A lot of people talk about wanting to kill people for a variety of reasons (revenge, jealosy, financial gain, etc.). Most never act upon these fantacies.
What about in the case below...would there be a credible risk (this is NOT a real person. I'm making this up as an example to better understand the topic).
Patient is seeing dr. for another reason (say, work stress resulting from demanding job). Talk of killing people comes up almost as an aside. The patient has never killed anyone although they do have a criminal past (no violent offences).
When asked, the patient says that he would readilly kill someone because he feels it is exciting, thrilling, and an experience he would like to have. He says he has not killed anyone yet, because he has not had sufficient opportunity.
The patient has a good job (executive) and does not want to risk his freedom and material wealth by commiting a major felony. He is looking for reasons why he wants to kill people and tips for not following through if the opportunity does present itself.
The patient does not present symptoms of another disorder (there is no talk of voices telling him to kill, he does not lie about other topics, etc.).
If he honestly wants to murder people for the experience and thrill of it, but has no other disorders or violent history, is there much chance he would do it?
In this case, the patient would have a lot to loose if the Dr. acted on a "hunch." So, how would the Dr. make the call?