English

Thomas Schilling

doi:10.15436/2377-1364.16.032

Abstract

Background: It is widely accepted that manifestations of pain cannot be detached from the case history, accompanying diseases, and the individual medication profile. An indirect association between pain and aggression (due to psychosis) as a cause of administration of neuroleptics has not been described yet.Aim & method: Here we report the connection between treatment of pain and additional medication with a neuroleptic for patients with manifest aggression and psychotic background in two impressive cases.Course & outcome:Case 1: A 57-year-old male patient underwent surgery for an esophageal carcinoma. Since the second postoperative day, the patient has been given long acting morphine orally. After several days, the patient became verbally aggressive. As he was suffering from a depression, he was administered higher doses of neuroleptics. As a consequence, his pain and aggression were reduced significantly and permanently.Case 2: A 24-year-old male patient was surgically treated for colon carcinoma. He complained about abdominal pain. Under long acting tilidine 50mg, pain increased. Increasing dosage had no effect. However, intensity of pain (NRS 10) could only be reduced to NRS 2 by piritramide (7.5mg). Despite of the lack of psychotic disorders in the past the patient became verbally aggressive. Presuming a reactive psychosis, an administered neuroleptic reduced pain and aggression effectively and permanently.Conclusion: If administration of painkillers does not lead to an adequate reduction of pain in the patient, and if an accompanying psychosis is present or suspected, this can manifest as aggression, an additional administration of neuroleptics needs to be considered.

Highlights

A direct connection between pain and aggression due to psychosis as a cause to prescribe neuroleptics has not been described until now
Aggression on the basis of psychosis is practically untreatable with analgesics and requires the administration of neuroleptics[4]
Summary To our knowledge, there are no reports of patients suffering from pain, depression and exhibiting a high level of verbal aggression

Summary

Introduction

A direct connection between pain and aggression due to psychosis as a cause to prescribe neuroleptics has not been described until now. He Combination of Pain and Aggression tween cause and manifestation of aggression. Aggression on the basis of psychosis is practically untreatable with analgesics and requires the administration of neuroleptics[4]. That can result in aggressive behavior of the involved parties. This situation can be triggered by an information deicit along the lines of “what is the further plan for pain therapy”. We present two cases in which alternating the medication of the patient reduced the pain trigger, the aggressiveness and thereby deescalating the situation (Table 1). Secondary Diagnoses: Acha- Secondary Diagnoses: lasia,biliary pancreatitis, cho- Pneumonia in both lower lecystectomy 2014, Juli; my- lobes; previous one-sided neasthenia gravis, thymectomy phrectomy 1987, depression

Analgesics when required

Discussion