Le parricide psychotique. La prévention en question

Psychiatric Hospitalizations of People Found Not Criminally Responsible on Account of Mental Disorder in France: A Ten-Year Retrospective Study (2011-2020)

Background

Criminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization.

Methods

We used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization.

Results

We identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units (Unités pour malades difficiles, UMD). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%.

Conclusion

We conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients.

Structural Deficits in the Frontotemporal Network Associated With Psychopathic Traits in Violent Offenders With Schizophrenia

People with schizophrenia (SZ) are at increased risk of violence compared to the general population. However, the neural mechanisms of violent behavior in patients with SZ are still unclear due to the heterogeneity of the diseased population. In this study, we aimed to examine the neural correlates of violent behavior in SZ and to determine whether the structural deficits were related to psychopathic traits. A total of 113 participants, including 31 SZ patients with violent behavior (vSZ), 39 SZ patients without violent behavior (nvSZ), and 43 healthy controls (HC), completed the T1-weighted magnetic resonance imaging (MRI) scan and were analyzed using voxel-based morphometry approach. The psychopathic traits were assessed using the Psychopathy Checklist: Screening Version (PCL:SV). The results showed decreased gray matter volume (GMV) in the vSZ group in the right temporal lobe and bilateral inferior frontal gyri compared to HCs; while reduced GMV in the inferior parietal lobe, parahippocampal and orbital frontal gyri was found in the nvSZ group compared with HCs. Correlation analyses showed that psychopathic traits were negatively associated with the GMV in the right superior temporal and left fusiform gyri in the vSZ group, indicating that psychopathic traits, as reflected by the score of antisocial factor, might be related to structural deficits in the temporal lobe, which led to a propensity to violent behavior in patients with SZ. Our findings suggest that violent behavior in patients with SZ might have a personality background associated with the frontotemporal network aberrance. In future studies, we need to take a closer look at psychopathic traits for better understanding of the mechanism of interpersonal violence in patients with SZ and to explore whether the imaging findings from this study can serve as a biomarker to predict future violent behaviors and community living.

Homicides committed by delusional patients in the early 20th and 21st centuries: A study conducted in a French secure unit

Homicides committed by delusional patients are the object of a rich scientific literature, which puts the risk of such acts occurring into perspective when analyzing the offenders' sociodemographic and clinical characteristics. However, few articles detail the themes and mechanisms underlying those patients' delusions. To help bridge that gap, the authors conducted this retrospective descriptive study, including two samples of delusional homicidal patients, one from near present day and one from nearly a century ago. This study considered similarities observed in the literature (such as patients' sociodemographic profile, clinical data, and acting-out dynamics), but also explored the characteristics of delusion. In the 2015-2019 sample, the typical patient profile was: single male (31.5 years old on average), without child, unemployed, and with psychiatric history (56.6%). Most patients suffered from schizophrenic disease (83%) with non-systematized delusions exhibiting multiple themes in 80% of cases. Four principal types of delusion were observed: persecutive (100%), mystical (43.3%), megalomaniac (30%), and bodily (30%). The mechanisms were interpretative, hallucinatory, and intuitive. There was a societal influence in 23.3% of the cases (most often terrorist acts). The 1910-1914 historical sample revealed several differences: patients were older, more often married and employed. There were more diagnoses of chronic delusional disorder (30%). Persecutory delusion was constant (100%), and the other delusional themes were the "intimate relationship" type (50%)-jealousy, erotomanic-and the bodily type (40%). Additional studies are useful in order to reinforce our findings, and to further investigate the possibilities of prevention.

Juveniles arrested for murder: A latent class analysis of male offenders

Researchers and practitioners have a need for valid and generalizable typologies of juvenile homicide offenders (JHOs) to better understand the heterogeneous nature of JHOs, and use this knowledge to inform prevention efforts. Prior studies of JHOs have typically utilized a clinical approach, which is rich in data but based on small nonrepresentative samples, or relied on larger aggregate datasets which are more reliable but have few measures available. This study aimed to address these limitations by examining the latent heterogeneity (i.e. unapparent differences) in JHOs, their victims, and incident characteristics among more than 40,000 male JHOs arrested in the United States between 1976 and 2016 using latent class analysis, to allow for the objective identification of latent taxonomies. Six distinct subtypes of male JHOs are found in the analysis, which contributes to the theoretical and substantive knowledge base regarding JHOs, and may be used to develop and implement more effective interventions and violence prevention programs for these young offenders.

Psychosocial Factors and Juvenile Homicide in Argentina

Although knowledge on and prevention of juvenile homicide are crucial for social welfare and have been approached through different methodological instruments, this behavior is still quite difficult to be addressed. In this study, we have analyzed several psychological and social factors that could be theoretically related to juvenile homicidal behavior. Our case-control study included young (M = 16.8 years) males institutionalized in the Province of Buenos Aires, Argentina, under judicial order for crime. Out of 195 cases, 130 had committed homicide, 15 had repeated homicide, and 50 had attempted homicide. The control group comprised 305 young males who had committed other types of crimes. Self-reported and informant-reported instruments and professional assessment were used: Consideration of Future Consequences (CFC) Scale, Weinberger Adjustment Inventory (WAI), Resistance to Peer Influence (RPI), Psychopathy Checklist-Youth Version (PCL-YV), and Inventory of Callous Unemotional Traits (ICU). Differences between indicators of the psychological and social dimensions were not statistically significant. Only Factor 4 of the PCL-YV showed statistically significant difference. However, the relevance of this result is under discussion.

