CLINICAL-ASSESSMENT OF DANGEROUSNESS IN PSYCHOTIC-PATIENTS - SOME RISK INDICATORS AND PITFALLS

In the assessment of psychotic patients, clinicians are recurrently co nfronted with the difficult task of deciding whether or not patients a re dangerous to others. Since no single predictor of dangerousness has proved to have superior predictive value, it is suggested that clinic ians should rely on sets of indicators, An indicator is defined here a s a variable that has been associated with increased risk of aggressio n in empirical studies. Most of these indicators are characterized by being of a dynamic and interactional nature rather than by being stati c trait measures, Based on findings from empirical studies, some sets of indicators of dangerousness in psychotic patients are presented. Th ese are: background variables, demographic variables, psychopathologic al and psychodynamic indicators, analysis of observed aggressive incid ents, and indicators derived from analyzing patients' apprehension of their dynamics of aggression. It is argued that clinicians should use such sets of indicators of dangerousness, rather than relying on clini cal anecdotes. Finally, some pitfalls in the clinical assessment of da ngerousness in psychotic patients are discussed. (C) 1997 Elsevier Sci ence Ltd.