Some factors related to guilty behavior in patients with mood disorders

Nội dung text: Some factors related to guilty behavior in patients with mood disorders

1. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 SOME FACTORS RELATED TO GUILTY BEHAVIOR IN PATIENTS WITH MOOD DISORDERS Nguyen Thanh Quang*; Bui Quang Huy**; Ngo Ngoc Tan** SUMMARY Objectives: To study some factors related to guilty behavior in patients with mood disorders. Subjects and methods: A prospective study on 83 patients with mood disorders (69 depressive disorders, 14 mental disorders) ranged from 20 to 69 years of age, was conducted by law enforcement agencies for mental health assessment from February 2012 to March 2017 at Bienhoa National Institute of Forensic Psychiatry. Results: Pathological factors predominated in 60.24% of guilty patients. Socio-psychological stress was present in 19.28% of these patients and 12.05% of the patients often use alcohol-beer. Most patients committed crimes in the progression of the diseases (66.27%). Most guilty behaviors were closely associated to the relationship between patients and victims. There was no difference in criminal acts between men and women. Such behaviors as homicide and then suicide, public disturbances and other forms of offense are mainly encountered in the age of over 40. The symptoms of delusions, hallucinations do not have a siginificant effect on the offense of patients. Conclusion: Pathological factors are very common in patients with mood disorders. Most patients commit crimes during progression of disease, but delusion and hallucinations do not affect markedly the offense of patients. * Key words: Mood disorder; Guilty behavior; Criminal act; Offense. INTRODUCTION industry as well as law enforcement agencies reduce criminal rate in these patients. Guilty bahavior in patients with mood Because of these above reasons, we disorders is of great popularity, being conducted this study. public’s great concern, however, it creates discrimination against mental illness. SUBJECTS AND METHODS According to Sadock B.J (2007), these - A prospective study on 83 patients behaviors include theft, intentionally inflicting with mood disorders (69 depressive disorders, injury, financial fraud, homicide, murder 14 mental disorders), 20 to 69 years of followed by suicide. age, were conducted by law enforcement The offenses of patients with mood agencies for mental health assessment disorders are governed by many external from February 2012 to March 2017 at factors. A study on the factors involved Bienhoa National Institute of Forensic in criminal acts will help the mental health Psychiatry. * Bienhoa National Institute of Forensic Psychiatry ** 103 Military Hospital Corresponding author: Bui Quang Huy (bshuy2003@yahoo.com) Date received: 11/07/2017 Date accepted: 21/11/2017 - Use the item F3 from diagnostic criteria of ICD-10 (1992) for mood disorder. 182
2. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 - Use cross-sectional descriptive research. The data was processed and analyzed on IBM SPSS statistic 20 program. RESULTS Table 1: Some pathological and exotic factors that provoke offense. Statistic analysis N° n = 83 % Factors 1 Pathological factors 50 60.24 2 Non-pathological factors 33 39.76 1 Family conflicts 9 10.84 2 Psychosocial stressors 16 19.28 3 Financial difficulties 14 16.87 4 Alcohol abuse 10 12.05 5 Drug use 4 4.82 6 Childhood stress history 2 2.41 7 Other motivational factors 3 3.61 The results in the table show that 60.24% of criminally ill patients were affected by mood disorders and only 39.76% of the offenders were due to non-pathological conditions. The difference was not statistically significant with p > 0.05 (Binomial = 50.00; p = 0.079). Of the exogenous factors, psychosocial stress accounted for the highest proportion (19.28%), financial difficulties (16.87%), alcohol use (12.05%), family conflict (10.84%), drug abuse (4.82%), and history of childhood injuries (2.41%) and other motivating factors (3.61%). This finding is consistent with Kaplan H.I’s (1994), who argues that the majority of crimes are due to pathological factors and exogenous factors such as psychosocial stress, alcohol abuse, familial conflict... push off the offender's mental disorder. Table 2: Different stages of illness at the time of the patients’ offense. Offenses Patients N° Period n = 83 % 1 Progressive stage 55 66.27 2 Stable period 5 6.02 3 Disease-free period 23 27.71 Table 2 shows that committing crimes during the progressive stage of illness was the highest (66.27%), followed by disease-free period (27.71%) and in the period of stabilization, guilty behavior accounted for only very low rate (6.02%). The difference 183
3. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 was statistically significant with p < 0.001 2(2) = 46.36; p = 0.000). According to DSM 5 (2013), patients with bipolar disorder tend to commit most crimes in the course of disease progression, with only a small proportion of patients committing offenses during the stable period of their illness. Table 3: The relationship between victims and the forms of criminal acts in patients with mood disorders. Victims Family Neighbors and Strange Social p members friends persons organizations Forms of criminal acts n = 15 % n = 23 % n = 32 % n = 13 % Intentional injury 1 6.67 6 26.09 7 21.88 0 0.00 Theft 1 6.67 1 4.35 2 6.25 2 15.38 > 0.05 Public disturbances 0 0.00 0 0.00 0 0.00 1 7.69 Homicide 5 33.33 8 34.78 1 3.13 0 0.00 < 0.01 Murder and then suicide 8 53.33 0 0.00 0 0.00 0 0.00 < 0.01 Robbery 0 0.00 0 0.00 8 25.00 1 7.69 < 0.01 Other forms of offense 0 