Forensic Psychiatrists Discuss Factors That Can Increase Violence Risk in Those With Mental Illness

Predicting violence among psychiatric patients “remains an inexact science,” a bit like predicting the weather, said forensic psychiatry experts Charles Scott, M.D., a professor of clinical psychiatry at the University of California, Davis, and Philip Resnick, M.D., a professor of psychiatry at Case Western Reserve University School of Medicine. While most people with mental illness are not violent, certain factors increase the risk of violence for people with psychosis or mood disorders, wrote Scott and Resnick in the October issue of CNS Spectrums.

“[I]ndividuals who suffer from persecutory delusions and negative affect are more likely to act on their delusions,” they said. Angry affect is a critical variable, especially when coupled with feelings of being spied upon, followed, plotted against, or being under external control. They pointed out as well that depression may be a risk factor when accompanied by a recent history of violence and/or alcohol use. Active manic symptoms are also associated with increased risk of engaging in a violent crime, but mostly when associated with comorbid substance abuse.

Scott and Resnick suggest using structured risk assessments to help gather appropriate data and reviewing research findings to identify violence-related risk factors associated with psychotic and mood disorder symptoms. “Like a good weather forecaster, the clinician does not state with certainty that an event will occur,” they concluded. “Instead, he or she estimates the likelihood that a future event will occur.

For more in Psychiatric News about assessment of risk for violence, see the article, “Experts Discuss Factors That May Lead to Violence Among Mentally Ill People.”

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