Violent Behavior

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

1. See Also
   1. Agitation
   2. Agitated Delirium
   3. Calming the Agitated Patient
   4. Physical Restraint
   5. Emergency Psychiatric Evaluation
2. 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)
3. Symptoms: Behavior Preceding Violent Outbursts
   1. Confusion
   2. Irritability
   3. Boisterous
   4. Physical or verbal threats
   5. Attacks on objects
4. Management: Emergency Department
   1. See Physical Restraint
   2. See Chemical Restraint
5. Management: Disposition of patient with Suicidality or homicidality
   1. Involuntary committment indications
      1. Mental illness
      2. Danger to self or others due to mental illness
      3. Not intoxicated
      4. Restrictive disposition for safety
   2. 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
6. Complications
   1. Interpersonal Violence
   2. Homicide
   3. Suicide
7. References
   1. Barsotti in Herbert (2015) EM:Rap 15(4): 12-14