TREATMENT OF IMMINENT VIOLENCE
Guidelines for clinical practice by the Royal College of Psychiatrists CIC Edizioni Internazionali, 1999 Rome; 130 pages, 12.91 euros.


(Paolo Scocco)

The idea of reviewing a book published a number of years ago stems from a desire to stress the topicality of this highly debated issue in psychiatric circles and from the conviction that it is important to disseminate management guidelines proposed for a clinical domain that often forces mental health providers to act according to common sense, experience or local practice, being unable to appeal to robust models that anticipate probable outcomes. One of the strengths of this work is its ease of consultation, its highly schematic design and the fact that it provides the guideline development process (e.g. the review protocol), a review of quantitative research and non-evidence-based data.

Through a review of quantitative research, the working group considered areas such as: the environment, restraint/isolation, use of medication and short-term prediction, starting from an hypothesis (e.g. the characteristics of the human and physical environment are important in preventing and reducing, or in exacerbating and precipitating manifestations of violence), working through a brief description of available studies, and reaching conclusions based on collected evidence.

Well-aware of the scarcity of good quality research evidence, the working group included non-evidence-based information in the formulation of these guidelines (e.g. material from national guidance documents published by government bodies, viewpoints of patients, their informal caregivers, and nursing staff). What emerges from these guidelines is that the basic evidence for each of the affirmations is based more on the opinion of the experts and competent authorities than on incontrovertible research evidence. Hence, even when guidelines are drawn up by authoritative institutions such as the Royal College of Psychiatrists, and represent a detailed analysis of available evidence, they should be read and implemented, but also integrated with local circumstances and be a source of discussion and inspiration for further reflection or research.