Psychiatric assessment of aggressive patients: a violent attack on a resident.
Aggressive patients often target psychiatrists and psychiatric residents, yet most clinicians are insufficiently trained in violence risk assessment and management. Consequently, many clinicians are reluctant to diagnose and treat aggressive and assaultive features in psychiatric patients and instead focus attention on other axis I mental disorders with proven pharmacological treatment in the hope that this approach will reduce the aggressive behavior. Unclear or nonexistent reporting policies or feelings of self-blame may impede clinicians from reporting assaults, thus limiting our knowledge of the impact of, and best response to, aggression in psychiatric patients. The authors pre-sent the case of a young adult inpatient with a long history of antisocial and assaultive behavior who struck and injured a psychiatric resident. With this case in mind, the authors discuss the diagnostic complexities related to violent patients, the importance of assessing violence risk when initially evaluating a patient, and the relevance of risk assessment for treatment considerations and future management. This report illustrates common deficiencies in the prevention of violence on inpatient psychiatric units and in the reporting and response to an assault, and has implications for residency and clinician training.
Antonius
Daniel
D
New York University School of Medicine, New York, NY 10016, USA. daniel.antonius@nyumc.org
Fuchs
Lara
L
Herbert
Farah
F
Kwon
Joe
J
Fried
Joanna L
JL
Burton
Paul R S
PR
Straka
Tara
T
Levin
Ze'ev
Z
Caligor
Eve
E
Malaspina
Dolores
D
D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003134:Commitment of Persons with Psychiatric Disorders; D015897:Comorbidity; D003617:Dangerous Behavior; D004359:Drug Therapy, Combination; D005391:Firesetting Behavior / Q000523:psychology; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011329:Prisoners / Q000523:psychology; D011570:Psychiatry / Q000193:education*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D012308:Risk Management; D014754:Violence / Q000517:prevention & control / Q000523:psychology*
D011619:Psychotropic Drugs