Rare psychiatric diagnosis involving discrete episodes of aggressive impulses resultingin serious injury or property damageEpisodes are out of proportion to any provocation, and the person is remorseful andembarrassed afterward.
An immature defense mechanism in which the person deals with emotional conflict orstress by actions rather than reflection or feelings; the person is trying to feel lesspowerless or helpless by acting out.
Etiology of Hostility and Aggression
: decreased serotonin, increased dopamine and norepinephrine;structural damage to limbic system, damage to frontal or temporal lobes
: failure to develop impulse control and ability to delaygratification
In certain cultures, expressing anger may be seen as rude or disrespectful; someculture-bound syndromes involve aggressive, agitated, or violent behavior.
Treatments and Medications
Treatment often focuses on treating the underlying or comorbid psychiatric diagnosissuch as schizophrenia or bipolar disorder.
Lithium for bipolar disorder, conduct disorder, or mental retardation
Carbamazepine (Tegretol) or valproate (Depakote) for dementia, psychosis, orpersonality disorders
Atypical antipsychotics such as clozapine (Clozaril), risperidone (Risperdal), andolanzapine (Zyprexa) for dementia, brain injury, mental retardation, and personalitydisorders
Benzodiazepines for older adults with dementia
Haloperidol (Haldol) and lorazepam (Ativan) for clients with psychoses
Application of the Nursing Process
Early assessment and intervention needed when clients are angry or hostile to avoidphysically aggressive episodes
Nurse must assess both individual clients and the therapeutic milieu or environment
Assessment and intervention are based on five phases of aggression
Common nursing diagnoses:
Risk for Other-Directed Violence