Assessment Of Psychiatric Patients Research Articles

Virtual supermarket shopping task for cognitive rehabilitation and assessment of psychiatric patients: Validation in chronic schizophrenia

Objectives. Schizophrenia has a debilitating impact on a patient's cognitive functioning and everyday activities. As a part of the treatment, schizophrenia patients attend sessions of cognitive remediation to restore impaired cognitive abilities. To combine cognitive and real life training, this study presents a virtual task to use in cognitive rehabilitation and assessment. Virtual Supermarket Shopping Task (VSST) simulates a shopping activity, in which participants have to memorize and collect items from a virtual supermarket. The aim of this study is to establish its validity for use in clinical practice. Sample and setting. Twenty patients suffering from chronic schizophrenia and twenty healthy controls were tested. Each participant completed the task and a battery of standard neuropsychological tests. Statistical analyses. Groups’ results were compared by Student’s t-tests. Validity of VSST was examined using correlations with standard neuropsychological measures. Several VSST metrics, such as trial difficulty, distances and times, and the effect the extraneous variables have on VSST measures were investigated using analyses of variance and mixed effect models. Results. The analyses demonstrate that patients perform worse in VSST than healthy controls and their performance corresponds to their mnemonic abilities measured by standard neuropsychological tests. VSST performance relates to the level of executive functioning only in patients. There was no effect of gaming experience on VSST performance. While potential gender effect has to be addressed in future studies, age seems to play a role in the additional VSST measures (trial time and distance). Study limitations. Subjects were tested only once and therefore long term benefits of using VSST in rehabilitation could not be investigated. Only schizophrenia patients were included in the sample, which reduces generalizability of results to other psychiatric and neurologic conditions.

Psychiatric Assessment in Patients with Mild Temporal Lobe Epilepsy.

Objectives The findings of previous studies focused on personality disorders in epileptic patients are difficult to interpret due to nonhomogeneous samples and noncomparable methods. Here, we aimed at studying the personality profile in patients with mild temporal lobe epilepsy (mTLE) with psychiatric comorbidity. Materials and Methods Thirty-five patients with mTLE (22 males, mean age 40.7 ± 12.1) underwent awake and sleep EEG, 3T brain MRI, and an extensive standardized diagnostic neuropsychiatric battery: Temperament and Character Inventory-Revised (TCI-R), Beck Depression Inventory-2, and State-Trait Anxiety Inventory. Drug history was collected in detail. Hierarchical Cluster Analysis was performed on TCI-R data, while all other clinical and psychological variables were compared across the resulting clusters. Results Scores of Harm Avoidance (HA), Reward Dependence (RD), Persistence (P), Cooperativeness (C), and Self-Transcendence (ST) allowed the identification of two clusters, describing different personality subtypes. Cluster 1 was characterized by an early onset, more severe anxiety traits, and combined drug therapy (antiepileptic drug and Benzodiazepine/Selective Serotonin Reuptake Inhibitors) compared to Cluster 2. Conclusions Our findings suggest that different personality traits may play a role in determining the clinical outcome in patients with mTLE. Specifically, lower scores of HA, RD, P, C, and ST were associated with worse clinical outcome. Thus, personality assessment could serve as an early indicator of greater disease severity, improving the management of mTLE.

Psychological well-being and marital satisfaction in response to weight loss after bariatric surgery.

To compare the marital satisfaction (MS) and psychological well-being (PWB) of men and women before and after bariatric surgery for obesity. The subjects of this prospective observational study were obese patients who underwent bariatric surgery. MS and PWB were assessed before, and 6months after the surgery, using specific scales for MS and PWB. The correlation matrix showed that age was not correlated with any of the scores from the PWB scales, and only with the total MS scores of men (P < 0.05). The pre-surgical BMI-post-surgical BMI (ΔBMI) was correlated negatively and significantly with the post-surgical total MS, especially for women, but it was not correlated with the sexual satisfaction of either gender. The score of positive interpersonal relationships was negatively correlated with the ΔBMI, especially for women (P < 0.05), whereas personal improvement was positively correlated for men (P < 0.05). There was also a significant correlation between ΔBMI and purpose in life for both genders. Post-surgical ΔBMIs were not associated with the other two indicators of PWB, namely, autonomy and environmental mastery for both genders. For women, weight loss after bariatric surgery seemed to improve PWB and MS when assessed 6months post-operatively; however, the psychiatric assessment of patients before and after the surgery is crucial.

