Violence in geropsychiatry

Physical aggression and violence are common reasons for referrals for geriatric psychiatric services. Medical history and examination should be focused on finding possible causes of delirium and assessing the limitations concurrent medical conditions place on treatment options. Analyzing the circumstances where and when the violence occurs helps in planning interventions. Differential diagnosis includes several clinical geriatric conditions known to be associated with violence. These include paranoid disorders, dementia, and cerebrovascular disease. Treatment involves environmental, behavioral, and psychopharmacologic modalities. Empiric treatments of the elderly violent patient have included antipsychotics, benzodiazepines, carbamazepine, trazodone, buspirone, and propranolol.