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Homicides by mentally ill persons have led to political concerns about deinstitutionalisation.
To provide accurate information about the contribution of mental illness to homicide rates.
Retrospective study of homicide in New Zealand from 1970 to 2000, using data from government sources. ‘Mentally abnormal homicide’ perpetrators were defined as those found unfit to stand trial, not guilty by reason of insanity, convicted and sentenced to psychiatric committal, or convicted of infanticide. Group and time trends were analysed.
Mentally abnormal homicides constituted 8.7% of the 1498 homicides. The annual rate of such homicides was 1.3 per million population, static over the period. Total homicides increased by over 6% per year from 1970 to 1990, then declined from 1990 to 2000. The percentage of all homicides committed by the mentally abnormal group fell from 19.5%in 1970 to 5.0% in 2000. Ten percent of perpetrators had been admitted to hospital during the month before the offence; 28.6% had had no prior contact with mental health services. Victims were most commonly known to the perpetrator (74%).
Deinstitutionalisation appears not to be associated with an increased risk of homicide by people who are mentally ill.
An increased risk of choking associated with antipsychotic medication has been repeatedly postulated.
To examine this association in a large number of cases of choking deaths.
Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.
The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.
The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence.
The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner.
A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services.
Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders.
The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.
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