Up to this point the primary focus has been on emotionally charged aggression and violence. In this chapter we look at what happens when the behaviour becomes increasingly disturbed - either due to an acute psychotic state or through alcohol and substance misuse. This chapter begins with another "Walk-through" case study, one that this time occurs in a public area of an office/clinic and in the presence of members of the public. As Disturbed Aggression often also involves high levels of emotion, the Psychosis Containment Skills are supplementary to the Rapid Reaction Skills. We explore the nature of acute psychotic episodes and then identify the interactive skills necessary to manage that behaviour. There is also a brief consideration of how race and culture play a part in our understanding of violence.