Violence by with found of a - National Organization of ...nofsw.org/wp-content/uploads/2014/07/D1B.pdf · To Manage Risk of Acute Severe/Fatal Violence by Persons with SMI found NCR/NGRI

To Manage Risk of Acute Severe/Fatal Violence by Persons with SMI found NCR/NGRI of a

Personal Violence Offence

Presented by: Billy Chan and Maria Shehtman

William Johannes was released from Humber Memorial Hospital in December 1996 after 10 weeks of involuntary hospitalization sought by his sister Roslyn Knipe

He went straight to his sister’s apartment. No one from the hospital had warned her that William had been released

He expressed bizarre conspiracy theories, complaining that he was under police surveillance

2The National Organization of Forensic Social Work Annual ConferenceJuly 25th-27th, 2014

William returned to Humber Hospital on three occasions

He was charged for trespassing on one occasion, and spent a night in jail

He was provocative, irritable, and hostile to Roslyn the morning before the killing

William killed Roslyn at her home on January 24, 1997, possessed by the notion that she was the devil


“Roslyn had been stabbed more than 50 times, a fist‐sized cavity carved into her chest. He had been possessed by the notion that his sister was the devil...” (Makin, 2007, p. 83)

William was found Not Criminally Responsible (an equivalent verdict of NGRI) and placed under the jurisdiction of the Ontario Review Board (ORB) in Canada


What can clinicians do to prevent similar tragic incidents from happening?

What are the available tools to assist clinicians in managing and reducing the risk of occurrence of similar severe/fatal violence?


Identify risk factors of acute severe/fatal violence to assist“…as soon as possible, in preventive clinical actions such as change in medication, monitoring, and admitting to or discharge from hospital” (Tardiff, 2008, p. 3)

Propose a screening tool in clinical settings with comparable predictive validity to validated violence risk assessment tools to assess acute risk (within days to a week) of severe/fatal violence to victims among persons with SMI


Review the current state of risk assessment tools for acute severe/fatal violence to assist clinical practice

Present the rationale, methodology, and results of this study

Discuss the applicability of the proposed screening tool based on the identified independent significant risk factors of acute severe/fatal violence among this population


Inconsistent definitions of violence among research with a wide spectrum of violent acts from verbal threats to homicide (Bo, Abu‐Akel, Kongerslev, Haahr, & Simonsen, 2011)“…leaving unanswered the question of whether mental illness predicts some kinds of violence but not others.” (Elbogen & Johnson, 2009, p.153)


Length of violence prediction

Types of violence

Imminent (within 24 hours)

Brøset Violence Checklist (BVC) (Almvik, Woods, & Rasmussen, 2000)

Aggressive behavior of psychiatric inpatients

Dynamic Appraisal of Situational Aggression (DASA) (Ogloff & Daffern, 2006)

Aggressive behavior of psychiatric inpatients



Types of violence

Short‐term (1‐12 months)Short‐Term Assessment of Risk and Treatability (START) (Webster, Nicholls, Martin, Desmarais, & Brink, 2006)

Violence among inpatients (up to 9 months)

Classification of Violence Risk (COVR) (Snowden, Gray, Taylor, & Fitzgerald, 2009)

Physical violence in the community (20 weeks); aggressive behavior among forensic inpatients

V‐RISK‐10 (Bjørkly et al., 2009; Roaldset, Hartvig, & Bjørkly, 2010)

Short‐term violence (3 to 12 months) after discharge from a general psychiatric hospital



Types of violence

Long‐term (more than 1 year)

11 common violence risk assessment tools (Farrington, Jolliffe, & Johnstone, 2008; Fazel, Singh, Doll, & Grann, 2012; Singh et al., 2011; Singh, Serper, Reinhart, & Fazel, 2011; Yang, Wong, & Coid, 2010)

Institutional violence, reconviction, and violent recidivism


Violence risk assessment Violence risk assessment toolstools

Predictive validation Predictive validation indicator indicator (AUC)

Brøset Violence Checklist (BVC) .82

Dynamic Appraisal of Situational Aggression (DASA)

.82

Short‐Term Assessment of Risk and Treatability (START)

.75 ‐ .79

Classification of Violence Risk (COVR) .63 ‐ .82

V‐RISK‐10 .75 ‐ .80

Long‐term violence risk assessment tools .62 ‐ .85


Focus of these tools is on less severe forms of violenceMost tools provide eithera probability of violence risk or a framework to reach an overall conclusion of the level of risk (low, moderate, or high) of the person with SMI,

over a period of follow‐up spanning years(Heilburn, Yashuara, & Shah, 2010)


