Violence and Suicide

Patients exhibiting violent or suicidal behavior have psychiatric symptoms varying along a spectrum of risk, from minimal to fatal. Evidence supports screening patients for intimate partner violence and suicide risk. Clinical care focuses on establishing a team and a working alliance, determining the “Why now?” of dangerousness, and using clinical judgments, risk assessment tools, a critical pathway, and a risk registry. Clinical care includes assessment of (1) violent or suicidal ideation, (2) recent dangerous behaviors, (3) past history of risky behaviors, (4) support system, (5) substance use, (6) cooperation with treatment, and (7) clinician reactions (8) diagnosis of medical and neurologic comorbidities. A multidisciplinary team can optimally manage these patients by deciding on the level of care needed for each problem or episode. Care can be delivered by using a practice registry and a critical pathway and focusing care on psychotherapy, with medications as needed. Steps are outlined for managing intimate partner violence.