Chapter 12: Risk assessment and management Which of the following DSM-IV TR categories include violence and aggression? Depressive disorder Conduct disorder Obsessive-compulsive personality disorder Antisocial personality disorder Oppositional defiant disorder Which of the following are important Psychiatric Intensive Care Unit multi disciplinary team skills to assist risk management? Develop patient’s history Validate perceptions Develop clear risk management plans Produce lengthy case notes purely on guesswork Pay attention to personal development Which of the following thought and perceptual cues are suggestive of imminent violence? Disorientation Drowsiness Bizarre and paranoid thoughts Insight into illness Confusion The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Appleby et al 1996, 2001) found that suicide occurred in what percentage of patients with bipolar-affective disorder? 1% 5% 10% 15% 25% Various inquiries into homicides and serious incidents comment on … Inability of services to manage seriously disturbed patients Adequate training in risk assessment Poor communication within the team Adequate resources of space Absent consultant supervision Powell et al (1994) examined antecedents of aggressive incidents in psychiatric hospitals over a 13-month period, and found which of the following to be the most common antecedents? Restrictions being placed Provocation by relatives Staff initiating contact Overcrowding Patient agitation Drinkwater and Gudjonsson (1989) suggested which of the following advantages in reporting serious assaults on staff? The clinical team can decide an appropriate outcome It enables staff to apply for compensation It helps maintain staff morale Responsibility lies with the criminal justice system Ensures offence is properly recorded and investigated What does RAMAS stand for? Risk and Management of Aspergers Syndrome Risk Analysis Module and Systems Rage and Anger Management Assessment System Risk Assessment Management and Audit Systems McNeil and Binder undertook a study of 330 patients admitted to a locked short stay unit (1994). A complex analysis of Brief Psychiatric Rating Scale and Overt Aggression Scale tools showed which summary scores were significantly associated with violence? Agitation-excitement Distractability-lability Guilt-fear Hostile-suspicious Thinking disturbance Aiken (1984) found that at least half of reported incidents of assault are thought by victims to be … Understandable Avoidable Thoughtless Dangerous / harmful Unexpected Actuarial risk assessment tools … Are generalisable Lack flexibility Have conceptual difficulties Are extremely good at predicting risk Clarify motivation for past behaviour Actuarial risk assessment tools include which of the following? Global Aggression Scale Aggressive Risk Tool Social Adjustment Scale Dangerous Behaviour Rating Scale Violence Risk Appraisal Guide Which of the following are risk factors associated with violence? Being female Being in pain Organic dysfunction Low stimulation Limit setting Staff attitudes A literature review carried about by Walsh et al (2002) indicated that less than what percentage of societal violence was attributable to schizophrenia? 10% 20% 30% 40% 50% Slama et al (2004) found which of the following to be risk factors for suicide in people with bipolar disorder? Later age of onset Female gender History of antidepressant-induced mania Low number of depressive episodes Co-morbid alcohol abuse Which of the following are therapeutic cues suggestive of imminent violence? When the patient isolates themselves from other disturbed patients Uncooperativeness Spending one to one time with key nurse Failure to respond to de-escalation Requesting ‘time out’ Which of the following were key findings from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Appleby et al 1996, 2001)? One quarter of suicides following discharge occurred before first follow-up appointment One quarter of inpatient suicides occurred during the first week of admission Patients are at reduced risk of suicide immediately after admission The majority of inpatient suicides occurred during authorised leave Suicide post-discharge is higher among those under 45 years old Mental health professionals should be concerned with assessment of risk rather than assessment of dangerousness for which of the following reasons? Risk is static Risk can be objectively assessed Risk is always negative Context in which risk behaviour occurs can be considered Risk can be subdivided into further manageable components In schizophrenia the risk of suicide is often associated with which of the following? Older age Male gender Fear of deterioration Development of insight After admission Reith (1998) identified which of the following as major themes that were consistently lacking in care provided to violent patients? Listening to carers Thoroughness Use of medication Lack of motivation Team working Loading …
