Developing a clinically useful actuarial tool for assessing violence risk

Monahan, John; Steadman, Henry J.; Appelbaum, Paul S.; Robbins, Pamela Clark; Mulvey, Edward P.; Silver, Eric; Roth, Loren H.; Grisso, Thomas

doi:10.1192/bjp.176.4.312

Cited by 293 publications

(205 citation statements)

References 22 publications

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“…Unfailingly, comorbid substance use diagnoses are pervasive [Swanson et al, 1990]. Additional factors are (1) a diagnosis of Paranoid Schizophrenia [Modestin and Ammann, 1996]; (2) symptoms [Link et al, 1998] although not as yet firmly established [see Appelbaum et al, 2000b;Stompe et al, 2004], threat control/over-ride; (3) young age [Hodgins et al, 1996]; (4) a history of exposure to childhood abuse [Monahan et al, 2000]; (5) sustaining traumatic brain injury [Tateno et al, 2003]; and (6) involuntary admission which could occur for many different reasons (e.g., suicide risk, poor self-care) one of which could be violent behavior [Foley et al, 2005]; we therefore decided to ascertain the lifetime number of voluntary and involuntary psychiatric hospitalizations to test as a potential contributing factor.…”

Section: Introductionmentioning

confidence: 99%

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Alia‐Klein

O’Rourke

Goldstein

et al. 2006

Aggressive Behavior

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Violence towards others by a minority of psychotic individuals is a significant public health concern. The severity of this otherdirected violence (ODV) in the community may be influenced by insight into illness and adherence to psychotropic medications; however, few studies have tested these associations. Sixty male psychotic inpatients, legally detained at a forensic unit in New York City, were assessed with semi-structured interviews, supplemented with information from hospital and official records, family members and the treating clinician. Results indicated that in this unique sample of detained persons with psychotic disorders; (1) increase in the severity of community violence is associated with medication non-adherence, all dimensions of poor insight into illness, and several previously reported covariates such as substance use comorbidity; (2) no relationship was found between insight and adherence in this particular sample; (3) multivariate analyses showed that select covariates, along with medication adherence, and select insight domains predicted a total of 73% of the magnitude of ODV behavior in this sample. Overall, medication nonadherence explained a large amount of how violently participants behaved toward others. Since non-adherence was independent of poor insight, it may be more worthwhile for clinicians to develop treatment strategies to target medication adherence without directly addressing an elusive target such as insight into illness. Treatment addressing medication adherence needs to concomitantly target substance use behaviors since the latter was responsible for a substantial increase in ODV. Aggr. Behav. 33:86-96, 2007. r

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Section: Introductionmentioning

confidence: 99%

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Alia‐Klein

O’Rourke

Goldstein

et al. 2006

Aggressive Behavior

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“…Os instrumentos padronizados têm recebido uma atenção crescente nos últimos anos, como lembram Monahan et al (2000), e podem aumentar a eficácia da avaliação de risco. Os principais deles são representados pelo HCR-20, PCL-R, PCL-SV e VRAG, sendo os dois primeiros mais conhecidos pelos psiquiatras brasileiros.…”

Section: Instrumentos De Avaliaçãounclassified

Avaliação de risco de violência em Psiquiatria Forense

Abdalla-Filho¹

2004

Rev. psiquiatr. clín.

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ResumoA relação entre transtorno psiquiátrico e comportamento violento vem sendo investigada de forma cada vez mais criteriosa e novos instrumentos de avaliação de risco de violência vêm sendo desenvolvidos nas últimas décadas. Este estudo apresenta um panorama atualizado dos recursos utilizados neste tipo de avaliação, tanto clínicos quanto sistematizados, enfatizando o surgimento de novos instrumentos padronizados. O objetivo maior não está concentrado na apresentação de dados matemáticos ou pontos de corte dos checklists desenvolvidos, mas, sim, nos fatores de risco, além do transtorno mental, levantados nestes instrumentos, o que permitirá uma melhor compreensão da complexidade de tal avaliação e do grau de participação da existência de doença mental. A conclusão aponta para a importância de uma avaliação equilibrada entre o exame clínico e os fatores citados nos instrumentos padronizados, bem como para a adoção de uma postura igualmente equilibrada no sentido de não supervalorizar nem tampouco n e g l i g e n c i a r a r e l a ç ã o q u e e x i s t e e n t r e t r a n s t o r n o p s i q u i á t r i c o e comportamento violento.Palavras-chave: Psiquiatria forense, avaliação de risco de violência, periculosidade. AbstractTranscranial magnetic stimulation (TMS) is a new technique capable of stThe correlation between psychiatric disorder and violent behaviour has been investigated in an increasingly judicious manner and new tools of violence risk assessment have been developed in the last decades. The present study presents an updated overview of the resources used in such type of evaluation, both clinical and systematic ones, focusing on the development of new standardized

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“…Regarding violence risk assessment methods (see online supplement) we asked specifically whether named instruments, i.e. Psychopathy Checklist -Revised (PCL-R; Hare, 1991), Psychopathy Checklist -Screening Version (PCL-SV; Hart et al, 1995), VRAG, Violence Risk Scale (VRS; www.psynergy.ca/pdf/vrssummary.pdf), Iterative Classification Tree (ICT; Monahan et al, 2000), Offender Group Reconviction Scale (OGRS; Taylor, 1999), Risk Assessment and Management Schedule (RAMAS; O'Rourke, 1995) and Historical Clinical Risk-20 (HCR-20), were used 'frequently', 'occasionally' or 'never'. If used, respondents were asked to rate utility of each method in routine practice on a five-point Likert scale (ranging between 'not useful' and 'very useful').…”

Section: Methodsmentioning

confidence: 99%

Use and perceived utility of structured violence risk assessments in English medium secure forensic units

2009

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Aims and MethodWe surveyed the usage and perceived utility of standardised risk measures in 29 forensic medium secure units (a 62% response rate).ResultsThe most common instruments were Historical Clinical Risk–20 (HCR–20) and Psychopathy Checklist – revised (PCL–R); both were rated highly for utility. the Risk Matrix 2000 (RM2000), Sex Offender Risk Appraisal Guide (SORAG) and Static-99 were the most common sex offender assessments, but the Sexual Violence Risks–20 (SVR–20) was rated more positively for its use of dynamic factors and relevance to treatment.Clinical ImplicationsMost medium secure units use structured risk assessments and staff view them positively. As HCR–20 and PCL–R/PCL–SV (Psychopathy Checklist – Screening Version) are so widely used they should be the first choices considered by other services.

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Developing a clinically useful actuarial tool for assessing violence risk

Abstract: A clinically useful actuarial method exists to assist in violence risk assessment.

Cited by 293 publications

References 22 publications

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Avaliação de risco de violência em Psiquiatria Forense

Use and perceived utility of structured violence risk assessments in English medium secure forensic units

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