Hızır ASLIYÜKSEK, Muhammed Emre YILMAZ, Sümeyye Demirdöven ÖZBAKIR, Zehra Topaloğlu TÜRKMEN, Ömer ASAN, Hüseyin Çağrı ŞAHİN, Hasan GÖKÇAY
Neuropsychiatric Investigation - 2026;64(1):1-8
Objective: To characterize the clinical and forensic features of individuals with bipolar disorder who committed homicide and to examine factors associated with prior criminal history. Methods: This retrospective, single-center study included 62 individuals with bipolar disorder who underwent criminal responsibility evaluation for homicide at the First Board of the Council of Forensic Medicine in Türkiye (2021-2025). Sociodemographic, clinical, and criminological variables were extracted from forensic psychiatric records. Participants with and without prior criminal history were compared using appropriate statistical tests. Results: The sample was predominantly male (88.7%) and showed a high prevalence of lifetime psychotic symptoms (91.9%), most commonly paranoid or persecutory delusions. At the time of the offense, residual or subthreshold psychopathological features were frequently documented; however, a causal link with the homicidal act was not established in most cases in terms of criminal responsibility. Most homicides were impulsive in nature (72.6%) and involved victims known to the offender. Alcohol or substance use at the time of the offense was documented in 17.7% of cases (alcohol: 12.9%; substance: 4.8%) and was not a predominant feature of the sample. A history of prior criminal offenses was observed in more than half of the cases (58.1%). Compared with participants without prior criminal history, those with prior criminal history more frequently exhibited a history of manic episodes, self-harm behavior, comorbid personality disorder, and a higher number of psychiatric hospitalizations, whereas sociodemographic characteristics and treatment adherence were broadly similar between groups. Conclusion: Homicidal behavior in bipolar disorder appears to be more closely associated with impulsivity and interpersonal or situational stressors than with severe, responsibility-abolishing psychopathology. Recurrent offending was linked to markers of illness severity, underscoring the need for sustained psychiatric follow-up and continuity of care in forensic populations.
