Risk Assessment for Violence Flashcards
Violence Demographics (A/S+1/C/IQ+1)
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
Violence by Dx (4)
SUD > Schiz > BPAD > MDD
5 Structured Instruments for Violence Risk Assessment
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)
Actuarial Risk Assessment Benefit
More accurate due to stability of historical factors
Clinical Factors
More relevant in acutely psychotic pts
Paranoid Psychosis Violence (3.3)
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)
Mean Time from Onset of Psychosis and Serious Violence
30d
Schizophrenia General Symptom Type and Violence
Positive sx incr
Negative sx decr
3 Hallucination Associations w/ Violence
- Hallucinations generate neg emotions (anger/anxiety/sadness)
- Less successful strategies to cope with AH
- cAH
cAH Content % (5)
Suicide 52%
Homicide 5%
Injury self/others 12%
Non-violent acts 14%
Unspec 17%
cAH Association
cAH to harm others 2x as likely to be violent than pts w/o such commands
cAH Compliance % and Reducer
Overall 10-80%
Decr if command is dangerous
4 Traits More Likely to Obey Harmful Command
Hallucination-related delusion
Familiar voice
Feelings of personal superiority
Benefit hallucinator
3 Threat/Control-Override (TCO) Sx Associated w/ Increased Violence (& rate)
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)
3 Non-Violent Delusions
Dead/dissolved/not existing
TB
Thoughts removed by external forces
Male v. Female Difference w/ Threat Delusions
Men more likely to respond w/ violence (fight or flight vs. tend and befriend), so women seek out nurturing relationships
5 Delusion Characteristics Associated w/ Violence
Persecutory
Systematized
Generate neg emotions (fear, anger)
Acted on before
Combined with SA
2 Specific Associated w/ Violence
Poisoned
Infidelity
Manic Violence (Type and Cause)
High percentage of assaultive/threatening behavior, but serious violence rare
Often respond violently to any form of limit setting
Premenstrual Tension Syndrome
Violence by wives towards husband, as many killings in 5 PMS days than remainder of month
PTSD (general association and other contribitor)
PTSD vets w/ higher incidence of violent crimes
Lots of SUD to numb pain which predisposes
2 PDs Associated w/ Violence
BPD and ASPD
10 Personality Traits Associated w/ Violence
- Impulsivity (absence of reflective delay)
- Low frustration tolerance
- Inability tol criticism
- Repetitive antisocial acts
- Drive automobiles recklessly
- Egocentricity/entitlement
- Superficial relationships/dehumanize others
- Paroxysmal, episodic quality
- MSE glibness, lack of introspection, projection of internal difficulties onto environment
- Suspicious about motives of others
3 Schizophrenia Pt Caregiver Violence Rates
Parents: 68%
Siblings: 12%
Spouses: 7%
4 Family Violence Risk Factors
- Financial dependence on family
- Family caregiver
- Limit setting by family
- Criticism/hostility by family
4 Family Violence Risk Reducers
- Professional representative payee
- Education in de-escalation
- ICM
- Affordable non-family housing
8 Childhood Factors Correlated with Violence
- Brutality from parent, particularly father
- Parental seduction
- Truancy/school failures/low IQ
- Being a bully (victims get depressed)
- Adolescent delinquency
- Arrest for prior assault
- Childhood hyperactivity or severe inattention
- First psyc hospital by age 18
MacDonald Triad (3 and point)
Enuresis, fire-setting, cruelty to animals
Later studies didn’t confirm enuresis
Best Predictor of Future Violence
Past violence
4 Components of Dangerousness History
- Past Violence
- Substance Abuse
- Weapons Hx
- Criminal Arrests
2 Types of Aggression (& comparison)
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
Reason for Intense Dangerousness of Predatory Aggression
No foreshadowing behaviors
Path to Affective Violence (3)
Grievance -> idea/emotion -> attack
Path to Predatory Violence (5)
Grievance -> Idea -> Research/Planning -> Prep -> Attack
Assessment of Dangerousness Acute Likelihood (3)
- Lack of empathy (combined w/ anger)
- Behavior: verbal abuse, standing close, swearing, loud, etc.
- Threats/likelihood of being carried out
5 Risk Factors for Threats Being Carried Out:
- More intimate relationship b/w threat/threatened
- Face-to-face
- More specific
- Signed name (as opposed to anonymous)
- Introduced late in controversy instead of early (considered decision to use violence, instead of initial emotional response)
2 Types of Risk Factors for Violence
Dynamic
Static
Dynamic Risk Factors (what they are, temporality, examples)
Subject to change by intervention/tx/situation control.
Typically current
E.g., living setting, weapon access, psychotic sx, med nonadherence
Static Risk Factors (what they are, temporality, examples)
Not subject to change by intervention
Typically historical
E.g., demographic info, hx of violence, childhood abuse, antisocial traits, etc.
3 Highest Recent Risk Factors for Violence
- Current ETOH use
- Recent violence
- Recent victimization
Components of Violence Prevention Plan (3)
Risk Factors
-> Management/Treatment
-> Status (implemented, attempted but unsuccessful, not attempted)
