Altered, when charging, can outrun B.J. with ease, unless he uses Mire. Therefore, it's best to keep maximum range. The first Altered must be killed by forcing him to ram 4 pillars twice. This is done by shooting him, and then putting a pillar between B.J and the rampaging Altered. Note, though, to stand away from the pillar, as the shockwave harms B.J. Also bear in mind that when in the first encounter you finish him and the portal attempts to suck you, a glitch may occur. Instead of being sucked by it to end the level you may be sucked by the floor being trapped under it. To avoid that you will have after you finish him to rise again to the small terrace you start at the beginning of the fight. For the other few Altered encountered, the Leichenfaust 44 is the quickest and easiest way to destroy them: it incinerates them in one shot. Beware when engage the Altered in the hospital, Geists are quite aggressive there.