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FORENSIC BOARDS > Risk Assessment for Violence > Flashcards

Risk Assessment for Violence Flashcards

1
Q

Violence Demographics (A/S+1/C/IQ+1)

A

A: Late teens/early 20s
Sex: Males in gen pop, but with MI, not significantly different
Class: Lower
IQ: Lower. But ID women 25x more likely, ID men 5x more likely

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2
Q

Violence by Dx (4)

A

SUD > Schiz > BPAD > MDD

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3
Q

5 Structured Instruments for Violence Risk Assessment

A

Psychopathy Checklist-Revised (PCL-R)
Hare Psychopathy Checklist-Revised
Violence Risk Appraisal Guide (VRAG)
Historical/Clinical/Risk Management 20 Item (HCR-20)
Classification of Violence Risk (COVR)

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4
Q

Actuarial Risk Assessment Benefit

A

More accurate due to stability of historical factors

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5
Q

Clinical Factors

A

More relevant in acutely psychotic pts

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6
Q

Paranoid Psychosis Violence (3.3)

A

More violent in community (as opposed to hospital, where less violent); recourse to weapons
Violence well-planned
Target is misperceived persecutors (90% out of fear, 10% anger)

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7
Q

Mean Time from Onset of Psychosis and Serious Violence

A

30d

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8
Q

Schizophrenia General Symptom Type and Violence

A

Positive sx incr
Negative sx decr

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9
Q

3 Hallucination Associations w/ Violence

A
  • Hallucinations generate neg emotions (anger/anxiety/sadness)
  • Less successful strategies to cope with AH
  • cAH
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10
Q

cAH Content % (5)

A

Suicide 52%
Homicide 5%
Injury self/others 12%
Non-violent acts 14%
Unspec 17%

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11
Q

cAH Association

A

cAH to harm others 2x as likely to be violent than pts w/o such commands

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12
Q

cAH Compliance % and Reducer

A

Overall 10-80%
Decr if command is dangerous

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13
Q

4 Traits More Likely to Obey Harmful Command

A

Hallucination-related delusion
Familiar voice
Feelings of personal superiority
Benefit hallucinator

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14
Q

3 Threat/Control-Override (TCO) Sx Associated w/ Increased Violence (& rate)

A

Mind feels dominated by external forces
Thoughts being put into head
Feeling that people wish you harm
(assault about 2x as likely as other psychotic sx)

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15
Q

3 Non-Violent Delusions

A

Dead/dissolved/not existing
TB
Thoughts removed by external forces

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16
Q

Male v. Female Difference w/ Threat Delusions

A

Men more likely to respond w/ violence (fight or flight vs. tend and befriend), so women seek out nurturing relationships

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17
Q

5 Delusion Characteristics Associated w/ Violence

A

Persecutory
Systematized
Generate neg emotions (fear, anger)
Acted on before
Combined with SA

18
Q

2 Specific Associated w/ Violence

A

Poisoned
Infidelity

19
Q

Manic Violence (Type and Cause)

A

High percentage of assaultive/threatening behavior, but serious violence rare
Often respond violently to any form of limit setting

20
Q

Premenstrual Tension Syndrome

A

Violence by wives towards husband, as many killings in 5 PMS days than remainder of month

21
Q

PTSD (general association and other contribitor)

A

PTSD vets w/ higher incidence of violent crimes
Lots of SUD to numb pain which predisposes

22
Q

2 PDs Associated w/ Violence

A

BPD and ASPD

23
Q

10 Personality Traits Associated w/ Violence

A
  1. Impulsivity (absence of reflective delay)
  2. Low frustration tolerance
  3. Inability tol criticism
  4. Repetitive antisocial acts
  5. Drive automobiles recklessly
  6. Egocentricity/entitlement
  7. Superficial relationships/dehumanize others
  8. Paroxysmal, episodic quality
  9. MSE glibness, lack of introspection, projection of internal difficulties onto environment
  10. Suspicious about motives of others
24
Q

3 Schizophrenia Pt Caregiver Violence Rates

A

Parents: 68%
Siblings: 12%
Spouses: 7%

25
Q

4 Family Violence Risk Factors

A
  1. Financial dependence on family
  2. Family caregiver
  3. Limit setting by family
  4. Criticism/hostility by family
26
Q

4 Family Violence Risk Reducers

A
  1. Professional representative payee
  2. Education in de-escalation
  3. ICM
  4. Affordable non-family housing
27
Q

8 Childhood Factors Correlated with Violence

A
  1. Brutality from parent, particularly father
  2. Parental seduction
  3. Truancy/school failures/low IQ
  4. Being a bully (victims get depressed)
  5. Adolescent delinquency
  6. Arrest for prior assault
  7. Childhood hyperactivity or severe inattention
  8. First psyc hospital by age 18
28
Q

MacDonald Triad (3 and point)

A

Enuresis, fire-setting, cruelty to animals
Later studies didn’t confirm enuresis

29
Q

Best Predictor of Future Violence

A

Past violence

30
Q

4 Components of Dangerousness History

A
  1. Past Violence
  2. Substance Abuse
  3. Weapons Hx
  4. Criminal Arrests
31
Q

2 Types of Aggression (& comparison)

A

Affective aggression - result of threatening (int/ext) stimuli that evoke ANS response, accompanied by threatening vocalizations and attacking/defending postures
Predatory aggression - planned, purposeful, goal-directed. Not reactive and requires emotional detachment

32
Q

Reason for Intense Dangerousness of Predatory Aggression

A

No foreshadowing behaviors

33
Q

Path to Affective Violence (3)

A

Grievance -> idea/emotion -> attack

34
Q

Path to Predatory Violence (5)

A

Grievance -> Idea -> Research/Planning -> Prep -> Attack

35
Q

Assessment of Dangerousness Acute Likelihood (3)

A
  1. Lack of empathy (combined w/ anger)
  2. Behavior: verbal abuse, standing close, swearing, loud, etc.
  3. Threats/likelihood of being carried out
36
Q

5 Risk Factors for Threats Being Carried Out:

A
  1. More intimate relationship b/w threat/threatened
  2. Face-to-face
  3. More specific
  4. Signed name (as opposed to anonymous)
  5. Introduced late in controversy instead of early (considered decision to use violence, instead of initial emotional response)
37
Q

2 Types of Risk Factors for Violence

A

Dynamic
Static

38
Q

Dynamic Risk Factors (what they are, temporality, examples)

A

Subject to change by intervention/tx/situation control.
Typically current
E.g., living setting, weapon access, psychotic sx, med nonadherence

39
Q

Static Risk Factors (what they are, temporality, examples)

A

Not subject to change by intervention
Typically historical
E.g., demographic info, hx of violence, childhood abuse, antisocial traits, etc.

40
Q

3 Highest Recent Risk Factors for Violence

A
  1. Current ETOH use
  2. Recent violence
  3. Recent victimization
41
Q

Components of Violence Prevention Plan (3)

A

Risk Factors
-> Management/Treatment
-> Status (implemented, attempted but unsuccessful, not attempted)

FORENSIC BOARDS (34 decks)

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