Murakami Saori, Rappaport Nancy, Penn Joseph V
Inpatient Unit, Beth Israel Deaconess Medical Center, Harvard Longwood Adult Psychiatry Residency Training Program, Harvard Medical School, Boston, MA, USA.
Psychiatr Clin North Am. 2006 Sep;29(3):725-41. doi: 10.1016/j.psc.2006.04.006.
Despite the relative rarity of school shootings, targeted violence, and school-associated violent deaths, any youth who presents with words, gestures, or actions of a threatening or violent nature in a school setting should be assessed and referred for further evaluation by a mental health professional and, if clinically indicated, a forensic evaluator.The request for a juvenile risk assessment for future dangerousness requires careful delineation of role and agency; confidentiality issues; a comprehensive diagnostic evaluation of the youth; and a detailed assessment of the youth's perceived threat or problematic behavior. Various protective and risk factors and consideration of other individual, family, school/peer, and situational factors should also be explored.There is still much information that is unknown when considering school violence or targeted school violence. There is clearly a need for additional research on the identification of at-risk youths, the contributions and significance of various protective and risk factors, the impact of peer relationships, and perceived rejection, socioeconomic status, subtypes of aggression, and developmental stages. Examples of future research direction might include difference by gender, presence of affective or psychotic disorders, substance abuse, emerging characterologic disturbances, and physiologic markers, such as cortisol or serotonin. Additional research regarding best practices and the development of clinical guidelines or practice parameters is also needed.
尽管校园枪击、有针对性的暴力行为以及与学校相关的暴力死亡事件相对罕见，但任何在学校环境中表现出具有威胁性或暴力性质的言语、手势或行为的青少年，都应接受评估，并转介给心理健康专业人员进行进一步评估，如有临床指征，还应转介给法医评估人员。对青少年未来危险性进行风险评估的要求需要仔细界定角色和机构；保密问题；对青少年进行全面的诊断评估；以及对青少年所感知到的威胁或问题行为进行详细评估。还应探讨各种保护因素和风险因素，以及其他个人、家庭、学校/同伴和情境因素。在考虑校园暴力或有针对性的校园暴力时，仍有许多信息未知。显然需要对高危青少年的识别、各种保护因素和风险因素的作用及意义、同伴关系的影响以及感知到的排斥、社会经济地位、攻击亚型和发育阶段进行更多研究。未来研究方向的例子可能包括性别差异、情感或精神障碍的存在、药物滥用、新出现的性格障碍以及生理指标，如皮质醇或血清素。还需要开展关于最佳实践以及临床指南或实践参数制定的更多研究。
