Clinical evaluation of the violent patient

Violence is a generic behavior whose evaluation must consider medical, emotional, social, and environmental factors. The evaluation setting should allow privacy (but not isolation), security (but not constriction), comfort (but not fragility), and respect (but not vulnerability). In addition to one's routine complete history, a very complete description of events and feelings before, during, and after the violent episode is critical. Organic causes and correlates of violent behavior must be carefully sought. Evaluation of future risk of violence is difficult but often necessary. The environment in which the patient will be placed, time limits of the prediction and stability of the patient's clinical condition are important factors. Acute risk is greater when certain conditions, such as acute psychosis, persecutory delusions, or intoxication, are present in an already-violent patient. The legal aspects of evaluation are briefly discussed, including basic recommendations for documenting one's good-faith efforts to weigh the risks and benefits of clinical actions and adhering to applicable laws.