[Murder of the doctor]. / L'omicidio del medico.

AIM: To examine possible risk factors for the doctor to be killed by the patient in the clinical practice by examining a series of murders that involved physicians. METHODS: This aim has been achieved through a retrospective review on clinical cases of doctors killed by patients within the period between 1988 and 2013, in Italy. RESULTS: In this period 18 Italian doctors have been killed in the workplace, with a rate of 0.3/100,000. In 7 cases, the murder resulted in the context of doctor-dissatisfaction; in 7 cases the murder was committed by a psychiatric patient; 1 case in the context of a stalking; 3 cases occurred in a workplace which was not safe enough. Four categories of at-risk contexts have been identified. One category includes a murder in the context of a doctor-dissatisfaction, perceived by patient. The second category concerns murders committed by patients suffering from mental illness. A third category includes homicides in a workplace which is not safe. The last category comprises the murder in the context of stalking. CONCLUSIONS: These categories identify specific dangerous situations for physicians, in which are highlighted elements that have played a crucial role in the murder and for which special precautions are suggested preventive.

[Suicidal contagion and collusion between therapist and patient]. / Il contagio e la collusione suicidaria tra terapeuta e paziente.

The purpose of the present study is to point out suicidal contagion and suicidal collusion describing clinical cases, to improve professional skills in suicidal risk evaluation and management. In suicide contagion we described three typologies of contagion between therapist and patient: 1) suicide contagion of the environment on the therapist and on the patient; 2) suicide contagion of the therapist on the patient; 3) suicide contagion of the patient on the therapist. We described also four typologies of suicidal collusion with specific kind of patients: 1) with patient suffering of physical illness; 2) with patient suffering of a serious mental illness; 3) with manipulative patients; 4) with patient who is aggressive toward himself and toward other people. In conclusion we pointed out the importance of an adequate recognizement and management of suicidal contagion and collusion to decrease patient suicidal risk.

[Psychopathology and risk of homicide committed by a patient with schizophrenia]. / Sulla psicopatologia e sulla valutazione del rischio dell'omicidio compiuto dal paziente con disturbo schizofrenico.

We describe, thirteen psychopathologic dynamics based on defense mechanism and primary process thinking, that could determined an homicide committed by a patient with schizophrenia. The purpose of this study is to allow: a) to improve diagnosis of the homicidal act; b) to emphasize psychopathological elements which can be treated by specific forensic psychotherapy; c) to prevent an homicidal recidivism through evaluation of risk passing to the homicidal act.

[Therapist's reactions on the treatment of suicidal patients]. / Reattività inadeguata del terapeuta nei confronti del paziente a rischio suicidario.

In the present study, we describe fourteen therapists' reactions (Avoidance, Rejection, Suicidal collusion, Over-involvement, Overprotection, Loss of patients' responsibilities, Loss of therapists' responsibilities, Reaction to the feeling of being exploited, Creation of dependency, Manipolatory acting out, Feeling of undergoing an iniquity, Patients psychopathology inflation, Therapists' psychopathology inflation, Suicidal Burnout Syndrome), based on emotions, behaviors and cognitivity, toward patients with suicidal risk. These responses can interfere with a correct assessment and management of suicidal risk in psychiatric patients. The purpose of the present clinical study was to improve therapist's professional skills through the recognition and management of his own responses to suicidal patients.