Varje dag utförs riskbedömningar inom rättspsykiatri och kriminalvård. Syftet med denna uppsats är att undersöka det vetenskapliga underlaget för riskbedömningar. Uppsatsen inleds med en kort beskrivning av i vilka sammanhang riskbedömningar används och den traditionella uppfattningen av hur området och instrumenten har utvecklats. Sedan följer en genomgång av olika studier som behandlar bedömningarnas träffsäkerhet generellt samt mellan olika generationer av bedömningar. Därnäst redovisas och framförs kritik mot validiteten i Psychopathy Checklist Revised (PCL-R, Hare, 1991) och dess tillämpning inom riskbedömningar. Avslutningsvis analyseras psykopatibegreppet utifrån Ian Hackings teorier om ”human kinds” och ”loopingeffekter” och det förs en kort diskussion av tänkbara konsekvenser av och farhågor kring användningen av PCL-R och psykopatibegreppet generellt. / Every day, forensic risk assessments are carried out. The aim of this thesis was to evaluate their scientific grounds. Initially, a short description of the contexts in which risk assesments are carried out, as well as a description of the historical development of risk assesment instruments are provided. A summary of evaluations of different types of risk assessments and their predictive validity is presented, followed by a critique on the validity of the Psychopathy Checklist Revised (PCL-R, Hare, 1991) and its use in risk assesments. The psychopathy construct is analysed in relation to Ian Hacking’s theories of human kinds and looping effects and potential risks and consequences of the application of PCL-R and the psychopathy construct are discussed.

While forensic psychiatric inpatient violence is a serious problem, research on risk assessment for this outcome is limited; the current research investigated the predictive validity of a number of structured risk/forensic instruments for inpatient violence. Research objectives included: 1) observing the profile of dynamic changes in violence risk detected by existing violence risk assessment instruments; 2) assessing whether existing violence risk assessment instruments could be used to assess risk for inpatient violence; 3) evaluating the contribution of dynamic risk measures to the prediction of inpatient violence; and 4) assessing the relationship between dynamic changes in risk and inpatient violence. Instruments included: the Historical Clinical Risk Management 20 - Version 3 (HCR-20V3), the Psychopathy Checklist Revised (PCL-R), the Short-Term Assessment of Risk and Treatability (START), the Revised Violence Risk Appraisal Guide (VRAG-R), and the Violence Risk Scale (VRS). Two studies were conducted on a maximum-security forensic psychiatric unit at Alberta Hospital Edmonton. Study 1 was a pseudo-prospective archival investigation (n = 99), while Study 2 was a prospective investigation (n = 19); all risk assessment scores were based on information available in institutional files. Instruments designed to capture dynamic/clinical risk variables (HCR-20V3, START, VRS) detected dynamic changes in risk in this setting over longer follow-ups (i.e., between admission and discharge), but not over shorter follow-ups (i.e., 28 day periods). Predictive validity analyses indicated that specialized measures designed to capture relevant dynamic/clinical variables were significant predictors of inpatient violence; instruments that were not designed for this purpose (PCL-R and VRAG-R), did not demonstrate predictive validity for inpatient violence. Dynamic measures consistently demonstrated incremental predictive validity for inpatient violence, beyond the static measures. Additionally, change scores demonstrated incremental relationships with decreased inpatient violence, beyond pretreatment scores. Put another way, positive risk change was associated with decreased violence over the course of the patients’ stays in hospital. Reliable and valid risk assessments are a necessary component of effective offender programming (Risk-Need-Responsivity Model) and the current results indicated that valid violence risk assessments for forensic psychiatric inpatient violence are possible. Implications for clinical practice and the reduction/mitigation of inpatient violence are discussed.