Citation

Fraser K. Medicine (Abingdon) 2004; 32(7): 10-11.

Copyright

(Copyright © 2004, Medicine Publishing)

DOI

10.1383/medc.32.7.10.36670

PMID

unavailable

Abstract

The only safe way in which to approach an unknown patient is to assume that he or she may become violent without warning. Clinical practice is therefore be based on a safety-first principle in terms of preparation of the environment, and for those working in the community in particular, systems should be established to ensure personal protection. Training should be available for all clinicians in de-escalation and breakaway techniques. Although patients suffering from mental illness are more likely to pose a risk of harm to themselves than to others, it has been established that individuals suffering from mental illness are more likely to initiate violence than the average person. Certain situations are clearly high risk, such as the paranoid patient who is intoxicated. Past behaviour is a good predictor of the future, and medical records should be clearly 'flagged', to alert clinicians who have subsequent contact with a patient who has been violent. If there are signs of disturbance in an unknown patient, routine early interaction should include a question about the carrying of a weapon. When mental disorder has been identified as a cause of disturbed behaviour the most appropriate drugs to consider are minor tranquillizers and antipsychotics, perhaps in combination. Use of orodispersible forms of atypical antipsychotics allows drugs with a lower risk of side-effects than traditional anti-psychotics to be successfully administered to apparently compliant patients. Following an incident involving actual violence or a 'near-miss', debriefing by trained staff is essential, with further counselling when appropriate.