Medical Management of the Violent Patient: Clinical Assessment and Therapy

Over recent decades, Americans have witnessed a significant increase in violence, particularly in criminal offenses. Despite the widespread public perception that violent behavior is associated with mental illness, patients with medical and psychiatric conditions are responsible for only a small percentage of violent offenses. Health care providers have the task of assessing and treating these patients. Ensuring the safety of clinicians and the protection of third parties becomes crucial to the process.

Medical Management of the Violent Patient, edited by the renowned expert in forensic psychiatry Dr. Kenneth Tardiff, is the 14th volume in the Medical Psychiatry series published by Marcel Dekker. The book is a valuable contribution to the clinician-oriented literature on violence. Dr. Tardiff and his contributors, a leading group of academic clinicians and researchers, collect, examine, and critically review current information on the topic.

The first section of the book consists of six well-organized and clearly written chapters illustrating the influence of developmental, social, environmental, and biological factors on the genesis of violent behavior. The second section clearly and concisely describes technical elements relevant to the clinical evaluation and prediction of a patient's risk of violence. A summary of treatment strategies follows, with chapters dedicated to the acute and chronic management of violent patients, clinicians' safety, and the use of psychotherapy.

In section 4, experts on violent victimization offer comprehensive reviews of the biological, psychological, and social consequences of severe trauma, sexual assault and rape, domestic violence, and child abuse. The book concludes with a section addressing special issues—among them, legal duties for clinicians and workplace violence.

Medical Management of the Violent Patient is a nicely presented hardcover volume. Although the editor states that the book is intended for "psychiatrists and other physicians, psychologists, social workers, and all other professionals who are involved in the care of patients," a few factors may prevent such wide reception. Many nonphysician mental health professionals whom I asked to read the book's title were under the impression that it focused on pharmacological interventions to treat violent patients. In addition, the book's cost may limit its availability to residents and other trainees. The high price also makes it difficult to excuse the typographical errors lingering in several chapters.

Overall, Dr. Tardiff and his colleagues offer a comprehensive, clear, and concise summary of current knowledge about violence in the clinical setting and identify issues in need of further investigation. Useful as a reference for physicians in general, psychiatrists, and other mental health clinicians, the text is well worth reading by anyone interested in the phenomenology of violence.

Dr. Vidal is co-chief resident in the psychopharmacology service at the University of Massachusetts Medical School in Worcester.