No risk assessment tools exist to specificallyassessAcute (within days to a week) violence risk in clinical settingSevere/fatal violence in any setting


Research has shown a modest but significant positive association between mental illness and violence (Fazel, Gulati, Linsell, Geddes, & Grann, 2009)

Family members have a higher prevalence of being victims of violence, of varying degrees of severity, by their mentally ill relatives, compared to non‐family members (Davis, 1991; Taylor, 2008)


57% of victims of assaultive behaviors, prior to admission to a private hospital, were spouses/mates and “other family members” (Tardiff, 1984)47% of the victims of physical violence were family members (mainly parents and spouses) within two weeks of admission (Straznickas, McNiel, & Binder, 1993)24‐38% of caregivers sustained physical assault in the past year (Swan & Lavitt, 1988; Vaddadi, Gilleard, & Fryer, 2002)18% of caregivers experienced an injury within the past year (Chan, 2008)


Between 73% and 79% of victims of homicide were family members of psychotic offenders (Gottlieb, Gabrielson, & Kramp, 1987; Nielssen, Westmore, Large, & Hayes, 2007) vs. 49% of family members being victims of non‐psychotic defendants (Gottlieb et al., 1987)23% of family of origin or a spouse/partner as victim of severe/fatal injury by offenders with schizophreniaRespective odds ratios of 5.10 and 3.29 of becoming a victim of severe/fatal injury, compared to strangers (Nordström & Kullgren, 2003)


Paranoid delusions and delusions of reference (Yee, Large, Kemp, & Nielssen, 2011; El‐Hadidy, 2012 ; Golenkov, Large, Nielssen, & Tsymbalova, 2011; Nordström, Dahlgren, & Kullgren, 2006)Command hallucinations (McNeil, Eisner, & Binder, 2000;Golenkov, Large, Nielssen, & Tsymbalova, 2011; Nordström et al., 2006)Threat/Control‐Override (TCO) symptoms (Bjørkly , 2002; Hodgins, Hiscoke, & Freese, 2003; Stompe, Ortwein‐Swoboda, & Schanda, 2004)Capgras syndrome (Bourget & Whitehurst, 2004; Silva, Harry, Leong, & Weinstock, 1996; Green, Chiu, McVie, & Hay, 2009)


Comorbid substance use (Fazel, Gulati et al., 2009; Yee, Large, Kemp, & Nielssen, 2011; Eronen, Tiihonen, & Hakola, 1996; Fazel, Långström, Hjern, Grann, & Lichtenstein, 2009)


Not associated or negatively correlated with violence against others by discharged mentally disordered patients during a one‐year follow‐up period in the community (Applebaum, Robbins, & Monahan, 2000)


Sampling bias of low prevalence of TCO symptoms and violenceSignificantly higher refusal rate of persons with schizophrenia (44% vs. 20%, p < .001)Significantly higher portion of subjects lost to follow‐up with a history of violence against their family (43% vs. 27%, p < .001) or others (54% vs. 39%, p < .01) (Monahan et al., 2001)


No evidence of an association between TCO symptoms and violence in the following week within a six‐month period among a cohort of 132 patients discharged from a psychiatric emergency unit (Skeeme et. al, 2006)


Sampling bias: Screening process has a sensitivity of .07.07 and a specificity of .99.99 (Skeem, Mulvey, Lidz, Gardner, & Schubert, 2002)High false negative (.93) (.93) suggests that high‐risk patients not identified in the sampleLower incidents of violence from low‐risk patients likely led to insignificant association between TCO symptoms and violence


Study Focus Results

Laajassalo & Häkkänen (2006)

Effect of symptoms on excessive violence among homicide offenders with schizophrenia

N.S. in logistic regressionCo‐occurrence of hallucinations and delusionsAny hallucination

Swanson et al. (2006) Correlates of PANSS with minor and serious violence

Serious violence associated with: HostilityHallucinatory behaviorSuspicion/persecutionGrandiosityExcitement

Taylor et al. (1998) Presence of psychotic symptoms to drive homicide, and other violent, sexual, or property offenses

Combinations of delusions and hallucinations were more influential in offending than either alone


Acute violence among persons with SMI:Violent behavior that took place within days or a week following the evaluation of the mental health condition of the person at a given time (Tardiff, 2008)


The most serious index offence leading to admission to the Ontario Review Board that includes charges of:HomicideManslaughterAttempted murderAggravated assault (Quinsey, Harris, Rice, & Cormier, 1998)


Major assaultSexual assaultAssaultRobberyCriminal harassmentThreats

Excluded violent acts not against person(s):

ArsonBreak and enterTheftMischiefNon‐violent acts (Quinsey, Harris, Rice, & Cormier, 1998)


