Treatment of the psychotic patient who is violent

Peter F Buckley, Stephen G. Noffsinger, Douglas A. Smith, Debra R. Hrouda, James L. Knoll IV

Research output: Contribution to journalReview article

41 Citations (Scopus)

Abstract

Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.

Original languageEnglish (US)
Pages (from-to)231-272
Number of pages42
JournalPsychiatric Clinics of North America
Volume26
Issue number1
DOIs
StatePublished - Mar 1 2003

Fingerprint

Antipsychotic Agents
Aggression
Violence
Therapeutics
Delayed-Action Preparations
Clozapine
Risk Reduction Behavior
Psychiatry
Mental Health
Recurrence

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Buckley, P. F., Noffsinger, S. G., Smith, D. A., Hrouda, D. R., & Knoll IV, J. L. (2003). Treatment of the psychotic patient who is violent. Psychiatric Clinics of North America, 26(1), 231-272. https://doi.org/10.1016/S0193-953X(02)00029-1

Treatment of the psychotic patient who is violent. / Buckley, Peter F; Noffsinger, Stephen G.; Smith, Douglas A.; Hrouda, Debra R.; Knoll IV, James L.

In: Psychiatric Clinics of North America, Vol. 26, No. 1, 01.03.2003, p. 231-272.

Research output: Contribution to journalReview article

Buckley, PF, Noffsinger, SG, Smith, DA, Hrouda, DR & Knoll IV, JL 2003, 'Treatment of the psychotic patient who is violent', Psychiatric Clinics of North America, vol. 26, no. 1, pp. 231-272. https://doi.org/10.1016/S0193-953X(02)00029-1
Buckley PF, Noffsinger SG, Smith DA, Hrouda DR, Knoll IV JL. Treatment of the psychotic patient who is violent. Psychiatric Clinics of North America. 2003 Mar 1;26(1):231-272. https://doi.org/10.1016/S0193-953X(02)00029-1
Buckley, Peter F ; Noffsinger, Stephen G. ; Smith, Douglas A. ; Hrouda, Debra R. ; Knoll IV, James L. / Treatment of the psychotic patient who is violent. In: Psychiatric Clinics of North America. 2003 ; Vol. 26, No. 1. pp. 231-272.
@article{10a4fd5f4a81476095536129b5c96a0a,
title = "Treatment of the psychotic patient who is violent",
abstract = "Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.",
author = "Buckley, {Peter F} and Noffsinger, {Stephen G.} and Smith, {Douglas A.} and Hrouda, {Debra R.} and {Knoll IV}, {James L.}",
year = "2003",
month = "3",
day = "1",
doi = "10.1016/S0193-953X(02)00029-1",
language = "English (US)",
volume = "26",
pages = "231--272",
journal = "Psychiatric Clinics of North America",
issn = "0193-953X",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Treatment of the psychotic patient who is violent

AU - Buckley, Peter F

AU - Noffsinger, Stephen G.

AU - Smith, Douglas A.

AU - Hrouda, Debra R.

AU - Knoll IV, James L.

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.

AB - Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.

UR - http://www.scopus.com/inward/record.url?scp=0037351134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037351134&partnerID=8YFLogxK

U2 - 10.1016/S0193-953X(02)00029-1

DO - 10.1016/S0193-953X(02)00029-1

M3 - Review article

C2 - 12683268

AN - SCOPUS:0037351134

VL - 26

SP - 231

EP - 272

JO - Psychiatric Clinics of North America

JF - Psychiatric Clinics of North America

SN - 0193-953X

IS - 1

ER -