Mania and crime: a study of 100 manic defendants.

As the diagnostic assessment and pharmacological treatment of mania have advanced during the last fifteen years, mental health professionals have become increasingly interested in the relationship between mania, aggression, and criminality .1-9 Nevertheless, the actual number of manic criminals who have been studied has been low. Good's8 review of 23 studies of manic-depressive defendants and criminals between 1918-1974 yielded a combined sample of 268 cases. Ninety-three of those cases were diagnosed as suffering solely from melancholia or psychotic depression, leaving a group of 175 individuals with bipolar or unipolar mania. A further problem is that there are significant differences in diagnostic practices between studies, across time and across cultures. For example, Good's comparison of eight European studies of psychiatrical1y referred criminals with eleven U.S. studies demonstrated a significantly higher percentage of diagnosed manic-depressive criminals overseas (8 percent in Europe versus 2.2 percent in the U.S.). If Good's 268 reported cases are limited to American manic criminals for the purpose of reducing crosscultural effects, the remaining group consists of 38 cases. One purpose of the present study was to expand the pool of American manic defendants so that their characteristics could be more carefully described using a larger, more uniform sample. A second purpose of the study was to explore the relationship between mania and aggression. Beigel and Murphyl have offered evidence suggesting there are two subgroups of manics. One type is elated and grandiose with little paranoid or destructive symptomatology, whereas the other type is paranoid and destructive with minimal euphoria and grandiosity. On the other hand, Carlson and Goodwin,IO in a longitudinal analysis of 20 manic patients, found that 15 demonstrated assauItiveness or threatening behavior but only during the middle phase of a three phase manic episode. The typical episode begins with euphoria; passes through hostility, anger, and aggression; and ends with panic. Based on these differing results, one may hypothesize either that only a subgroup of manics is aggressive or that most manics are aggressive during some point in their illness.