Psych · Emergency psychiatry — violence risk
Violence risk assessment
Also known as Aggression risk assessment · HCR-20 · Structured professional judgement · Dangerousness assessment · Violence risk formulation · DASA · Brøset Violence Checklist · Threat assessment psychiatry
Exam-exhaustive fellowship reference on violence risk assessment — static vs dynamic vs protective factors; HCR-20 and structured professional judgement concepts; imminence vs long-term tools; mental illness–violence relationship without stigma; command hallucinations; substance use; personality; risk formulation and management plans; least restrictive care; documentation; special populations. FRANZCP-primary, globally tagged.
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Meet the patient
A 27-year-old man is brought by police under emergency powers after his mother reported that he believes his neighbour is poisoning him through the walls. He has not slept for four days. This morning he told his mother he "has to stop him before he stops me". He has a kitchen knife in his bag. This is his first contact with mental health services.[12][13]
The examiner's questions arrive in a fixed order: who is at risk, by what means, and over what horizon? — then what will you do in the next hour, and what is your statutory and clinical framework? Everything below exists to answer those without either over-predicting dangerousness or under-protecting a named victim.[4][17]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods Arch Gen Psychiatry, 1998.PMID 9596041
- [2]Appelbaum PS, Robbins PC, Monahan J Violence and delusions: data from the MacArthur Violence Risk Assessment Study Am J Psychiatry, 2000.PMID 10739415
- [3]Fazel S, Gulati G, Linsell L, et al. Schizophrenia and violence: systematic review and meta-analysis PLoS Med, 2009.PMID 19668362
- [4]Witt K, van Dorn R, Fazel S Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies PLoS One, 2013.PMID 23418482
- [5]Whiting D, Gulati G, Geddes JR, et al. Association of Schizophrenia Spectrum Disorders and Violence Perpetration in Adults and Adolescents From 15 Countries: A Systematic Review and Meta-analysis JAMA Psychiatry, 2022.PMID 34935869
- [6]Elbogen EB, Johnson SC The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions Arch Gen Psychiatry, 2009.PMID 19188537
- [7]Van Dorn R, Volavka J, Johnson N Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol, 2012.PMID 21359532
- [8]Fazel S, Singh JP, Doll H, et al. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis BMJ, 2012.PMID 22833604
- [9]Singh JP, Grann M, Fazel S A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants Clin Psychol Rev, 2011.PMID 21255891
- [10]Yang M, Wong SC, Coid J The efficacy of violence prediction: a meta-analytic comparison of nine risk assessment tools Psychol Bull, 2010.PMID 20804235
- [11]Douglas KS, Guy LS, Hart SD Psychosis as a risk factor for violence to others: a meta-analysis Psychol Bull, 2009.PMID 19702378
- [12]Nielssen O, Large M Rates of homicide during the first episode of psychosis and after treatment: a systematic review and meta-analysis Schizophr Bull, 2010.PMID 18990713
- [13]Large MM, Nielssen O Violence in first-episode psychosis: a systematic review and meta-analysis Schizophr Res, 2011.PMID 21208783
- [14]McNiel DE, Eisner JP, Binder RL The relationship between command hallucinations and violence Psychiatr Serv, 2000.PMID 11013329
- [15]Ogloff JR, Daffern M The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients Behav Sci Law, 2006.PMID 17171770
- [16]Abderhalden C, Needham I, Dassen T, et al. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial Br J Psychiatry, 2008.PMID 18700217
- [17]Buchanan A Risk of violence by psychiatric patients: beyond the "actuarial versus clinical" assessment debate Psychiatr Serv, 2008.PMID 18245161
- [18]Fazel S, Grann M The population impact of severe mental illness on violent crime Am J Psychiatry, 2006.PMID 16877653
- [19]Whiting D, Lichtenstein P, Fazel S Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment Lancet Psychiatry, 2021.PMID 33096045
- [20]Taylor PJ, Gunn J Homicides by people with mental illness: myth and reality Br J Psychiatry, 1999.PMID 10211145