Violent Patient
Psychiatric Emergencies 439(f) cognition with a Mini-Mental State Examination (see Table
2.7 on p. 83)
(g) insight and judgement
(h) impulsivity.MANAGEMENT1 Perform the necessary investigations and resuscitative procedures to save
life, and refer the patient directly to the medical, surgical or orthopaedic
team if there is serious illness or injury, with a clear alert as to the mecha-
nism.
2 A medically unimportant acute poisoning, including a patient also intoxi-
cated with alcohol, may still have been a serious self-harm attempt.
(i) Admit the patient for 24 h, possibly to the emergency
department’s own observation ward.
3 Then refer any patient considered to have a continuing suicide risk or mental
illness behaviour immediately to the psychiatric team.
4 Alternatively, make a psychiatric outpatient appointment for the patient if
there is no current suicidal intent, no high-risk factor for completed suicide
and a normal mental state examination.
5 Refer problems with a domestic or social basis to the Social Work team.
6 Inform the general practitioner (GP) by fax and letter in every case, if the
patient is allowed home. The patient should ideally be accompanied by a
relative or friend when t hey go.
VIOLENT PATIENT
DIAGNOSIS
1 Much violence encountered by staff in the emergency department will be the
result of alcohol intoxication, either by the patient or sometimes by relatives
or friends, who may be irritated and angry at having to wait when the depart-
ment is busy.
2 Other causes for violent behaviour include:
(i) Drugs, such as cocaine and freebase ‘crack’ cocaine,
amphetamines including methylamphetamine ‘Ice’ and ‘Ecstasy’,
or phencyclidine ‘PCP’.
(ii) Mental illness especially mania and paranoid schizophrenia,
personality disorder.