Homicide-suicides (HS) are relatively infrequent events. Yet, they are of great concern because they often result in the death of family members, young children, and cause additional morbidity, family disruption and childhood psychological trauma. The aims of our study were (a) to examine the sociodemographic, clinical, and autopsy characteristics of HS in Paris and its suburbs from 1991 through 1996, and (b) to analyze the psychodynamic determinants leading up to the onset of HS. Our findings are compared with those obtained in other international studies. For the purpose of the present study. HS was defined as a violent event in which an individual committed homicide and subsequently committed suicide within a few hours. The main results are as follows. During the six-year study period, 56 HS involving 133 victims were investigated at the Institute of Forensic Medicine of Paris. Seventeen events occurred in Paris and 39 in its suburbs. Paris has a population of approximately 2,200,000 while its suburbs are home to another 8,500,000. Of the 56 offenders, 48 (85%) were males. The mean age of offenders was 51 years in males (range, 24 to 83) and 40.5 years in females (range, 33 to 56). In 45 events (80%), the offenders used a gun for both the homicide and suicide. A knife was used in only 4 murders, strangulation in 4 other cases, with poisoning, arson, or beating occurring in one case each. In 9 cases, the offender used a different weapon for homicide and suicide. Among firearms, handguns were more likely to be used (26 cases) than shotguns (6 cases) or rifles (13 cases). In 40 cases the offender killed one victim, in 11 cases 2 victims, and in 5 cases 3 victims. The homicide victims consisted of 34 children (21 boys), mean age 8 years (range, 1 to 16), 29 spouses (26 females), 2 girlfriends, 10 strangers, and 2 relatives. Five pets were killed. HS were most likely to be committed in the home. A suicide note was found near the victims in 29 cases (50% of events). In 42 cases the offender was found to be severely depressed. Familial HS were the most frequent events followed by suicidal pacts. When male sexual proprietariness and amorous jealousy were involved, the HS perpetrators acted often impulsively in carrying out the HS. There had been a chronically chaotic relationship and frequent physical violence and verbal threats. The triggering event was often the female withdrawal or estrangement. Only in a few cases, other motivations such as occupational or money problems were involved. Chronic alcoholism was found in 16 cases. In conclusion, the offender was more likely to be a male, severely depressed, violent and jealous who killed his spouse, and often his children, with impulsiveness, but after numerous threats. Our findings suggest that HS differ from both homicide and suicide and thus occupy a distinct epidemiological domain requiring specific prevention programs.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized histologically by massive infiltration of the right ventricular wall by fat tissue, with surviving strands of cardiomyocytes bordered by or embedded in fibrosis. ARVC has been recognized as a cause of sudden death, especially in the young. The purpose of our autopsy study was to examine the clinical characteristics and the pathological patterns in the hearts of 20 people who died suddenly of ARVC. In view of our findings and the literature, we discussed the possible causes and pathogenesis of ARVC, as well as the mechanisms by which sudden death occurs in this disease. During the 7-year study period, 20 hearts from 9 men and 11 women fulfilled the criteria for ARVC. The mean age was 41 years (range, 17 to 80). The disease was unknown prior to death in all cases. Fourteen persons died at rest, and six on effort. In 9 of the 20 cases, the trigger of sudden death was an acute emotional stress, sometimes associated with a moderate physical activity. The mean heart weight was 380 g (range, 280 to 520). Both ventricles were involved in 40% of the cases. Inflammatory infiltrates consisting of lymphocytes were present in 60% of the cases, but myocyte necrosis was found in only one case. ARVC is more likely to result from a degenerative process than a congenital disorder. Genetic factors, viral or autoimmune inflammation or both, and apoptosis are also involved in the degenerative disorder.

In the Western world previous studies have shown that the majority of cases of the Wernicke-Korsakoff syndrome (WKS), which is caused by thiamine deficiency, occur in alcoholics. However, in France, a country with one of the highest per capita consumptions of alcohol, the prevalence of the WKS was found to be only 0.4% in a small retrospective autopsy study. This figure is compared with data sent to the authors by a number of neuropathologists from the U.S.A., Europe, Scandinavia and Australia. There was no obvious correlation between the prevalence rates of the WKS, which were highest in Australia (2.8%-previously published), and per capita consumption of alcohol. Other issues such as diet, National programs for supplementation of foods with thiamine, and drinking habits are considered. The pathological diagnosis of the WKS can often be made on macroscopic examination of the brain after fixation in formalin. The mammillary bodies are smaller than normal in most cases of chronic WKS. However in this study it was found that the most common causes of small mammillary bodies were Alzheimer's disease and atrophy due to transneuronal degeneration secondary to lesions in the hippocampus.

Our results in humans do not support the hypothesis that aging influences the percentage of cardiomyocyte apoptosis. However, gender appears to be an important determinant of the occurrence of apoptosis.

The aims of our study were (1) to examine the socio-demographic, clinical characteristics, autopsy and toxicological findings in 392 youth suicides in Paris, between 1989 through 1996, and (2) to analyze the psychodynamic determinants leading up to the onset of the suicide. During the eight-year study period 392 suicides involving young people were investigated at the Institute of Forensic Medicine of Paris. Two hundred and sixty victims (66%) were males. The mean age was 22 years in both sexes. Fifteen percent of the victims were below 20 years. Ninety-two percent of the subjects were single. Forty percent of the victims were students, 35% were unemployed. One third of the victims had previously attempted suicide. Thirty-five percent of the subjects used to take psychoactive prescription drugs and some of them had been under the care of a mental health professional at the time of the suicide. In 40% of the cases a suicide note was found near the body. Depression (70% of victims), schizophrenia, (10%), affective disorders, parent-child relational problems, partner relational problems, adolescent antisocial behavior, and borderline personality were found to be the most frequent diseases and stressors involved in the suicides. The suicide was rarely an accidental reaction to stress. It was constantly preceded by situational distress, which led to suicidal ideas if the adolescent failed to cope with problems. Ten percent were known as heroin users. In more than 40% of the cases, the victim's parents were divorced or separated. The most frequent method of suicide was poisoning followed by jumping from a height, gunshot, subway death, and hanging/asphyxia. Among firearms, a handgun was more likely to be used than rifles (85/15%). Tranquilizers were the most frequent psychoactive drugs used for suicide followed by antipsychotic drugs, antidepressants, and barbiturates (10%).