Violent behavior in psychiatric emergencies can include verbal, physical, and self-harm aggression. Verbal aggression involves harmful words while physical aggression endangers others through actions like hitting. Self-harm includes minor injuries to serious suicide attempts. Risk factors include previous violence, abuse exposure, genetics, drugs/alcohol, and stressors. Biological and psychological causes may relate to brain abnormalities, genetics, chemical imbalances, mental health conditions, and more. Treatment involves therapies like CBT to change behaviors and address underlying issues. Medications may also help regulate brain chemistry.

1. Psychiatric emergency- violent behaviour

2. Violent behaviour
This is a severe form of aggressiveness. patient will be irrational,
uncooperative, delusional and assaultive
Types of aggression :
Verbal aggression: Verbal aggression has been defined
as communication with an intention to harm an individual
through words, tone or manner, regardless of whether harm
occurs.
Insulting, obscene or profane language, or sexual
advances
Physical aggression ; Physical Aggression Toward Person-
Exhibiting one of the following (or similar) behaviors that
have the potential to cause harm to another person.
includes hitting, kicking, scratching, pushing, biting,
punching, grabbing, pinching, cutting, and stabbing

3. TYPES OF AGGRESSION CONTD…
Self-harm/auto aggression: CASE STUDY
A 23-year-old male had tattooed initials of a girl on his left fore arm with whom he
was in love. After few years, one day when the girl did not respond to him
properly, he placed camphor on the tattoo mark and burnt the camphor in a bid to
erase the tattoo mark. He was a social drinker to begin with and later developed
alcohol dependence with depressive features.
Aggression against self involves picking or scratching the skin, pulling of
hair, banging the head or objects, small cuts or bruises, minor burns,
mutilating self, deep cuts, and serious injury like suicidal attempt

4. Factors Which Increase Risk of Violent
Behavior
Previous aggressive or violent behavior
Being the victim of physical abuse and/or sexual abuse
Exposure to violence in the home and/or community
Being the victim of bullying
Genetic (family heredity) factors
Exposure to violence in media (TV, movies, etc.)
Use of drugs and/or alcohol
Presence of firearms in home
Combination of stressful family socioeconomic factors (poverty,
severe deprivation, marital breakup, single parenting, unemployment,
loss of support from extended family)
Brain damage from head injury

5. What causes aggressive behavior ?
Biological factors
Irregular brain development. ExpertsTrusted Source have linked
increased activity in the amygdala and decreased activity in the prefrontal
cortex to aggression. Lesions in the brain, which can happen with
neurodegenerative conditions, can also lead to aggressive behavior.
Genetics. Mutations of certain genes, including monoamine oxidase
ATrusted Source, can also contribute.
Brain chemical and hormone imbalances. Unusually high or low levels
of certain neurotransmitters, including serotonin, dopamine, and gamma-
amino-butyric acid (GABA), may lead to aggressive behavior. Higher levels
of testosterone can also lead to aggression in people of any gender.
Side effects of prescription medications and other substances.
Medications and substances that cause changes in the brain can
sometimes lead to aggressive behavior. A few examples include
corticosteroids, alcohol, anabolic steroids, and phencyclidine (PCP).
Medical conditions. Aggressive behavior could happen as a result of
certain health conditions that damage your brain, including stroke,
dementia, and head injuries.

6. Psychological factors
Aggressive behavior can sometimes happen as a symptom of certain
mental health conditions, including:
conduct disorder
intermittent explosive disorder
oppositional and defiant disorder (ODD)
attention deficit hyperactivity disorder (ADHD)
post-traumatic stress disorder (PTSD)
autism
bipolar disorder
schizophrenia
depression
substance use disorders
chronic stress
certain personality disorders, including borderline, antisocial,
and narcissistic personality disorders

7. "warning signs" for violent behavior
Intense anger
Frequent loss of temper or blow-ups
Extreme irritability
Extreme impulsiveness
Becoming easily frustrated
shouting at parents and siblings
destroying belongings or property

8. How is the treatment done?
Types of therapy for aggression
A therapist might recommend different therapy approaches, depending on any underlying
mental health symptoms you experience.
Cognitive behavioral therapy (CBT) can help you learn to identify and change unhelpful
behavior patterns and practice more helpful coping techniques. This approach doesn’t focus
much on past experiences, but it can help improve symptoms of depression, anxiety,
personality disorders, bipolar disorder, and ADHD.
Psychodynamic therapy can help you address mental health symptoms and emotional
distress by tracing their roots to earlier life events.
Dialectical behavior therapy can help you build and practice skills to tolerate distress,
regulate emotions, and navigate interpersonal relationships more effectively.
Interpersonal therapy can help you explore relational challenges that affect your mood and
contribute to depression and other mental health symptoms.
Parent management training can help address tense family dynamics or unhelpful parenting
tactics contributing to or reinforcing aggressive behavior.

