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Parricide, defined as the act of killing one's parent by a child, represents 2 to 3% of all homicides in France and North America, an incidence rate that remains relatively stable. This particular murder seems, to most people, an unthinkable act of violence andhas been a source of fascinationsince antiquity, becoming a founding myth. Double parricide (the murder of both parents) is less frequent, accounting for 2 to 3 cases per year in France. The double horror of the crime seems to definitively mark the offender as mad, but is the double parricide really the archetype of a schizophrenic acting-out? After a review of the scientific literature, we present two cases in order to explore the psychopathological profile of double parricide, by discussing clinical and criminological features. Apart from adolescent parricides (more rarely due to a mental disorder but rather to a subject suffering from severe abuse), characteristic features of mentally ill adult parricides emerge from the review of literature. Offenders are mostly young men, suffering from paranoid schizophrenia with persecutory delusions, substance use and/or antisocial comorbidity, living at the parental home. With regard to double parricide, case reports of the literature are consistent with this profile, but cohort studies find a real heterogeneity concerning the diagnosis (schizophrenia spectrum, but also mood disorders and personality disorders). We then describe two different cases of double parricide. The first patient, aged 22 and diagnosed with schizophrenia, commits a double parricide in a delusional context with mysticism and persecution. There is no premeditation, but a precipitating factor (a trivial dispute), and a history of repeated conflicts with his stepmother. The act is characterized by its brutality and a grandiose atmosphere, without remorse afterwards. The second patient, in her fifties, kills both parents during a partly premeditated, organized acting-out, with dissimulation. The double parricide occurs in a context of anger and even rage, rooted in a history of childhood abuse and exalted by an unstable psychological state due to a decompensated bipolar disorder. The literature review and our reported cases of double parricide highlight a complex psychodynamic substratum as well as the variety of psychiatric pathologies involved. If the first case appears to be pathognomonic of schizophrenic disorders, the second seems to be the result of a combination of mood elation, unresolved intrafamilial conflict, and emotional motivation. These results underline the excessive trend to attribute double parricide cases exclusively to schizophrenic disorders. However, one of our cases demonstrates that double parricide may be related to mood disorders and/or severe abuse. Thus, double parricide cannot be said to be the archetype of schizophrenia, and an analysis of the act should make use of a general psychopathological reflection that would include the existence of possible mood disturbances, as well as a systemic study of the family dynamic. [ABSTRACT FROM AUTHOR]

S'il existe une association maintenant établie entre schizophrénie et violence, le rôle médiateur d'un trouble de l'usage des substances psycho-actives associé est encore débattu. Les comorbidités addictives, retrouvées chez près de la moitié des sujets schizophrènes, expliqueraient principalement la délinquance de cette population, indépendamment du trouble mental. D'autres auteurs décrivent cependant l'existence de sous-groupes de schizophrènes violents pour lesquels l'émergence de comportements violents n'est pas nécessairement associée à la prise de substances psycho-actives. Le but de notre étude était d'évaluer la fréquence de trouble de l'usage de substances psycho-actives chez des sujets atteints de schizophrénie ayant commis des infractions pénales et de comparer les caractéristiques sociodémographiques, historiques, cliniques et criminologiques de ces sujets selon qu'ils présentaient un trouble de l'usage de substances psycho-actives associé ou non. Nous avons mené une étude descriptive à partir d'expertises psychiatriques réalisées entre 2001 et 2018 par un expert unique dans le cadre de procédures pénales. Tous les rapports impliquant des patients souffrant de schizophrénie ont été rétrospectivement inclus dans notre étude. Notre échantillon comportait 104 sujets atteints de schizophrénie et auteurs d'infractions pénales. Un trouble de l'usage de substances psycho-actives (USPA) était retrouvé chez 52 sujets (50 %). La comparaison des deux groupes ne faisait pas apparaître de différences significatives quant au type d'infractions commises. Cependant, on retrouvait des spécificités cliniques propres à chaque groupe. Ainsi, les sujets schizophrènes délinquants non-usagers de substances psycho-actives (NUSPA) présentaient significativement plus d'antécédents judiciaires de violence envers autrui (73,9 % VS 42,3 % ; p = 0,026) et une symptomatologie psychotique aiguë au moment des faits (67,3 % VS 30,8 %, p < 0,001). L'expert retenait majoritairement une abolition du discernement dans le groupe NUSPA (68,6 VS 32,7 ; p < 0,01) et une altération du discernement chez les sujets schizophrènes usagers de substances psycho-actives (USPA) (31,4 % VS 67,3 % ; p < 0,01). La moitié des délinquants schizophrènes ne présentait pas de trouble de l'usage des substances comorbide. Le risque accru de délinquance des sujets atteints de schizophrénie ne peut donc pas être uniquement attribué aux effets de l'usage de substances associé. La délinquance associée à la maladie schizophrénique, en dehors de tout usage de substances psycho-actives, présente quelques particularités justifiant la poursuite d'études plus approfondies. Although the association between schizophrenia and violence has been established, the mediating role of associated substance use disorder is still debated. Addictive comorbidities, identified in almost half of people with schizophrenia, are considered to be a main explanation for delinquency in this population, regardless of the mental disorder. However, some authors describe the existence of sub-groups of subjects with schizophrenia who may be violent and for whom substance-related disorders would not always be necessary for the emergence of violent behaviors. The purpose of this study was to assess the frequency of substance use disorders in subjects with schizophrenia who had committed criminal offenses and to compare the socio-demographic, historical, clinical, and criminal characteristics of these subjects with and without an associated substance use disorder. We conducted a descriptive study based