H1: Family members will be at a significantly higher risk than non‐family members of becoming victims of severe/fatal violence by persons with SMI who had been found NCR for their index offence involving a personal violence offence and are under the jurisdiction of a mandatory review board system


H2: At least one of the independent clinical variables of

paranoid delusionsparanoid delusionsdelusions of referencedelusions of referencecommand hallucinationscommand hallucinationsthreat/controlthreat/control‐‐override (TCO) symptomsoverride (TCO) symptomsCapgras syndrome, or Capgras syndrome, or ongoing substance (alcohol and/or drug) useongoing substance (alcohol and/or drug) use,

within days or a week before the index offence leading to the NCR verdict, will be positively and significantly associated with severe/fatal violence to victims by the aforementioned persons with SMI


Severe/fatalSevere/fatalviolence toviolence to

victimsvictims


Alcohol use Alcohol use (OR)(OR)

Drug use Drug use (OR)(OR)

Clinical variables of Clinical variables of substance use within days substance use within days or a week before the index or a week before the index offenceoffence

H2

H2

H1

ContextualContextualvariable of victimvariable of victim

being a familybeing a familymembermember

Victim Victim relationrelation((OR)OR)

Clinical variables of psychoticClinical variables of psychoticsymptoms within days or asymptoms within days or aweek before the index offenceweek before the index offence

ParanoidParanoiddelusions (delusions (OR)OR)

Delusions ofDelusions ofreference (reference (OR)OR)

CommandCommandHallucinations Hallucinations ((OR)OR)

CapgrasCapgrassyndrome (syndrome (OR)OR)

H2

H2

H2

H2

H2

TCOTCOsymptoms (symptoms (OR)OR)

The Centre for Addiction and Mental Health in Toronto, Ontario, under the jurisdiction of the Ontario Review Board (ORB)Provides treatment to over 500 forensic patients found either

Unfit to Stand Trial, or Not Criminally Responsible (not guilty by reason of insanity)

Number of patients under ORB as of March 2011 was 1622


Chart review of 500 patients found NCR or UFST and under the jurisdiction of the Ontario Review Board between October 2010 and June 2011416 NCR patients identified in initial sample350350NCR patients with a personal injury offence included in the final sample Focus on mental status of the patient immediately prior to the criminal offence of personal injury leading to the NCR verdict


The sources of information found in a patient file included: Police summary of the arrest record Data from collateral sourcesInterviews with family members and friends

Intraclass correlation coefficients (ICC) for inter‐rater reliability ranged between .66.66 (drug use within days or a week before the index offence) and .96.96 (alcohol use within days or a week before the index offence)


CAMH (2011) (N = 416) Review Board Study of Canada (2006) (N = 6801)

Gender 85% 84%

Serious mental illness 82% 82%

Major violence 26.4% 22%

Near fatal violence 5.6% 6.5%

Fatal violence 8.65% 7.2%

Note. The comparison is based on all patients found NCR of the index offence. CAMH = Centre for Addiction and Mental Health. ORB = Ontario Review Board. NCR = Not Criminally Responsible.



0%

20%

40%

60%

80%

100%

37% 33%

Drug use

Alcohol use


Significant acute clinical risk factorsSignificant contextual risk factor

Severe/fatal Severe/fatal violence to violence to victimsvictims

p < .0001 Victim Victim relationshiprelationship

Command Command hallucinationshallucinations

p < .01

Paranoid delusionsParanoid delusions p < .01

TCO symptomsTCO symptomsp < .00001

Capgras syndromeCapgras syndrome

p < .01


Significant acute clinical risk factorsSignificant contextual risk factor

Severe/fatal Severe/fatal violence to violence to victimsvictims

χ2 (9, N = 337) = 48.86, p < .000001, Nagelkerke R2 = 0.20

OR = 2.55

CI = 1.46 – 4.45

Victim Victim relationshiprelationship

p < .001

TCO symptomsTCO symptoms

OR = 3.00

CI = 1.50 – 6.00

p < .01

Capgras Capgras syndromesyndrome

OR = 3.35

CI = 1.02 – 11.07

p < .05


Acceptance of hypothesis 1: family members had a significantly higher risk than non‐family members of becoming victims of severe/fatal violence by CAMH ORB NCR patients whose index offence involved violence against persons


Acceptance of hypothesis 2: active psychotic symptoms of TCO symptoms and Capgras syndrome present within days or a week before the index offence were independently and significantly associated with severe/fatal violence by CAMH ORB NCR patients whose index offence involved violence against persons


Predicted

Severe/fatal violence

Minor/moderate violence

Percentage correct

Observed Severe/fatal violence

True positive (sensitivity)

