Le passage à l’acte homicidaire inaugural : mythe ou réalité clinique ?

Abstract

ObjectivesLiterature from the first half of the twentieth century describes unmotivated, brutal, irrational homicides, committed at the onset of a psychiatric illness, without precursor symptoms. This description is no longer found in contemporary scientific articles. Is homicide as the inaugural symptom for psychiatric disorder a truth or a myth? MethodsAfter reviewing international publications, the results of a retrospective descriptive study are presented. This study aimed to describe the patients who were admitted to a French secure unit (Henri Colin) over the past ten years after a homicide committed prior to any psychiatric care. Finally, two clinical cases illustrate these results. ResultsAmong the 19 patients, the large majority are men (94.8%), young adults (31.4 years on average), single (63.1%), and unemployed (63.1%). They have paranoid schizophrenia (63%), abuse substances (73.7%), and committed homicide in a delusional context. The offenders essentially suffer persecutory delusions but also religious and grandiose delusions. Most patients (89.5%) have disorders which have progressed for several months or even several years. DiscussionThe contemporary literature and the results of our study nuance the notion of homicide as the inaugural symptom for mental illness. Indeed, if the aggressors never had contact with mental health services before committing the homicide, they generally suffered from chronic disorders that had previously gone unnoticed. Different hypotheses can explain this delay in access to care: the patient's symptoms, his refusal to consult, his environment, or his socio-emotional isolation. ConclusionsNo particular sociodemographic, clinical, or criminological specificity is highlighted concerning homicides committed before any psychiatric care. Reflection and prevention are therefore based on early identification and intervention in the case of psychiatric disorders, particularly psychotic disorders.