Serial killing in schizophrenia.

Serial criminality, although rare, has always aroused the interest of researchers in criminology, psychiatry, psychology, and sociology. We report the case of a patient, suffering from a chronic psychotic disorder, having committed several murders over a period of 9 years, underpinned by a delirium of misidentification of Frigoli syndrome.

Correlates of psychopathy in a Tunisian sample of incarcerated women.

BACKGROUND: Considerable effort has been devoted to elucidating correlates of psychopathy in males, but only few researchers have turned their attention to this field in female counterparts, with most of the research in this field having been driven from western countries. We aimed to explore psychopathic traits, impulsiveness and psychiatric symptoms that characterize a Tunisian female prison population. METHOD: Data were collected in a cross-sectional design during September 2017. The sample was comprised of 100 adult females who were incarcerated at the "Manouba Women's Prison" at the time of the survey. The Levenson Self-Report Psychopathy Scale, the Barratt Impulsiveness Scale, and The Brief Symptom Inventory were used. RESULTS: In the univariate analysis, socioeconomic level (p = .001), tobacco use (p = .001), poly drug use (p = .014) and physically aggressive behaviors in the 6 months before incarceration (p = .043) were significantly associated with psychopathy total scores. After multivariable adjustment, motor impulsiveness (ß = 0.426, p < .01) and phobic anxiety (ß = 0.284, p < .05) contributed significantly to the variance of psychopathy total scores. CONCLUSION: The current findings not only add to the growing body of literature on female psychopathy, but also help inform decision making about mental health-related programs and policies in female prison settings in underdeveloped and underrepresented countries similar to our sociocultural context.

Homicide committed by individuals with severe mental illnesses: A comparative study before and after the Tunisian revolution of January 14th, 2011.

BACKGROUND: Many studies have established a correlation between the increase of homicide rates, and economic crises and rapid social changes following historical events. We propose to analyse the impact of the Tunisian Revolution on homicide rates in Tunisia in a clinical population. METHODS: We conducted a retrospective comparative study of all individuals who commited an homicide and were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 2004 and December 31st, 2018 after a decision of irresponsibility by reason of insanity. RESULTS: The number of homicides committed by the individuals with mental illness included in our study was multiplied by a factor of 1.3 after the revolution, with a prevalence of 11.0% between 2004 and 2011, compared to a prevalence of 14.7% during the period 2011-2018. No significant difference was noted between the two groups regarding the socio-demographic characteristics or the characteristics of the act committed. CONCLUSION: Our results highlighted that political and socio-economic crises following the Tunisian revolution significantly contributed to an increase of homicide rates in people with severe mental illness. Thus, macro-level socioeconomic determinants would be important to consider in homicide prevention strategies.

The link between sleep disturbances and suicidal thoughts and behaviors in remitted bipolar I patients.

OBJECTIVE: We aimed to evaluate the links between different sleep parameters and suicidal ideation and behavior in remitted bipolar I patients. METHODS: One hundred eight remitted bipolar I patients were recruited from the psychiatry department of Razi Hospital. The third item of the "Hamilton Depression Rating Scale" was used to evaluate current suicidal behaviors. Circadian typology, daytime sleepiness and sleep quality were evaluated using the "Horne and Ostberg Morningness-Eveningness Questionnaire," the "Epworth Sleepiness Scale," and the "Pittsburgh Sleep Quality Index," respectively. RESULTS: Current suicidal ideation and behavior were significantly associated with circadian typology, daytime sleepiness, and sleep quality. After controlling for demographic variables (age and gender) and psychosocial factors (depression and substance use), suicidal ideation significantly contributed to sleep quality. Depression was a significant predictor within the second step when entered with other psychosocial variables; however, once suicide variables were included, depression was no longer a significant predictor. CONCLUSIONS: An evaluation of sleep's quality should be included in the suicide risk assessment of bipolar I patients.

Correlates of offense recidivism in patients with schizophrenia.