False negative Sen. =24

Minor/moderate violence

False positive True negative (specificity)

Spec. = 93

PPV = .54 NPV = .78

Overall percentage correct 75

AUC = .75 (95% CI = .69 ‐ .81)



Predictive validation indicatorsPredictive validation indicators ValueValue

AUC .75 (95% CI = .69 ‐ .81, p < .000001)

Sensitivity .24

Specificity .93

Positive Predictive Value (PPV) .54 (CI = .37 ‐ .70)

Negative Predictive Value (NPV) .78 (CI = .72 ‐ .82)

Number needed to detain (NND) 2, (1/.54) = 1.85

Number safely discharged (NSD) 4, (1/[1 ‐ .78] ‐1) = 3.55


Retrospective screening of William Johannes’mental status before the offence:Family member(s) at risk?Presence of TCO symptoms?Presence of Capgras syndrome?

What would the proposed screening tool suggest?


The high false negative rate (1‐.24)A public safety issue of releasing (3 out of 4) patients who would commit acute severe/fatal violence to victims

The less than perfect false positive rate (1‐.93) A moral issue of wrongfully detaining (7 out of 100) patients who would not commit acute severe/fatal violence to victims


Violence risk assessment Violence risk assessment toolstools

Predictive validation Predictive validation indicator (AUC)indicator (AUC)

Proposed screening tool for acute acute severe/fatal violence severe/fatal violence CAMH ORB patients

.75.75

Brøset Violence Checklist (BVC) .82

Dynamic Appraisal of Situational Aggression (DASA)

.82

Short‐Term Assessment of Risk and Treatability (START)

.75 ‐ .79

Classification of Violence Risk (COVR) .63 ‐ .82

V‐RISK‐10 .75 ‐ .80Long‐term violence risk assessment tools .62 ‐ .85


Sensitivity and Specificity Sensitivity and Specificity of population of population

PPVPPV NNDNND

.52 & .68 (Buchanan & Leese, 2001)

.15 7 (6.67)

.75 & .75 (Monahan, 2001) .25 4

.27 & .98 (Monahan, 2001) .60 2 (1.67)

.24 .24 && .93 .93 (CAMH ORB)(CAMH ORB) .54.54 2 (1.85)2 (1.85)



Predictive Predictive validation validation performance performance indicatorsindicators

Violent Violent offending offending (n = 30)*(n = 30)*

Criminal Criminal offending offending (n = 23)(n = 23) ‡‡

CAMH ORB CAMH ORB samplesample

AUCAUC .72 (.68 ‐ .78) .66 (.58 ‐ .67) .75

SensitivitySensitivity .92 (.88 ‐ .94) .41 (.28 ‐ .56 .24

SpecificitySpecificity .36 (.28 ‐ .44) .80 (.67 ‐ .89) .93

PPVPPV .41 (.27 ‐ .60) .52 (.32 ‐ .59) .54

NPVNPV .91 (.81 ‐ .95) .76 (.61 ‐ .84) .78

*HCR‐20, SARA, SAVRY, and VRAG ‡LSI‐R and PCL‐R

Sample characteristics a close approximation to Review Board Study (Latimer & Lawrence, 2006)Predictive validity performance of the model comparable to validated risk assessment toolsAUC (length of follow‐up) = .75 vs. range of .63 ‐.85AUC (criminal and violent offending) = .75 vs. range of .58 ‐ .78PPVPPV = .54 vs. range of .27 ‐ .60NPV NPV = .78 vs. range of .61 ‐ .95


Replicated previous results where family members were at a higher risk of becoming victims of severe/fatal violence by persons with SMI (Belli et al., 2010; Gottlieb et al., 1987; Ibrahim & Humaidi, 2009; Meehan et al., 2006; Nordström et al., 2006; Taylor, 2008)

Replicated results of TCO symptoms (Green et al., 2009; Stompe, Ortwein‐Swoboda, & Schanda, 2004) and Capgras syndrome (Bourget & Whitehurst, 2004; Green et al., 2009; Silva et al., 1996) being significant clinical risk factors of severe/fatal violence by persons with SMI


Underscore the importance of involving family members as partners to reduce risk reduce risk of acute severe/fatal violenceTCO symptoms and Capgras syndrome can be identified through routine clinical assessment; no additional training requiredDynamic risk factors responsive to treatment as part of risk management plan (Buchanan, et al., 2012)


Secondary data analysis: data were not collected for the purpose of this research (Wade & Brannigan, 2010)Retrospective design cannot establish causality (Hess, 2004)The approximate temporal sequence of the events can help generate hypotheses to further examine the possible causal relationship


