Marked by sudden loss of self-control, violent behavior refers to the use of physical force to violate, injure, or abuse an object or person. This behavior may also be self-directed. It may result from an organic or psychiatric disorder or from the use of certain drugs.
During your evaluation, determine if the patient has a history of violent behavior. Is he intoxicated or suffering symptoms of alcohol or drug withdrawal? Does he have a history of family violence, including corporal punishment and child or spouse abuse? (See Understanding family violence, page 800.)
Watch for clues indicating that the patient is losing control and may become violent. Has he exhibited abrupt behavioral changes? Is he unable to sit still? Increased activity may indicate an attempt to discharge aggression. Does he suddenly cease activity (suggesting the calm before the storm)? Does he make verbal threats or angry gestures? Is he jumpy, extremely tense, or laughing? Such intensifying of emotion may herald loss of control.
If your patient’s violent behavior is a new development, he may have an organic disorder. Obtain a medical history, and perform a physical examination. Watch for a sudden change in his level of consciousness. Disorientation, failure to recall recent events, and a display of tics, jerks, tremors, and asterixis all suggest an organic disorder.
Disorders resulting from metabolic or neurologic dysfunction can cause violent behavior. These include epilepsy, brain tumor, encephalitis, endocrine disorders, and metabolic disorders (such as uremia and calcium imbalance). Severe physical trauma, such as a head injury, can also cause violent behavior.
Violent behavior occurs as a protective mechanism in response to a perceived threat in psychotic disorders such as schizophrenia. A similar response may occur in personality disorders, such as antisocial or borderline personality.
Violent behavior is an adverse effect of some drugs, such as lidocaine, penicillin G, hallucinogens, and amphetamines. Alcohol abuse or withdrawal and barbiturate withdrawal may also cause violent behavior.
Violent behavior is most prevalent in emergency departments, intensive care units, and crisis and acute psychiatric units. Natural disasters and accidents also increase the potential for violent behavior, so be on guard in these situations.
If your patient becomes violent or potentially violent, your goal is to remain composed and to establish environmental control. First, protect yourself. Remain at a distance from the patient, call for assistance, and don’t overreact. Remain calm and make sure you have enough personnel to subdue or restrain the patient if necessary. Encourage the patient to move to a quiet location—free from noise, activity, and people—to avoid frightening or stimulating him further. Reassure him, explain what’s happening, and tell him that he’s safe.
If the patient makes violent threats, take them seriously, and inform those at whom the threats are directed. If ordered, administer a psychotropic medication.
Remember that your own attitudes can affect your ability to care for a violent patient. If you feel fearful or judgmental, ask another staff member for help.
Adolescents and younger children sometimes make threats resulting from violent dreams or fantasies or unmet needs. Adolescents who come from families with a history of physical or psychological abuse may display violent behavior toward their peers, siblings, and pets.
Read excerpts from these other book chapters related to Violence:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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