Patricide and schizophrenia – A case report

Abstract

I wish to bring for your attention the case of S.L.R., single, male, retired and inmate of the Complexo Hospitalar do Juquery. According to the police, the patient (48 years) struck iron shots to the head of his father (73 years) who was sleeping and caused his death. He would have discussed with the victim who asked the son to leave the house and not having accepted such request he decided to kill him. The defendant reported that on the day of the crime, his head was “a thousand degrees”, he heard voices of his father and neighbors, he thought that people wanted to kill him, a woman would have voodoo to kill his father, he couldn’t sleep, he was agitated and without receiving haloperidol decanoato injection for four years. According to reports from his family members, the patient’s father was psychotic and violent. There are many relatives who suffer from mental illness and others committed homicides. The patient is coming from the countryside and with unfinished basic education. He was engaged twice for a few years. One of the his women was assaulted often by him, once he threw her from a ravine and she fractured her skull. He had the habit of killing animals. He changed his behavior at age 25 after his mother’s death. He became aggressive and began to have hallucinations, incoherent thought and persecutory delusions. He was admitted to the psychiatric hospitals and he followed treatment outpatient irregularly. The patient lived with his father for more than ten years, the relationship was bad, they attacked each other and he always talked about killing his father. The patient violently assaulted his father a year before the murder. Some days before the murder, father and son were fighting, the patient was seen with erratic behavior, disorganized speech, delusions, hallucinations and repeatedly said he wanted “blood and kill”. After the murder the patient told a neighbor: “I killed that damn old man and still turned on the light to see if he was dead”. Then he said he wanted to kill his neighbours and killed a dog. He was found by a brother-in-law and he said that he wished to kill the whole family. He was captured by the police in a bus station in a near town, he was quiet and waiting his brother arrives. At the present, the patient occasionally has periods of intensification of productive symptoms with homicide and suicidal ideation even hospitalized and in regular use of depot antipsychotic. Currently the patient reveals mannerisms, residual persecutory delusions and inappropriate affect. He meets diagnostic criteria for Paranoid Schizophrenia. Parental homicide or parricide is defined as murder of the father or the mother or any other legitimate ascendant and patricide is defined as murder of the father (predominantly committed by sons). It is a rare crime, represents 2%-3% of homicides in general and 20% to 30% of psychotic murders1,2,4. The relationship between mental illness and violence has been controversial, for some authors schizophrenia is associated with an increased risk of violence while other authors claim that this mental illness must not be considered dangerous1-3. Several studies show that the subtype paranoid schizophrenia, persecutory delusions, auditory hallucinations, a history of violent acts, the association of use of alcohol or drugs and stopping the use of antipsychotic medication or absence of treatment increase the risk of violent behavior1-5. The case reported is congruent with the literature described. The most common diagnosis among the patricides is schizophrenia and a review of the literature reveals that such offenders are usually male, young, unmarried, unemployed, living with his father in the countryside, have low education and low socio-economic level. The victim is usually dead in his bedroom and the attacker using sharp objects1-4. These crimes are not premeditated and can be precipitated by some misunderstanding, are brutal and abrupt, with affective indifference and often caused by persecutory delusions and command auditory hallucinations. Classically has been described an apparent “calming” the murderer after the crime and about half of them attempted suicide after the act1-4. The crime reported shows similarity to the revision of several authors and it can be concluded that adherence to psychiatric treatment, continuous use of antipsychotic medication (preferably in the form depot in cases of little cooperation), constant supervision of their acts, family support and hospitalization if necessary are actions more effective in reducing violent behavior or homicide among people who suffer from schizophrenia.