Patients may have misrepresented psychopathology prior to the index offence in assessment to avoid unfavorable consequencesTriangulation of information from collateral sourcesmay mitigate this possibility


Research assistants not blind to the hypotheses of the study, which might have resulted in bias of overestimating the association between the independent variables and dependent variable (Gearing, Mian, Barber, & Ickowicz, 2006)Principal investigator, not involved in data coding, was responsible for the final coding of the dependent variable


Further studies should be conducted among persons with SMI who had been found NCR for their index offence involving personal injury, under the Review Board system in Ontario and other provinces/territories to validate the utility of the predication model as a screening tool in risk prediction and management of acute severe/fatal violence to victims


Almvik, R., Woods, P., & Rasmussen, K. (2000). The Brøset Violence Checklist: Sensitivity, specificity, and interrater reliability. The Journal of Interpersonal Violence, 15(12), 1284‐1296. doi: 10.1177/088626000015012003

Andreasen, N. C. (1984). Scale for the assessment of positive symptoms (SAPS). IowaCity, IA: University of Iowa.

Applebaum, P. S., Robbins, P. C., & Monahan, J. (2000). Violence and delusions: Data from the MacArthur Violence Risk Assessment Study. The American Journal of Psychiatry, 157(4), 566‐572. doi:10.1176/appi.ajp.157.4.566

Belli, H., Ozcetin, A., Ertem, U., Tuyluoglu, E., Namli, M., Bayik, Y., & Simsek, D. (2010). Perpetrators of homicide with schizophrenia: Sociodemographic characteristics and clinical factors in the eastern region of Turkey. Comprehensive Psychiatry, 51(2), 135‐141. doi: 10.1016/j.comppsych.2009.03.006

Bjørkly, S. (2002). Psychotic symptoms and violence toward others—A literature review of some preliminary findings: Part 1. Delusions. Aggression and Violent Behavior, 7(6), 617‐631.


Bjørkly, S., & Havik, O. E. (2003). TCO symptoms as markers of violence in a sample of severely violent psychiatric inpatients. International Journal of Forensic Mental Health, 2(1), 87‐97. doi: 10.1080/14999013.2003.10471181

Bjørkly, S., Hartvig, P., Heggen, F. A., Brauer, H., & Moger, T. A. (2009). Development of a brief screen for violence risk (V‐RISK‐10) in acute and general psychiatry: Anintroduction with emphasis on findings from a naturalistic test of interrater reliability. European Psychiatry, 24(6), 388‐394. doi: 10.1016/j.eurpsy.2009.07.004

Bo, S., Abu‐Akel, A., Kongerslev, M., Haahr, U. H., & Simonsen, E. (2011). Risk factors for violence among patients with schizophrenia. Clinical Psychology Review, 31(5), 711‐726. doi: 10.1016/j.cpr.2011.03.002

Bourget, D., & Whitehurst, L. (2004). Capgras syndrome: A review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. Canadian Journal of Psychiatry, 49(11), 719‐725.

Buchanan, A., Binder, R., Norko M., & Swartz, M. (2012). Resource document on psychiatric violence risk assessment. American Journal of Psychiatry, 169(3), data supplement: 1‐9. doi: 10.1176/appi.ajp.2012.169.3.340


Chan, B. W‐Y. (2008). Violence against caregivers by relatives with Schizophrenia. International Journal of Forensic Mental Health, 7(1), 65‐81. doi:10.1080/14999013.2008.9914404

Davis, S. (1991). Violence by psychiatric inpatients: A review. Hospital and CommunityPsychiatry, 42(6), 585‐590.

Elbogen, E. B., & Johnson, S. C. (2009). The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of general Psychiatry, 66(2), 152‐161.

El‐Hadidy, M. A. (2012). Schizophrenia with and without homicide: A clinical comparative study. Journal of Forensic Psychiatry and Psychology, 23(1), 95‐107. doi: 10.1080/14789949.2011.650183

Eronen, M., Hakola, P., & Tiihonen, J. (1996). Mental disorders and homicidal behavior in Finland. Archives of General Psychiatry, 53(6), 497‐501. doi: 10.1001/archpsyc.1996.01830060039005

Farrington, D. P., Jolliffe, D., & Johnstone, L. (2008, May). Assessing violence risk: A framework for practice final report. Institute of Criminology, Cambridge University. Retrieved from http://www.crim.cam.ac.uk/people/academic_research/david_farrington/violrisk.pdf


Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: Systematic review and meta‐analysis. PLoS Medicine, 6(8), e1000120. doi: 10.1371/journal.pmed.1000120

