Chap 6 - Aggression and Violence

Qs

Is violence higher in people with mental health disorder? Why?

Yes. 2-8x higher but not a causality.

There are other factors involved such as clinical (substance use, delusions) , historical (hx of previous violence, jail etc), demographic (sex, income) and social factors (divorce, unemployment, victimization)

What are the two categories of violence?

Impulsive: reactive and emotional driven. Usually in psychotic states, emotional states.

Instrumental: Premediated - predatory ( to cause harm with gain) or pathological (deliberate response to delusions or misinterpretation). Usually by antisocial personality.

Brain lesions that lead to uncontrolled rage?

Hypothalamus and Amygdala

There is a known syndrome called hypothalamic limibic rage syndrome - will have other symptoms like hyperphagia, obesity, polydypsia. There will be other organs involved.

What is the most common cause of substance induced violence?

Alcohol!

Cocaine and amphetamine can also do so but less common.

Also opioids and PCP.

Not hallucinogens - and PCP is not a hallucinogen

What medications can be use to treat acute vs chronic aggression?

Acute: need for rapid tranquilization

• Benzos - first line

• Antipsychotics ( for aggression with psychosis)

Chronic: Ex male pts, prisoners, personality do

• Antipsychotics - most widely used

• Cochrane review- depakote, carbamazapine, oxcarbazine and phenytoin

• Beta-blockers - for patients with TBI, dementia or psychosis

What kind of seizures can lead to violence?

Complex partial seizure can.

Grandmal seizure cannot

Ictal violence is rare - its spontaneous, undirected and not purposeful.

Postictal violence is usually short lasting and likely in a confused state.

What is posictal psychosis?

• Tends to follow psychosis free interval of hours to days after the seizure

• Manifests as mood congruent psychosis but can also be other

• Short duration (hours) but can reoccur multiple times for several weeks

• Most resolve spontaneously or with low dose antipsychotics

What brain injury can lead to violence?

Injury to the frontal and temporal lobes

Called frontal lobe syndrome ( think phines cage accidenct) - sxs include disinhibition, impulsive, irritable etc

What are the stats for intimate partner violence?

36% of women and 26% of men experience one episode of IPV