Am J Psychiatry 1991; 148:1562-1565
Copyright © 1991 by American Psychiatric Association
Emergency psychiatric assessment of violence
JC Beck, KA White and B Gage
Department of Psychiatry, Cambridge Hospital, MA 02141.
OBJECTIVE: The purpose of the study was to 1) ascertain whether there are
clinical and demographic characteristics that distinguish dangerous from
nondangerous patients evaluated in a psychiatric emergency service and 2)
identify variables that distinguish dangerous patients who are hospitalized
form those who are not. METHOD: The authors conducted a case comparison
study of 99 psychiatric emergency patients whom staff identified as
dangerous to others, that is, violent or potentially violent. Clinical
staff were interviewed and records reviewed. These data were contrasted
with record review data for 95 nondangerous patients. RESULTS: Log linear
analysis showed that 1) variables relating to violence in community
samples--age, sex, and past history of violence--related minimally or not
at all to violence in this sample and 2) disposition to hospital versus
community was associated with psychotic mental status and restraint in the
psychiatric emergency service. Patients requiring restraint were more
likely to have recently committed assault or battery and to have been
brought in by the police. CONCLUSIONS: Enduring personal characteristics of
patients relate neither to psychiatric emergency service assessments of
current dangerousness nor to the decision to hospitalize. These
determinations appear to be related to assessments of current patient state
and immediate past behavior.
