Violent Behavior.

Abstract

Violence is a significant public health problem representing one of the leading causes of death worldwide for people aged 15-44 years. Although violence and aggression are more frequent in adolescence and early adult life and decline with advancing age, these conditions can still develop for the first time in old age especially in association with organic brain disorder. Rates of violent death vary according to country income levels and are twice as higher in low- to middle-income countries than in high-income countries. Males are more affected than females. Violence is a multifactorial condition. A combination of biologic, psychodynamic, and social factors may play a role in development of violence and aggression. Since it may accompany or be result of different medical conditions it is important to determine the underlying condition or disease including mental illness for targeting the proper therapeutic strategy. In the acute setting with a behavioral emergency the primary task for the clinician is to act as soon as possible in order to stop the violence from escalating and to find the quickest way to keep the patient's agitation and violence under control with the maximum of safety for everybody using the less severe yet effective interventions. Multiple steps of talk down interventions and non-coercive behavioral and environmental treatments have been proposed. If such an approach is not effective, more coercive interventions are needed including involuntary medications and chemical restrain as well as physical restraint or seclusion in some cases.