Violence Risk Assessment Flashcards
rate of homicide in first episode psychosis
15X greater than the annual rate after treatment
demographics of violence
age: late teens and early 20s
sex: M > F
IQ: lower = more violence
social class: lower = more street violence
clinical judgment errors in estimating future violence
- underestimating female
- overestimating minorities
- underestimating attractive ppl
- overestimating after seeing details of crime
violent beh in last yr by dx
no dx: 2%
mania/BP: 11%
MDD: 12%
schizophrenia: 13%
alcohol: 25%
other drugs: 35%
civil commitment criteria
“A substantial risk of physical harm to others as manifested by…”
“substantial risk”
a strong possibility (as contrasted w/a remote or significant possibility) that a certain result may occur
(“risk” = significant possibility)
standardized instruments for assessment of risk of violence
PCL-R (Psychopathy Checklist-Revised)
VRAG (Violence Risk Appraisal Guide)
HCR-20 (Historical/Clinical/Risk Management 20 Item)
COVR (Classification of Violence Risk)
self-assessments of violence risk
ICT-CF (Classification Tree)
MST (Modified Screening Tool)
Direct Question of Patient (0-5 scale)
violence in psychosis
(CATIE trial)
CATIE trial
+ sx increase violence
- sx decrease violence
risk of serious violence increases with:
- persecution/suspiciousness
- grandiosity
- hallucinations
characteristics of violence in paranoid psychosis
- more violent in community
- violence is well planned
- target is misperceived persecutors
factors that increase violence due to hallucinations
- negative emotions
- less successful strategies to cope with hallucinations
- command hallucinations
factors that increase likelihood of obeying a harmful command hallucination
related delusion
familiar voice
personal superiority
benefit hallucinator