Validity of the 36-item Persian (Farsi) version of the world health organization disability assessment schedule (WHODAS) 2.0

The purpose of this study was to validate a self-administered 36-item Persian (Farsi) version of the World Health Organization (WHO) Disability Assessment Schedule II (now referred to as WHODAS 2.0) for assessment of psychiatric patients’ perceptions of their functioning and disability. WHODAS 2.0 items were analyzed using two approaches. Reliability, consistency, and factor structure were assessed using Cronbach’s α and factor analysis, and item response theory (IRT) was used to determine how well the WHODAS 2.0 items fitted the Rasch paradigm. Data were collected from 614 psychiatric outpatients in Tehran. The mean overall disability score for the sample was 37.57. The scale had excellent reliability (Cronbach’s α = 0.94). The IRT-based analysis showed that overall the set of items had a poor fit to the Rasch paradigm; the exceptions were items belonging to domains D1 (cognition), D2 (mobility), and D5 (life activities). There were several problematic items associated with dimensions D3 (self-care) and D4 (getting along). There were at least two badly fitted items associated with all dimensions. This study is the first to examine the psychometric properties of the self-administered, 36-item, Persian version of WHODAS 2.0 in psychiatric outpatients. This version has acceptable reliability and validity in psychiatric patients, but a reformulation of problematic items and further validation tests would be required to produce a robust measurement instrument.

Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables

We aimed to investigate the changes in the objective and subjective sleep variables during painful episodes of fibromyalgia and post-episode period, and to evaluate the impact of the sleep variables on the current clinical, psychological, and immunologic parameters. Thirty-one consecutive patients who were referred to the Erenköy Physical Therapy and Rehabilitation Polyclinic with a diagnosis of fibromyalgia were evaluated before and in the sixth week of the acute pain treatment. The sleep variables were measured by polysomnography, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. The clinical and psychiatric assessment of patients was performed by using Fibromyalgia Impact Questionnaire; Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms; and Visual Analog Scale. Serum pro-inflammatory molecules were measured to evaluate the immunological status. The pain treatment significantly affected subjective sleep variables, psychiatric variables, clinical variables, and IL-6 levels. The subjective sleep parameters, clinical and psychiatric variables, and IL-6 levels were improved with pain treatment in fibromyalgia. The objective sleep variables, IL-1 and TNF-alpha levels were not significantly improved with the pain treatment, and they were not related to clinical presentation of patients with fibromyalgia. Subjective variability of sleep contributes to the clinical presentation, suggesting that the objective structure is trait-specific with IL-1 and TNF-alpha.

One Pass Thalamic and Subthalamic Stimulation for Patients with Tremor-Dominant Idiopathic Parkinson Syndrome (OPINION): Protocol for a Randomized, Active-Controlled, Double-Blinded Pilot Trial.

