The evaluation of homicidal patients by psychiatric residents in the emergency room: a pilot study

The authors report the results of a preliminary prospective study involving 110 patients who were involuntarily committed from the emergency room. The study was designed to clarify the process of how psychiatric residents evaluate homicidal patients. Eighteen patients (16%) were committed for homicidal ideation, of whom 89% were psychotic. Surprisingly, for patients committed because of a risk of homicide, vital signs were obtained for only 11%, during a mean evaluation time of 2.5 hours. Aspects of an appropriate physical examination and laboratory studies that enable the clinician to distinguish organic from functional illness are described. The authors conclude that patients with homicidal ideation may receive inadequate assessment prior to their involuntary commitment. Possible explanations and solutions for this, and recommendations for further studies are offered.