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Chapter 44. Assessment of Dangerousness

Charles L. Scott, M.D.; Cameron D. Quanbeck, M.D.; Phillip J. Resnick, M.D.
DOI: 10.1176/appi.books.9781585623402.319497

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Excerpt

The term dangerousness is not a psychiatric diagnosis; the concept of dangerousness is a legal judgment based on social policy. In other words, dangerousness is a broader concept than either violence or dangerous behavior; it indicates an individual's propensity to commit dangerous acts (Mulvey and Lidz 1984). Unfortunately, no psychological test or interview can predict future violence with high accuracy. Relatively infrequent events (e.g., homicide) are more difficult to predict than more common events (e.g., domestic violence) because they have a low base rate of occurrence. The accuracy of a clinician's assessment of future violence is related to many factors, including the circumstances of the evaluation and the length of time over which violence is predicted.

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TABLE 44–1. Components of dangerousness
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TABLE 44–2. Demographic factors associated with violence
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TABLE 44–3. Evaluation of past history of violence
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TABLE 44–4. Factors associated with delusionally driven violence
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TABLE 44–5. MacArthur Community Violence Interview: definitions of violence
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TABLE 44–6. Characteristics of aggression associated with brain injuries
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TABLE 44–7. Components of threat evaluation
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TABLE 44–8. Sample violence risk management chart
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TABLE 44–9. Common characteristics of assaultive psychiatric inpatients
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TABLE 44–10. Characteristics of impulsive, organized, and psychotic assaults
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TABLE 44–11. Systematic approach to the pharmacological treatment of chronic aggression
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TABLE 44–12. Off-label pharmacotherapy interventions for aggression
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TABLE 44–13. Essential components of social skills training
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TABLE 44–14. Key components of anger management skills training
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TABLE 44–15. Policy considerations for prosecuting inpatient assaults
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The best predictor of future violent behavior is a past history of violent behavior.

Mental disorders, particularly paranoia and suspiciousness, increase the risk of violence.

Substance use represents a major risk factor for future violent behavior.

Actuarial risk assessment instruments can assist the evaluator in more accurately predicting future violence.

Inpatient violence includes impulsive, planned, and psychotic assaults.

Treatment interventions should match type of assaultive behavior.

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Which of the following is not true regarding the epidemiology of violence?
2.
The clinician is advised to consider the history of past violence in assessing current violence risk. Which of the following does not predict greater risk of violence?
3.
Psychosis and violence risk is of particular importance when evaluating schizophrenic patients. All of the following symptoms seen in psychotic illness have been found to increase violence risk except
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