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JAMA: "No easy way to tell which patients may be violent."

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Jackpine Radical Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Mar-21-11 08:02 AM
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JAMA: "No easy way to tell which patients may be violent."
This morning's issue of the American Medical Association's *American
Medical News* includes an article: "No easy way to tell which patients
may be violent."

Paul S. Appelbaum, MD, Dollard Professor of Psychiatry,
Medicine and Law; director, Division of Psychiatry, Law and Ethics,
Columbia University/New York State Psychiatric Institute.


Concern after the tragic shootings in Tucson, Ariz., reflects deep-rooted public belief that such tragedies should be preventable.

Research suggests that schizophrenia and other psychotic disorders increase the risk of violent behavior, particularly early in the illness. Even so, only a minority of people with such illnesses commit acts of violence. Conversely, only about 3% to 5% of violence in our society is due to serious mental illness. Thus, eliminating violence committed by people with mental illnesses still would leave society with almost all the violence it now experiences.

Research on the predictors of violence among people with mental illnesses has identified at least two groups of patients associated with differing patterns of behavior. One subgroup tends to be young, male and substance abusing, with unstable personal histories, early onset of antisocial acts and records of previous violence. Their violence is likely to be independent of symptoms of psychosis and not particularly responsive to treatment. A second subgroup without an antisocial history displays violence more closely linked to positive psychotic symptoms such as delusions and command auditory hallucinations; negative symptoms of psychosis (e.g., social isolation, apathy) may lower violence risk. Treatment may help reduce violence risk in this group.

Identification of variables that heighten risk of violence does not imply that accurate prediction is possible in individual cases. After decades of over-predictions that often led to prolonged involuntary hospitalization, progress has been made in developing structured assessment tools based on variables known to correlate with violence. Achieving reasonable degrees of accuracy, however, appears to be possible only when classifying patients into approximate levels of risk (e.g., low, average and high), with false positive predictions more prevalent as the degree of predicted risk increases.

And preventive treatment may help deter the rare person who otherwise might commit a serious act of violence.

The article is online at:
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