Characterization of Risk-Taking in Adults With Bipolar Spectrum Disorders.

Individuals with bipolar spectrum disorders experience higher morbidity and mortality rates relative to the general population because of increased commission of dangerous behaviors. Despite this impact, little is known about the overall rates of risk-taking behaviors in patients currently being treated for such illness. This study examined the frequency of a variety of risk-taking behaviors in 100 adults with bipolar spectrum disorders in an active outpatient psychiatric treatment. It was found that 70% of individuals assessed reported at least one risk-taking behavior over the preceding 7 days. Implications for assessment and intervention are discussed.

Meningioma and psychiatric symptoms: A case report and brief review.

BACKGROUND: Atypical presentation of psychiatric symptoms can lead to a variety of misdiagnoses. Organic causes, including brain tumors, should be considered under these circumstances. METHODS: We present a case report of an 84-year-old woman with irritable, aggressive, and delusional behavior. Her earlier diagnoses included altered mental status, encephalopathy, dementia, nonspecified psychosis, and delirium with delusions. We suspected that a brain tumor could be causing her psychiatric symptoms. RESULTS: CT of the head revealed 2 calcified meningiomas, which did not require surgery. Neuropsychological testing results were consistent with frontal lesion type of cognitive and psychotic symptoms. Psychiatric symptoms improved with risperidone. A brief review of the literature is included. CONCLUSIONS: Brain imaging should be considered in cases of atypical psychiatric presentations. Past medical records and neuropsychological testing could assist in the diagnosis.

Structured assessment of violence risk in schizophrenia and other psychiatric disorders: a systematic review of the validity, reliability, and item content of 10 available instruments.

OBJECTIVES: To undertake a systematic review on structured violence risk assessment tools in individuals with schizophrenia. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.