on forensic reports realized between 2001 and 2018 from a single expert in criminal cases. All reports involving patients suffering from schizophrenia were retrospectively included in our study. Our sample consisted of 104 subjects suffering from schizophrenia and having committed criminal offenses. A psychoactive substance use disorder (USPA) was found in 52 subjects (50%). There were no significant differences between the two groups in the pattern of infractions committed. However, there were clinical specificities in each group. Thus, offenders with schizophrenia who were non-users of psychoactive substances (NUSPA) had significantly more criminal history of violence against others (73.9% vs. 42.3%; p = 0.026) and more acute psychotic symptoms at the time of the offense (67.3% vs. 30.8%, p < 0.001). The expert more often retained an abolition of discernment in the NUSPA group (68.6 VS 32.7; p < 0.01) and a diminished discernment in schizophrenic subjects using psychoactive substances (USPA) (31.4% VS 67.3%; p < 0.01). Half of the schizophrenic offenders did not have a comorbid substance use disorder. The increased risk of delinquency in subjects with schizophrenia cannot only be attributed to the effects of associated substance use. There is delinquency associated with schizophrenic illness, apart from substance use, that has some specific characteristics that warrant the pursuit of further studies. [ABSTRACT FROM AUTHOR]

Le parricide, défini comme le meurtre sur ascendant, représente 2 à 3 % des homicides en France. Si cette incidence est relativement faible, le double parricide (meurtre du père et de la mère) est encore plus rare, estimé à 2 à 3 cas par an. La double horreur du crime semble signer la folie de l'auteur, mais le double parricide est-il réellement archétypique d'un passage à l'acte schizophrénique ? Après une revue de la littérature, nous exposons deux vignettes permettant d'explorer la dynamique psychopathologique de l'acte, en discutant les éléments cliniques et criminologiques. Dans la littérature, à l'exclusion des parricides adolescents (plus rarement le fait d'un trouble mental mais plutôt d'un sujet victime de maltraitance sévère), un profil-type du parricide adulte se dégage : un homme jeune, atteint de schizophrénie paranoïde avec un appoint toxique, une comorbidité antisociale, vivant au domicile parental dans une impasse situationnelle. Dans les cas de double parricide, si les vignettes cliniques de la littérature retrouvent ce profil, les études de cohorte relèvent une hétérogénéité diagnostique (troubles du registre schizophrénique, mais aussi troubles de l'humeur et troubles de la personnalité), également présente dans les deux cas que nous exposons. La revue de littérature et les cas présentés de double parricide mettent en lumière un substratum psychodynamique complexe ainsi qu'une diversité des pathologies psychiatriques en jeu. Si le premier cas apparaît pathologique sur un mode anté-oedipien schizophrénique, le second semble le résultat d'une combinaison entre élation de l'humeur, conflit intrafamilial ancien et motivation émotionnelle. Les éléments présentés permettent d'ouvrir la discussion et de relativiser la tendance à attribuer les cas de double parricide exclusivement à des troubles du registre schizophrénique. L'analyse de l'acte doit intégrer une réflexion psychopathologique globale incluant l'existence d'éventuelles perturbations de l'humeur, mais aussi une étude de la dynamique familiale dans sa compréhension systémique, afin de préciser le rôle respectif de chacun de ces facteurs dans la génèse du passage à l'acte. Parricide, defined as the killing of a parent by a child, accounts for 2 to 3% of all homicides in France and North America, an incidence rate that remains relatively stable. Considered by most to be an unthinkable act of violence, parricide has fascinated human beings since antiquity, becoming a founding myth. Double parricide (murder of both parents) is less frequent, accounting for 2 to 3 cases per year in France. The double horror of the crime seems to signal the offender's delirium, but is double parricide really characteristic of schizophrenic acting out? After a review of the scientific literature, we report two cases in order to explore the psychopathological profiles of perpetrators of double parricide, discussing clinical and criminological features. Apart from adolescent parricides (more rarely the result of a mental disorder but rather concerning subjects suffering severe abuse), characteristic features of mentally ill adult perpetrators of parricide emerge from the review of literature. Offenders are mostly young men presenting paranoid schizophrenia with persecutory delusions, substance use and/or antisocial comorbidity, living at the parental home. With regard to double parricide, case reports in the literature are consistent with this profile, but cohort studies find a real heterogeneity concerning diagnosis (schizophrenia spectrum, but also mood disorders and personality disorders). We describe two different cases of double parricide. The first patient, aged 22 and diagnosed with schizophrenia, committed a double parricide in a delusional context involving mysticism and persecution. There was no premeditation, but a precipitating factor (a trivial dispute), and a history of repeated conflicts with his step-mother. The act was characterized by a brutal killing and a megalomaniac atmosphere, without remorse afterwards. The second patient, in her fifties, killed both parents during a partly premeditated, organized acting out, with dissimulation. The double parricide occurred in a context of anger and even rage, rooted in a history of abuse since her childhood and exalted by an unstable psychological state due to a decompensated bipolar disorder. The literature review and our reported cases of double parricide highlight a complex psychodynamic substratum as well as the involvement of a variety of psychiatric pathologies. If the first case appears to be pathognomonic of schizophrenic disorders, the second seems to be the result of a combination of elated mood, long-standing intrafamilial conflict and emotional motivation. These results underline the excessive trend of attributing double parricide cases exclusively to schizophrenic disorders. Alongside, one of our cases demonstrates that double parricide can be related to mood disorders and / or severe abuse. Therefore, double parricide is not characteristic of schizophrenia and the analysis of the act should integrate psychopathological reflection, including possible mood disorders, and should also study family dynamics in its systemic understanding. [ABSTRACT FROM AUTHOR]