Psych · Forensic psychiatry — homicide
Homicide and mental disorder
Also known as Psychotic homicide · Abnormal homicide · Homicide due to mental disorder · First-episode psychosis homicide · Filicide mental illness · Homicide-suicide · Schizophrenia homicide · Mental impairment homicide · NGRI homicide · Forensic homicide assessment
Exam-exhaustive fellowship reference on homicide and mental disorder — absolute vs relative risk, myth versus epidemiology, first-episode untreated psychosis concentration, substances and personality pathways, domestic/filicide/homicide-suicide subtypes, criminal responsibility interface, post-homicide forensic assessment, secure pathway and multi-agency public protection principles. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
A 21-year-old man is brought to the police cells after his mother is found dead at home. For seven months the family had watched him stop sleeping, stop washing, and start barricading his bedroom door. Nobody had ever referred him anywhere.[5][22]
In the cell he is guarded, frightened, and says his mother "was not really her any more". He has never seen a psychiatrist, never taken an antipsychotic, and has no criminal history whatsoever.[5][6][19]
Two examiner questions are already live: what was his mental state at the moment of the killing, and what does this case tell us — and not tell us — about homicide risk in psychosis? The second question is where most candidates lose marks.[1][17]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Taylor PJ, Gunn J Homicides by people with mental illness: myth and reality Br J Psychiatry, 1999.PMID 10211145
- [2]Large M, Smith G, Swinson N, et al. Homicide due to mental disorder in England and Wales over 50 years Br J Psychiatry, 2008.PMID 18669997
- [3]Shaw J, Hunt IM, Flynn S, et al. Rates of mental disorder in people convicted of homicide. National clinical survey Br J Psychiatry, 2006.PMID 16449701
- [4]Meehan J, Flynn S, Hunt IM, et al. Perpetrators of homicide with schizophrenia: a national clinical survey in England and Wales Psychiatr Serv, 2006.PMID 17085616
- [5]Nielssen O, Large M Rates of homicide during the first episode of psychosis and after treatment: a systematic review and meta-analysis Schizophr Bull, 2010.PMID 18990713
- [6]Large M, Nielssen O Evidence for a relationship between the duration of untreated psychosis and the proportion of psychotic homicides prior to treatment Soc Psychiatry Psychiatr Epidemiol, 2008.PMID 17960314
- [7]Eronen M, Hakola P, Tiihonen J Mental disorders and homicidal behavior in Finland Arch Gen Psychiatry, 1996.PMID 8639032
- [8]Fazel S, Gulati G, Linsell L, et al. Schizophrenia and violence: systematic review and meta-analysis PLoS Med, 2009.PMID 19668362
- [9]Witt K, van Dorn R, Fazel S Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies PLoS One, 2013.PMID 23418482
- [10]Shaw J, Hunt IM, Flynn S, et al. The role of alcohol and drugs in homicides in England and Wales Br J Psychiatry, 2006.PMID 16869841
- [11]Nielssen O, Bourget D, Laajasalo T, et al. Homicide of strangers by people with a psychotic illness Schizophr Bull, 2011.PMID 19822580
- [12]Flynn SM, Shaw JJ, Abel KM Filicide: mental illness in those who kill their children PLoS One, 2013.PMID 23593128
- [13]Flynn S, Gask L, Appleby L, et al. Homicide-suicide and the role of mental disorder: a national consecutive case series Soc Psychiatry Psychiatr Epidemiol, 2016.PMID 27086087
- [14]Oram S, Flynn SM, Shaw J, et al. Mental illness and domestic homicide: a population-based descriptive study J Interpers Violence, 2013.PMID 23820784
- [15]Rodway C, Flynn S, While D, et al. Patients with mental illness as victims of homicide: a national consecutive case series Lancet Psychiatry, 2014.PMID 26360576
- [16]Flynn S, Ibrahim S, Kapur N, et al. Mental disorder in people convicted of homicide: long-term national trends in rates and court outcome Br J Psychiatry, 2021.PMID 32624025
- [17]American Academy of Psychiatry and the Law AAPL Practice Guideline for forensic psychiatric evaluation of defendants raising the insanity defense J Am Acad Psychiatry Law, 2014.PMID 25492121
- [18]Douglas KS, Guy LS, Hart SD Psychosis as a risk factor for violence to others: a meta-analysis Psychol Bull, 2009.PMID 19702378
- [19]Keers R, Ullrich S, Destavola BL, et al. Association of violence with emergence of persecutory delusions in untreated schizophrenia Am J Psychiatry, 2014.PMID 24220644
- [20]Appelbaum PS, Robbins PC, Monahan J Violence and delusions: data from the MacArthur Violence Risk Assessment Study Am J Psychiatry, 2000.PMID 10739415
- [21]Fazel S, Grann M The population impact of severe mental illness on violent crime Am J Psychiatry, 2006.PMID 16877653
- [22]Nielssen OB, Westmore BD, Large MM, et al. Homicide during psychotic illness in New South Wales between 1993 and 2002 Med J Aust, 2007.PMID 17371211
- [23]Flynn S, Abel KM, While D, et al. Mental illness, gender and homicide: a population-based descriptive study Psychiatry Res, 2011.PMID 20724002
- [24]Fazel S, Singh JP, Doll H, et al. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis BMJ, 2012.PMID 22833604