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Homicidal ideation

Homicidal Ideation
Classification and external resources
ICD-10 X85
ICD-9-CM E960
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Homicidal ideation is a common medical term for thoughts about homicide. There is a range of homicidal thoughts which spans from vague ideas of revenge to detailed and fully formulated plans without the act itself. Many people who have homicidal ideation do not commit homicide. 50-91% of people surveyed on university grounds in various places in the United States admit to having had a homicidal fantasy. Homicidal ideation is common, accounting for 10-17% of patient presentations to psychiatric facilities in the United States.

Homicidal ideation is not a disease itself, but may result from other illnesses such as delirium and psychosis. Psychosis, which accounts for 89% of admissions with homicidal ideation in one US study, includes substance-induced psychosis (e.g. amphetamine psychosis) and the psychoses related to schizophreniform disorder and schizophrenia. Delirium is often drug induced or secondary to general medical illness(es) (see ICD-10 Chapter V: Mental and behavioural disorders F05).

It may arise in association with personality disorders or it may occur in people who do not have any detectable illness. In fact, surveys have shown that the majority of people have had homicidal fantasies at some stage in their life. Many theories have been proposed to explain this.

Homicidal ideation is noted to be an important risk factor when trying to identify a person's risk for violence. This type of assessment is routine for psychiatric patients or any other patients presenting to hospital with mental health complaints. There are many associated risk factors which include: history of violence and any thoughts of committing harm, poor impulse control and an inability to delay gratification, impairment or loss of reality testing, especially with delusional beliefs or command hallucinations, the feeling of being controlled by an outside force, the belief that other people wish to harm him or her, the perception of rejection or humiliation at the hands of others, being under the influence of substances or a history of antisocial personality disorder, frontal lobe dysfunction or head injury.


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