A 16-year-old boy is brought to the office for a routine health maintenance examination. The mother discloses concerns about his recent irritability and "moodiness." He was recently bullied at school, got into a fistfight, and was suspended for 10 days. The patient has also been caught using marijuana and alcohol. Last month he was assaulted by a group of teenagers while walking home late at night. He is learning to box and also takes his mother's gun to a shooting range to practice so he can protect himself and her if needed. The patient spends his spare time in the evenings playing violent video games. Family history is significant for an uncle with schizophrenia and an aunt with bipolar disorder. His father used physical punishment to discipline him as a child. Which of the following factors is most concerning for this patient's future risk of committing homicide?

Question

A 16-year-old boy is brought to the office for a routine health maintenance examination.  The mother discloses concerns about his recent irritability and "moodiness."  He was recently bullied at school, got into a fistfight, and was suspended for 10 days.  The patient has also been caught using marijuana and alcohol.  Last month he was assaulted by a group of teenagers while walking home late at night.  He is learning to box and also takes his mother's gun to a shooting range to practice so he can protect himself and her if needed.  The patient spends his spare time in the evenings playing violent video games.  Family history is significant for an uncle with schizophrenia and an aunt with bipolar disorder.  His father used physical punishment to discipline him as a child.  Which of the following factors is most concerning for this patient's future risk of committing homicide?

Quizplus · Accepted Answer

11ec25c8_d7cc_e8f8_bc81_5768b020abe9_MD0003_00 Firearms are the most commonly used weapon in youth homicide in the United States, making access to guns an important issue to address in violence risk assessments. Homicides are most often committed by males, usually against friends or acquaintances. The majority of homicides occur one-on-one, with mass shootings being far less common. Although this patient has other risk factors, his access to his mother's gun is the most concerning. Parents of adolescents should be counseled on safe handling and limiting access to weapons (eg, keeping weapons unloaded and locked away, putting away ammunition). Practitioners can increase protective factors, such as referral to mental health programs that promote resilience and healthy coping skills, and encourage a connection to family and community. (Choice A) Although excessive exposure to violent media is a risk factor for increased aggression and a decreased likelihood of intervening when witnessing violence, access to firearms is a greater risk factor for committing homicide. (Choice B) A family history of mental illness confers a greater risk for the development of mental illness, but it is not as strongly associated with homicide as access to firearms. (Choices D, E, and G) Although exposure to violence in general increases the risk of future aggression, none of the options listed are as strongly correlated with homicide as access to firearms. (Choice F) Participation in violent sports is not a consistently recognized risk factor for homicide. (Choice H) Although substance use, especially alcohol, is a risk factor for violence, access to firearms is more strongly correlated with homicide. Educational objective: Access to firearms is the greatest risk in completing homicide. Other important risk factors include a history of violence, substance abuse, and high levels of impulsivity. Parents of adolescents should be advised to limit access to firearms. References: Invited address: street killings: prediction of homicide offenders and their victims. (http://www.ncbi.nlm.nih.gov/pubmed/24122366) Adolescent gun violence prevention: what we know, and what we can do to keep young people safe. (http://www.ncbi.nlm.nih.gov/pubmed/27176665)

A 16-Year-Old Boy Is Brought to the Office for a Routine