Anderson Tanya R, Bell Carl C, Powell Traci E, Williamson Johnny L, Blount Morris A
University of Illinois, Chicago 60608, USA.
Community Ment Health J. 2004 Aug;40(4):379-99. doi: 10.1023/b:comh.0000035231.24472.bc.
Managing violent patients is a dilemma that every clinician faces. This article reviews the current literature and assesses the evidence on the management of violent patients in the clinical setting. Risk factors (dispositional, historical, contextual and clinical) and early warning signs of violence will be outlined. Understanding these issues will facilitate the short-term prediction and prevention of violence in clinical settings. Interventions have been categorized for use according to the urgency of the situation. This degree of urgency has been designated as either potential, imminent or emergent violence. Special considerations that may alter the management of violence will be delineated. Specifically, we will highlight issues related to gender, age and mental retardation. Aspects of professional training in regards to the management of the violent patient will be underscored as well. Finally, the review of the literature has led to a decision tree that can inform the reader in the evidence-based management of the violent patient. This decision tree is offered to the busy practitioner as a practical clinical tool for using evidence based practices in managing violent patients.
管理暴力患者是每位临床医生都面临的难题。本文回顾了当前文献，并评估了临床环境中暴力患者管理方面的证据。将概述暴力的风险因素（性格、病史、背景和临床因素）及早期预警信号。了解这些问题将有助于在临床环境中对暴力进行短期预测和预防。已根据情况的紧急程度对干预措施进行了分类。这种紧急程度被指定为潜在、即将发生或紧急暴力。将阐述可能改变暴力管理方式的特殊考虑因素。具体而言，我们将突出与性别、年龄和智力迟钝相关的问题。还将强调在暴力患者管理方面的专业培训内容。最后，文献综述得出了一个决策树，可为读者在暴力患者的循证管理方面提供参考。这个决策树作为一种实用的临床工具提供给忙碌的从业者，以便在管理暴力患者时采用循证实践。
