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Clinical assessment of psychotic and mood disorder symptoms for risk of future violence

Published online by Cambridge University Press:  20 October 2014

Charles L. Scott*
Division of Psychiatry and the Law, Department of Psychiatry and Behavioral Sciences, University of California–Davis School of Medicine, Sacramento, California, USA
Phillip J. Resnick
Division of Forensic Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
*Address for correspondence: Charles Scott, MD, Division of Psychiatry and the Law, Department of Psychiatry and Behavioral Sciences, UC Davis Health System, University of California–Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, California 95817, USA. (Email:


This article reviews important components to consider when evaluating the relationship of psychotic and mood disorder symptoms to violence. Particular attention is given to assessing persecutory delusions and command auditory hallucinations. Clinical implications of research findings to evaluating violence risk in psychiatric patients are reviewed.

Review Article
Copyright © Cambridge University Press 2014 

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1. Mulvey, EP. Assessing the evidence of a link between mental illness and violence. Hosp Community Psychiatry. 1994; 45(7): 663668.Google ScholarPubMed
2. Douglas, KS, Guy, LS, Hart, SD. Psychosis as a risk factor for violence to others: a meta-analysis. Psychol Bull. 2009; 135(5): 679706.CrossRefGoogle ScholarPubMed
3. Witt, K, van dorn, R, Fazel, S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PloS One. 2013; 8(2): e55942.CrossRefGoogle ScholarPubMed
4. Wessely, S, Buchanan, A, Reed, A, etal. Acting on delusions. I: Prevalence. Br J Psychiatry. 1993; 163(1): 6976.CrossRefGoogle ScholarPubMed
5. Link, BG, Stueve, A. Evidence bearing on mental illness as a possible cause of violent behavior. Epidemiol Rev. 1995; 17(1): 172181.CrossRefGoogle ScholarPubMed
6. Swanson, JW, Borum, R, Swartz, M. Psychotic symptoms and disorders and risk of violent behavior in the community. Crim Behav Ment Health. 1996; 6(4): 317338.CrossRefGoogle Scholar
7. Monahan, J, Steadman, HJ, Silver, E, etal. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York: Oxford University Press; 2001.CrossRefGoogle Scholar
8. Teasdale, B, Silver, E, Monahan, J. Gender, threat/control-override delusions and violence. Law Hum Behav. 2006; 30(6): 649658.CrossRefGoogle ScholarPubMed
9. Stompe, T, Ortwein-Swoboda, G, Schanda, H. Schizophrenia, delusional symptoms, and violence: the threat/control override concept reexamined. Schizophr Bull. 2004; 30(1): 3144.CrossRefGoogle ScholarPubMed
10. Nederlof, AF, Muris, P, Hovens, JE. Threat/control-override symptoms and emotional reactions to positive symptoms as correlates of aggressive behavior in psychotic patients. J Nerv Ment Dis. 2011; 199(5): 342347.CrossRefGoogle ScholarPubMed
11. Appelbaum, PS, Robbins, PC, Roth, LH. Dimensional approach to delusions: comparison across types and diagnoses. Am J Psychiatry. 1999; 156(12): 19381943.CrossRefGoogle ScholarPubMed
12. Buchanan, A, Reed, A, Wessely, S, etal. Acting on delusions. II: The phenomenological correlates of acting on delusions. Br J Psychiatry. 1993; 163(1): 7781.CrossRefGoogle ScholarPubMed
13. Cheung, P, Schweitzer, I, Crowley, K, Tuckwell, V. Violence in schizophrenia: role of hallucinations and delusions. Schizophr Res. 1997; 26(2–3): 181190.CrossRefGoogle ScholarPubMed
14. Coid, JW, Ullrich, S, Kallis, C, etal. The relationship between delusions and violence: findings from the East London first episode psychosis study. JAMA Psychiatry. 2013; 70(5): 465471.CrossRefGoogle ScholarPubMed
15. Ullrich, S, Robert, K, Coid, JW. Delusions, anger, and serious violence: new findings from the MacArthur violence risk assessment study. Schizophr. Bull. In press. doi: 10.1093/schbul/sbt126.Google Scholar
16. Shawyer, F, Mackinnon, A, Farhall, J, Trauer, T, Copolov, D. Command hallucinations and violence: implications for detention and treatment. Psychiatry, Psychology and Law. 2003; 10(1): 97107.CrossRefGoogle Scholar
17. Chadwick, P, Birchwood, M. The omnipotence of voices: a cognitive approach to hallucinations. Br J Psychiatry. 1994; 164(2): 190201.CrossRefGoogle ScholarPubMed
18. Rudnick, A. Relation between command hallucinations and dangerous behavior. J Am Acad Psychiatry Law. 1999; 27(2): 253257.Google ScholarPubMed
