Evaluation and management of the violent patient in emergency settings

The evaluation and management of the violent patient in emergency settings is a complicated task for emergency psychiatric specialists. Etiologic considerations must be carefully weighed. The interplay of biologic, psychologic, and social factors has to be clearly recognized. Psychiatrists and physicians staffing emergency departments must be facile with the application of psychopharmacologic treatment. In addition, a familiarity and comfort with physical restraint must be developed. Interview styles and stances that diverge from traditional psychiatric "examining" should be employed. There is no sure-fire way to prevent violence, but adhering to the above principles should help to minimize violence as well as allow staff to comfort this most difficult aspect of emergency psychiatry.