Assessment and Management of The Risk of Violence in Schizophrenia Scenario A 21-year-old lady with the diagnosis of schizophrenia informs you she will kill her neighbour tomorrow as she has ruined her life. She tells not to disclose this to anyone. How will you assess the homicidal risk in this patient? What treatment and follow up recommendations will you make in this case? Clinical Assessment  Listen to the patient and develop a therapeutic relationship.  begin the assessment and enquire about her demographics.  Enquire about the issue that she brought up—she will kill her neighbour.  Elaborate on how she thinks her neighbour has ruined her life.  Explore her thoughts a nd whether the patient may have persecutory delusions Assess how much resentment she feels? Follow up with inquiry about her mood, esp. about irritability and depression How she plans to commit the act Has she threatened the person? Whether she has done so in the past If so, what provoked such an in

Insanity defense or the plea of insanity is based on McNaughton’s rules in English law. In the states, four variants of the insanity defense exist, namely: McNaughton, irresistible impulse, substantial capacity, and Durham. Some states do not recognize the insanity defense. There are two requirements for this defense. Firstly, at the time of the crime, the defendant must have been suffering from a ‘mental defect’ or a“defect of reason” or a “disease of the mind,” depending on the jurisdiction. Secondly, due to the mental defect, he/she did not know either the nature and quality of the criminal act or that the act was wrong.

Assessment of Fitness to Plead (Capacity to Stand Trial) Pritchard Criteria Introduction To stand trial, the accused should be able to describe his behaviour and whereabouts at the time of the alleged offence, understands what happens in the courtroom and understands the role of the courtroom personnel, instruct his solicitor, distinguish between various pleas and understand the range and nature of verdicts. Pritchard Criteria In the law of England and Wales, fitness to plead is the capacity of a defendant in criminal proceedings to comprehend the course of those proceedings. Its equivalent in the United States and Canada is ‘competence to stand trial.’ If the defendant raises fitness to plead, a judge will decide whether an individual fit to plead, usually following a psychiatric evaluation.  To decide whether a patient is fit to plead, it is important to determine the extent to which the defendant can:  Understand the nature of the charge Understand the difference between pleading gu