[Homicide, schizophrenia and substance abuse: a complex interaction]. / Homicide, schizophrénie et abus de substances : des liaisons dangereuses ?

BACKGROUND AND AIM: The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia. METHODS: A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol". Abstract selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively. RESULTS: Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into "early-starters" and "late-starters" according to the age of onset of their antisocial and violent behavior. The violence of the "early-starters" is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the "late-starters", the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not. CONCLUSION: Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse.

[Homicide and psychosis: criminological particularities of schizophrenics, paranoiacs and melancholic. A review of 27 expertises]. / Homicide et psychose: particularités criminologiques des schizophrènes, des paranoïaques et des mélancoliques. A propos de 27 expertises.

INTRODUCTION: During the night of the 11 to 12 of December 2002, Mathieu X. 21 years old, convinced he was defending himself from evil human beings decapitated a nurse and an auxiliary nurse of the psychiatrist hospital. This crime, which received saturated media coverage, obviously raises questions about the dangerous and violent nature of the mentally ill, which can sometimes culminate in homicide. Firmly rooted in the collective consciousness is the popular idea that someone who kills an unknown person in the street is mentally ill. Conversely, the epidemiological data are reassuring; only 15% of such crimes are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia). AIM: Typing and comparison of homicides committed by schizophrenic, paranoiac and melancholic persons. METHOD: Several murders committed by psychotic persons are presented in this article. This retrospective study shows several types of pathological murder (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania). Twenty-seven cases have been selected and analysed from 268 cases prepared over 30 years by two psychiatrists, whose diagnoses were schizophrenia, paranoia, melancholia or hypomania. RESULTS: From these 268 cases of homicide examined, 27 murderers were psychotic. Ten of these were young, single, jobless, male schizophrenics: they drank little alcohol. Most of them had a criminal history. They were paranoid schizophrenics whose hallucinatory mechanisms fed mostly persecuted, sexual and metaphysical themes. Forty percent of them were disorganised, and half of them showed negative features. They knew their victim (family, friends). Nine others were paranoiac, for the most part male, older, married, family men, without psychiatric or criminal record. Intuitions with delirious fed persecuted (77%), jealous (40%) or prejudicial themes. They murdered their wife or husband or neighbour. Alcohol consumption was often involved. Schizophrenic and paranoiac murderers often have an emotional temper. Conversely, melancholic murderers are mostly female aged around 30, married, family women, drinking little alcohol. Two-thirds of them have psychiatric records of depression, bipolar disorders and attempted suicide. Altruism is the most frequent delirious theme. Their murders are more often premeditated. They know the victim: child or partner. Suicide often follows the murder.