Décrire les caractéristiques des malades atteints de schizophrénie auteurs d’homicides, de leurs victimes et des modalités et des circonstances de leurs homicides. Et comparer ces homicides à ceux commis par des personnes indemnes de troubles mentaux graves.

Étude descriptive transversale concernant des homicides commis par des personnes atteintes de schizophrénie, selon les critères du DSM-5, hospitalisées par un internement judiciaire d’octobre 2015 à mars 2018.

Les schizophrènes auteurs d’homicides étaient des adultes jeunes d’âge moyen de 33,83 ans, de sexe masculin dans la majorité des cas (86,67 %), célibataires dans la majorité des cas (68,33 %), avaient des antécédents de violences physiques avant l’homicide dans 41,67 % des cas, avaient une mauvaise observance thérapeutique dans la majorité des cas (68,33 %), avaient un abus ou une dépendance à une substance dans 50 % des cas. Les victimes de l’homicide étaient d’âge moyen de 35,37 ans, de sexe masculin dans 60,50 % des cas, étaient connues des schizophrènes dans 82,90 % des cas. Le mobile de l’homicide était délirant dans 55 % des cas. Le lieu de l’homicide était dans 51,67 % des cas un lieu d’habitation. Dans 53,34 % des cas, l’homicide était commis par arme blanche.

Cette étude a permis une meilleure compréhension de l’homicide commis par des schizophrènes et d’établir un profil des patients à risque de passage à l’acte.

The objective of this study is to describe the characteristics of schizophrenic homicides, their victims, and the modalities and circumstances of these homicides. Also, compare these homicides to those committed by people free from serious mental disorders.

It is a descriptive cross-sectional study concerning the homicides committed by schizophrenics hospitalized by a forensic internment in the forensic Psychiatric Services of the hospital establishment specialized in psychiatry (EHS) of Sidi Chami. The study period extended from October 2015 to March 2018. The study population is the group of schizophrenics from the western region of Algeria. Indeed, the forensic psychiatry service of Sidi Chami's EHS is a referral center that takes care of all homicidal patients in the western region. Thus, our sample is exhaustive, it is all the patients with schizophrenia, according to the criteria of DSM 5, followed or hospitalized following a homicide, during the study period. The data were collected using an analysis grid with the patients, their families and their medical records.

During the study period, there were 60 homicidal schizophrenic patients who were treated on an outpatient or hospital basis and who were included in the study. The average age of schizophrenic perpetrators at the time of the act was 33.83 years with extremes ranging from 21 to 56 years. The age group of those under 30 was the most represented (n=27, 45%). The vast majority were male (n=52, 86.67%). The sex ratio is 6.5. The majority were single (n=41 or 68.33%). Most of them had a low level of education. In fact, only 16.67% (n=10) had reached a secondary education level and only 3.33% (n=2) had a university level. The majority were either unemployed or unstable at work. Indeed, 58.33% (n=35) had no professional activity and 10% (n=6) had an irregular professional activity. During childhood, parental separation was found in 15% of cases (n=9) and the death of parents was found in 8.33% of cases (n=5). In addition, 25% of schizophrenic homicide perpetrators reported childhood maltreatment. In 13% of cases (n=8) it was physical abuse, in 10% of cases it was physical and psychological abuse (n=6), in 1.7% of cases (n=1) it was sexual abuse. The vast majority, 81.67% of cases (n=49), lived in an urban environment. In 90% (n=54), they lived with their families, 6.67% (n=4) were homeless and 3.33% (n=2) lived alone. More than half had either poor family care or no care at all. In fact, 35% of cases (n=21) had poor family care and 20% of cases (n=12) had no family care and were left to fend for themselves. In 18.33% of cases (n=11), the patient had no medical follow-up and this was the first contact with psychiatry. The majority of homicidal schizophrenics had poor therapeutic adherence (n=41 or 68.33%). The vast majority, 80% (n=48), were not taking neuroleptic treatment during the period when the act was committed. In 88% (n=48) of the cases they were smoking and half (n=30 or 50%) presented an abuse or a dependence on a substance. Twenty percent had a criminal record prior to the onset of the disorder. In 6.66% of cases (n=4), it was a criminal record of violence. Also, schizophrenic homicides had a history of physical violence after the onset of the disorder in 41.67% of the cases (n=25). In the vast majority of cases there was only one victim (n=54 or 90%), in 5% of cases (n=3) there were 2 victims, in 3.33% of cases (n=2) there were 3 victims. There was only one case with 4 victims (1.67%). The total number of victims is 76. The average age of victims is 35.37 years with a standard deviation of 23.68, and extreme ages ranging from 1 year to 96 years. The victims were male in 60.53% of the cases (n=46). In the vast majority of cases, the schizophrenic perpetrator knew his victim (n=63 or 82.90%). The link was a family relationship in more than half of the cases (n=42 or 55.26%), an acquaintance in 19.74% of the cases (n=15) and a marital relationship in 7.90% of the cases (n=6). The motive for the homicide was pathological in the majority of cases (n=45 or 75%). More than half of the homicides were motivated by delirium. The homicide was committed in a private space in 63.33% of the cases (n=38). The place of the homicide was a place of habitation in half of the cases (n=31 or 51.67%). Homicide was committed during the day in the majority of cases (n=45 or 75%). It was committed by a weekday in 60% of the cases (n=36) and by a weekend in 36.67% of the cases (n=22). The homicide was committed using a weapon in the majority of cases (n=47 or 78.34%). It was committed with a stabbing weapon in more than half of the cases (n=32 or 53.34%), by a weapon by destination in 18.33% of the cases (n=11), by physical beatings and violence in 13.33% of cases (n=8), by firearm in 6.67% of cases (n=4), by defenestration in 3.33% of cases (n=2), by fire in 3, 33% (n=2) of the cases and finally by poisoning in 1.67% of the cases (n=1). The act was not premeditated in the majority of cases (n=40 or 66.66%). In 98.33% of the cases (n=59), there was no accomplice and the schizophrenic committed his crime alone. In 65% of the cases (n=39) the schizophrenic was relentless on the victim beyond the blows necessary to cause murder. In 48.33% of cases (n=29) the perpetrator stayed behind after the act, in 25% of cases (n=15) fled, in 18.33% of cases (n=11) he denounced himself, and in 6.67% of cases (n=4) he was brought under control immediately after the act. In 23.33% of cases (n=14), schizophrenics attempted suicide after the homicide. By comparing our results with data from the literature on non-pathological homicide, similarities and differences were highlighted. Homicide offenders share common socio-demographic characteristics. In both cases, the perpetrators are young, single adults with low education, low income, who live in an urban area. They had a disturbed childhood and family environment, had frequent criminal records and addictive behaviors. On the other hand, the schizophrenic kills mainly members of his immediate family and people around him. While victims of non-pathological homicide differ according to the motive of the homicide and the context. The motive behind the homicide committed by a schizophrenic is pathological and motivated essentially by delusional activity. While the motive for non-pathological homicide is rational. The schizophrenic crime is carried out during the day and in the majority of cases in a private place, most often a dwelling. While the non-pathological crime is carried out at night, the location differs depending on the victim and the circumstances.

This study looked at one form of violence, homicide. It allowed a better understanding of this act committed by people with schizophrenia. The profile of these patients thus produced allows first of all the identification of patients at risk of committing homicidal acts and therefore better prevention of this type of crime. Then, an improvement and a greater precision of the psychiatric expertises carried out within the framework of this type of homicide.