Dr C Thomas (Consultant Forensic Psychiatrist) Dr S Gunasekaran (Consultant Forensic Psychiatrist) Ella Hancock- Johnson (Research Assistant) Dr

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1 Dr C Thomas (Consultant Forensic Psychiatrist) Dr S Gunasekaran (Consultant Forensic Psychiatrist) Ella Hancock- Johnson (Research Assistant) Dr Alessandra Girardi (Research Associate)

2 1. Case presentation 10 minutes 2. Audience to rate the risk factors on templates provided - 5 to 10 minutes 3. Presentation/ Discussion of factors associated with violence risk in autism 20 to 30 minutes 4. Second rating of the risk on templates combined with 3 5. Final discussion and questions 6. Submit BOTH filled templates

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4 Young male, poorly dressed and kempt, not showered for 6 months in protest, clothes torn, wearing a blanket wrapped around him with food stains, on a 2:1 observation in a seclusion room/ enhanced care room Talks in a loud voice and can be often heard shouting at staff and threatening staff, threats include violent threats, graphic threats and rape threats

5 Affect appears volatile, several aggressive outbursts in a day Thoughts show evidence of circumstantiality, tangentiality Content of thought includes detailed facts about a variety of subjects, physics, politics (facts are accurate and intelligent) No evidence of self harm No perceptual abnormality

6 Oriented to time, place and person Has insight into his diagnosis but refusing treatment on a low secure ward Has made several complaints to CQC about incompetence of staff Says he feels like the wants to anally rape and kill the ward manager and send pieces of his body to the manager s children

7 Made threats to staff in a community placement Assaulted staff on one occasion Had to be transferred due to safeguarding reasons and several threats from other service users

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9 Was in the community with his mother Then living independently for a few years Several problems with neighbours Graphic threats of violence, throwing faeces into neighbours garden, poor self care, Placed in supervised accommodation Assaulted staff Transferred to intensive care

10 Transferred to a general ward Refused to comply Returned to intensive care Diagnosed with schizophrenia and started on depot risperdal consta for verbally and physically aggressive behaviour to staff Queried whether he has a diagnosis of ASD

11 Transferred to STAH low secure ASD ward Engaged well with ASD interventions, diagnosis of schizophrenia removed After 1 year he was stepped down into supported accommodation Relapsed as described in HOPC and returned to low security In the current ward he has accumulated several datix incidents over 6 months

12 Including verbal aggression, physically threatening behaviour, racist comments to staff, serious verbal threats to staff, refusing to eat, refusing to comply with staff, refusing to bathe or change clothes, only engaging with certain staff. Around 4 to 10 incidents per day over 6 months

13 Bullied at school Completed 4 GCSE s (above average) A levels physics and maths then left college due to being taken into care Supported by his mother through education Some voluntary work No relationships, believes sex is only to pass on his genetic material

14 Any guesses?

15 Father and brothers do not want contact with him

16 None

17 Cautioned by police for walking near a school with a camera and attempting to take pictures of children

By Dr C Thomas (Consultant Forensic Psychiatrist) Dr S Gunasekaran (Consultant Forensic Psychiatrist) Ella Hancock- Johnson (Research Assistant) Dr

By Dr C Thomas (Consultant Forensic Psychiatrist) Dr S Gunasekaran (Consultant Forensic Psychiatrist) Ella Hancock- Johnson (Research Assistant) Dr By Dr C Thomas (Consultant Forensic Psychiatrist) Dr S Gunasekaran (Consultant Forensic Psychiatrist) Ella Hancock- Johnson (Research Assistant) Dr Alessandra Girardi (Research Associate) Why do we use

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