Fazel, S., Långström, N., Hjern, A., Grann, M., & Lichtenstein, P. (2009). Schizophrenia, substance abuse, and violent crime. Journal of the American Medical Association, 301(19), 2016‐2023. doi: 10.1001/jama.2009.675

Fazel, S., Singh, J. P., Doll, H., & Grann, M. (2012, July 24). Use of risk assessment instruments to predict violence and antisocial behaviors in 73 samples involving 24,827 people: A systematic review and meta‐analysis. British Medical Journal. Retrieved from http://www.bmj.com/content/345/bmj.e4692

Fleminger, S. (1997). Number needed to detain. British Journal of Psychiatry, 171(3), 287. doi: 10.1192/bjp.171.3.287a

Fluttert, F., Meijel, B. N., Webster, C., Nijman, H., Bartels, A., & Grypdonck, M. (2008). Risk management by early recognition of warning signs in patients in forensic psychiatric care. Archives of Psychiatric Nursing, 22(4), 208‐216. doi: 10.1016/j.apnu.2007.06.012


Gearing, R. E., Mian, I. A., Barber, J., & Ickowicz, A. (2006). A methodology for conducting retrospective chart review research in child and adolescent psychiatry. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15(3), 126‐134.

Golenkov, A., Large, M., Nielssen, O., & Tsymbalova, A. (2011). Characteristics of homicide offenders with Schizophrenia from the Russian Federation. Schizophrenia Research, 133(1‐3), 232‐237. doi: 10.1016/j.schres.2011.07.008

Gottlieb, P., Gabrielsen, G., & Kramp, P. (1987). Psychotic homicides in Copenhagen from 1959 to 1983. Acta Psychiatrica Scandinavica, 76(3), 285‐292. doi: 10.1111/j.16000447.1987.tb02897

Green, B., Schramm, T. M., Chiu, K., McVie, N., & Hay, S. (2009). Violence severity and psychosis. International Journal of Forensic Mental Health, 8(1), 33‐40. doi: 10.1080/14999010903014713

Hart, S. D., Michie, C., & Cooke, D. J. (2007). Precision of actuarial risk assessment instruments: Evaluating the ‘margins of error’ of group v. individual predictions of violence. British Journal of Psychiatry, 190(49), 60‐65. doi: 10.1192/bjp.190.5.s60


Heilburn, K., Yasuhara, K, & Shan, S. (2010). Violence risk assessment tools. In R. K. Otto & K. S. Douglas (Eds.), Handbook of violence risk assessment (pp. 1‐19). New York, NY: Taylor & Francis.

Hellerstein, D., Frosch, W., & Koeningsberg, H. W. (1987). The clinical significance of command hallucinations. The American Journal of Psychiatry, 144(2), 219‐221.

Hess, D. R. (2004). Retrospective studies and chart reviews. Respiratory Care, 49(10), 1171‐1174.

Hodgins, S., Hiscoke, U. L., & Freese, R. (2003). The antecedents of aggressive behavior among men with schizophrenia: A prospective investigation of patients in community treatment. Behavioral Sciences & the Law, 21(4), 523‐546. doi: 10.1002/bsl.540

Ibrahim, A. H., & Humaidi, N. S. (2009). Homicidal behavior in schizophrenics. The New Iraqi Journal of Medicine, 5(3), 41‐45.

Latimer, J., & Lawrence, A. (2006). The Review Board Systems in Canada: An overview of results from the mentally disordered accused data collection study. Ottawa, ON: Department of Justice Canada.


Litwack, T. R. (2001). Actuarial versus clinical assessments of dangerousness. Psychology, Public Policy, and Law, 7(2), 409‐443. doi: 10.1037/1076‐8971.7.2.409

Makin, K. (2007, November). Who killed Roslyn Knipe? Toronto Life (pp. 82–86).McNeil, D. E., Eisner, J. P., & Binder, R. L. (2000). The relationship between

command hallucinations and violence. Psychiatric Services, 51(10), 1288‐1292. doi: 10.1176/appi.ps.51.10.1288

Meehan, J., Flynn, S., Hunt, I. M., Robinson, J., Bickley, H., Parsons, R., . . . Shaw, J. (2006). Perpetrators of homicide with schizophrenia: A national clinical survey in England and Wales. Psychiatric Services, 57(11), 1648‐1651. doi: 10.1176/appi.ps.57.11.1648

Monahan, J., Steadman, H. J., Silver, E., Applebaum, P. S., Robbins, P. C., Mulvey, E. P., . . . Banks, S. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York, NY: Oxford University Press.

