Predicting the risk of future violence within forensic mental health services is currently heavily reliant on subjective clinical judgment. Structured professional judgment risk instruments introduce a greater degree of consistency into the process of risk assessment and remind clinicians to take account of factors known to promote violence. However, these instruments also rely on clinical judgment, and there can be significant variation in practice.
More objective or numerical parameters will help to introduce greater objectivity and consistency into the risk assessment process, which in turn influences the length of stay for forensic patients. This could offer a greater degree of protection for clinicians to defend their practice as the consequences of errors in forensic services are considerable in terms of reputational damage for the service and public safety. It could enable more positive risk taking as forensic patients often have the longest lengths of stay and hence most expensive for the taxpayer.
This Research Topic addresses the failure to accurately predict violence among patients with psychosis or who are developing psychosis. While there are measurable predictors of violence, such as previous aggressive behavior and level of positive symptoms, the accuracy of risk prediction could be improved by exploring the extent to which biological, neuropsychological, and neurophysiological characteristics are associated with violent behavior among those with psychosis.
With regards to biological markers, there is encouraging evidence of a link between low total cholesterol, low LDL and HDL, and violence to others. There is some promising evidence of high Creatine Kinase being a measure of violence within a forensic in-patient setting.
With regards to neuropsychological markers, there is emerging evidence of a link between cognitive markers like poor cognitive inhibition, poor social cognition, misperception of angry voices, and poor reading of emotions to be linked to violence.
As regards neurophysiological markers, impulsivity, as assessed by the contingent negative variation event-related potential, shows promise as a predictor of inpatient violence.
Large-scale prospective studies are required to follow up on these markers to show which one develops an acceptable level of sensitivity and specificity sufficient to add incremental validity to the process of risk assessment in forensic practice.
The scope of the Research Topic is to explore recent findings on biological, neuropsychological, and neurophysiological factors that are associated with violent behavior among persons with psychosis and to discuss how such factors could be assessed in clinical practice and integrated into a risk assessment tool. The focus should be on any prospective studies to evaluate the validity of such markers in forensic practice. Of particular interest are studies that critically evaluate not only the sensitivity and specificity of the marker but also the feasibility of applying such a marker to clinical practice. In addition to the biological, neuropsychological, or neurophysiological markers mentioned above, studies reporting any other developments, like genetic markers or others like gut microbes, with the potential to be used in the forensic field are also very welcome.
This is still a relatively new field, so the focus will be very much on studies with potential for translation into mainstream clinical practice of forensic psychiatry in general, more specifically, risk assessment.
Predicting the risk of future violence within forensic mental health services is currently heavily reliant on subjective clinical judgment. Structured professional judgment risk instruments introduce a greater degree of consistency into the process of risk assessment and remind clinicians to take account of factors known to promote violence. However, these instruments also rely on clinical judgment, and there can be significant variation in practice.
More objective or numerical parameters will help to introduce greater objectivity and consistency into the risk assessment process, which in turn influences the length of stay for forensic patients. This could offer a greater degree of protection for clinicians to defend their practice as the consequences of errors in forensic services are considerable in terms of reputational damage for the service and public safety. It could enable more positive risk taking as forensic patients often have the longest lengths of stay and hence most expensive for the taxpayer.
This Research Topic addresses the failure to accurately predict violence among patients with psychosis or who are developing psychosis. While there are measurable predictors of violence, such as previous aggressive behavior and level of positive symptoms, the accuracy of risk prediction could be improved by exploring the extent to which biological, neuropsychological, and neurophysiological characteristics are associated with violent behavior among those with psychosis.
With regards to biological markers, there is encouraging evidence of a link between low total cholesterol, low LDL and HDL, and violence to others. There is some promising evidence of high Creatine Kinase being a measure of violence within a forensic in-patient setting.
With regards to neuropsychological markers, there is emerging evidence of a link between cognitive markers like poor cognitive inhibition, poor social cognition, misperception of angry voices, and poor reading of emotions to be linked to violence.
As regards neurophysiological markers, impulsivity, as assessed by the contingent negative variation event-related potential, shows promise as a predictor of inpatient violence.
Large-scale prospective studies are required to follow up on these markers to show which one develops an acceptable level of sensitivity and specificity sufficient to add incremental validity to the process of risk assessment in forensic practice.
The scope of the Research Topic is to explore recent findings on biological, neuropsychological, and neurophysiological factors that are associated with violent behavior among persons with psychosis and to discuss how such factors could be assessed in clinical practice and integrated into a risk assessment tool. The focus should be on any prospective studies to evaluate the validity of such markers in forensic practice. Of particular interest are studies that critically evaluate not only the sensitivity and specificity of the marker but also the feasibility of applying such a marker to clinical practice. In addition to the biological, neuropsychological, or neurophysiological markers mentioned above, studies reporting any other developments, like genetic markers or others like gut microbes, with the potential to be used in the forensic field are also very welcome.
This is still a relatively new field, so the focus will be very much on studies with potential for translation into mainstream clinical practice of forensic psychiatry in general, more specifically, risk assessment.
