1 BACKGROUND I The urgency of the project Mood disorders is a group of the most common mental illnesses, accounting for a high proportion of the population These patients have a much higher crime rate than normal people According to Sadock B.J et al (2007), offenses of mood disorder can occur in both depressive episodes and manic episodes These behaviors include theft, robbery, financial fraud, aggression, beating, intentional injury, homicide and murder and then suicide The author argues that the factors that motivate the offender's crimes are abuse or addiction to alcohol, drugs and stimulating factors from the surrounding environment [4] In Vietnam, we have not recorded any complete and system research in this area but only sporadic notices of statistical nature II The aim of the thesis Analysis of clinical features of offenders with mood disorder Analyzing the forms of crime and characteritics of offense in mood disorder Study some factors related to offense in mood disorder III Practical significance and new contributions of the project - Crime committed during a depressive episode is a deliberately inflicting injury (20.29%), homicide (18.84%), and crime committed during a manic episode is a theft (14, 29%), acts of robbery (14.29%) - The consequences of the cases are property damage (46.99%), death (24.10%), injury (20.48%) - Acts of homicide - suicide occurs frequently in relatives (53.33%), Acts of homicide often happens to relatives (33.33%) - 54.22% of subjects lost cognitive ability their awareness and behavior control capacity 2 - The majority of offenders are due to the pathological factor (60.24%) and in the progressive disease period (66.27%) - The age group of 20-30 often suffers from robbery (77.8%) and homicide (57.14%) Age group 30-40 often suffers from deliberately inflicting injury (50.00%) IV Structure of the project: The project is presented in 146 pages, 44 tables of data and 11 charts The content includes pages of background, 38 pages overview, 19 pages of subjects and methodology, 32 pages of study results, 35 pages of discussion, pages of conclusion, page of the limited of the thesis, page of proposal, page of articles related to the thesis and 15 pages of references ( 19 Vietnamese and 125 foreign languages) CHAPTER OVERVIEW 1.1 General issues about mood disorder 1.1.1 Concept of mood disorder DSM-5 (2013) as well as ICD 10 (2016) based on the presence or absence of mania, separating magnetic affective disorder into two parts: depression and related disorders; mania, bipolar disorder and related disorders 1.1.2 Etiology of mood disorder 1.1.2.1 Depressive disorder ⁕ Genetic hypothesis According to Bui Quang Huy et al (2016), the cause of depressive disorder is not due to a single gene but many genes that are responsible under a complex gene combination mechanism [2] In terms of gene location causing depression, recent research shows that some common genes that cause depression may originate from a specific area of the chromosome 2q33-34, 3p, 12q, 15q and 18q [8], [9] It is these disease-causing genes that are passed on from generation to generation, which makes depressive disorder of family nature ⁕ Hypothesis of neurotransmitters In 2011, Gelder M.G et al suggest that neurotransmitters such as serotonin, noradrenalin, and dopamine play an important role in the pathogenesis of depression The author thinks there is a decrease in serotonin levels in the brains of depressed patients [6] 1.1.2.2 Bipolar disorder ⁕ Genetic hypothesis Genetic linkage studies of bipolar disorder have shown results in many genes, many areas with evidence for association, particularly with chromosome 13q14-32, Xp22, Xq26-28 [40] ⁕ Hypothesis of neurotransmitters Psychiatrists have admitted that dopamine abnormalities are related to the occurrence of severe manic episodes, and that noradrenalin is associated with mild mania [24], [59] 1.1.3 Clinical features of mood disorder 1.1.3.1 Clinical features of depressive episode ⁕ Main symptoms + depressed mood must present for most of the day and almost every day +loss of interest and enjoyment for most activities: loss of interest and enjoyment always manifests at a certain level + reduced energy leading to increased fatigue ability and diminished activity Marked tiredness after only slight effort is common [62] ⁕ Common symptoms + Changes in eating, appetite and weight: 95% of patients have significant weight loss + Disturbed sleep: Insomnia is the most common type of people with typical depression (accounting for 95% of cases) + Change in psychomotor activity, with agitation or retardation + Diminished ability to think or concentrate, make decision: It is difficult for patients to make decisions or to have trouble in thinking, concentration and attention [4] + Bleak and pessimistic views of the future + Ideas of guilt and unworthiness: Depressed patients have negative views about the world around them and themselves [61] + Ideas or acts of self-harm or suicide: About two-thirds of depressed patients have ideas, suicidal behaviors and 10% to 15% succeed in suicide 1.1.3.2 Clinical features of manic episode ⁕ Main symptoms: mood elevated during a manic episode that manifests as euphoria, excitement and overjoyed or irritable [61] ⁕ Common symptoms are: - Inflated self-esteem or grandiosity: the patient elevates himself to normal [4] - Decreased need for sleep: reduced need for sleep in most patients - Talking a lot, talking fast: patients often have pressure to speak, their voices are loud, speak fast and when they say it is difficult to stop them - Excessive fun: the patient always shows an overly happy attitude to any phenomena that occur around [7 - Quick thoughts: the patient's thoughts may