Mossman, D. (2013). Evaluating risk assessments using receiver operating characteristics analysis: Rationale, advantages, insights, and limitations. Behavioral Sciences & the Law, 31(1), 23‐39. doi: 10.1002/bsl.2050


Nielssen, O. B., Westmore, B. D., Large, M. M. B., & Hayes, R. A. (2007). Homicide during psychotic illness in New South Wales between 1993 and 2002. Medical Journal of Australia, 186(6), 301‐304.

Nordström, M. A., & Kullgren, G. (2003). Do violent offenders with schizophrenia who attack family members differ from those with other victims? International Journal of Forensic Mental Health, 2(2), 195‐201. doi: 10.1080/14999013.2003.10471191

Nordström, M. A., Dahlgren, L., & Kullgren, G. (2006). Victim relations and factors triggering homicides committed by offenders with schizophrenia. The Journal of Forensic Psychiatry Psychology, 17(2), 192‐203. doi: 10.1080/14789940600631522

Ogloff, J. R. P., & Daffern, M. (2006). The Dynamic Appraisal of Situational Aggression: An instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences and the Law, 24(6), 799‐813. doi: 10.1002/bsl.741

Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.


Roaldset, J. O., Hartvig, P., & Bjørkly, S. (2010). V‐RISK‐10: Validation of a screen for risk of violence after discharge from acute psychiatry. European Psychiatry, 26(2), 85‐91. doi: 10.1016/j.eurpsy.2010.04.002

Robbins, P. C., Monahan, J., & Silver, E. (2003). Mental disorder, violence, and gender. Law and Human Behavior, 27(6), 561‐571. doi: 10.1023/B:LAHU.0000004886.13268.f2

Schanda, H., Knecht, G., Schreinzer, D., Stompe, T. H., Ortwein‐Swoboda, G., & Waldhoer, T. H. (2004). Homicide and major mental disorders: A 25‐year study. Acta Psychiatrica Scandinavica, 110(2), 98‐107. doi: 10.1111/j.1600‐0047.2004.00305.x

Silva, J. A., Harry, B. E., Leong, G. B., & Weinstock, R. (1996). Dangerous delusional misidentification and homicide. Journal of Forensic Sciences, 41(4), 641‐644. doi: 10.1520/JFS13968J

Singh, J. P., & Fazel, S. (2010). Forensic risk assessment: A metareview. Criminal Justice and Behavior, 37(9), 965‐988. doi: 10.1177/0093854810374274


Singh, J. P., Grann, M., & Fazel, S. (2011). A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25, 980 participants. Clinical Psychology Review, 31(1), 499‐513. doi: 10.1016/j.cpr.2010.11.009

Singh, J. P., Serper, M., Reinhart, J., & Fazel, S. (2011). Structured assessment of violence risk in schizophrenia and other psychiatric disorders: A systematic review of the validity, reliability, and item content of 10 available instruments. Schizophrenia Bulletin, 37(5), 899‐912. doi: 10.1093/schbul/sbr093

Singh, J. P. (2013). Predictive validity performance indicators in violence risk assessment: A methodological primer. Behavioral Sciences & the Law, 31(1), 8‐22. doi: 10.1002/bsl.2052

Singh, J. P., Desmarais, S. L., & Van Dorn, R. A. (2013). Measurement of predictive validity in violence risk assessment studies: A second‐order systematic review. Behavioral Sciences & the Law, 31(1), 55‐73. doi: 10.1002/bsl.2053


Skeem, J. L., Mulvey, E. P., Lidz, C., Gardner, W., & Schubert, C. (2002). Identifying psychiatric patients at risk for repeated involvement in violence: The next step toward intensive community treatment programs. International Journal of Forensic Mental Health, 1(2), 155‐170. doi: 10.1080/14999013.2002.10471170

Skeem, J. L., Schubert, C., Odgers, C., Mulvey, E. P., Gardner, W., & Lidz, C. (2006). Psychiatric symptoms and community violence among high‐risk patients: A test of the relationship at the weekly level. Journal of Consulting and Clinical Psychology, 74(5), 967‐979. doi: 10.1037/0022‐006X.74.5.967

Skeem, J. L., & Monahan, J. (2011). Current directions in violence risk assessment. Current Directions in Psychological Science, 20(1), 38‐42. doi: 10.1177/0963721410397271

Snowden, R. J., Gray, N. S., Taylor, J., & Fitzgerald, S. (2009). Assessing risk of future violence among forensic psychiatric inpatients with the Classification of Violence Risk (COVR). Psychiatric Services, 60(11), 1522‐1526. doi: 10.1176/appi.ps.60.11.1522


Stompe, T., Ortwein‐Swoboda, G., & Schanda, H. (2004). Schizophrenia, delusional symptoms, and violence: The threat/control‐override concept reexamined. Schizophrenia Bulletin, 30(1), 31‐44.

