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assault (violence)
Etiology:
1) motives: fear, anger, frustration
2) predisposing factors
a) alcoholism, drug abuse
b) coexisting illness or pain
c) mental illness
- dementia, depression, schizophrenia, personality disorder
e) lack of support system
f) stress: hostile work environment, high-risk occupation
3) precipitating factors
a) environmental stimuli
b) financial stress
c) invasion of personal space
d) lack of privacy
e) lack of respect
f) long waiting times
4) axis 1 disorders associated with violent outbursts
a) episodic dyscontrol syndrome
b) antisocial personality disorder
c) borderline personality disorder
d) attention deficit hyperactivity disorder
Clinical manifestations:
1) warning signs
a) confusion, fear or altered state of consciousness
b) perceived threat
c) excessive psychomotor activity
- restlessness, intensified facial features, fist or jaw clenching
d) use of profanity
2) axis 1 disorders may not be associated with warning signs prior to a violent outburst
Management:
1) see anger
2) reporting:
a) if a provider is treating an injury suspected to be a result of violence (gunshot, knife, assault), he/she is mandated to report this to the police
b) if a patient is a threat others or another person, a provider is mandated to report this to the police [5]
3) screening veterans [3]
- financial instability
- combat experience
- alcohol misuse
- history of lifetime noncombat violence or arrest for crime
- probable post-traumatic stress disorder plus past-week irritability or angry outbursts
Related
anger
fear
firearm (gun, rifle, handgun)
trauma
Specific
domestic violence (includes intimate partner violence)
gun violence
workplace violence
General
aggression
References
- Veterans Administration
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Elbogen EB et al.
Screening for violence risk in military veterans: Predictive
validity of a brief clinical tool.
Am J Psychiatry 2014 May 16
PMID: 24832765
- Moy JA, Sanchez MR.
The cutaneous manifestations of violence and poverty.
Arch Dermatol. 1992 Jun;128(6):829-39.
PMID: 1599274
- NEJM Knowledge+ Psychiatry
- Blightman K et al
Patient confidentiality: when can a breach be justified?
Continuing Education in Anaesthesia Critical Care & Pain. 2014;14(2):52-56
https://www.sciencedirect.com/science/article/pii/S1743181617301063
- The National Institute for Clinical Excellence (NICE)
http://www.nice.org.uk/page.aspx?o=244477
- National Center for Injury Prevention and Control (NCIPC)
http://www.cdc.gov/ncipc/