That comorbid substance use disorders substantially increase the risk for violence in mental illness has been known for decades.1 However, the prevailing view, based on US1 and Scandinavian epidemiologic studies,2 has been that serious mental illness also confers a significant relative risk for violence even in the absence of such comorbidity. Accordingly, a broad clinical consensus has emerged that violence risk management in psychiatric patients with dual diagnoses requires treatment of both the underlying psychopathology and comorbid substance abuse.
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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
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