Risk Factors
- History of violent behavior/antisocial personality disorder
- Psychiatric illness (eg, psychosis, delirium, suicidal/homicidal ideation)
- Substance use; acute intoxication, withdrawal
- Prolonged wait times
Warning Signs
- Angry, irritable demeanor
- Loud, aggressive speech, cursing, verbal threats
- Tense posture, clenched fists, pacing
- Desk or wall pounding, throwing objects
Management
- Maintain a distance of 2 arm lengths; avoid direct eye contact
- Interview with door open, clinician closer to the exit
- Verbal de-escalation:
- Use calm voice, nonconfrontational approach
- Provide for basic needs (eg, offer food, drink, blanket) c
- Listen attentively to clarify patient’s wants/needs
- Set clear expectations that violence is unacceptable; reinforce that patient will not be harmed
- Offer choices if appropriate (eg, oral vs intramuscular medications)
- Chemical & physical restraint when verbal de-escalation fails & violence is imminent