Impact of clinical training on violence risk assessment

Mr. A, a 46-year-old man, requests evaluation of possible depression. He reports stressors including marital separation, unemployment, and limitation of his visits with his children. He has been tense, sad, angry, and unable to sleep, eat, or relax and has had racing and occasionally suicidal and homicidal thoughts. He expresses a desire to feel better and to reconcile with his wife. He previously has been given a variety of medication regimens that he discontinued because of a perceived lack of efficacy and intolerable side effects. He acknowledges a long history of infidelity and domestic violence toward his wife. He assaulted one of his parents as an adolescent and has been in physical fights with others as an adolescent and an adult. He was unable to complete school because of his behavior. He lives alone and spends his days surfing the Internet and pacing in his home. He owns several guns. Mr. A is cooperative during the interview but appears tense, frequently clenching his fists and sighing in an exasperated way. His thoughts are organized in a linear and goal-directed manner. He denies hallucinations, delusions, or current homicidal or suicidal ideation. This article addresses whether training psychiatric residents and clinical psychology interns in evidence-based risk assessment can enhance their documentation of assessment and management of patients' risk of violence.