Some factors related to guilty behavior in patients with mood disorders

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.

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 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 not affect markedly the offense of patients * Key words: Mood disorder; Guilty behavior; Criminal act; Offense INTRODUCTION Guilty bahavior in patients with mood disorders is of great popularity, being public’s great concern, however, it creates discrimination against mental illness According to Sadock B.J (2007), these behaviors include theft, intentionally inflicting injury, financial fraud, homicide, murder followed by suicide The offenses of patients with mood disorders are governed by many external factors A study on the factors involved in criminal acts will help the mental health industry as well as law enforcement agencies reduce criminal rate in these patients Because of these above reasons, we conducted this study SUBJECTS AND METHODS - A prospective study on 83 patients with mood disorders (69 depressive disorders, 14 mental disorders), 20 to 69 years of age, were conducted by law enforcement agencies for mental health assessment from February 2012 to March 2017 at Bienhoa National Institute of Forensic 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 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° Factors n = 83 % Pathological factors 50 60.24 Non-pathological factors 33 39.76 Family conflicts 10.84 Psychosocial stressors 16 19.28 Financial difficulties 14 16.87 Alcohol abuse 10 12.05 Drug use 4.82 Childhood stress history 2.41 Other motivational factors 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 N° Period Patients n = 83 % Progressive stage 55 66.27 Stable period 6.02 Disease-free period 23 27.71 Table 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 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 was statistically significant with p < 0.001 2(2) = 46.36; p = 0.000) According to DSM (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 members Neighbors and friends Strange persons Social organizations p Forms of n = 15 % n = 23 % n = 32 % n = 13 % Intentional injury 6.67 26.09 21.88 0.00 Theft 6.67 4.35 6.25 15.38 Public disturbances 0.00 0.00 0.00 7.69 Homicide 33.33 34.78 3.13 0.00 < 0.01 Murder and then suicide 53.33 0.00 0.00 0.00 < 0.01 Robbery 0.00 0.00 25.00 7.69 < 0.01 Other forms of offense 0.00 34.78 14 43.75 69.23 < 0.01 criminal acts > 0.05 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 JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 Sex Male Female p Forms of offense n = 53 % n = 30 % Intentional injury 10 18.87 13.33 Homicide 11 20.75 10.00 Murder followed by suicide 9.43 10.00 Theft 5.66 10.00 Robbery 13.21 6.67 Public disturbances 1.89 0.00 Other forms of offense 16 30.2 15 50.00 > 0.05 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 n 14 % 28.57 50.00 21.43 100 n 14 % 57.14 14.29 28.57 100 n % 12.50 25.00 62.50 100 n 3 % 50.00 0.00 50.00 100 n 1 % 77.78 11.11 11.11 100 n 0 1 % 0.00 0.00 100 100 n 17 31 % 16.13 29.03 54.84 100 Forms of offense Intentional injury Homicide Murder followed by suicide Theft Robbery Public disturbances Other forms of offense Table 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 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 hallucinations No-psychosis Hallucinations Delusions Forms of offense n = 53 % n = 10 % n = 10 % n = 10 % Intentional injury 10 71.43 7.14 7.14 14.29 Homicide 10 71.43 14.29 7.14 7.14 Murder and then suicide 50.00 12.50 25.00 12.50 Theft 6.67 16.67 16.67 0.00 Robbery 55.56 22.22 0.00 22.22 Public disturbances 100,0 0,00 0,00 0,00 Other forms of offense 19 61.29 9.68 16.13 12.90 p p > 0.05 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 - The pathological factors that governed the offense were found in 60.24% of the patients The psycho-social stress factor was found in 19.28% and the common alcohol use was found in 12.05% of the patients 186 - Most patients commit crimes in the course of disease progression (66.27%) - Victims tend to be closely related to or have relationship with the offenders, except for theft and intentional injury - There isn’t difference in forms of offense such as intentionally inflicting injury, homicide, JOURNAL OF MILITARY PHARMACO-MEDICINE N09-2017 murder followed by suicide, theft between male and female offenders American Psychiatric Association Diagnostic and statistical manual of mental - Such criminal acts as homicide then suicide, public disturbances and other forms of offense are encountered mainly in the age of over 40 disorder Fifth edition 2013 - Psychosis symptoms such as delusions and hallucinations haven’t had significant effect on the patients' criminal acts First edition 2006 REFERENCES Dan J Stein, David J Kupfer, Alan F Schatzberg Textbook of mood disorders Volume American Psychiatry Publishing Kaplan H.I, Sadock B.J, Grebb J.A Synopsis of a Psychiatrist Second edition William and Wilkins 1994 Ngo Van Vinh Epilepsy in forensic Sadock B.J, Sadock V.A Concise Textbook psychiatric assessment Psychiatry Subject, 8/4 Medical Publishing House Hanoi 2011 of Clinical Psychiatry Second edition William and Wilkins 2004 187 ... 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... According to DSM (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... 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