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Block 4 PSYCH Exam -- Violence

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% of women abused by partner at some time
20 - 40%
% of homicides committed by a family member
20%
% of American households that have guns
40 - 50%
3 most common motivations for workplace violence
Revenge
Jealousy
Financial gain
Breakdown of victims (%) of workplace violence
Customer (44%)
Stranger (24%)
Co-worker (20%)
Boss (7%)
Former employee (3%)
Most common diagnoses that entail violent patients (5)
Schizophrenia
Mania
Personality disorder
Alcoholism
Delirium/Dementia
Between manic and schizophrnic pts.

Who is more likely to be assaultive in ABSENCE of prior threats?
Manic pts. (due to general disinhibition)
In the community, type of schizo pt. more likely to engage in violence
PARANOID type
In inpatient setting, type of schizo pt. more likely to engage in violence
DISORGANIZED type
Psychiatric diagnosis most prone to violent behavior
Substance abuse/dependence disorder
Age group most prone to violence
Late teens to early 20s

There is also increased violence in >70 group
(assoc. w/ dementia)
How does socioeconomic status correlate to risk of engaging in violence?
Lower SES is assoc. w/ increased risk
In Borderline and Anti-social patients

What subtle neuropsychological dysfunctions are seen (3)?
Decreased cortical arousal
Increased EEG temporal activity
Low CSF serotonin metabolites
What 2 personality disorders are especially assoc. w/ impulsive aggression?
Borderline
Anti-social
3 most important screening questions for a history of prior violence
What's the most violent thing you've ever done?
Have you ever seriously injured another person?
Do you ever now think about harming someone else?
Some symptoms that account for violence in psych pts. (3)
Command hallucinations
Taking symptoms to logical extreme
Akathisia

These are called "threat-control override symptoms"
Most common command encountered in command hallucinations
Commit suicide (51%)
2 factors that predict compliance w/ command hallucinations
Delusion is assoc. w/ the hallucination
Hallucinated voice was of a person they could identify
What is the Capgras delusion?
Belief that acquaintance has been replaced by an impostor
(usually, "acquaintance" is a family member)
What is the goal of violence assessment
Assess whether pt. is at high risk
Identify factors that are amenable to clinical intervention
Situation for which SSRIs are best treatment
(in context of impulsive aggression)
Depression/dysphoric mood in setting of personality disorder
Situations for which beta-blockers are good treatment
(in context of impulsive aggression)
Mental retardation and head injury
Situations for which trazodone and buspirone are good treatments
(in context of impulsive aggression)
Mental retardation
Head injury
Dementia
What is the Tarasoff rule?
If a patient poses a serious danger of violence to others, the therapist bears a duty to exercise reasonable care to protect the foreseeable victim of that danger

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