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Tijdschrift voor Psychiatrie 51 (2009) 3, 173 - 182

Review article

Assessment and management of the risk for violence. An overview of the literature

A.J. Tholen

In general psychiatry the risk of violence has to be assessed regularly, for instance in cases where civil commitment is under consideration.
aim This article gives an overview of the actuarial instruments for risk assessment, discusses a model for the clinical assessment of risks of violence and for the compulsory management of such risks.
method The relevant literature was located via cross-references from key publications and via bibliographic references in specialised journals. The key words used in the search were violence, violent behaviour, dangerousness, risk assessment, risk prediction and risk management.
results Standardised actuarial assessment of the risk of violence is only of limited value in general psychiatric practice. Among certain high-risk groups standardised instruments targeted at the specific type of risk (acute, long-term) and at the type of decision (relating to security, treatment) can have added value within a broader clinical assessment.
conclusion In general psychiatric practice a potential risk of violence should be assessed systematically in a structured manner. If there are risks of violence these can best be studied and assessed in specialised clinics or by specialised teams. Dynamic risk factors and protective factors should be evaluated systematically in cooperation with the various organisations concerned.

keywords dangerousness, risk assessment, risk prediction, risk management, violence, violent behaviour