Violent Behavior

Aka: Violent Behavior, Dangerous Behavior, Dangerous and Harmful Thoughts, Dangerousness, Homicidal Thoughts

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II. Risk Factors

  1. Schizophrenia or other Psychosis (e.g. paranoid Delusions)
  2. Personality Disorder
  3. Prior Violent Behavior
  4. Access to weapons
  5. Substance Abuse or Alcohol Abuse
  6. Prior victimization (e.g. Bullying victim)

III. Symptoms: Behavior Preceding Violent Outbursts

  1. Confusion
  2. Irritability
  3. Boisterous
  4. Physical or verbal threats
  5. Attacks on objects

IV. Management: Emergency Department

  1. See Agitation
  2. See Agitated Delirium
  3. See Calming the Agitated Patient
  4. See Physical Restraint
  5. See Chemical Restraint

V. Management: Disposition of patient with Suicidality or homicidality

  1. See Emergency Psychiatric Evaluation
  2. Involuntary committment indications
    1. Mental illness
    2. Danger to self or others due to mental illness
    3. Not intoxicated
    4. Restrictive disposition for safety
  3. No formal guidelines on how access to weapons (e.g. firearms) directs the disposition
    1. Some states mandate reporting if firearm access in a patient at risk for Violence
    2. Apply best clinical judgement, and err on the side of safety
    3. Work to remove access to weapons in unclear situations
    4. Notifying police of credible threat to the patient or others does not breach HIPAA

VI. Complications

  1. Interpersonal Violence
  2. Homicide
  3. Suicide

VII. References

  1. Barsotti in Herbert (2015) EM:Rap 15(4): 12-14

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