Management

1. Ensure the safety of others including oneself.

2. Restrain or seclusion may be required. ( care to be taken not to violate human rights of any patient by forceful restraint/ injection unless as last resort).

3. To rule out organicity and look for treatable medical cause and if needed prescribe Medication oral or parentral to control agitation.

5. Psychiatric assessment by history and MSE to establish underlying diagnosis and treat underlying psychiatric disorder.

“Management of a violent patients require patience, vigilance, team effort and preparedness”.

Presentation

1. Such patients have either- frequently thought of/ contemplated suicide/have
planned the act/ have attempted the act.

2. Such patients are brought by family members.

Special precautions

1. Don’t approach a violent patients alone, staff should be present.

2. Ensure removal of potentially harmful objects from patients vicinity.

3. Assess for the possibility of possession of weapon by patient.

4. Ensure suitable escape route in case of uncontrollable violence.

5. Don’t intimidate, argue or pose any threat to the patient.

6. Approach patient in calm and non threatening manner.

7. Maintain at least 3-6 feet distance from patient.

8. If patient agrees to speak with you, sit him down and listen him, let him know you are there to help him and he need not to fear.

When to refer a violent patient

– All suspected cases of organicity should be investigated and referred to concerned speciality.

– All stabilised patients should be sent for psychiatric evaluation and management.

– Medical conditions should be examined and stabilised before a psychiatric referral.

– Very severe cases need inpatient management.