19. McNiel, DE, Eisner, JP, Binder, RL. The relationship between command hallucinations and violence. Psychiatr Serv. 2000; 51(10): 12881292.CrossRefGoogle ScholarPubMed
20. Mackinnon, A, Copolov, DL, Trauer, T. Factors associated with compliance and resistance to command hallucinations. J Nerv Ment Dis. 2004; 192(5): 357362.CrossRefGoogle ScholarPubMed
21. Junginger, J. Predicting compliance with command hallucinations. Am J Psychiatry. 1990; 147(2): 245247.Google ScholarPubMed
22. Erkwoh, R, Willmes, K, Eming-Erdmann, A, Kunert, HJ. Command hallucinations: who obeys and who resists them? Psychopathology. 2002; 35(5): 272279.CrossRefGoogle Scholar
23. Beck-Sander, A, Birchwood, M, Chadwick, P. Acting on command hallucinations: a cognitive approach. Br J Clin Psychol. 1997; 36(Pt 1): 139148.CrossRefGoogle ScholarPubMed
24. Fox, JRE, Gray, NS, Lewis, H. Factors determining compliance with command hallucinations with violent content: the role of social rank, perceived power of the voice and voice malevolence. The Journal of Forensic Psychiatry & Psychology. 2004; 15(3): 511531.CrossRefGoogle Scholar
25. Bucci, S, Birchwood, M, Twist, L, Tarrier, N, Emsley, R, Haddock, G. Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices’ power and intent. Schizophr Res. 2013; 147(1): 163168.CrossRefGoogle ScholarPubMed
26. Walsh, E, Buchanan, A, Fahy, T. Violence and schizophrenia: examining the evidence. Br J Psychiatry. 2002; 180(6): 490495.CrossRefGoogle ScholarPubMed
27. Wallace, C, Mullen, PE, Burgess, P. Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatry. 2004; 161(4): 716727.CrossRefGoogle Scholar
28. Short, T, Thomas, S, Mullen, P, Ogloff, JRP. Comparing violence in schizophrenia with and without comorbid substance-use disorders to community controls. Acta Psychiatr Scand. 2013; 128(4): 306313.Google ScholarPubMed
29. Graz, C, Etschel, E, Schoech, H, Soyka, M. Criminal behavior and violent crimes in former inpatients with affective disorder. J Affect Disord. 2009; 117(1–2): 98103.CrossRefGoogle Scholar
30. Marzuk, PM, Tardiff, K, Hirsch, CS. The epidemiology of murder-suicide. JAMA. 1992; 267(23): 31793183.CrossRefGoogle ScholarPubMed
31. Hatters Friedman, S, Hrouda, DR, Holden, CE, Noffsinger, SG, Resnick, PJ. Filicide-suicide: common factors in parents who kill their children and themselves. J Am Acad Psychiatry Law. 2005; 33(4): 496504.Google ScholarPubMed
32. Rodenburg, M. Child murder by depressed parents. Can Psychiatr Assoc J. 1971; 16(1): 4148.CrossRefGoogle ScholarPubMed
33. Yang, S, Mulvey, EP, Loughran, TA, Hanusa, BH. Psychiatric symptoms and alcohol use in community violence by person with a psychotic disorder or depression. Psychiatr Serv. 2012; 63(3): 262269.CrossRefGoogle ScholarPubMed
34. Krakowski, M, Volavka, J, Brizer, D. Psychopathology and violence: a review of literature. Compr Psychiatry. 1986; 27(2): 131148.CrossRefGoogle ScholarPubMed
35. Tardiff, K, Sweillam, A. Assault, suicide, and mental illness. Arch Gen Psychiatry. 1980; 37(2): 164169.CrossRefGoogle ScholarPubMed
36. Fazel, S, Lichtenstein, P, Grann, M, Goodwin, GM, Langstrom, N. Bipolar disorder in violent crime: new evidence from population-based longitudinal studies and systematic review. Arch Gen Psychiatry. 2010; 67(9): 931938.CrossRefGoogle ScholarPubMed
37. Menzies, JR, Webster, CD, Sepejak, DS. The dimensions of dangerousness: evaluating the accuracy of psychometric predictions of violence among forensic patients. Law Hum Behav. 1985; 9(1): 4970.CrossRefGoogle Scholar
38. Buckley, PF, Hrouda, DR, Friedman, L, Noffsinger, SG, Resnick, PJ, Camlin-Shingler, K. Insight and its relationship to violent behavior in patients with schizophrenia. Am J Psychiatry. 2004; 161(9): 17121714.CrossRefGoogle ScholarPubMed
39. Convit, A, Jaeger, J, Lin, SP, Meisner, M, Volavka, J. Predicting assaultiveness in psychiatric inpatients: a pilot study. Hosp Community Psychiatry. 1988; 39(4): 429434.Google ScholarPubMed
40. Asnis, GM, Kaplan, ML, Hundorfean, G, Saeed, W. Violence and homicidal behaviors in psychiatric disorders. Psychiatr Clin North Am. 1997; 20(2): 405425.CrossRefGoogle ScholarPubMed
41. Roaldset, JO, Bjørkly, S. Patients’ own statements of their future risk for violent and self-harm behaviour: a prospective inpatient and post-discharge follow-up study in an acute psychiatric unit. Psychiatry Res. 2010; 178(1): 153159.CrossRefGoogle Scholar
42. Singh, JP, Fazel, S. Forensic risk assessment: a metareview. Criminal Justice and Behavior. 2010; 37(9): 965988.CrossRefGoogle Scholar