Homicidal Ideation in Youth With Attention-Deficit/Hyperactivity Disorder
This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher's Terms & Conditions. Yunchan Chen, BS, a and Alice Danforth Caesar, MD, BA a,* Prim Care Companion CNS Disord 2022;24(4):21cr03190 To cite: Chen Y, Caesar AD.
Relevance: Large-scale homicides and mass shootings are increasingly prevalent in the United States. While a complex interplay of personal and social motivations drives perpetrators, public attention often turns to the role of psychiatric illnesses. Child psychiatrists are often called to assess, predict, and mitigate the risk of violence among youth. We present the case of a 14-year-old patient with attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD), admitted for homicidal ideations with plans to murder 26 people. We will discuss the approach to adolescent violence assessment, along with management strategies that address both psychosocial factors and comorbid mental illnesses.
• Source: The Primary Care Companion for CNS Disorders
• Relevance: “We present the case of a 14-year-old patient with attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD), admitted for homicidal ideations with plans to murder 26 people.”
• Violence in children/adolescents is an exigent topic. Although the frequency of juvenile violence has been on the decline, mass shootings are more frequent. Child psychiatrists are asked to evaluate youths who express homicidality for violence risk. The goal is to treat aggression and impulsivity.
• The Structured Assessment for Violence Risk in Youth is a questionnaire with 25 items that assesses violence and aggression, including trauma, disturbed attachment, and psychiatric illness, traits which were demonstrated in the current case.
• After the patient was hospitalized, the healthcare team provided psychotherapy for trauma, as well as family sessions that focused on enhancing communication and rebuilding relationships. Psychiatric drugs were given for comorbid illness.
• Numerous studies show that treating comorbid psychiatric illness can decrease impulsivity and aggression; stimulants curb aggression in youth with ADHD along with oppositional defiant disorder/conduct disorder or ADHD along with proactive aggression plus callousness.
• “Psychiatrists can never predict homicide. Yet, by systematically addressing psychosocial risk factors for aggression and treating comorbid psychiatric illness, we can hopefully mitigate a youth’s risk of future violence,” the authors wrote.