When COVID-19 Is Not All: Femicide Conducted by a Murderer with a Narcissistic Personality “Masked” by a Brief Psychotic Disorder, with a Mini-Review

Abstract

Several cases of COVID-19-related mental disorders have emerged during the pandemic. In a case of femicide that occurred in Italy during the first phase of the pandemic, coinciding with a national lockdown, a discrepancy arose among forensic psychiatry experts, particularly toward the diagnosis of Brief Psychotic Disorder (BPD) related to COVID-19. We aimed to discuss the evaluation of the case through an integration of information and a literature review on comparable reported cases. An analysis of the diagnosis of brief acute psychosis was then performed, as well as a mini-review on cases of COVID-19-related psychosis. Results showed that psychotic symptomatology was characterized by polythematic delusions that always involved a SARS-CoV-2 infection. To a lesser extent, the delusions were accompanied by hallucinations, bizarre cognitive and associative alterations, insomnia, hyporexia, dysphoria, and suicidal behavior. No particularly violent acts with related injury or death of the victim were described. Finally, we could hypothesize that our case was better represented by a diagnosis of personality with predominantly narcissistic and partly psychopathic traits. The present case highlighted the importance, in the context of forensic psychiatry, of integrating assessments with the crime perpetrators, namely through accurate clinical interviews, neuropsychological tests, diachronic observations, and comparison with similar cases present in the literature. Such an integrated approach allows precise evaluation and reduces the odds of errors in a field, such as forensic psychiatry, where a diagnostic decision can be decisive in the judgment of criminal responsibility. Moreover, discerning forensics from health cases represents an important issue in risk management.

The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County—Central Region, Romania

“…On the other hand, we found admissions for patients diagnosed with psychosis increased by 40.23% during the pandemic. These results can be interpreted both as a consequence of the epidemiological measures and of the delay in accessing specialized medical services due to the fear of contamination [11,49], the social isolation triggered by incorrect information from the mass media [51,52] or the lack of a social support network [68]. Our results are not consistent with the results of the studies conducted by Bonello et al(2021) [54] and Clerici et al (2020) [44].…”

Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey

“…Excessive attention to one's own professional liability can also lead to prioritizing unnecessary medical interventions for violent people who mask their conduct with malingered psychiatric symptoms (mostly psychotic symptoms) in order to avoid legal repercussions for their conduct [28].…”

Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die

“…Suicide and self-injurious behaviors are also frequently reported in other PDs, especially for cluster B [50]. In narcissistic personality disorder, for example, there is a desperate need of protecting the own image of perfection by obtaining continuous external self-affirmation [51,52]; failure can trigger a strong sense of shame and humiliation from which, sometimes, only suicide is recognized as a way out. High suicidal risk is also present in antisocial personality disorder and, in general, in disorders characterized by high levels of aggressiveness [53].…”