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Background and Aim: The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia., Methods: A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol". Abstract selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively., Results: Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into "early-starters" and "late-starters" according to the age of onset of their antisocial and violent behavior. The violence of the "early-starters" is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the "late-starters", the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not., Conclusion: Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Abstract: Schizophrenics are at increased risks of violence and of committing homicide as compared to the general population. The objective of this review was to examine which factors were associated with schizophrenia, and to assume a “homicidal crisis” and an analysis tool of the homicidal potential. First, the authors highlighted that male gender, a young age, a low socioeconomic status, a history of violence and alcohol abuse could be considered as general homicide-related factors, while drug abuse, personality disorders, clinical paranoia, delusions of persecution, religious or not, delusions of grandeur, lack of insight, disorganized thinking, a lengthy duration of untreated psychosis, or a monitoring or treatment which were discontinued were more schizophrenia-specific factors for homicide. Secondly, the urgency of homicide plans (place, time, conception, preparation of the homicidal scenario, frequency and intensity of homicidal thoughts) needed to be completed by the danger of the homicide itself (lethality and accessibility of murder weapon). The relationship between past and current episodes of aggressive behaviour reinforces the importance of including a careful assessment of past history of violent behaviour as part of the routine psychiatric evaluation. [Copyright &y& Elsevier]

Introduction: The spousal homicide is committed on a partner or ex-partner of intimate life whatever the stature of this one. In France, it represents about 20% of total homicide. Its multifactorial origin makes its spotting complex. Objective: The aim of this study is to determine predictive factors of acting out, by analyzing sociodemographical, psychopathological and criminological features of men committing spousal homicide. Method: It is a descriptive and retrospective study of 37 spousal homicides (or attempts of homicides) files judged between 1999 and 2010 by the Court of Appael of Poitiers. An important number of variables concerning the perpetrators, the victims and the facts have been searched. Then, they have been sorted to establish profiles. Results: Men stand for 88% of spousal homicides perpetrators. Most of them are impulsive (80,4%), have a judicial (64,8%) and domestic violence (70,3%) previous history. Half drinks excessively. The acting out is often motivated by the couple breaking up (64,8%). Homicide is frequently committed with an excessive violence (54%). Before the crime, about half of the perpetrators had expressed death or suicide threats. Conclusion: Our study showed that spousal homicide is an unpremeditated act committed by men, facing the difficulty to accept their partner leaving. This crime is often linked to domestic violence and chronical alcoholism. Emphasizing these profiles allow to offer better-aimed prevention measures. [Copyright &y& Elsevier]

Objective: The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk. Methods: A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials. Results: Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions. Conclusions: We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence. [Copyright &y& Elsevier]