Which factors are evaluated to assess risk for violence or aggression in a patient with psychosis?

• A. Assess diet and sleep; ignore agitation.
• B. Assess economic status.
• C. Evaluate command hallucinations, threat language, agitation, history of violence, impulsivity, substance use, and implement safety planning and de-escalation.
• D. No assessment is needed.

Answer: (C)

Assessing risk for violence in psychosis hinges on identifying signals that point to potential aggression and using that information to guide safety planning. The best approach looks at both dynamic indicators and the patient’s history. Command hallucinations can drive harm if they direct the person to act, while threat language signals intent. Current agitation increases the likelihood of acting in the moment, and a history of violence raises baseline risk. Adding factors like impulsivity and substance use helps capture the trajectory toward potential aggression. With these signals, safety planning and de-escalation become essential tools to reduce risk and protect everyone involved.

Focusing on diet or sleep alone misses key warning signs and ignoring agitation leaves looming danger unaddressed. Economic status isn’t a reliable predictor of imminent violence, and saying no assessment is needed would leave risk unmanaged.