BackgroundBesides fluctuations, therapy refractory tremor is one of the main indications of deep brain stimulation (DBS) in patients with idiopathic Parkinson syndrome (IPS). Although thalamic DBS (ventral intermediate nucleus [Vim] of thalamus) has been shown to reduce tremor in 85-95% of patients, bradykinesia and rigidity often are not well controlled. The dentato-rubro-thalamic tract (DRT) that can directly be targeted with special diffusion tensor magnetic resonance imaging sequences has been shown as an efficient target for thalamic DBS. The subthalamic nucleus (STN) is typically chosen in younger patients as the target for dopamine-responsive motor symptoms. This study investigates a one-path thalamic (Vim/DRT) and subthalamic implantation of DBS electrodes and possibly a combined stimulation strategy for both target regions.ObjectiveThis study investigates a one path thalamic (Vim/DRT) and subthalamic implantation of DBS electrodes and a possibly combined stimulation strategy for both target regions.MethodsThis is a randomized, active-controlled, double-blinded (patient- and observer-blinded), monocentric trial with three treatments, three periods and six treatment sequences allocated according to a Williams design. Eighteen patients will undergo one-path thalamic (Vim/DRT) and STN implantation of DBS electrodes. After one month, a double-blinded and randomly-assigned stimulation of the thalamic target (Vim/DRT), the STN and a combined stimulation of both target regions will be performed for a period of three months each. The primary objective is to assess the quality of life obtained by the Parkinson’s Disease Questionnaire (39 items) for each stimulation modality. Secondary objectives include tremor reduction (obtained by the Fahn-Tolosa-Marin tremor rating scale, video recordings, the Unified Parkinson’s disease rating scale, and by tremor analysis), psychiatric assessment of patients, and to assess the safety of intervention.ResultsAt the moment, the recruitment is stopped and 12 patients have been randomized and treated. A futility analysis is being carried out by means of a conditional power analysis.ConclusionsThe approach of the OPINION trial planned to make, for the first time, a direct comparison of the different stimulation conditions (Vim/DRT, compared to STN, compared to Vim/DRT+STN) in a homogeneous patient population and, furthermore, will allow for intraindividual comparison of each condition with the “quality of life” outcome parameter. We hypothesize that the combined stimulation of the STN and the thalamic (Vim/DRT) target will be superior with respect to the patients’ quality of life as compared to the singular stimulation of the individual target regions. If this holds true, this work might change the standardized treatment described in the previous section.Trial RegistrationClinicalTrials.gov: NCT02288468; https://clinicaltrials.gov/ct2/show/NCT02288468 (Archived by WebCite at http://www.webcitation.org/6wlKnt2pJ); and German Clinical Trials Register: DRKS00007526; https://www.drks.de/drks_ web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007526 (Archived by WebCite at http://www.webcitation.org/6wlKyXZZL).

Comparison Between Marital Satisfaction and Self-Esteem Before and After Bariatric Surgery in Patients With Obesity.

BackgroundObesity is one of the most common chronic diseases with important medical effects, as well as mental and social health problems. Bariatric surgery is one of the most effective treatments of morbid obesity.ObjectivesBecause of the possible psychological changes, and its effects on weight loss after surgery, the current study aimed to compare marital satisfaction and self-confidence in patients with obesity before and after bariatric surgery in Rasoul-e-Akram hospital in 2013.Materials and MethodsThis prospective observational study was conducted on 69 candidates for bariatric surgery. Marital satisfaction and self-confidence were assessed before and six months after the surgery by Enrich marital satisfaction scale and Coopersmith self-esteem inventory. Descriptive statistics and T-tests were utilized to analyze data. Values of P ≤ 0.01 were considered statistically significant.ResultsDespite the improvement of sexual relationship, marital satisfaction scores significantly decreased from141.26 ± 12.75 to 139.42 ± 12.52 six months after the surgery (P = 0.002). Satisfaction in scales of conflict resolution and communication showed a descending pattern (P < 0.001). No significant difference was found between self-esteem before and after the surgery (P = 0.321).ConclusionsWeight loss after bariatric surgery did not improve self-esteem and marital satisfaction six months post operatively; therefore, psychiatric assessment of patients before and after the surgery is crucial; since even if they are not associated with prognosis of the surgery, it is important to provide treatment for psychiatric problems. Prospective studies are recommended to assess post-operative changes of other psychological aspects.

Risk factors for attempted suicide: A prospective study on psychiatric consultations in the emergency room

IntroductionStudies conducted on Italian samples suggested that 70% of self-harms referred to the emergency room (ER) were suicide attempts. Suicide attempts are associated with societal, relationship and individual risk factors, which vary with age and gender, occur in combination, and may change over time. We conducted a previous study on a sample of psychiatric consultations in ER from 2008 to 2011. We observed that female gender, a permanent job and being in the warmer months of the year were risk factors for suicide attempts.AimTo update knowledge about risk factors for attempted suicide analyzing a larger sample of ER psychiatric consultations.MethodsDeterminants of emergency room visits for psychiatric reasons were studied prospectively in a period of 8 years, from 2008 to 2015 at the “Maggiore della Carità” Hospital in Novara. The psychiatric assessment of patients was performed by experienced psychiatrists with a clinical interview. For each patient, a data sheet was filled in order to gather demographic and clinical features. Comparison of qualitative data was performed by means of the Chi2 test while differences between groups for continuous variables were assessed through a t-test. Statistical significance was set at P ≤ 0.05. A multivariate analysis was performed using logistic regression in order to assess the potential predictors of attempted suicide. Results are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).ConclusionsWe have collected data from more than 500 psychiatric consultations for attempted suicide. Data collection and statistical analyses are still ongoing. Implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric assessment of patients with dementia in the community.

