Over the past two decades, the scientific literature has reflected the rapidly growing public concern about violence committed by psychiatric patients. Violence is an important topic because of the seriousness of its consequences—injury and possibly death; it is an interesting topic because it invites a number of methods of inquiry and crosses many domains—biological, psychological, social, and legal. Recent texts have attempted to consolidate research findings about causation and treatment comprehensively and in a form that is useful for clinicians who evaluate and treat violent psychiatric patients (
1,
2).
Understanding and Treating Violent Psychiatric Patients is edited by Martha L. Crowner, M.D., who has worked for a number of years as a psychiatrist treating and studying violent patients hospitalized at the Manhattan Psychiatric Center. She is also a clinical associate professor of psychiatry at the New York University School of Medicine.
Chapters in the first two-thirds of the book present advice about the management of violent patients in the inpatient setting. The last three chapters are more conceptual and less directly related to treatment. The diversity of the topics covered in this book may stem from the fact that they come from a symposium at an annual meeting of the American Psychiatric Association. The book offers some useful ideas about the management of violent patients on inpatient units, but it is not comprehensive and it is uneven in the depth of information and topics covered.
The strongest chapters are the two on behavior therapy. Both provide excellent reviews of the literature on behavior therapy in inpatient settings. They are detailed and rigorous, with numerous references, and they make a complex topic clear. However, behavior therapy is a small part of the treatment of violent psychiatric patients.
The chapters on the evaluation of violent patients and the use of medication are uneven and somewhat superficial. Discussion of the indications, contraindications, and procedures for the use of seclusion and restraint is clear and is consistent with national standards (
3). The chapter on the use of videotaping violence by psychiatric patients on an inpatient unit, which presents results from studies done by Dr. Crowner, is interesting. The chapters on dissociation, impulsivity, and recent research on violence and mental disorders provide excellent reviews of the literature with ample references.
Although not comprehensive, this book is a sampler of tips, facts, and views about violence committed by psychiatric patients and is appropriate for all practitioners in mental health professions.
