A firearm double homicide committed by a paranoid neigh- bor: a psychopathological study.

Abstract: Serious mental illness is associated with a higher risk of violent interpersonal behavior. Characteristic traits denoting a psychopatho-logical picture such as schizophrenia, depression, a borderline, or narcissistic, antisocial, or paranoid personality disorder, are frequently observed in the personality of those who have committed one or more murders. For example, mass murderers are affected by a delusional syndrome with a persecution fixation, that develops in a subject with a paranoid, anacastic personality disorder. An abnormal mental frame-work develops as a consequence of continual experiences interpreted as traumatic. We present a complex case regarding a double murder whose vic-tims were shot by a 50-year-old neighbor, who underwent a psychiatric evaluation for the assessment of criminal responsibility. In the light of the historical reconstruction of his relation sensitive delusional mindset that triggered the final reaction, his life history, the "key event" and the "triggering environment" (constant conflictual and dysfunctional rela-tions with others) led to the violence. The correct understanding of the reported case demands investigation not only of the clinical, diagnostic and psychodiagnostic aspects, but also of the perpetrator-victim/s, their relational context and the situation where the crime evolves, in order to be able to reconstruct the event in a meaningful manner.

From doctor to incendiary nun: the importance of analysing the pathways of trauma.

ABSTRACT: Childhood traumatic experiences have often been associated with the development of severe psychiatric disorders or, at least, with serious impairment in the victims' developing personality. Emotional abuse and neglect can cause gradual damage to Self-image and to models of self-in-relation to Others. We report a case of a woman who underwent psychiatric evaluations for marriage annulment. The issues were the as-sessment of the outcomes of early psychic trauma and the examination of the remaining individual capacities from a judicial standpoint. The examiners found that the memories of the woman's history of childhood abuse had become integrated into her personality organization. The spheres most strongly influenced were those of psycho-sexual/affective maturation and a dysfunctional bond with religion. Psychodiagnostic evaluation diagnosed a Borderline Personality Disorder. The complexity of the case suggests the need of a multi-dimen-sional analysis by an interdisciplinary team including experts in legal medicine, forensic psychiatry and psychology as well as clinical crimi-nology.

A para-religious setting for financial exploitation of the mentally incapacitated: when the habit doesn't make a monk.

ABSTRACT: Exploitation and circumvention of the mentally incapacitated is a criminal offence listed in the Italian penal code (Penal Code Art. 643). It involves the exploitation and circumvention of people who are fragile and vulnerable owing to their health conditions and/or mental status, and fits into the grey area between such subjects' freedom to make decisions about their physical conditions and economic assets, and the abuse of their trust perpetrated by third parties for personal gain. The authors describe a case of financial exploitation and circumven-tion of a married couple that is remarkable in view of both the huge sums extorted from the victims and the duration of the peculiar illicit activities (that lasted more than 10 years). These were perpetrated by a charismatic figure leading a "para-religious" group. He claimed to be a prophet, but his private life was highly questionable. The method of ascertainment used to verify the victims' mentally incapacitated state is described, analyzed and commented; the diagnosis could not be deferred in view of the characteristics of the prolonged penal offences committed.

Multiple stab wounds: understanding the manner of death through the psychological autopsy.

A 48-year-old physical therapist with no history of psychiatric disorders or suicidal tendencies was found dead by his relatives inside his apartment. Multiple stab wounds were present on the chest and the abdomen. Several more superficial cuts were also seen on the neck and the left wrist. At the death scene, there was a large pool of blood in the room, with secondary droplets and stains; a kitchen knife was found beside the body, and a suicide note on a table. Especially the number of wounds raised strong suspicion of a homicide in the first instance but some circumstances (the farewell letter, the absence of clothing injuries, no signs of third-party involvement) and autopsy findings (absence of defense or blunt injuries, the localization of the wounds, the presence of hesitation marks) pointed toward a suicide etiology. Because of the many stab injuries and the lack of a psychiatric history, further forensic investigations were required including a so-called psychological autopsy. This case report highlights that only a comprehensive interpretation of all the elements (circumstances, the scene of death, autopsy findings, and psychological autopsy) can lead to the correct solution of atypical cases of suicide.

Occupational asphyxiation by unknown compound(s): environmental and toxicological approach.

During a routine truck-tank washing operation, five healthy workers were found motionless inside an empty tanker. Four of them died inside the tanker while the fifth died the following day in hospital. Since the true nature of the fatal compound(s) were not known, a rigorous environmental and toxicological approach supported by autopsy findings was essential to clarify the cause of death. Environmental results indicated that H(2)S fumes arising from the liquid sulfur previously shipped were responsible for the serial deaths, also confirmed by a simulation performed on two similar truck-tanks. These environmental findings were supported by toxicological analyses through the measurement of thiosulfate, one of the main H(2)S metabolites. Abnormal thiosulfate concentrations from 1.1 to 186.2 mg/kg were revealed in all post-mortem biological samples (blood, lung, liver, kidney, brain and fat). Finally, the cluster analysis performed on thiosulfate body distribution contributed to establishing the time of death according to the accident scene reconstruction. This report presents valuable findings in correctly identifying the cause of death in gas asphyxiation cases by unknown compound(s).