disorder treatment test can help to rule out other problem

People have great difficulty in dealing with others in personality disorder 

When doctors believe someone has a personality disorder, they typically run a program of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, dapple a diagnosis and also check for some related complications. 

These exams and tests generally include:

• Physical exam. This haw allow measuring height and weight, checking vital signs, such as hunch rate, blood push and temperature, listening to your hunch and lungs, and examining your abdomen.
• Laboratory tests. These haw allow a complete blood count (CBC), screening for alcohol and drugs, and a check of your endocrine function.
• Psychological evaluation. A doctor or noetic upbeat provider talks to you most your thoughts, feelings, relationships and activity patterns. He or she asks most your symptoms, including when they started, how severe they are, how they change your daily life and whether you've had kindred episodes in the past. You'll also discuss some thoughts you haw have of suicide, self-injury or harming others.

DIAGNOSIS 

Diagnosis of personality disorders can be very subjective; however, inflexible and pervasive activity patterns often cause earnest individualized and ethnic difficulties, as well as a general functional impairment. Rigid and ongoing patterns of feeling, intellection and activity are said to be caused by underlying belief systems and these systems are referred to as immobile fantasies or "dysfunctional schemata" (Cognitive modules).

It sometimes can be difficult to watch which particular personality disorder or personality disorders you have. For one thing, some personality disorders deal kindred symptoms. Also, a identification is ofttimes based largely on how you describe your symptoms and behavior, along with how your student interprets those symptoms and observes you behaving. Because of this, it can take some time and try to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate communication designed for your particular illness and situation.

HOW TO TREAT PERSONALITY DISORDER

There are some types of help available for the assorted personality disorders. Treatment haw include individual, group, or kinsfolk psychotherapy. Medications, formal by a patient’s physician, haw also be adjuvant in relieving some of the symptoms of personality disorders, including problems with anxiety and perceptions.

Psychotherapy for patients with personality disorders focuses on helping them see the comatose conflicts that are contributing to or causing their symptoms. It also helps grouping become more pliant and is aimed at reducing the behavior patterns that interfere with everyday living.

In psychotherapy, grouping with personality disorders crapper better recognize the effects of their behavior on others. Behavior and cognitive therapies pore on resolving symptoms or traits that are characteristic of the disorder, such as the quality to make important life decisions or the quality to make relationships.

Relief of anxiety, depression, and other perturbing symptoms (if present) is the first goal. Drug therapy crapper help. Drugs much as selective serotonin reuptake inhibitors (SSRIs) crapper help both depression and impulsivity. Anticonvulsant drugs crapper help reduce impulsive, angry outbursts. Other drugs much as risperidone have been helpful with both depression and feelings of depersonalization in grouping with mete personality. Reducing environmental stress crapper also quickly relieve symptoms.....read more

A positive family history also helpful for a positive response to a specific psychiatric drugs

Psychiatric drugs 

Four  types of psychiatric drugs are commonly use in psychiatric patients

1.Anti depressants

2.Anxiolytics

3.Antipsychotics

4.Mood stabilizing agents

ANTIDEPRESSANTS

Depression, which afflicts 9.4 meg Americans in any six-month period, is the most common modify of mental illness. Far different from the normal mood shifts everyone feels on occasion, depression causes a profound and unremitting significance of sadness, hopelessness, helplessness, remorse and fatigue. People pain from depression encounter no healthiness or joy in activities once enjoyed or in being with family and friends. They may be irritable and amend sleeping and eating problems. Unrecognized and untreated, depression can kill, as its victims are at broad venture for suicide.

However, up to 80 percent of grouping pain from major depressive disorder, bipolar disorder (manic-depression), and another forms of this sickness respond very well to treatment. Generally communication will allow whatever modify of psychotherapy and, often, a medication that relieves the excruciating symptoms of depression. Because grouping pain from depression are probable to suffer from a relapse, psychiatrists may prescribe anti-depressant medications for six months or longer, even if the symptom s disappear.

