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Psychiatrists' accuracy in predicting violent behavior on an inpatient unit
J S Janofsky1, S Spears, D N Neubauer
1Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
Hospital & Community Psychiatry
|October 1, 1988
Summary
Psychiatrists cannot accurately predict patient dangerousness, including battery or suicidal behavior. While some success was found in predicting threatening behaviors, this study highlights limitations in psychiatric risk assessment.
Area of Science:
- Psychiatry
- Clinical Psychology
- Forensic Psychology
Background:
- Legislators and courts rely on psychiatrists' predictions of dangerousness.
- Existing research indicates psychiatrists lack special abilities in predicting patient dangerousness.
Purpose of the Study:
- To evaluate the accuracy of psychiatrists' predictions of dangerousness in psychiatric inpatients.
- To identify factors that may aid in predicting violent or threatening behavior within a short timeframe.
Main Methods:
- Two psychiatrists assessed 47 new inpatient admissions.
- Predictions focused on battery, threatening behavior, or suicidal behavior within seven days.
- Analysis included admission behaviors, mental status examination findings, and discharge diagnoses.
Main Results:
- Psychiatrists demonstrated low accuracy in predicting battery and suicidal behavior.
- Some efficacy was observed in predicting threatening behaviors.
- Assaultive/threatening behavior on admission, hallucinations, and mania diagnosis were predictive of battery.
- Mania diagnosis was predictive of threatening behavior.
Conclusions:
- Psychiatric prediction of dangerousness, particularly battery and suicidal behavior, remains unreliable.
- Specific clinical factors like prior aggression and mania may offer limited predictive value for certain behaviors.
- The study underscores the need for improved methods in psychiatric risk assessment.