Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, UK.
Schizophr Bull. 2011 Sep;37(5):899-912. doi: 10.1093/schbul/sbr093.
To undertake a systematic review on structured violence risk assessment tools in individuals with schizophrenia.
A systematic search was conducted from 1990 to 2011 to identify violence risk assessment tools and studies examining their predictive validity. Item content of the identified instruments was analyzed, and areas under the curve (AUC) from the studies were extracted. In addition, an 11-item checklist was developed to assess the utility and psychometric properties of these tools.
Ten risk assessment tools designed to predict community violence in psychiatric patients were identified, but only 2 studies reporting predictive validity estimates in patients with schizophrenia were found (median AUC = 0.69; interquartile range = 0.60-0.77). When inclusion criteria was broadened to include studies measuring accuracy for any diagnostic group, mixed evidence of predictive validity was found, with median AUCs ranging from 0.62 to 0.85 depending on the population. Item content included mostly clinical, sociodemographic, and criminal history factors. As only 1 tool included a neurobiological item, a structured review of brain-based and cognitive risk factors for violence was included, and 3 clusters (neurocognitive ability, neurocognitive awareness, and attitudinal cognition) were identified.
While a number of violence risk assessment tools exist that can be used to predict the likelihood of community violence in psychiatric patients, there is currently little direct evidence for their utility in individuals with schizophrenia. In addition, there is large variation in item content between instruments, and further research is necessary to determine whether the inclusion of alternative factors could improve risk assessment.
对精神分裂症个体的结构化暴力风险评估工具进行系统评价。
从 1990 年到 2011 年进行了系统检索，以确定暴力风险评估工具和研究其预测效度的研究。分析了确定工具的项目内容，并从研究中提取了曲线下面积（AUC）。此外，还制定了一个 11 项检查表，以评估这些工具的实用性和心理测量特性。
确定了 10 种旨在预测精神病患者社区暴力的风险评估工具，但仅发现 2 项研究报告了精神分裂症患者的预测效度估计（中位数 AUC = 0.69；四分位距= 0.60-0.77）。当纳入标准扩大到包括测量任何诊断组准确性的研究时，发现了混合的预测效度证据，根据人群，中位数 AUC 范围从 0.62 到 0.85。项目内容主要包括临床、社会人口统计学和犯罪史因素。由于只有 1 种工具包含神经生物学项目，因此还包括了针对暴力的基于大脑和认知风险因素的结构化综述，并确定了 3 个聚类（神经认知能力、神经认知意识和态度认知）。
虽然存在一些可以用于预测精神病患者社区暴力可能性的暴力风险评估工具，但目前几乎没有直接证据表明它们在精神分裂症个体中的实用性。此外，工具之间的项目内容存在很大差异，需要进一步研究确定是否纳入替代因素可以改善风险评估。
