Management of the acutely violent patient

Violence in the work place is a new but growing problem for our profession. It is likely that at some point a psychiatrist will be confronted with a potentially violent patient or need to assess a violent patient. Understanding predictors and associated factors in violence as well as having a clear and well-defined strategy in approaching and dealing with the violent patient, thus, are crucial. Ensuring patient, staff, and personal safety is the most important aspect in the management of a violent patient. All of the staff must be familiar with management strategies and clear guidelines that are implemented and followed when confronted with a violent patient. The more structured the approach to the violent patient, the less likely a bad outcome will occur. Manipulating one's work environment to maximize safety and understanding how to de-escalate potentially mounting violence are two steps in the approach to the violent patient. Restraint, seclusion, and psychopharmacologic interventions also are important and often are necessary components to the management of the violent patient.

The violent patient

Encounters with violent behavior are an inevitable part of working in emergency departments. By adoption of a cohesive, multidisciplinary approach to behavioral decompensation, as is done in preparation for airway compromise, the risk for injury to patients and staff is minimized. As with airway compromise, anticipation of and preparation for deterioration can avoid the necessity of the most invasive measures and can ensure a calm, positive outcome. With the appropriate knowledge, teamwork, and skills, even patients requiring the most intensive intervention can be treated safely and professionally.

Life-threatening psychiatric emergencies in the elderly: overview

Behavioral emergencies in the elderly can often be life threatening. Diagnosis and management are problematic, in part due to the high incidence of comorbidity, including medical and neurologic disorders, as well as adverse effects of medications. The behavioral types of life-threatening psychiatric emergencies are confusion, suicidality, homicidality, aggression, and abuse. Substance-induced behavioral changes contribute to morbidity and mortality of elderly patients seen in various settings, including emergency departments, medical floors, and intensive care units. These potentially serious psychiatric disturbances in the elderly are discussed under the subheadings of epidemiology and diagnosis, clinical features and presentations, and management and disposition.