Risk for suicide and risk for violence: a case for separating the current violence diagnoses

PURPOSE

To identify accurate descriptive terms for risk for violence and risk for suicide and to provide operational definitions for these terms

METHODS

The Delphi technique, with two rounds, was used to differentiate the operational definitions that represent risk for suicide from those that represent risk for violence. The expert panel consisted of 23 healthcare professionals with a minimum of a master's degree. In addition to the expert panel, a control group (N = 11) participated to assess content validity.

FINDINGS

Thirty-six definitions were agreed upon for suicide, 39 for violence.

CONCLUSIONS

These definitions represent the basic distinctions between the two behavioral manifestations.

Validation of the defining characteristics of potential for violence

A high incidence of violence occurs in contemporary society, which is reflected in the violence exhibited by psychiatric patients. To validate the defining characteristics of potential for violence, 125 registered nurses were asked to rate the relevance of defining characteristics of the diagnosis. A diagnostic content validity index was used to ascertain which defining characteristics the nurses believed to be the most critical in the identification of violence potential. Nine major and 20 minor characteristics were identified by these nurses.

Pentamidine-induced torsades de pointes in a renal transplant recipient with Pneumocystis carinii pneumonia

Pentamidine isethionate, an important agent used to treat Pneumocystis carinii pneumonia, has been shown to be associated with the development of torsades de pointes in patients with AIDS. We have described a case of pentamidine-induced polymorphous ventricular tachycardia in a renal transplant recipient whose renal insufficiency may have prolonged the duration of arrhythmias. Careful ECG monitoring should be done during pentamidine administration, especially in patients with renal insufficiency. Physicians should be aware that this variety of polymorphous ventricular tachycardia can occur well within the recommended dose of pentamidine. More data are needed to define the relationship between renal dysfunction, plasma levels, and pentamidine cardiotoxicity.

Diazoxide in the management of chlorpropamide overdose

Three cases of chlorpropamide overdose are reported. Plasma levels of chlorpropamide, diazoxide, glucose, and insulin are presented for each patient during treatment. The simultaneous analysis of chlorpropamide, hydrochlorothiazide, and diazoxide in plasma by high pressure liquid chromatography (HPLC) is also reported. Although all three cases presented at hospital with potentially lethal plasma levels of chlorpropamide, each was successfully treated with intravenous diazoxide and glucose. Plasma diazoxide concentrations between 50-100 microgram/mL appear to be optimal in achieving therapeutic control of chlorpropamide induced hypoglycemia.