Gary Chaimowitz

The Clinical Use of Risk Assessment

In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry.

Treatment-resistant depression: a survey of practice habits of Canadian psychiatrists.

Treatment-resistant depression is a fascinating yet poorly defined condition. The various management strategies in use are a source of controversy. The objective of this survey was to determine how Canadian psychiatrists treat patients with “intractable depression.” This information may be used to plan future research into the management of treatment-resistant depression. It may also provide information about the practices of Canadian psychiatrists and help direct residency training. Confidential questionnaires were mailed to all psychiatrists residing in Canada registered with the Canadian Psychiatric Association. Respondents indicated that 12.4% of their depressed patients were “resistant to treatment.” Respondents were asked to rank a list of treatment choices in the order they would use them to treat patients with treatment-resistant depression. Ninety-five point eight percent of respondents used tricyclics as the first treatment of choice. Almost equal portions of respondents chose a second tricyclic, a monoamine oxidase inhibitor (MAOI) or a combination of lithium and tricyclics as their treatment of second choice.

Cost savings associated with fitness-to-stand-trial assessments in detention centres: a pilot program.

Objective: To determine whether fitness-to-stand-trial assessments “in detention” offer cost benefits over inpatient assessments. Method: The development of a pilot “fitness clinic” in a detention centre is described, and the results of 1 year of assessments are presented. The cost benefit of fitness assessments conducted in detention centres is outlined. Results: Significant cost savings were realized by operating fitness clinics in detention centres. Conclusion: Fitness clinics in detention centres offer important benefits and are recommended as an adjunct to forensic programs.

Validating the Hamilton Anatomy of Risk Management–Forensic Version and the Aggressive Incidents Scale:

The Hamilton Anatomy of Risk Management–Forensic Version (HARM-FV) is a structured professional judgement tool of violence risk developed for use in forensic inpatient psychiatric settings. The HARM-FV is used with the Aggressive Incidents Scale (AIS), which provides a standardized method of recording aggressive incidents. We report the findings of the concurrent validity of the HARM-FV and the AIS with widely used measures of violence risk and aggressive acts, the Historical, Clinical, Risk Management–20, Version 3 (HCR-20V3) and a modified version of the Overt Aggression Scale. We also present findings on the predictive validity of the HARM-FV in the short term (1-month follow-up periods) for varying severities of aggressive acts. The results indicated strong support for the concurrent validity of the HARM-FV and AIS and promising support for the predictive accuracy of the tool for inpatient aggression. This article provides support for the continued clinical use of the HARM-FV within an inpatient forensic setting and highlights areas for further research.

Geriatric Forensic Psychiatry: Risk Assessment and Management

As the population of North America ages and the prevalence of systemic medical illnesses and certain psychiatric disorders increases, the number of older individuals presenting to the legal system having committed aggressive offenses is also likely to grow. Consequently, the demand for forensic psychiatric assessments of such individuals is only likely to increase. The present chapter will provide a brief overview of the types of geriatric forensic assessments which are commonly undertaken, with a focus on psychiatric risk assessment and management.