VIOLENCE IN PSYCHIATRIC-INPATIENTS - REVIEW AND CLINICAL IMPLICATIONS

The literature on violence by psychiatric patients is reviewed. Emphas is is given to recent papers relevant to clinical management. Most stu dies are cross-sectional. The Maudsley/Bethlem Violent Incidents Regis ter is used to provide longitudinal data over a period in excess of 20 years. In acute units most violent actions are carried out by patient s suffering from schizophrenia, personality disorder and alcohol or su bstance abuse. In longer stay units violence tends to be associated wi th either intractable schizophrenia or with organic syndromes-particul arly mental impairment Most in-patient violence is minor and repetitiv e. Patients at risk are usually easily identifiable by a past history of violence or aggression. Most psychiatric patients are non-violent, but a small proportion of patients account for a large number of incid ents. Violence by psychotic patients is particularly likely to occur i n the period leading up to and immediately following admission, when t he patient is acutely disturbed. The prevention of violence is largely a matter of good psychiatric and nursing care for patients at risk. M uch of the violence committed by recently admitted psychotic patients could be prevented if after care facilities were more effective in pre venting non-compliance and relapse.