Abstract

ABSTRACTTo characterize violent behavior in hospitalized medical and surgical patients, we reviewed documented violant incidents at the San Francisco General Hospital during a two-year period. Twenty-nine incidents of verbal and physical violence occurred. One patient was gravely ill and three were delirious. All the incidents wer associated with increasing levels of tension and loss of impulse control. In most cases, contention with the staff regarding pain medication or ward regulations was a precipitating event. Of hte 28 patients with mental disorders, 19 were substance abusers, six had organic brain syndrome, two had neurosis, and one had schizophrenia. The findings suggest that physicians should be more sensitive to patient characteristics and to the situational characteristics of the violent incident. Explicit measures that anticipate and reduce violent behavior are reviewed.