A classification of combined homicide-suicide: An update-Part I: Introduction and psychopathology.

A 1995 classification of combined homicide-suicide was based on the psychopathology of the perpetrator and the relationship between the perpetrator and the victim(s). A three-part model was proposed for the study and potential understanding of individual homicide-suicide acts. This triarchic model consisted of the concepts of ego weakness, stress, and vector, the vector representing the ideational component. Today, approaching a quarter of a century after this initial classification based on a review of the literature available then, a considerable volume of experience and investigative knowledge has been published advancing our knowledge of homicide-suicide. The present review updates and revises the original classification, retains the two-part, psychopathological and relational classification, and adds several categories. Because this updated classification is more expansive than the original, it is presented in three parts. Part I, the present article, provides the introduction to this classification and the classification of mental conditions that may attend homicide-suicide. Parts II and III will address intrafamilial and extrafamilial homicide-suicide, respectively, the two major divisions of the classification based on the relationship between the actor and the homicide victim(s). All three parts are integral to this classification and belong together.

A classification of combined homicide-suicide: An update-Part II: Intrafamilial homicide-suicide.

This Part II of the three-part presentation of the updated classification of combined-homicide published in the Journal of Forensic Sciences addresses intrafamilial homicide-suicides (H-Ss). Intrafamilial H-Ss in this classification includes all close relationships including dating and intimate partners, not just traditional family relationships, in contrast to extrafamilial H-Ss where the victim(s) of homicide are either strangers or in a more formal but nonintimate relationship with the actor. Intrafamilial H-Ss are further divided and classified as intimate partner, filicide, familicide, parricide, and siblicide H-Ss, respectively, and are typically so grouped in the literature.

A classification of combined homicide-suicide: An update-Part III: Extrafamilial homicide-suicide.

The subclassification of homicide-suicide into psychopathology and intrafamilial homicide-suicides having been presented in the foregoing Parts I and II, this Part III concerns extrafamilial homicide-suicides. Extrafamilial homicide-suicides are divided into adversarial, autogenic mass, cult, and terrorist homicide-suicides. Adversarial homicide-suicides involve a "formal" relationship between actor and homicide victims, further divided according to the role of the actor in their relationship as employee, current or former pupil/student as in school shootings, patient, and litigant. For comparison, school shootings were divided into those resulting in 10 or more homicide victims and those with fewer. The autogenic mass homicide-suicide, wherein victims are strangers to the actor, was heuristically bifurcated here depending on the number of homicide victims, 10 or more or fewer. As expected, the homicide-suicides with larger numbers of victims were more homogenous.

Over-The-Counter Remedies in Older Adults: Patterns of Use, Potential Pitfalls, and Proposed Solutions.

Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.