Most of the literature on intimate partner homicide addresses violence between the two partners, spousal abuse, and family violence. There is less focus on the relationship of mental illness, intellectual functioning, and drug and alcohol abuse to these homicides.We investigated this type of homicide in a collection of forensic cases seen by the first author over a period of 10 years. Twenty-eight patients who underwent forensic psychiatric evaluation for heterosexual intimate partner homicide from August 1993 to June 2003 were studied using a retrospective case review methodology.We found that firearms were used as the method of killing more often by females than by males.We also compared method of killing with substance abuse and intoxication at the time of the homicide. Educational status indicates that this group of accused perpetrators is functioning at higher intellectual levels compared with a previously studied sample of filicides. We also found significant presence of serious mental illness in our sample of accused perpetrators of heterosexual intimate partner homicide.

The forensic psychiatric examiner often encounters defendants who deny memory for their offense. Past research proposes a variety of factors to account for offense amnesia. To date there have been few systematic studies of offense amnesia in relation to psychiatric diagnosis, either alone or in combination with other known factors such as substance use and malingering. We studied 53 pretrial felony defendants who had been referred for psychiatric examination; 40% claimed amnesia for their offense. Examinees with psychotic disorders in general, and schizophrenia in particular, were relatively less likely to claim amnesia than were examinees with other diagnoses. Substance use at the time of the offense and associated substance use disorder diagnoses were positively associated with offense amnesia. Malingering diagnosed by general clinical criteria was a poor predictor of amnesia claims. These data suggests that two prominent reasons for referral for forensic psychiatric evaluation include the presence of psychotic symptoms and claims of amnesia for the offense.

A 29-year-old African-American male was admitted for an inpatient forensic evaluation. Due to the presence of auditory and visual hallucinations with paranoid ideation, the patient was started with olanzapine, 5 mg each morning and 10 mg each evening. The patient was continued on the Albuterol and thephylline. On admission, LDH was 193, SGOT 62, and SGPT 75. Serum electrolytes were normal and physical examination was normal with no dependent edema. Blood pressure was 130/84 mm/Hg. Twelve days later olanzapine was increased to 20 mg/day for continued auditory hallucination. On the same day, pitting edema (++) was noted on both feet and blood pressure was 160/90 mm/Hg. The patient was therefore started on hydrochlorothiazide and a potassium supplement. Patient liver enzymes were slightly in the upper level of therapeutic range upon admission. Patient exhibited improvement with lessening of auditory and visual hallucinations, but edema continued. On day 20, LDH was 263, SGOT was 103, and SGPT was 141. Systolic blood pressures ranged between 140 and 160 and diastolic pressures were 76 to 90. Hypotension is common with typical and atypical antipsychotics, but transient hypertension is uncommon.Bilateral dependent edema progressed from ++ to +++ during the rest of his hospital course. However, edema and an increase in liver transaminases have become more common side effects of olanzapine, but this is not frequently encountered in the literature. Patient admission EKG showed sinus tachycardia and nonspecific T-wave abnormality, but chest X-ray, EEG, and CT scan of head were all normal on admission. Olanzapine was discontinued and Risperdol was started at 2 mg/day. Fourteen days after discontinuation of the olanzapine, the edema completely cleared, transaminases returned to baseline, and blood pressures returned to normal. Hydrochlorothiazide and the potassium supplement were therefore discontinued.This patient developed dependent pedal edema with transient increases in transaminase levels from the use of olanzapine, which was not dose dependent. Complete resolution of his edema, lowering of transaminases, and stabilization of blood pressure were noted after the discontinuation of olanzapine. Further research needs to be performed in order to identify vulnerable patients who reveal edema and blood pressure elevation with this medication. Bibliography: Pharmacopsychiatry 2003; 36: 83´ Georg Thieme Verlag Stuttgart´New York´ISSN 0032-0943Olanzapine (Zyprexa) is one of the novel atypical antipsychotics that act as a serotonin-dopamine receptor antagonist. Its use is increasing in frequency among psychiatrists to treat both the positive and negative symptoms of schizophrenia. It is also becoming a commonly prescribed antipsychotic because of its low association with dystonia and other extrapyramidal side effects. More commonly, sedation, weight gain, and transient, nondose-dependent, symptomatic elevations in liver enzymes are seen with the use of this drug [1, 2, 3]. This is a case of a patient who had elevation of transami...

We examined the reactions of 17 male inpatients on a secure psychiatric unit to television news coverage of the September 11 attacks. All had psychotic diagnoses. We hypothesized that self-exposure and affective response to the news coverage and use of social support would be influenced by predominance of negative symptoms. Additionally, we examined for the emergence of common stress symptoms and exacerbations of psychosis. Results showed a dose-response relationship between amount of viewing and magnitude of response to the coverage. Anger was the emotion most clearly tied to coverage exposure and the other response variables. A wide range of stress symptoms was reported. Hypotheses concerning the influence of negative symptoms were partially supported. A significant minority of the patients disclosed exacerbation of psychotic symptoms in response to the attacks. Patients who reported a negative emotional reaction were more likely to talk to others about the attacks, but social contact did not predictably lead to affective relief.