Schizophrenia: A New Guide for Clinicians

By John G. Csernansky | Go to book overview

11

Violence and Forensic Issues in Schizophrenia

John Rabun

St. Louis Psychiatric Rehabilitation Center
St. Louis, Missouri

Susan K. Boyer

Washington University School of Medicine
and St. Louis Psychiatric Rehabilitation Center
St. Louis, Missouri

One concept addressed in forensic psychiatry is the assessment of violence. Violence is often a sleeping volcano. A volcano manifests a calm demeanor and occasionally rumbles over months and even years, then suddenly turns into a cataclysmic event. Scientists over time have outlined the evolving behavior of a quiescent volcano becoming active. They have learned through painstaking research what circumstances are vital for determining the risk of an eruption. And we all, especially those living near volcanoes, are greatly indebted to them.

Just as most volcanoes remain quiescent, most people with schizophrenia are not violent. While assessment of potential violence in those with schizophrenia is feasible, actual prediction is difficult. Monahan ( 1) has noted that predictions of violent behavior among the mentally ill are accurate only one-third of the time. Why is this? Well-trained psychiatrists face the same problem when attempting to screen for any infrequent event, such as suicide or homicide-relatively small errors in sensitivity and specificity become huge errors in predicting outcomes. It turns out that psychiatrists overpredict violence by 40 to 90% ( 2).

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