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Chief complaint: Homicidal. Assessing violence risk

Current Psychiatry. 2018 May;17(5):26-28,30-32,34,55
May 1, 2018|Psychiatry
Adrienne Saxton, MD;Phillip Resnick, MD;Stephen Noffsinger, MD
Author and Disclosure Information

Adrienne Saxton, MD
Assistant Professor Department of Psychiatry
Case Western Reserve University School of Medicine
Cleveland, Ohio

Phillip Resnick, MD
Forensic Psychiatry Section Editor Current Psychiatry
Professor Department of Psychiatry
Case Western Reserve University School of Medicine
Cleveland, Ohio

Stephen Noffsinger, MD
Associate Professor
Department of Psychiatry
Case Western Reserve University School of Medicine
Cleveland, Ohio

Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

A structured approach can help identify risk factors, including those not due to mental illness.

Bottom Line

Use a structured approach to identify risk factors for violence. Address dynamic risk factors, including access to weapons. Carry out the duty to warn/protect if applicable. Document your decisions and actions carefully, and then discharge the patient if clinically indicated. Do not be “held hostage” by a patient’s homicidal ideation.

Related Resources

  • Dolan M, Doyle M. Violence risk prediction. Clinical and actuarial measures and the role of the psychopathy checklist. Br J Psychiatry. 2000;177:303-311.
  • Douglas KS, Hart SD, Webster CD, et al. HCR-20V3: Assessing risk of violence–user guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 2013.
  • National Conference of State Legislatures. Mental health professionals’ duty to warn. https://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx. Published September 28, 2015.

Drug Brand Names

Sertraline • Zoloft

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