Physical decline and behavioural disturbance in advancing dementia often precipitates hospital or nursing home admission.1 The coexistence of behavioural or psychological symptoms and physical illness requires timely input from a number of professionals in both the health and social services. Numerous rating scales are available to assess different aspects of dementia, including cognition, psychopathology, quality-of-life, and caregiver burden. The …

Paliperidone Use in Behavioural Symptoms in Patients with Intellectual Disabilities

Introduction Behavioural symptoms are the first reason of psychiatric assessment in patients with intellectual disabilities (ID), and also the most frequent cause of psychopharmacological treatment. Different rates of prevalence of these symptoms appear in literature data (10-60%). Paliperidone has shown effectiveness in the treatment of behavioural symptoms in patients with autism and asperger syndrome, with significant reduction in ABC-I subscale scores. Conclusions Objectives: Study paliperidone effect in behavioural symptoms' improvement in patients with intellectual disabilities of diverse etiology. Methods 10 outpatients with intellectual disabilities and behavioral symptoms were selected and treated with paliperidone. Sociodemographic and clinical data (type of intellectual disability, previous antipsychotic and paliperidone dose) were registered. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores were compared prior and 4 weeks after psychopharmacological treatment change. Otherwise we assessed clinical improvement with Clinical Global Impression-Improvement (CGI-I). Results All patients were similar in clinical and sociodemographic characteristics. Paliperidone mean dose was 8,4 mg/day (3-18 mg/day), changing from risperidone (44,4%), olanzapine (44,4%) and levomepromacine (11,1%). Mean reduction in ABC-I scores with paliperidone treatment was 6,2 points [with most significant improvement in items like irritability (1,2 points), aggressions (1,1 points) and slams (0,9 points)]. CGI-I scores showed a much better improvement in 60% patients, mildly betterin 30% patients and slightly better in 10% patients. No significant adverse effects leaded to treatment discontinuation. Conclusions 1. Paliperidone is an effective and safe treatment in behavioral symptoms associated to intellectual disabilities. 2. Paliperidone treatment reduces ABC-I subscale scores, with most significant improvement in irritability and aggressions.

Influence of the DSM‐IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health

The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM‐IV‐TR) includes an Outline for Cultural Formulation (CF) that identifies cultural information that can be used to modify diagnosis, clinical assessment and treatment plan. This study examined the use of the CF by a Cultural Consultation Service in the psychiatric assessment of patients referred by primary care providers. The study uses conversation analysis of 12 clinical case conferences to explore the ways in which the CF influenced the interaction of a multidisciplinary group of mental health professionals in conceptualizing the implications of patients’ cultural background and current context for diagnosis and treatment planning. The results suggest that the CF can be a useful tool for interdisciplinary collaboration and knowledge transfer by providing a framework to systematically introduce different disciplinary perspectives and levels of description that transcend the narrow frame of disorder‐centred psychiatric diagnosis, assessment and care.

Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department

Objective This study aimed to compare diagnoses obtained from routine psychiatric assessment in accident and emergency (A&E) settings with those from a standardized diagnostic interview. Methods Using Cohen's kappa, the agreement between diagnoses from routine psychiatric assessment and structured interview was calculated. Further statistical analysis was used to investigate differences between some of the main diagnostic subgroups. Results The overall kappa value for all diagnoses was .47. Adjustment disorder, major depressive disorder and alcohol misuse/dependence were commonly identified, both at routine assessment and on structured interview. There was a disparity between the two diagnostic systems in the extent to which major depressive disorder and adjustment disorder were identified. Further analysis between these two groups was inconclusive as to the reasons for this difference. Conclusions There was moderate agreement between clinical and standardized diagnoses. Anxiety disorders were poorly identified at routine assessment. There is difficulty distinguishing between adjustment disorder and depressive episode in the A&E setting.

