Emergency psychiatric assessment of violence

Article Abstract:

Legally, persons cannot be hospitalized for mental illness against their will unless they are assessed as being dangerous to self or others. Demonstrating danger to others usually requires showing that violence would be imminent if the patient is allowed to remain free. Demographic variables that are associated with violent behavior in the general population do not predict violence in the clinical setting, but certain clinical variables - such as hostility, mania, or the presence of hallucinations - have been shown to be predictive of patient violence. This study attempts to discern the characteristics that distinguish dangerous from nondangerous patients in the psychiatric emergency setting and also the variables that distinguish which dangerous patients are likely to be hospitalized and which are not. A questionnaire concerning demographic, clinical, and situational data pertaining to 99 patients evaluated as dangerous was completed by clinical staff who evaluated and treated the patients. Demographic and clinical data were also obtained from the records of 95 nondangerous psychiatric emergency patients. The dangerous patients were more likely to be men, younger, more often brought in by police, far more often put into restraints, and more often hospitalized than the nondangerous patients. Of the 99 dangerous patients, 61 were hospitalized, 57 involuntarily so. Dangerous patients who were psychotic or who had to be restrained were more likely to be hospitalized. Variables associated with violence in the general population related minimally to violence in the study subjects. Patients either brought in by police or who had committed assault and battery were more likely to be restrained. The results indicate that assessments of dangerousness and decisions to hospitalize patients in the psychiatric emergency setting were based upon the current state and immediate past behavior of the patient, not on demographic variables. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Violence, Insane, Criminal and dangerous, Criminally insane persons, Psychiatric emergencies

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Psychiatric complications in a patient with complex partial seizures

Article Abstract:

A 41-year-old woman was examined for her complex partial seizure disorder. The woman has had medication-resistant epilepsy since she was 12, recurrent depressive and psychotic symptoms, and a borderline IQ. It was found that the patient suffers from complex partial seizures of temporal lobe origin. She also exhibited mood disorder, psychotic disorder, personality change, and borderline intellectual functioning. Such patients must be treated with neuroleptics, mood-stabilizing agents, and antiepileptic medications, as well as psychosocial and psychotherapy support.

Seizures (Medicine)

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