Straznickas, K. A., McNiel, D. E., & Binder, R. L. (1993). Violence toward family caregivers by mentally ill relatives. Hospital and Community Psychiatry, 44(4), 385‐387.

Stueve, A., & Link, B. G. (1998). Gender differences in the relationship between mental illness and violence: Evidence from a community‐based epidemiological study in Israel. Social Psychiatry and Psychiatric Epidemiology, 33(1), S61‐S67.

Swan, R. W., & Lavitt, M. (1988). Patterns of adjustments to violence in families of the mentally ill. Journal of Interpersonal Violence, 3(1), 42‐54. doi: 10.1177/088626088003001004

Szmukler, G. (2003). Risk assessment: ‘Numbers’ and ‘values’. The Psychiatrist, 27(6), 205‐207. doi: 10.1192/pb.27.6.205

Tardiff, K.(1984). Characteristics of assaultive patients in private hospitals. American Journal of Psychiatry, 141, 1232‐1235.


Tardiff, K. (2008). Clinical risk assessment of violence. In R. I. Simon & K. Tardiff (Eds.), Textbook of violence assessment and management (pp. 3‐16). Arlington, VA: American Psychiatric Publishing.

Taylor, P. J. (2008). Psychosis and violence: Stories, fears, and reality. The Canadian Journal of Psychiatry, 53(10), 647‐659.

Vaddadi, K. S., Gilleard, C., & Fryer, H. (2002). Abuse of carers by relatives with severe mental illness. International Journal of Social Psychiatry, 48(2), 149‐155.

Wade, T. J., & Brannigan, A. (2010). On the use of secondary data as a method for population based studies in mental health, addictions and social behaviour: An introduction. In J. Cairney & D. L. Streiner (Eds.), Mental disorder in Canada: An epidemiological perspective (pp. 73‐91). Toronto, ON: University of Toronto Press.

Webster, C. D., Nicholls, T. L., Martin, M., Desmarais, S. L., & Brink, J. (2006). Short‐Term Assessment of Risk and Treatability (START): The case for a new structured professional judgment scheme. Behavioral Sciences & the Law, 24(6), 747‐766. doi: 10.1002/bsl.737


Yang, M., Wong, S. C. P., & Coid, J. (2010). The efficacy of violence prediction: A metaanalytic comparison of nine risk assessment tools. Psychological Bulletin, 136(5), 740‐767. doi: 10.1037/a0020473

Yee, N. Y., Large, M. M., Kemp, R. I., & Nielssen, O. B. (2011). Severe non‐lethal violence during psychotic illness. Australian and New Zealand Journal of Psychiatry, 45(6), 466‐472. doi: 10.3109/00048674.2011.541417


Clinical risk factors of acute severe/fatal violence to victims among CAMH ORB NCR patients whose index offence involved injury against person(s) Patient’s name: _______________________________ File No.: ________________________________ Clinician’s name (print): _________________________ Period of assessment: _____________________ Based on the current observation of the patient: • Observer ratings of Threat/Control‐Override (TCO) symptoms*‡ Please put a check mark against each of the following TCO symptoms, if present. Add up the total number of items in the ‘Present’ column. Using the rating guide in the last row, and based on the total number of items in the ‘Present’ column, enter the rating of TCO symptoms. Description Present at the time of

observation 1) The idea that someone else can control her/his thoughts 2) Other people being aware of her/his thoughts 3) Having thoughts that are not her/his own 4) Feeling that most people cannot be trusted 5) Feeling that she/he is watched or talked about by others

6) Feeling that people will take advantage of her/him if he/she let them Total items marked Present

Rating guide for TCO symptoms based on the total items marked Present 0 = Not present (no items endorsed) 1 = Possibly present (one item endorsed) 2 = Definitely present (two or more items endorsed)

* Used with the permission of Professor Stål Bjørkly, Faculty of Health and Social Sciences, Molde University College, for the

current research. • Capgras syndrome‡ Please rate the following symptom, as it is currently observed in the patient, in the appropriate column. Description No

(0) Possibly

(1) Definitely

(2) The patient believes that another person has taken over the appearance (imposter) of someone she/he knows (e.g., the patient’s parent, spouse, sibling, friend, co‐worker, etc.)

‡ Risk management plan is strongly recommended if the rating of either the TCO symptoms or Capgras syndrome, or both, of

the patient is a (2).

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Violence by with found of a - National Organization of ...nofsw.org/wp-content/uploads/2014/07/D1B.pdf · To Manage Risk of Acute Severe/Fatal Violence by Persons with SMI found NCR/NGRI