Maniaci Michael J, Burton M Caroline, Lachner Christian, Vadeboncoeur Tyler F, Dawson Nancy L, Roy Archana, Dumitrascu Adrian G, Lewis Patricia C, Rummans Teresa A
From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
South Med J. 2019 Sep;112(9):463-468. doi: 10.14423/SMJ.0000000000001019.
This study describes the specific threats of harm to others that led to the use of the Baker Act, the Florida involuntary hold act for emergency department (ED) evaluations. The study also summarizes patient demographics, concomitant psychiatric diagnoses, and emergent medical problems.
This is a retrospective review of 251 patients evaluated while on involuntary hold from January 1, 2014 through November 30, 2015 at a suburban acute care hospital ED. The data that were collected included demographic information, length of stay, reason for the involuntary hold, psychiatric disorder, substance use, medical illness, and violence in the ED. The context of the homicidal threat also was collected.
We found that 13 patients (5.2%) were homicidal. Three patients had homicidal ideations alone, whereas 10 made homicidal threats toward others. Of the 10 making homicidal threats, 7 named a specific person to harm. Ten of the 13 homicidal patients (76.9%) also were suicidal. Eleven patients (84.6%) had a psychiatric disorder: 9 patients (69.2%) had a depressive disorder and 8 patients (61.5%) had a substance use disorder. Eight patients had active medical problems that required intervention in the ED.
We found that three-fourths of patients expressing homicidal threats also were suicidal. The majority of patients making threats of harm had a specific plan of action to carry out the threat. It is important to screen any patient making homicidal threats for suicidal ideation. If present, there is a need to implement immediate management appropriate to the level of the suicidal threat, for the safety of the patient. Eighty-five percent of patients making a homicidal threat had a previously documented psychiatric disorder, the most common being a depressive disorder. This finding differs from previous studies in which psychosis predominated. More than 60% of homicidal patients had an unrelated medical disorder requiring intervention. It is important not to overlook these medical disorders while focusing on the psychiatric needs of the patient; most of our homicidal patients proved to be cooperative in the ED setting.
本研究描述了导致使用《贝克法案》（佛罗里达州急诊科非自愿拘留评估法案）的对他人造成伤害的具体威胁。该研究还总结了患者的人口统计学特征、伴随的精神科诊断以及紧急医疗问题。
这是一项对2014年1月1日至2015年11月30日期间在一家郊区急症医院急诊科接受非自愿拘留评估的251例患者的回顾性研究。收集的数据包括人口统计学信息、住院时间、非自愿拘留的原因、精神障碍、物质使用情况、医疗疾病以及急诊科内的暴力行为。还收集了杀人威胁的背景情况。
我们发现13例患者（5.2%）有杀人倾向。3例患者仅有杀人念头，而10例对他人发出了杀人威胁。在这10例发出杀人威胁的患者中，7例指明了要伤害的特定人员。13例有杀人倾向的患者中有10例（76.9%）也有自杀倾向。11例患者（84.6%）患有精神障碍：9例患者（69.2%）患有抑郁症，8例患者（61.5%）患有物质使用障碍。8例患者有需要在急诊科进行干预的活动性医疗问题。
我们发现，四分之三发出杀人威胁的患者也有自杀倾向。大多数发出伤害威胁的患者有实施威胁的具体行动计划。对任何发出杀人威胁的患者筛查自杀念头很重要。如果存在自杀念头，为了患者安全，有必要根据自杀威胁的程度立即实施适当的管理措施。85%发出杀人威胁的患者此前有精神障碍记录，最常见的是抑郁症。这一发现与之前以精神病为主的研究不同。超过60%有杀人倾向的患者有需要干预的无关医疗疾病。在关注患者精神需求的同时，不忽视这些医疗疾病很重要；我们的大多数有杀人倾向的患者在急诊科环境中表现得很配合。