increase rapidly, but these thoughts are still interconnected -Distractibility: patients are easily distracted by stimuli that are not important [79] - Increasing preferred activity: patients often increase excessive activity for a purpose such as occupation, politics, religion [4] 1.2 Crime in subjects with mood disorder Modestin J (2002) studied 179 male and 99 female subjects with mood disorder in Switzerland, showing that 37% of male subjects had brief or recurrent depressive episodes, the rest were depressive episodes Among these people, 40% of men and 7% of women have committed criminal acts [90] Shaw J et al (2006) suggest that people who are depressed at the time of the crime have never been treated [91] According to Swanson J.W et al (1990), violence reported by patients was five times more severe in people with depression, bipolar disorder and schizophrenia than in people without mental illness [92] In Vietnam, there have not been many studies on the crime situation in subjects with affective disorder 1.2.3 Crime characteristics in mood disorder 1.2.3.1 Crime characteristics in the depressive episode ⁕ Violent behavior About in depressed subjects have committed suicide, but only / 100,000 have violent behaviors against others Often the victim is family members like wives and children [3] ⁕ Homicide According to Sadock B.J (2007), depression and homicide are uncommon (annual rate of 0.2 to 0.3/100,000 people/year), victims are often female partners [24] ⁕ Murder and then suicide Murder and then suicide often involves depression The study showed that 75% of the killer’s subjects were depressed at the time of the crime [113] ⁕ Killing children Mothers who kill children often have two types, mothers who kill infant often suffer from psychosis and The mother was identified as severe depression, they commit high suicide behavior after committing child murder [119] 1.2.3.2 Crime characteristics in manic episode ⁕ Violent behavior Some studies show that less than 50% of people with bipolar disorder have a history of violent behavior [104] ⁕ Serious crimes The subjects with manic episode also committed very serious offenses, such as causing death by driving in danger, fire and rape [3] 1.3 Some related factors, promoting offense in mood disorder 1.3.1 Sex and age A study in the United States for more than 22 years found that 10% of women and 0.3% of male offenders were diagnosed with affective disorder [121] 1.3.2 Substance abuse and environmental impact The more people abuse alcohol and drugs, the more likely they are to commit violence CHAPTER SUBJECTS AND METHODOLOGY 2.1 Subjects 2.1.1 Characteristic of the subjects Subjects of the study included 83 subjects diagnosed with affective disorders with criminal offenses, in the ages of 20 - 69 years old, sent to criminal procedure agencies for monitoring, inpatient treatment and psychiatric forensic assessments from February 2012 to January 2018 The study was conducted at Bien Hoa national Institute of Psychiatric Forensic Medicine 2.1.2 Selection criteria + Research subjects meet the diagnostic criteria for affective disorders according to ICD - 10 under the following items: F30, F31, F32 and F33 + Subjects to be examined by the criminal procedure agency such as the Police, Procuracy and Court + The appraisal request documents provided by the criminal procedure agency must be clearly recorded and full of information about illness and crime 2.1.3 Exclusion criteria Not included in the study group of subjects with severe general medical condition such as heart failure, liver and kidney dysfunction, dementia who are unable to cooperate in research Not included in the study group of subjects with mood disorder due to a general medical condition and substance-induced mood disorder, mixed anxiety and depressive disorder 2.2 Study method 2.2.1 Study design + Using the prospective descriptive method, combining retrospective with the study of documents provided by assessment agencies, personal and family history of the subject + Analysis of clinical symptoms of mood disorders, nature and factors related to criminal acts 2.2.2 Study sample size The sample is calculated by the formula: p (1 – p) n = Z – α / -d2 n: sample size is calculated 8 z: limited reliability coefficients: z values relating to the determination of the level of trust, so in this study chose the confidence level is 95%, then the value of z is 1,96 α: probability of error type p: is the percentage of previous studies according to Fazel S (2002), Nguyen Van Tho (2009), we chose p = 0.25 [100], [130] d: desired accuracy (tolerance), choose d = 0,10 Instead of the formula we have: 1,962 (0.25.0,75) n = - = 72.03 0.1 Thus the minimum sample size is 73 objects The research team selected 83 subjects 2.3 Data processing method - The data were analyzed by SPSS Version 20 - The results are presented by Tables and Charts 2.4 Ethics in research The research data are kept confidential The objects does not have to pay any extra cost in the research process 9 CHAPTER 3: RESULTS 3.1 The general characteristic of the research subjects Figure 3.1 Sex of the research subjects The figure 3.1 shows that the number of people with mood disorders in men is 63.86% and women account for 36.14% This difference is statistically significant with p59 4.82 Age group The results in Table 3.1 show that the age group from 20-29 years old accounts for the highest proportion (33.73%), followed by the age group 30-39 years, accounting for 25.30% The average age of men is 34.47 ± 10.96 years and women are 42.17 ± 11.53 years 10 3.2 Clinical features of mood disorders Table 3.7 The episodes of mood disorders Statistical index No n=83 % p Episodes Manic episodes 14 16.87 p