Akinetic mutism followed by a manic reaction on introduction of steroid replacement for Addison’s disease

Neuropsychiatric changes during exogenous corticosteroid administration are well-recognized. However, reports of neuropsychiatric reactions to corticosteroid replacement for Addison's disease are distinctively rare. We report on a patient with primary adrenocortical insufficiency, initially presenting with depressive symptoms, who developed akinetic mutism followed by acute manic illness shortly after the initiation of steroid replacement. Both disorders occurred with physiological doses of hydrocortisone and resolved spontaneously. The pathogenesis of the above neuropsychiatric reactions is discussed in the context of glucocorticoid receptor-related brain effects of glucocorticoids. In addition, this report points to the need for accurate psychiatric assessment of patients with Addison's disease upon introduction of replacement therapy.

Psychiatric morbidity in non-psychiatric geriatric inpatients

Aim:To evaluate the profile of psychiatric disorders in geriatric inpatients.Methods:A total of 528 patients (age 65 years and above) admitted to various departments of the teaching hospital attached to the Government Medical College, Amritsar from 15 September 2001 to 14 September 2002 were included in the study. Psychiatric assessment of patients was made on the basis of psychogeriatric assessment scales (PAS) and present state examination (PSE-ninth edition, 1974). The ICD-10 criteria were used for psychiatric diagnoses. General medical conditions were diagnosed by consultants of the respective departments. The patients were finally assessed by the consultant of the Department of Psychiatry. The obtained data were analysed using the chi-square test.Results:Of the 528 patients, 260 (49%) had psychiatric co-morbidity. The most common psychiatric disorder was depression (25.94%), followed by adjustment disorders (11%), anxiety disorders (4.54%), dementias (3.6%), delirium (3%), bipolar disorders (0.8%), and substance-related disorders (0.4%).Conclusion:The above findings emphasize the importance of consultation-liaison psychiatry, especially in geriatric patients.

Psychiatric assessment of patients with self-inflicted lacerations to the wrist and forearm admitted to a nonpsychiatric ward: The experience of a regional plastic surgery unit

In 1984, the Department of Health (DoH) recommended that all patients with deliberate self-harm (DSH) must have a mental assessment before discharge. DSH patients, especially those with lacerations to wrist and forearm, are a regular source of admission to plastic surgery units. In Northern Ireland, the regional plastic surgery service is provided at the Ulster Hospital, which does not have an on-site psychiatric department. Consequently, it was often difficult to arrange a psychiatrist assessment for these patients on the ward even when the assessment was required urgently. The objective of this study was to develop and validate a protocol that would ensure that these patients were assessed and followed up for their mental health as recommended by the DoH. In the absence of clear guidelines from the DoH and utilising the existing arrangement between Accident and Emergency (A&E) and the psychiatric services, all referring A&E departments were instructed at the time of referring patients with DSH to wrist and forearm to arrange a psychiatric examination before transferring the patient to the plastic surgery unit. Data were collected retrospectively (August 2002-October 2002) and prospectively (November 2002-October 2003) and comprised demographic features, previous history of self-harm, conduct of the patient in A&E and the ward, length of stay in the hospital and various aspects of psychiatric assessment and follow-up. In total, 42 referrals were made during the period studied. The average age was 28 years with a male to female ratio of 2:1. The average hospital stay was two days. Despite difficulties, our practice was found effective in ensuring psychiatry assessment and follow-up without risking the patient's physical health. The study also highlighted the need for collaboration between plastic surgeons and psychiatrists to improve services in regards to DSH patients.

Psychopathology and personality features in orthopedic patients with boxer's fractures

A boxer's fracture (BF) is the most common type of metacarpal fracture and is usually an intentional injury. This study aims to investigate the severity of depressive and anxiety symptoms and evaluate the personality features of patients with BF in comparison with patients with fractures other than boxer's fractures [other fractures (OFs)] and a group of healthy controls (C). The study group was comprised of 14 patients who were diagnosed to have BF, 13 patients who were assessed due to OF and 11 C. Patients and controls were assessed with Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-2) was used to screen axis II, personality disorders' symptoms. The results showed that patients with BF had more anxiety as a trait and had higher mean scores for self-defeating, borderline and antisocial personality disorders than both the group of OF and C. Additionally, BF group had higher scores on the anger and cynicism subscales of MMPI-2. These results suggest that maladaptive personality traits and anxiety symptoms are common in patients with BF. Psychiatric assessment of patients who apply to orthopedy clinics with BF should be a part of their treatment plan.

