Some factors related to guilty behavior in patients with mood disorders

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
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 ()
Date received: 11/07/2017
Date accepted: 21/11/2017

- Use the item F3 from diagnostic criteria of ICD-10 (1992) for mood disorder.
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- 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

%

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
N°

Period

1

Patients
n = 83

%

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
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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
members

Neighbors and

friends

Strange
persons

Social
organizations

p

Forms of
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

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

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.

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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

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

> 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

4

7

3

14

%

28.57

50.00

21.43

100

n

8

2

4

14

%

57.14

14.29

28.57

100

n

1

2

5

8

%

12.50

25.00

62.50

100

n

3

0

3

6

%

50.00

0.00

50.00

100

n

7

1

1

9

%

77.78

11.11

11.11

100

n

0

0

1

1

%

0.00

0.00

100

100

n

5

9

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 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
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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

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

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

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.

2. 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

3. Dan J. Stein, David J. Kupfer, Alan F.

Schatzberg. Textbook of mood disorders.
Volume 1. American Psychiatry Publishing.

4. Kaplan H.I, Sadock B.J, Grebb J.A.
Synopsis of a Psychiatrist. Second edition.
William and Wilkins. 1994.

1 . Ngo Van Vinh. Epilepsy in forensic

5. 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.

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