Elder abuse and neglect vs. parricide: a letter from Russia

In Russia, elder abuse is rarely discussed in the professional literature and the media. However, it is posited that parricide can be considered a form of elder abuse in Russia, as the line between elder abuse and parricide can be vague. Instances of parricide can appear trivial, hardly realized as such by victims and the social environment. Borderline cases can include involving older people in binge drinking, denying them help, and manipulating them to commit suicide. The perpetrators are often nonpsychotic, although sometimes exhibiting abnormal personality traits. Anger toward the victim can be absent on the part of the perpetrator, with their actions often driven by economic desires. A concluding point is that for better prevention of parricide and, therefore, elder abuse, it should not be considered only an unusual horrific crime committed by the mentally ill.

Elder Abuse and Neglect Versus Parricide

Violence in families and elder abuse can take many forms, which his sometimes difficult to recognize. In Russia, elder abuse is rarely discussed in professional literature and mass media. A border between elder abuse and parricide can be indistinct. Borderline cases can include involvement of older people in binge drinking, denial of help, and manipulation towards suicide. Three example cases are discussed in this report. A concluding point is that for prevention of parricide, it should be kept devoid of its reputation as an extraordinary crime, committed mainly by mentally ill individuals. The perpetrators can be mentally healthy or have a personality disorder. Parricide can have trivial appearance, not always recognized as such by victims and social environment.

["It was me or them!": the no exit escape of a future author of psychotic double parricide]

CASE-REPORT

H. had perceived his father as an evil persecutor ever since his adolescence. He developed paranoid schizophrenia of persecution in which his father occupied the main role. Little by little, in his desperate resistance against his father, perceived as his enemy, he acquired such a feeling of prejudice, of violation of his personality, and of impotence that the only way out was to escape in order to survive. At the age of 18, he decides to run away from home and from France to stop suffering. He goes to Canada and later to the USA where he would stay 9 years, during which his madness does not stop. Wherever he goes, he always feels the presence of his father in his head: "He orders me, he criticizes me from a distance, he steals all my thoughts, he is in charge of my actions, he takes away the bread from my mouth to humiliate me and kill me…" Thanks to his marginal lifestyle, he maintains a relative adaptation, a fragile equilibrium in his existential bubble in which he doesn't tolerate any breaking and entering. His delusion of prejudices and persecution, of which the main character had always been his father, extends to include society in general, cornering and leading the subject to commit an offense as a reaction of irrepressible pathological self-defense. He is questioned by the police, taken to prison and later taken to an American psychiatric hospital, after shooting at those whom he thinks are "CIA agents" (who are actually people forcing him to move the boat in which he lives). After being deported back to France, he returns to his parent's home, the source of all his madness. During the following months, he lives locked up in his room afraid of being near his father and tormented by his delirious ideas. In order to stop his suffering, he decides to buy a fire-arm to kill himself. One day, his father, accompanied by his mother, break into his room. He takes the rifle hidden under the mattress, and kills his father at point blank. "I thought that I had instantly killed my father, because he fell face down on the ground. On the other hand, my mother remained standing while my sister, screaming, escaped through the window of the living room. My mother, injured on her right side, moved back to the living room. Seeing that my mother hadn't fallen to the ground and not wanting to make her suffer, I reloaded my rifle. I took out the cartridge, and reloaded the rifle with a cartridge of buckshot. It seemed to me that she was still standing in front of the couch. I fired the gun a second time without looking and at that moment she falls on the couch… dead… She is the enemy because she is my father's wife".

DISCUSSION

The recounting and analysis of this double psychotic parricide case illustrate the psychopathologic constants and criminal dynamic that are most often present in this type of crime. The constants are the following: the perpetrator of the post-adolescence or adult parricide is often a psychotic young man; he/she lives a long, delusional story in which one or both parents have an important role; this insane delusion leads to suffering and/or to identifiable behavioral problems that together can constitute a criminal psychic state; The homicidal reaction takes place right after one or a group of factors (such as an argument, brawl, a fit of delusion, interruption of the therapeutic treatment…) that are set off in the criminal pathological state. These psychopathological constants, if they conjoin, are also the factors and indicators of danger. They should be considered as a warning sign to take preventive and remedial measures.

Parricides by mentally disordered offenders in Zimbabwe

AIM

The aim of this study was to examine the similarities and differences between matricide and patricide committed by mentally disordered offenders in Zimbabwe.

METHODS

A comprehensive, retrospective and national study was carried out of all individuals in Zimbabwe who, between 1980 and 1990 inclusive, were charged with homicide of their biological parents. The data were obtained from a hospital-wide survey, in a written semistructured format.

RESULTS

The sample size was 39 offenders (34 men, 5 women) and there were 39 victims (20 matricides and 19 patricides). Sons committed 18 patricides and 16 matricides, and daughters committed one patricide and four matricides. The mean age of the offenders was 35 years with a standard deviation of 9.8, and the mean age of the victims was 60 years with a standard deviation of 9.3. Ethnicity of all the offenders and their victims was African. About one-third of the offenders were known to the psychiatric services and the rest were found to be mentally ill at the time of the crime when they were tried in the court of law. Most of the offenders were suffering from a psychotic illness and one offender had a diagnosis of personality disorder. Half of the offenders had been to a traditional healer some time before committing the crime. Most of the offenders used a blunt instrument, 15 used sharp instruments and one woman used strangulation. Firearms were not used in committing parricide.

CONCLUSION

The study showed that sons committed most parricides. However, daughters committed matricide more frequently than patricide. Male offenders were 10 years younger than female offenders. In all cases both the offender and victim were African, and lived in the same house in the rural areas of Zimbabwe. Psychosis among the offenders had substantially increased the risk of parricide.