The evaluation of homicidal patients by psychiatric residents in the emergency room: A pilot study

Abstract

The authors report the results of a preliminary prospective study involving 110 patients who were involuntarily committed from the emergency room. The study was designed to clarify the process of how psychiatric residents evaluate homicidal patients. Eighteen patients (16%) were committed for homicidal ideation, of whom 89% were psychotic. Surprisingly, for patients committed because of a risk of homicide, vital signs were obtained for only 11%, during a mean evaluation time of 2.5 hours. Aspects of an appropriate physical examination and laboratory studies that enable the clinician to distinguish organic from functional illness are described. The authors conclude that patients with homicidal ideation may receive inadequate assessment prior to their involuntary commitment. Possible explanations and solutions for this, and recommendations for further studies are offered.

Hospitalizing the Suicidal Adolescent: Decision-Making Criteria of Psychiatric Residents

“…Concerning decisions to hospitalize, studies have found that psychiatric residents hospitalize at significantly higher rates than attending psychiatrists (Friedman et al, 198 1;Mendel and Rapport, 1969;Meyerson et al, 1979;Streiner et al, 1975) and that emergency rooms with the lowest admission rates were staffed by attending psychiatrists, not residents (Feigelson et al, 1978). Residents have been found to base their decisions to hospitalize on clinical criteria of dangerousness to self and others, diagnosis, and inability to care for self (Apsler and Bassuk, 1983;Stern et al, 1991). Studies that polled psychiatric residents found that other factors were important in the decision to hospitalize: lack of suitable outpatient services, inability to accomplish diagnosis or treatment as an outpatient, and clinical interest (Hanson and Babigian, 1974;Wood et al, 1965).…”