[MURDER STEMMING FROM INSANITY: DEMOGRAPHIC, CRIMINAL, PSYCHIATRIC AND FORENSIC CHARACTERISTICS OF THE PERPETRATORS].

INTRODUCTION: Violence among individuals with mental disorders and murder while in a psychotic state have been studied extensively worldwide. AIMS: To examine the socio-demographic, psychiatric, criminal, forensic and other characteristics of people who committed murder in Israel and were not prosecuted for reasons of insanity. This is the largest such study to date conducted in Israel. METHODS: The files (medical and legal documents) of all patients (N=80) hospitalized in the maximum-security division of Sha'ar Menashe Mental Health Center by court order following murder, were examined. RESULTS: Ninety percent of the participants were diagnosed with schizophrenia and 70% had prior psychiatric hospitalizations before committing murder. Most participants had documented substance abuse and previous violence stemming from mental disorders and did not regularly attend psychiatric follow-ups or take medication between hospitalizations. The motives were usually paranoid delusions. The victims were generally known to the killer, usually family members, and most perpetrators remained at the scene after the murder. CONCLUSIONS: Therapeutic sequence and preventive actions should be implemented in the treatment of this high-risk group. DISCUSSION: Findings delineate characteristics of homicide perpetrators stemming from mental disorders, from which a risk group may be described.

Coping patterns as a valid presentation of the diversity of coping responses in schizophrenia patients.

This study aimed to identify coping patterns used by schizophrenia inpatients in comparison with those used by healthy individuals, and to explore their association with selected clinical and psychosocial variables. The Coping Inventory for Stressful Situations (CISS) was used to assess coping strategies among 237 inpatients who met DSM-IV criteria for schizophrenia and 175 healthy individuals. Severity of psychopathology and distress, insight into illness, feelings of self-efficacy and self-esteem (self-construct variables), social support, and quality of life were also examined. Factor analysis, analysis of covariance and correlations were used to examine the relationships between the parameters of interest. Using dimensional measures, we found that emotion-oriented coping style and emotional distress were significantly higher in the schizophrenia group, whereas the task-oriented coping style, self-efficacy, perceived social support and satisfaction with quality of life were lower compared with controls. When eight CISS coping patterns were defined, the results revealed that patients used emotion coping patterns 5.5 times more frequently, and task and task-avoidance coping patterns significantly less often than healthy subjects. Coping patterns have different associations with current levels of dysphoric mood and emotional distress, self-construct variables, and satisfaction with quality of life. Thus, the identified coping patterns may be an additional useful presentation of the diversity of coping strategies used by schizophrenia patients. Coping patterns may be considered an important source of knowledge for patients who struggle with the illness and for mental health professionals who work with schizophrenia patients.

Predictors of quality of life in major psychoses: a naturalistic follow-up study.

BACKGROUND: Improved quality of life (QOL) of patients suffering from major psychoses has become an important treatment goal. We sought to determine predictors of perceived QOL and to explore the changes that occur regarding QOL among individuals with schizophrenia as compared to patients with schizoaffective/mood disorders. METHOD: In a naturalistic longitudinal design, 148 inpatients with schizophrenia and 51 inpatients with schizoaffective/mood disorders (DSM-IV) were tracked for 16 months (SD = 4.6 months). Subjects were assessed at 2 timepoints for psychopathology, stress process-related factors, and perceived QOL, as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire. Predictors of fluctuations in QOL index scores during the follow-up period were identified using multiple regression techniques. RESULTS: We found that poor QOL is not a more severe problem for schizophrenia patients than for schizoaffective/mood disorder patients. Improved QOL of schizophrenia patients is associated with reduced paranoid and distress (obsessiveness, somatization) symptoms and increased self-efficacy and self-esteem ratings. Individual changes in QOL index scores among patients with schizoaffective/mood disorders are associated with changes in depression, sensitivity, expressed emotion, and task-oriented coping scores. CONCLUSION: Predictors of changes in satisfaction with life quality over time among schizophrenia patients are distinct from those associated with schizoaffective/mood disorders. Changes in stress process-related factors, rather than psychopathology, predict change in perceived QOL and should be considered when evaluating QOL outcomes.