Objective: Newly qualified doctors on the wards are sometimes faced with difficult situations and difficult patients on the wards. We report a case and provide insight into management of these patients. Methods: This was only second week into the job. This patient was admitted to psychiatry ward from medical assessment unit because of acute episode of psychosis. Results: The patient was given some medications along with physical restraint. He was first given haloperidol and then lorazepam. He settled after these medications. He was thoroughly assessed by a multidisciplinary team headed by the consultant next day. He was diagnosed as brief psychotic disorder. He stayed on the unit for some time and was then discharged home on regular antipsychotic. He was booked into 1 monthly clinic and was given community support as well. Conclusion: Aggression can happen for a variety of reasons, i.e. acute psychosis and mania. Management varies according to the diagnoses. Physical restraint and medications form an essential part of management. However it is of utmost important to rule out medical causes of aggression. Substance abuse is the most common cause of aggression in developed countries.

Background/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes. Methods: We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated. Results: Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device. Conclusions Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.