Violence, death and associated factors on a mental handicap ward

The characteristics of all the patients admitted to a high-dependency mental handicap ward over a 21-month period were examined. The patients that had been responsible for acts of violence on the ward were compared with those who had not. Violent patients were significantly younger and more likely to have an abnormal electroencephalogram. Meningoencephalitis as the aetiology of mental handicap was over-represented in the violent group. The level of violence was alarmingly high with 620 violent incidents over 21 months (30 per month). Four patients accounted for 74% of the violence and two of these four patients suffered sudden, unexpected deaths. The relationship between violence and sudden death is examined, and the implications of pharmacological intervention with anticonvulsants for violent patients with abnormal electroencephalogram results are discussed.