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Homicidal Behaviors Among Psychiatric Outpatients
Gregory M. Asnis; Margaret L. Kaplan; Herman M. van Praag; William C. Sanderson
Psychiatric Services 1994; doi:
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Albert Einstein College of Medicine-Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10467

1994 by the American Psychiatric Association

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Objective: Most studies of violent behavior among psychiatric patients focus on inpatients or patients recently discharged from psychiatric units. To explore violent behavior among patients living in the community, the authors examined the prevalence of homicidal behaviors in a general psychiatric outpatient population. Methods: During an intake evaluation, 517 outpatients completed several selfreport instruments that included a detailed survey of past and current homicidal behaviors covering homicidal ideation, plans, and attempts. Demographic and clinical characteristics of patients with and without a history of homicidal behaviors were compared. Results: Twenty-two patients (4 percent) reported a past homicide attempt. Patients who reported homicide attempts could be distinguished from patients with no homicidal behaviors by the presence of other aggressive behavior such as suicidal ideation and suicide attempts by themselves and their family members and by elevated current measures of interpersonal sensitivity, hostility, and paranoid ideation. Conclusions: The rate of homicide attempts in the general outpatient population studied was considerably lower than the reported rates of assault among inpatients. The relationship between past and current episodes of aggressive behavior reinforces the importance of including a careful assessment of past history of violent behaviors as part of the routine psychiatric evaluation.

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