Vancouver/Richmond EPI
Early Psychosis Intervention

Aggression

Definition:

Verbal or physical acting out in a destructive, threatening or violent manner.

Causes:

• Fear
  
• Misinterpretation of intent of others: person thinks they are in danger
  
• Too much stimulation
  
• Psychosis
  
• Drugs and alcohol: lower impulse control
  
• Loss of personal power and control: person feels they have no choices and no freedom

A PAST HISTORY OF VIOLENCE AND AGGRESSION IS A PREDICTOR OF AGGRESSION

SUCCESSFUL LIMIT SETTING

Keep it simple:

• Watch non-verbal behaviour
  
• Provide room for the person so they don't feel crowded

Give choices:

• "You can stop yelling or you can take time out in your room"

Lower Stimulation:

• Turn off radio and tv and stereo
  
• Reduce room lights
  
• Have one person appointed as spokesman
  
• Have only 2 others in the room with you

Be Clear:

• Clearly describe behaviours that are unacceptable
  
• Don't ignore or minimize concerns
  
• Don't explain, defend, argue, debate
  
• Speak quietly, calmly
  
• Keep a safe distance

Enforceable:

• Clearly describe consequences and be sure that you will be able to enforce them
  
• Be realistic
  
• Apply consequences immediately
  
• Avoid power struggles

Reasonable:

• Be calm, factual, non-punitive
  
• Target only important issues
  
• Don't remind them of all the things they've done wrong in the past
  
• Maintain safety
  
• Avoid making it a public issue (don't discuss in front of a lot of other people)
  
• Consider if the person will be able to follow through with what you've discussed
  
• Have a plan ahead of time if you can
  
• After the incident, when the person is calm and able, discuss what happened and what changes might be made in the future to prevent a repeat

Top of Page