Department of Psychiatry, National Institute of Forensic Psychiatry, Ministry of Justice, Bonggok-ri, Banpo-myeon, Gongju-si, Chungnam 314-716, Republic of Korea.
Forensic Sci Int. 2012 Apr 10;217(1-3):113-8. doi: 10.1016/j.forsciint.2011.10.037. Epub 2011 Nov 16.
Non-serious offenses in manic phase have been mainly studied in patients with bipolar disorder. However, some authors reported that depressive phase is related with the violent and homicidal manifestations of bipolar disorder.
We investigated the characteristics of homicide by the polarity of mood episode in patients with bipolar I disorder.
Among the offenders who were sentenced to undergo treatment at the National Institute of Forensic Psychiatry from October 1987 to January 2008, a total 219 offenders whose final diagnoses were bipolar I disorder based on DSM-III-R and DSM-IV were selected. Retrospective medical chart review was performed for characteristics of mood episodes. Descriptions of offenders were supplemented by review of the written records of the police or prosecutors.
The general rate of total offense was higher in the manic phase than in the depressive phase (86.8% vs. 13.2%). However, the rate of homicide was higher in the depressive phase than in the manic phase. The victims of homicide were more likely to be family members of the patients in depressive phase than in manic phases (96.2% vs. 63.9%, p=0.001). However, parricide was committed only in manic phases. Altruistic motivation of homicide was significantly higher in depressive phase (34.6% vs. 0%, p<0.001) whereas impulsivity was the most common one in manic phases.
The risk of offenses, particularly homicide for family members, should not be overlooked in the depressive phases of bipolar I disorder.
躁狂相中非严重违法行为主要在双相障碍患者中进行了研究。然而，一些作者报道称，抑郁相与双相障碍的暴力和杀人表现有关。
我们调查了双相 I 型障碍患者情绪发作极性与凶杀行为特征之间的关系。
在 1987 年 10 月至 2008 年 1 月期间被国家法医精神病学研究所判处接受治疗的罪犯中，选择了总共 219 名根据 DSM-III-R 和 DSM-IV 最终诊断为双相 I 型障碍的罪犯。对情绪发作的特征进行了回顾性病历审查。通过审查警方或检察官的书面记录来补充罪犯的描述。
总的犯罪率在躁狂相中高于抑郁相（86.8%比 13.2%）。然而，凶杀率在抑郁相高于躁狂相。在抑郁相的凶杀案中，受害者更可能是患者的家庭成员，而在躁狂相则相反（96.2%比 63.9%，p=0.001）。然而，只有在躁狂相中才会发生杀亲行为。抑郁相的利他动机导致凶杀的比例明显更高（34.6%比 0%，p<0.001），而躁狂相中则以冲动为最常见的动机。
不应忽视双相 I 型障碍抑郁相发作时犯罪的风险，特别是对家庭成员的凶杀风险。
