Management of the violent patient in an emergency situation.

The management of an acute episode of violence by a psychiatric patient is probably one of the most demanding actions in psychiatry in terms of clinical competence and emotional impact on the clinician. In such situations, consideration of the safety of staff and other patients is paramount. Interventions available to the clinician in the management of acute violence include verbal intervention, restraint, seclusion and medication. This article offers guidelines for how to communicate with the patient. Issues of countertransference and emotional reactions to patients are addressed. The author has worked to develop national guidelines for the psychiatric use of seclusion and restraint in terms of indications, contraindications, implementation, review by the physician and the monitoring and care of the patient by staff.