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

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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.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Warren 605, 02114, Boston, MA

    Theodore A. Stern M.D.

Authors
  1. Theodore A. Stern M.D.
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  2. Jonathan H. Schwartz M.D.
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  3. M. Cornelia Cremens M.D.
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  4. Albert G. Mulley M.D., M.P.P.
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Additional information

Theodore A. Stern, M.D., is Associate Professor of Psychiatry, Harvard Medical School, and Psychiatrist and Director, Resident Psychiatric Consultation Service, Massachusetts General Hospital. Jonathan H. Schwartz, M.D., is Clinical Fellow in Psychiatry, Harvard Medical School, Massachusetts General Hospital. M. Cornelia Cremens, M.D., is Clinical Fellow in Psychiatry, Harvard Medical School, and Chief Resident, Psychiatric Consultation Service, MGH. Albert G. Mulley, M.D., M.P.P., is Associate Professor of Medicine, Harvard Medical School, and Chief, General Internal Medicine Unit, Massachusetts General Hospital.

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Stern, T.A., Schwartz, J.H., Cremens, M.C. et al. The evaluation of homicidal patients by psychiatric residents in the emergency room: A pilot study. Psych Quart 62, 333–344 (1991). https://doi.org/10.1007/BF01958801

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