9. PANIC ATTACKS
What Is a Panic Attack?
A panic attack is a sudden and intense
feeling of terror, fear, or apprehension,
without the presence of actual danger.
The symptoms of a panic attack usually
happen suddenly, peak within 10 minutes,
and then subside.
However, some attacks may last longer or
may occur in succession, making it difficult
to determine when one attack ends and
another begins.

10. Types of Panic Attacks
1. Spontaneous or uncued panic attacks occur without warning or
“out of the blue.” No situational or environmental triggers are
associated with the attack. These types of panic attacks may even
occur during sleep.
2. Situationally bound or cued panic attacks occur upon actual or
anticipated exposure to certain situations. These situations
become cues or triggers for a panic episode. For example, a
person who fears enclosed spaces may experience a panic attack
when entering or thinking about entering an elevator.
3. Situationally predisposed panic attacks don’t always occur
immediately upon exposure to a feared situation or cue, but the
person is more likely to experience an attack in such situations.
For example, a person who has a fear of social situations but who
does not experience a panic episode in every social situation, or
who experiences a delayed attack after being in a social
environment for an extended period of time.

11. Panic Attack Symptoms
Panic attacks usually appear suddenly and lead to intense feelings of fear.
They tend to last around 10 to 20 minutes but can last longer in some
instances. The experience can vary from one person to the next, but some
of the most common symptoms include:
Chest pain or discomfort
Chills or hot sensations
Feeling of choking
Feeling dizzy, unsteady, lightheaded, or faint
Fear of dying
Fear of losing control or going crazy
Feelings of unreality (derealization) or being detached from oneself
(depersonalization)
Nausea or abdominal distress
Numbness or tingling sensations (paresthesias)
Palpitations, pounding heart, or accelerated heart rate
Sensations of shortness of breath or smothering
Sweating
Trembling or shaking

12. DIAGNOSIS
A complete physical exam
Blood tests to check your thyroid and other possible conditions and tests on your heart,
such as an electrocardiogram (ECG or EKG)
A psychological evaluation to talk about your symptoms, fears or concerns, stressful
situations, relationship problems, situations you may be avoiding, and family history
Criteria for diagnosis of panic disorder
For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published by the American Psychiatric Association, lists these
points:
You have frequent, unexpected panic attacks.
At least one of your attacks has been followed by one month or more of ongoing
worry about having another attack; continued fear of the consequences of an attack, such
as losing control, having a heart attack or "going crazy"; or significant changes in your
behavior, such as avoiding situations that you think may trigger a panic attack.
Your panic attacks aren't caused by drugs or other substance use, a medical condition,
or another mental health condition, such as social phobia or obsessive-compulsive
disorder.

13. Treatment for Panic Attacks
Treatment for panic attacks can involve psychotherapy, medication, or a
combination of both.
Treatment options are focused on
Reducing the frequency and intensity of these attacks.
The treatment options that recommends may depend on a variety of factors
including your diagnosis, your history, your preferences, and the severity of your
symptoms.
MEDICATION
Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk
of serious side effects, SSRI antidepressants are typically recommended as the
first choice of medications to treat panic attacks. SSRIs approved by the Food and
Drug Administration (FDA) for the treatment of panic disorder include fluoxetine
(Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications
are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA
approved for the treatment of panic disorder.
Benzodiazepines. These sedatives are central nervous system depressants.
Benzodiazepines approved by the FDA for the treatment of panic disorder include
alprazolam (Xanax) and clonazepam (Klonopin).

14. PSYCHOTHERAPY
PSYCHOTHERAPY, ALSO CALLED TALK THERAPY
COGNITIVE BEHAVIORAL THERAPY
Your therapist will help you gradually re-create the symptoms of a panic attack in
a safe, repetitive manner. Once the physical sensations of panic no longer feel
threatening, the attacks begin to resolve. Successful treatment can also help you
overcome fears of situations that you've avoided because of panic attacks.
PROGNOSIS
Seeing results from treatment can take time and effort. You may start to see
panic attack symptoms reduce within several weeks, and often symptoms
decrease significantly or go away within several months. You may schedule
occasional maintenance visits to help ensure that your panic attacks remain
under control or to treat recurrences.

15. Coping With Panic Attacks
DEEP BREATHING: This can help prevent the rapid breathing
or hyperventilation that often happens during a panic attack
MINDFULNESS: This involves grounding yourself and being more
aware of what is happening with your body in the moment
PROGRESSIVE MUSCLE RELAXATION: This involves tensing and
then relaxing muscles throughout the body; when practiced regularly,
you can learn how to induce a relaxation response when you are
anxious or stress
MENTAL IMAGERY: This involves thinking of something that you find
calming and relaxing; picturing this scene in your mind can help produce
a relaxation response to combat your feelings of fear