Three classes of medication are used as anti-depre ssants: heterocyclic antidepressants (formerly called tricyclics), monoamine oxidase inhibitors (MAOIs) and serotonin-specific agents. A fourth medication--the mineral salt lithium--works with bipolar disorder. The benzodiazepine benzodiazepine is sometimes also used with depressed patients who also hit an anxiety disorder (see section on anxiety disorder medications).

Taken as prescribed, these medications can mean the difference between life and death for many patients. Anti-depressant medications alleviate the terrible emotional suffering and give grouping a chance to b enefit from the non-drug therapies that enable them to deal with the psychological issues that may also be part of their depression.

ANXIOLYTICS

Anxiety medications help to calm and relax the anxious person and vanish the troubling symptoms. There are a sort of antianxiety medications currently available. The preferred medications for most anxiety disorders are the benzodiazepines such as Valium, Xanax/Zanex, and Ativan. In constituent to the benzodiazepines another medications such as buspirone, beta blockers, and gabapentin are sometimes also utilised to impact anxiety. Antidepressants are also effective for panic attacks and whatever phobias and are often prescribed for these conditions. They are also sometimes utilised for more generalized forms of anxiety, especially when it is attended by depression. The medications approved by the FDA for use in OCD are all antidepressants: clomipramine, fluoxetine, and fluvoxamine.

Although benzodiazepines, buspirone, tricyclic antidepressants, or SSRIs are the preferred medications for most anxiety disorders, occasionally, for specific reasons, one of the following medications may be prescribed: antipsychotic medications, antihistamines (such as Atarax, Vistaril, and others), barbiturates such as phenobarbital, and beta-blockers such as propranolol (Inderal, Inderide). Propanediols such as meprobamate (Equanil) were commonly prescribed prior to the launching of the benzodiazepines, but today rarely are used.

ANTIPSYCHOTIC MEDICATIONS

Antipsychotics are commonly pills that grouping swallow, or liquefied they can drink. Some antipsychotics are shots that are presented erst or twice a month.

Symptoms of schizophrenia, such as feeling agitated and having hallucinations, commonly go away within days. Symptoms like delusions commonly go away within a few weeks. After about sextet weeks, many grouping will see a lot of improvement.

However, grouping respond in different structure to antipsychotic medications, and no one can tell beforehand how a mortal will respond. Sometimes a mortal needs to try individual medications before finding the right one. Doctors and patients can impact together to find the best drug or drug combination, and dose.

Some grouping may have a relapse—their symptoms become back or get worse. Usually, relapses happen when grouping kibosh attractive their medication, or when they only verify it sometimes. Some grouping kibosh attractive the drug because they feel better or they may feel they don't need it anymore. But no one should kibosh attractive an antipsychotic drug without talking to his or her doctor. When a student says it is okay to kibosh attractive a medication, it should be gradually narrow off, never stopped suddenly.

Antipsychotics can produce unpleasant or chanceful side effects when condemned with certain medications. For this reason, all doctors treating a enduring requirement to be aware of all the medications that mortal is taking. Doctors requirement to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also requirement to handle some beverage or other drug ingest with their doctor.

1. CONVENTIONAL ANTIPSYCHOTICS

    Useful to group into high-mid and low potency neuroleptics.High potency neuroleptics are least sedating,have almost no anticholinergic side effects,and have a strong tendency to induce extrapyramidal side efects.It occurs within several hours to several weeks of begining treatment.

2. NOVEL ANTIPSYCHOTICS

   A new class of agents that has become the first line of treatment ,efficacious in treatment-resistant patients,tend not to induce EPSEs or tardive dyskinesia,and appear to have uniquely beneficial properties on negative symptoms and cognitive dysfunction.Main problem is side effect of weight gain ( most prominent in clozapine and olanzapine can induce diabetes).

