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Psychiatric Quarterly

, Volume 62, Issue 4, pp 333–344 | Cite as

The evaluation of homicidal patients by psychiatric residents in the emergency room: A pilot study

  • Theodore A. Stern
  • Jonathan H. Schwartz
  • M. Cornelia Cremens
  • Albert G. Mulley
Articles

Abstract

The authors report the results of a preliminary prospective study involving 110 patients who were involuntarily committed from the emergency room. The study was designed to clarify the process of how psychiatric residents evaluate homicidal patients. Eighteen patients (16%) were committed for homicidal ideation, of whom 89% were psychotic. Surprisingly, for patients committed because of a risk of homicide, vital signs were obtained for only 11%, during a mean evaluation time of 2.5 hours. Aspects of an appropriate physical examination and laboratory studies that enable the clinician to distinguish organic from functional illness are described. The authors conclude that patients with homicidal ideation may receive inadequate assessment prior to their involuntary commitment. Possible explanations and solutions for this, and recommendations for further studies are offered.

Keywords

Public Health Physical Examination Pilot Study Laboratory Study Emergency Room 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Weissberg MP, Dubovsky SL: Assessment of psychiatric emergencies in medical practice. Primary Care 4:651–660, 1977.Google Scholar
  2. 2.
    Tupin JP: The violent patient: A strategy for management and diagnosis. Hospital & Community Psychiatry 34:37–40, 1983.Google Scholar
  3. 3.
    Grunberg F, Klinger BI, Grumet BR: Homicide and community-based psychiatry. Journal of Nervous and Mental Disorders 166:868–873, 1978.Google Scholar
  4. 4.
    Husain A, Anasseril DE, Harris PW: A study of young-age and mid-life homicidal women admitted to a psychiatric hospital for pre-trial evaluation. Canadian Journal of Psychiatry 28:109–112, 1983.Google Scholar
  5. 5.
    Tennent G, Parker E, McGrath PG, et al: Male admissions to the English Specials Hospitals-1961–1965; A demographic survey. British Journal of Psychiatry 136:181–190, 1980.Google Scholar
  6. 6.
    Sendi IB, Blomgren PG: A comparative study of predictive criteria in the predisposition of homicidal adolescents. American Journal of Psychiatry 132:423–427, 1975.Google Scholar
  7. 7.
    Anderson WH: The physical examination in office practice. American Journal of Psychiatry 137:1188–1192, 1980.Google Scholar
  8. 8.
    Riba M: Medical clearance: Fact or fiction in the hospital emergency room. Psychosomtics 31:400–404, 1990.Google Scholar
  9. 9.
    Koran LM, Sox HC, Marton KI, et al: Medical evaluation of psychiatric patients. Archives of General Psychiatry 46:733–740, 1989.Google Scholar
  10. 10.
    Muller JJ, Chafetz ME, Blane HT: Acute psychiatric services in the general hospital: III Statistical survey. American Journal of Psychiatry 124:46–56, 1967.Google Scholar
  11. 11.
    Atkins RW: Psychiatric emergency services. Archives of General Psychiatry 17:176–182, 1967.Google Scholar
  12. 12.
    Tischler GL: Decision-making process in the emergency room. Archives of General Psychiatry 14:69–78, 1966.Google Scholar
  13. 13.
    Anderson WH: Differential Diagnosis, Postgraduate Education Course on Differential Diagnosis, Massachusetts General Hospital, Boston, 1980.Google Scholar
  14. 14.
    de Bures I, Houillon G, Debaisleux T, et al: Detection of a brain tumor during a psychiatric evaluation. Annales Medico-Psychologiques 140:453–457, 1982.Google Scholar
  15. 15.
    Easson WM: Myxedema with psychosis. Archives of General Psychiatry 14:277–283, 1966.Google Scholar
  16. 16.
    Asher R: Myxoedematous madness. British Medical Journal 2:555–562, 1949.Google Scholar
  17. 17.
    Milne HB: Epileptic homicide: Drug-induced. British Journal of Psychiatry 134:547–548, 1979.Google Scholar
  18. 18.
    Trafford PA: Homicide in acute porphyria. Forensic Science 7:113–120, 1976.Google Scholar
  19. 19.
    Markowitz M: Acute intermittent porphyria: A report of five cases and a review of the literature. Annals of Internal Medicine 41:1170–1188, 1954.Google Scholar
  20. 20.
    Goldberg A: Acute intermittent porphyria: A study of fifty cases. Quarterly Journal of Medicine 28:183–209, 1959.Google Scholar
  21. 21.
    Simon RH, Dasilva M: Intracranial tuberculoma coexistent with uncinate seizures and violent behavior. Journal of the American Medical Association 245:1247–1248, 1981.Google Scholar
  22. 22.
    Peturson H, Gudjonsson GH: Psychiatric aspects of homicide. Acta Psychiatrica Scandanavia 64:363–372, 1981.Google Scholar
  23. 23.
    Wetli CV: Changing patterns of methaqualone abuse. Journal of the American Medical Association 249:621–626, 1983.Google Scholar
  24. 24.
    Luchins DJ, Sherwood PM, Gillin JC, et al: Filicide during psychotropic-induced somnambulism: A case report. American Journal of Psychiatry 135:1404–1405, 1978.Google Scholar
  25. 25.
    Cornelius JR, Soloff PH, Reynolds CF: Paranoia, homicidal behavior and seizures associated with phenylpropanolamine. American Journal of Psychiatry 141:120–121, 1984.Google Scholar
  26. 26.
    Rofman ES, Askinazi C, Fant E: The prediction of dangerous behavior in emergency civil commitment. American Journal of Psychiatry 137:1061–1064, 1980.Google Scholar
  27. 27.
    Rosen A: Detection of suicidal patients: An example of some limitations in the prediction of infrequent events. Journal of Consulting Psychology 18:397–403, 1954.Google Scholar
  28. 28.
    Shah SA: Dangerousness and civil commitment of the mentally ill: Some public policy considerations. American Journal of Psychiatry 132:501–505, 1975.Google Scholar
  29. 29.
    McDonald A, Paitich D: A study of homicide: The validity of predictive test factors. Canadian Journal of Psychiatry 26:549–554, 1981.Google Scholar
  30. 30.
    Estelle v Smith: Amicus brief for the American Psychiatric Association 445US 926, 1980.Google Scholar
  31. 31.
    Beck JC, White KA, Gage B: Emergency psychiatric assessment of violence. American Journal of Psychiatry 148:1562–1565, 1991.Google Scholar
  32. 32.
    Weissberg MP: Emergency medical clearance: An educational problem. American Journal of Psychiatry 136:787–790, 1979.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1991

Authors and Affiliations

  • Theodore A. Stern
    • 1
  • Jonathan H. Schwartz
  • M. Cornelia Cremens
  • Albert G. Mulley
  1. 1.Department of PsychiatryMassachusetts General HospitalBoston

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