Pediatric emergency medicine trisk 4166 4166
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TABLE 126.6
PREDICTORS OF DANGEROUSNESS TO OTHERS
High degree of intent to harm
Presence of a victim
Frequent and open threats
Concrete plan
Access to instruments of violence
History of loss of control
Chronic anger, hostility, or resentment
Enjoyment in watching or inflicting harm
Lack of compassion
Self-view as victim
Resentful of authority
Childhood brutality or deprivation
Decreased warmth and affection in home
Early loss of parent
Fire setting, bed-wetting, and cruelty to animals
Prior violent acts
Reckless driving
Adapted with permission from Sadock BJ, Sadock VA, eds. Kaplan & Sadock’s Synopsis of Psychiatry
. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.
Patients should be given as much autonomy as possible; try to present a
few reasonable treatment options and allow them to choose. Patients often
feel empowered and are better able to control themselves. It is equally
important to set clear limits with the patient to maintain safety. Limit setting,
done in a nonpunitive manner, may include discussing acceptable and
unacceptable behaviors as well as consequences for these behaviors. With
few exceptions, one should avoid “bargaining” with patients as this may
encourage limit testing. Feeling threatened or punished may exacerbate a
patient’s agitation and/or behavior.
