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.