Emergency Management of Potentially Violent Patients
The complexities of emergency psychiatric practice are especially dramatized by the agitated, threatening, or potentially violent patient. The need for decisive, accurate assessment and management must be balanced against the risk to personal safety. At the very core of this complicated intervention is the necessary, but virtually impossible, task of predicting the patient’s potential for future violence. In essence, the emergency clinician must predict whether a patient who is now agitated or has a history of violence will sooner or later lose control. To this end, the clinician must assess the patient’s history of aggression and the current psychological and environmental conditions aggravating or inhibiting his violent impulses, and must identify the precipitants of the current crisis. And yet there is no set of criteria based on etiologies, historical factors, syndromes, or symptoms with absolute predictive value. There is ultimately only an educated opinion. This chapter discusses the process of turning clinical impressions, historical data, and physical/psychological findings into just those sorts of seasoned judgments and management decisions.
KeywordsPersonality Disorder Temporal Lobe Epilepsy Violent Behavior Emergency Management Psychotic Disorder
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