INTRODUCTION: Schizophrenia increases the risk of offending. Recidivism rates are significant. Literature doesn't provide recidivism risk factors specific to patients with schizophrenia independently of the offenses' types. OBJECTIVE: Identifying recidivism risk factors in schizophrenia patients independently of the offenses' types. METHODS: We conducted a case-control study. All included patients were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. Univariate and multivariate analyses were performed to identify recidivism risk factors. RESULTS: We included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in poor urban neighborhoods (P = 0.023; OR = 4.86), having been unemployed (P = 0.042; OR = 2.18) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.026; OR = 4.89) and cannabis use disorders (P = 0.018; OR = 6.01). A hospitalization shorter than 6 months multiplied the risk by 1.79 (P = 0.046). A combination of conventional antipsychotics (P = 0.023; OR = 4.81) and a poor adherence to treatment (P = 0.001; OR = 10.42) were considered as recidivism risk factors too. CONCLUSIONS: All eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients' families, society and the government should be undertaken.

Postictal Delirium and Violent Behavior in Patients with Post-Neurosurgical Epilepsy.

BACKGROUND: Neurosurgical brain interventions may result in lesions that can cause epilepsy. Diagnosis may be delayed in some situations. Meanwhile, violent behavior can occur during postictal delirium states. Although benign behavioral manifestations are well documented in literature, violent offenses in post-neurosurgical epilepsy have been rarely reported. Here we describe 2 such cases, focusing on management and emphasizing the need for prevention. CASE DESCRIPTION: Both patients were suffering from post-neurosurgical epilepsy and offended during postictal delirium states. The first patient had generalized epilepsy and committed an attempted rape. The second patient had temporal lobe epilepsy and committed an attempted homicide. Both patients were well managed using anticonvulsant medication after the offenses. CONCLUSIONS: Early diagnosis and regular follow-up are measures to take into consideration to prevent violent behavior in patients with post-neurosurgical epilepsy.

Matricide in schizophrenia : a case report.

INTRODUCTION: matricide is the murder of the mother. In this study, we report through a clinical case the circumstances of matricide and we underlined the predictive elements of the acting out. CLINICAL CASE: mister S, 31 years old had low socioeconomic conditions. He was a single man, unemployed and consumed alcohol. He was followed for a paranoid schizophrenia, but his therapeutic observance was bad, and he was aggressive with his mother. This aggressiveness was fostered by persecution and filiations' delusions. At the moment of the crime, his mother had appeared to him as so terrifying form that he had to kill her to defend itself. This clinical case confronts us with the difficulty of matricide prevention. If the short term prediction of the violence act was possible, the medium and long terms were harder. CONCLUSION: the regular evaluation of psychotic patients' dangerousness is needed to reduce the acting out risqué.

[Psychotic parricide: clinical and analytic study of 16 cases]. / Le parricide psychotique: etude clinique et analytique. A propos de 16 cas.

BACKGROUND: The parricide is defined as "murder of the father or the mother or any other legitimate ascendant." It represents 1 to 5% of all homicides and 20 to 30% of psychotic homicides. In Tunisia, few studies have focused on this issue. AIM: We propose in this work to describe the profile of psychotic parricide. We tried to identify risk factors in order to prevent this acting out. METHODS: Our study is retrospective we observed 16 male patients diagnosed with schizophrenia hospitalized between June 1979 and March 2008 in the forensic psychiatry department at the psychiatric hospital in Tunis, discharged for no ground for prosecution following parricide. RESULTS: They accounted for 20.8% of psychotic homicides hospitalized during the same period (16/77) and approximately 30% of homicides committed by schizophrenic patients. We found as many as patricide as matricide. The main factors that have emerged through our study are an early age (28 years), being single (70%), the socio-cultural poverty, unemployment, paranoid delusions, hallucinations and recent treatment interruption. All these factors have been cited by many authors including Millaud et al, they also cited history of violence and violent behavior and alcohol or drug abuse. One important point is that some signs of this imminent gesture are often present but misunderstood, such a sense of situational impasse, a request for help, or reluctance during interview. CONCLUSION: It is essential to identify risk factors, even to actively seek some warning signs, which often are not spontaneously reported by the psychotic patient. Hospitalization under constraint in psychiatry should be the appropriate response if these dangerousness signals are noticed by the psychiatrist.