Assessment of psychiatric patients' competency to give informed consent: legal safeguard of civil right to autonomous decision-making.

Amendment of the Mental Health and Welfare Law in Japan will limit admission for medical care and protection only for those individuals who are incapable of giving consent to admission. This is a first in the history of the Japanese mental health legislation. By reviewing the law and psychiatric literature, it is argued that: (i) informed consent is a legal transaction that embodies the idea of an individual's right to autonomous decision-making in medical settings; (ii) health professionals have a duty to protect those individuals who cannot decide medical matters because of lack of capacity to do so; (iii) some patients are marginally incompetent so assessment of their competency is essential in protecting patients' civil rights; (iv) in order for a competency assessment to be reliable (and hence fair) the method should be psychometrically sound; (v) at the same time, in order for a competency assessment to be valid, the structure of a competency assessment should match the patient's psychological, cultural, and social background; and (vi) because informed consent is a process rather than a cross-sectional event, a competency assessment should be performed in everyday practice. The use of a brief and semistructured interview to assess patients' competency to give informed consent may meet all of the requirements described.

THE PSYCHIATRIC INTERVIEW IN THE EMERGENCY DEPARTMENT

Psychiatric assessment of patients in the emergency department requires a psychological and medical approach. Acute medical problems must be investigated immediately, before a more nuanced exploration of emotional, cognitive, and behavioral aspects of these patients is undertaken. A multidimensional, nonreductive description then guides the treatment and disposition of patients in the emergency department.

Assessment of psychiatric patients' risk of violence toward others.

Evaluating a patient’s risk of committing violence against another person is one of the more common duties of the physician in the psychiatric emergency service. In the psychiatric emergency service at the University of Cincinnati Medical Center, with which the first author previously was affiliated, some 10 percent of patient visits are occasioned by concern about homicidal thoughts. Others have reported that up to 17 percent of patients seen in the psychiatric emergency service are homicidal, and that up to 5 percent are both homicidal and suicidal (1). This paper presents guidelines to help clinicians in the psychiatric emergency service evaluate patients who present with homicidal ideation or violent behavior. The guidelines are styled after a similar presentation on the assessment of suicide risk published in this column last year (2). General considerations As with suicide, no clinician can predict what is going to happen. The goal is risk assessment. The treatment decision must be related to the outcome of that risk assessment. In other words, the emergency clinician is not in the business of predicting an out come, but of making a logical assessment of a prevailing risk of violence in order to develop a reasonable treatment plan (3). A limited database on risk factors for violence exists, but researchers have concluded that, in general, the only factor associated with future violent behavior is a history of violence (4). In any case, epidemiological databases are largely irrelevant to the clinician in the psychiatric emergency service. Epidemiology focuses on longterm prevalence rates—for example, three-year rates—or lifetime prevalence rates. The data are related to the overall probability that a person will eventually attempt or commit a violent act. In the psychiatric emergency service, the clinician is con cerned with short-term risk, not the risk over future months or years. The definition of short-term risk is controversial. Does a homicide committed by someone who was evaluated two weeks earlier suggest faulty risk assessment? As we suggested in our discussion of suicide risk assessment (2), we consider a period of 24 hours as the short term. This period represents the maximum amount of time most emergency facilities can retain patients without admitting them as inpatients. As in the assessment of the suicidal

The relationship between confidence and accuracy in clinical assessment of psychiatric patients' potential for violence.

The authors studied the relationship between confidence and accuracy in clinical assessments of psychiatric patients' short-term risk of violence. At the time of entry to the hospital, physicians (N = 78) estimated the probability that each of 317 patients would physically attack other people during the first week of psychiatric hospitalization. The clinicians also indicated the degree of confidence they had in their estimates of violence potential. Nurses rated the occurrence of inpatient physical assaults with the Overt Aggression Scale. The results showed that when clinicians had a high degree of confidence, their evaluations of risk of violence were strongly associated with whether or not patients became violent. At moderate levels of confidence, clinicians' risk estimates had a lower, but still substantial relationship with the later occurrence of violence. However, when clinicians had low confidence, their assessments of potential for violence had little relationship to whether or not the patients became violent. The findings suggest that the level of confidence that clinicians have in their evaluations is an important moderator of the predictive validity of their assessments of patients' potential for violence.