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Editorial
Canadian Journal of Psychiatry: New Editor and New Policies
Joel Paris, MD
(PDF)

Guest Editorial
Risk Assessment in Psychiatric Practice
Kenneth Hashman, MD, FRCPC, DABPN
(PDF)

In Review
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Hy Bloom, LLB, MD, Christopher Webster, PhD, Stephen Hucker, MB, Karen De Freitas, MD
(PDF)

The Clinical Use of Risk Assessment
Graham D Glancy, MB, ChB, FRCPsych, FRCPC, Gary Chaimowitz, MB, ChB, FRCPC
(PDF)

The State of Contemporary Risk Assessment Research
Michael A Norko, MD, Madelon V Baranoski, PhD
(PDF)

Review Paper
Community Treatment Orders: Profile of a Canadian Experience
Ann-Marie A O’Brien, MSW, RSW, Susan J Farrell, PhD, CPsych*
(PDF)

International Dosage Differences in Fluoxetine Clinical Trials
Scott Patten, MD, Andrea Cipriani, MD, Paolo Brambilla, MD3, Michela Nosè, MD, Corrado Barbui, MD
(PDF)

Original Research
Panic-Agoraphobic Spectrum and Light Sensitivity in a General Population Sample in Italy
Letizia Bossini, MD, Mirko Martinucci, MD, Katia Paolini, MD, Paolo Castrogiovanni, MD
(PDF)

Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Suzanne Archie, MD, FRCPC, Jane Hamilton Wilson, RN, Kevin Woodward, BSc, Heather Hobbs, RN, Shelley Osborne, RN, Jean McNiven, RN
(PDF)

Screening for Mild Cognitive Impairment: Comparing the SMMSE and the ABCS
D William Molloy, MB, MRCPI, FRCPC, Timothy IM Standish, David L Lewis, PhD
(PDF)

Attention-Deficit Hyperactivity Disorder With and Without Obsessive–Compulsive Behaviours: Clinical Characteristics, Cognitive Assessment, and Risk Factors
Paul Daniel Arnold, MD, FRCPC, Abel Ickowicz, MD, FRCPC, Shirley Chen, MD, MPH, Russell Schachar, MD, FRCPC
(PDF)

Brief Communication
Validation de la version française de l’inventaire de détresse péritraumatique
Louis Jehel, MD, PhD, Alain Brunet, PhD, Sabrina Paterniti, MD, PhD, Julien D Guelfi, MD, Pr
(PDF)

Book Reviews
(PDF)

The Confinement of the Insane: International Perspectives, 1800–1965
Review by
Laurence Jerome, MD

Suicide in Children and Adolescents
Review by
Paul S Links, MD, FRCPC

Letters to the Editor
(PDF)

A Novel Form of Treatment Resistance in Anorexia Nervosa

Capgras Syndrome in the Modern Era: Self Misidentification on an ID Picture

Effectiveness of Risperidone in Delirium

Family-Oriented Rehabilitation for Unexplained Chronic Pain

Hypokalemia from Risperidone and Quetiapine Overdose

A Renewed Interest in Day Treatment

Quetiapine Therapy for Corticosteroid-Induced Mania

Guest Editorial

Risk Assessment in Psychiatric Practice

Kenneth Hashman, MD, FRCPC, DABPN¹

Every day, clinicians assess risk in various settings. Psychiatrists in all forms of practice are asked to use their skills to forecast the risk of violence: Is the patient dangerous? Should the patient be detained against his or her will? When can we safely release the patient into the community? These are just a few of the formidable questions that are asked daily in clinical practice.

Given these expectations, how are we to navigate the inherent uncertainties of risk assessment? Providing didactic education and clinical training for residents within the core psychiatric curriculum would seem essential. Continuing professional development is equally important for psychiatrists to remain well informed of developments in the field. This issue’s In Review section highlights many developments, both in Canada and internationally, along with their clinical implications.

The first article, by Dr Hy Bloom and colleagues, gives us a historical overview and suggests implications for current psychiatric practice from a Canadian perspective (1). Canadians have contributed significantly to the international literature on risk assessment, and Bloom and colleagues highlight the importance of assessing the risk of violence to others. They describe this as “undoubtedly the most essential and onerous risk decision-making area (civil commitment) for psychiatrists,” and offer psychiatrists contemporary risk assessment principles to guide clinical practice.

The second article, by Dr Graham Glancy and Dr Gary Chaimowitz, provides an overview of the clinical use of risk assessment (2). These authors argue that risk assessment should be part of daily clinical psychiatric practice—indeed, not only risk assessment but, more importantly, risk management and risk reduction. Glancy and Chaimowitz advocate for the use of as much information as possible, including clinical (dynamic), historical (static), and collateral information. This in turn allows clinicians to consider the imminence and severity of potential violence, under what circumstances this risk will be increased, and what can be changed to reduce the risk. In this regard, the authors point out that, in practice, risk assessment becomes an exercise in risk management.

The third article, by Dr Michael Norko and Dr Madelon Baranoski, gives an international perspective on the state of contemporary risk assessment research (3). Norko and Baranoski focus on the significant amount of recent research seeking to enhance the accuracy of risk assessment. The effects of deinstitutionalization, voluntary hospitalization, and civil rights movements are considered. These authors review research on the correlates of violence, considering the effect of factors such as substance abuse, sociodemographic and environmental influences, and mental illness. They also review research on prediction accuracy, considering both clinical and actuarial predictions. Finally, they remind us of the duality of being both a scientist and a healing professional and the need to keep an appropriate balance while considering the limitations of the literature on risk assessment.

Risk assessment remains an inherently difficult task, given the low base rate of violence. It is challenging to accurately predict a low-frequency event. Considerable efforts and advancements have been made on both clinical and actuarial fronts to provide clinicians with the knowledge and tools to enhance their ability to conduct a risk assessment. It is critical that this expertise become a part of our training and ongoing educational efforts, so that we can meaningfully assess and manage the risk of violence in our patients, while considering the strengths and limitations of the current literature.

References

1. Bloom H, Webster CD, Hucker SJ, De Freitas KD. The Canadian contribution to violence risk assessment: history and implications for current psychiatric practice. Can J Psychiatry 2005;50:3-11.

2. Glancy GD, Chaimowitz G. The clinical use of risk assessment. Can J Psychiatry 2005;50:12-7.

3. Norko MA, Baranoski MV. The state of contemporary risk assessment research. Can J Psychiatry 2005;50:18-26.

Author

Program Medical Director and Academic Division Chief, Division of Forensic Psychiatry, Calgary Health Region and the University of Calgary, Calgary, Alberta.