0.00 8 34.78 14 43.75 9 69.23 < 0.01 Investigating the relationship between the victim and forms of offense shows a wide variety of behaviors, but there was statistically insignificant difference in the act of intentionally inflicting injury, theft and public disturbances (p > 0.05, with Fisher's Exact Test = 5.428, 1.822, 4.032, p = 0.123, 0.742, and 0.157). The victim are mainly murders’ relatives (33.33%), friends and neighbors (34.78%). Murder followed by suicide is most likely to harm family members (53.33%). Most of the strange people were subjected to robbery (25.00%). The differences were statistically significant with different values p < 0.01 and p < 0.001 (Fisher's exact test = 9,610 to 25,610, p = 0.008 to 0.000). The most common victims were social organizations (69.23%), followed by unrelated people (43.75%) neighbors and friends (34.78%). The difference was statistically significant with p < 0.01 (2 (3) = 16.974; p = 0.001). Our study is in line with the opinion of Dan J. Stein (2006), Ngo Van Vinh (2011), who argued that homicide, suicide followed by homicide occur to either relatives or neighbors of the patients. Table 4: Relationship between sex and forms of offense in patients with mood disorders. 184
4. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 Sex Male Female p Forms of offense n = 53 % n = 30 % Intentional injury 10 18.87 4 13.33 Homicide 11 20.75 3 10.00 Murder followed by suicide 5 9.43 3 10.00 Theft 3 5.66 3 10.00 > 0.05 Robbery 7 13.21 2 6.67 Public disturbances 1 1.89 0 0.00 Other forms of offense 16 30.2 15 50.00 There was not statistically significant difference between male and female offenders (p > 0.05; with 2 = between 0.418 - 3.213 and p = 0.073 - 0.518 and Fisher's exact test with p = 0.477 - 1.000). Table 5: Relationship between age and forms of offense in patients with mood disorders Years of age 20 - 29 30 - 39 ≥ 40 Total Forms of offense n 4 7 3 14 Intentional injury % 28.57 50.00 21.43 100 n 8 2 4 14 Homicide % 57.14 14.29 28.57 100 n 1 2 5 8 Murder followed by suicide % 12.50 25.00 62.50 100 Theft n 3 0 3 6 % 50.00 0.00 50.00 100 n 7 1 1 9 Robbery % 77.78 11.11 11.11 100 n 0 0 1 1 Public disturbances % 0.00 0.00 100 100 n 5 9 17 31 Other forms of offense % 16.13 29.03 54.84 100 Table 5 shows that the behavior of intentional injuries at the age of 30 took up 50.00%, the robbery and homicide aged 20 accounted for 77.78% and 57.14% in the group, respectively; Having committed crimes of homicide then suicide, public disturbances 185
5. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 and other forms of offense were encountered mainly in the age of over 40 with the rate of 62.50%; 100% and 54.84% in each group. The difference was statistically significant with p < 0.01 (Fisher's exact test = 23.816, p = 0.007). Our findings were similar with Kaplan H.I’s (1994), who argued that murder followed by suicide is the most frequent in elderly patients. These results were consistent with Ngo Van Vinh’s (2011) who recognized that the types of offenses were found in all age groups. Table 6: Relationship between psychosis and forms of offense in patients with mood disorders. Psychosis Delusions and No-psychosis Hallucinations Delusions p hallucinations n = 10 Forms of offense n = 53 % n = 10 % % n = 10 % Intentional injury 10 71.43 1 7.14 1 7.14 2 14.29 Homicide 10 71.43 2 14.29 1 7.14 1 7.14 Murder and then suicide 4 50.00 1 12.50 2 25.00 1 12.50 p > 0.05 Theft 4 6.67 1 16.67 1 16.67 0 0.00 Robbery 5 55.56 2 22.22 0 0.00 2 22.22 Public disturbances 1 100,0 0 0,00 0 0,00 0 0,00 Other forms of offense 19 61.29 3 9.68 5 16.13 4 12.90 The results of the survey show that the data were different, but offenses such as intentional injury, murder, murder and subsequent suicide, theft, robbery and other forms of crime were not related to psychotic symptoms. The difference wasn’t statistically significant with Fisher's exact test = 10.025, p = 0.977. This finding was corresponding with Sadock B.J (2007), who argues that patients with psychosis mood disorders are not different from patient with non-psychotic mood disorders. CONCLUSION - Most patients commit crimes in the course of disease progression (66.27%). - The pathological factors that governed the offense were found in 60.24% of the - Victims tend to be closely related to patients. The psycho-social stress factor or have relationship with the offenders, was found in 19.28% and the common except for theft and intentional injury. alcohol use was found in 12.05% of the - There isn’t difference in forms of offense patients. such as intentionally inflicting injury, homicide, 186
6. JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 murder followed by suicide, theft... between 2. American Psychiatric Association. male and female offenders. Diagnostic and statistical manual of mental - Such criminal acts as homicide then disorder. Fifth edition. 2013. suicide, public disturbances and other forms 3. Dan J. Stein, David J. Kupfer, Alan F. of offense are encountered mainly in the Schatzberg. Textbook of mood disorders. age of over 40. Volume 1. American Psychiatry Publishing. - Psychosis symptoms such as delusions First edition. 2006. and hallucinations haven’t had significant 4. Kaplan H.I, Sadock B.J, Grebb J.A. effect on the patients' criminal acts. Synopsis of a Psychiatrist. Second edition. REFERENCES William and Wilkins. 1994. 1. Ngo Van Vinh. Epilepsy in forensic 5. Sadock B.J, Sadock V.A. Concise Textbook psychiatric assessment. Psychiatry Subject, of Clinical Psychiatry. Second edition. William 8/4. Medical Publishing House. Hanoi. 2011. and Wilkins. 2004. 187