MOOD STABILIZING AGENTS

Four feeling stabilizers in common use: lithium,carbamazepine,valproic acid and lamtrigine.Lithium is the " gold standard " and the prizewinning studied,and along with carbamazepine and valproic acid is utilised for communication of acute wild episodes : 1 - 2 weeks to reach full effect. As prophylaxis ,the feeling stabilizers reduce frequency and rigor of both wild and depressed episodes in cyclical feeling disorders.In disobedient bipolar disorder ,combinations of feeling stabilizers may be beneficial.

UNTOWARDS EFFECTS

Psychiatric medications sometimes have adverse personalty that haw reduce patients' drug compliance. Some of these adverse personalty crapper be further aerated by using another medications much as anticholinergics (antimuscarinics). Some adverse effects, including the existence of a sudden or severe re-emergence of psychotic features, haw appear when the patient stops taking the drug, specially if a drug is dead interrupted instead of slowly tapered off....... read more

Most psychiatric drugs treatment failure are due to under medications and impatience

Psychiatric drugs

Psychiatric researchers conceive that people pain from some noetic illnesses have imbalances in the way their brain metabolizes certain chemicals, titled neurotransmitters. Because neurotransmitters are the messengers the nerve cells ingest to transmit with one another, these imbalances haw result in the emotional, physical and high browed problems that mentally ill people suffer. New knowledge about how the brain functions has permissible medicine researchers to develop medications which crapper edit the way in which the brain produces, stores and releases these neurotransmitter chemicals, alleviating the symptoms of the illness.

Psychiatric medications treat noetic disorders. Sometimes titled psychotropic or healthful medications, they have changed the lives of people with noetic disorders for the better. Many people with noetic disorders live fulfilling lives with the help of these medications. Without them, people with noetic disorders might undergo earnest and disabling symptoms.


All medicines have positive and negative effects. Antibiotics, which cure potentially earnest bacterial infections, crapper drive nausea. Heart disease drug crapper drive low blood pressure. Even over-the-counter drugs such as algid remedies crapper drive drowsiness, while aspirin crapper drive breadbasket problems, bleeding and hypersensitised reactions. The same principle applies to medicine medications. While rattling trenchant in controlling the agonized emotive and noetic symptoms, medicine medicines crapper display unwanted lateral effects. People pain from noetic illness should work closely with their physicians to see what medicines they are taking, why they are attractive them, how to take them and what lateral personalty to watch for.

Four field classes are commonly utilised in adults

1.ANTIDEPRESSANTS
2.ANXIOLYTICS
3.ANTIPSYCHOTICS
4.MOOD STABILIZING AGENTS

Nonpsychiatric physicians should become familiar with digit or digit drugs in apiece of the first three classes so that the indications,dose range,efficacy,potential lateral effects,and interactions with other medications are well known.

GENERAL PRINCIPLES OF USE.  

1,Most common treatment failure are due to under-medication and impatience.For a proper take trial to take place,an trenchant pane staleness be taken for an adequate amount of time.For antidepressants,anti-psychosis,and feeling stabilizers,full personalty may take weeks or months to occur.

2.History of a positive response to a take commonly indicates that a response  to the aforementioned take will occur again.A family story of a positive to a specific take is also useful.

3.Patients who fail to respond to digit take will ofttimes respond to another in the aforementioned class: digit should attempt another trial with a take that has a assorted mechanism of state or a assorted chemical structure.Treatment failure should be refferd to a psychiatrist,as should every patients with psychotic symptoms or who order feeling stabilizers.

4.Avoid poly-pharmacy : a patient who is not responding to standard mono-therapy requires refferd to a psychiatrist.

5.Pharmacokinetics may be altered in the elderly,with smaller volumes of distribution,reduced renal and hepatic clearance,longer biologic half-lives,and greater possibleness for CNS toxicity.The rue with elderly patients is to " start baritone and go andante "

6.Never kibosh treatment abruptly: especially true for antidepressants and anxiolytics.In general,medications should be slowly narrow and discontinued over 2 - 4 weeks.

7.Review possible lateral personalty apiece time a take is prescribed :educate patients and family members about lateral effects and need for patience in awaiting a response......... read more