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Inpatient Evaluation and Treatment of a Self-Professed Budding Serial Killer

NCJ Number
198851
Journal
International Journal of Offender Therapy and Comparative Criminology Volume: 47 Issue: 1 Dated: February 2003 Pages: 58-70
Author(s)
Andrew D. Reisner; Mark McGee; Stephen G. Noffsinger
Date Published
February 2003
Length
13 pages
Annotation
This article presents the case study of the inpatient evaluation and treatment of a man ("Mr. X") who was hospitalized after claiming that he was about to become a serial killer.
Abstract
Before admission to the hospital, Mr. X developed an obsessive rage toward friends, acquaintances, and strangers. He also developed a delusion that he was transforming into a nonhuman entity named Windigo, with special powers and no remorse about killing humans. He fantasized obsessively about killing friends and acquaintances and torturing and/or killing strangers and burning their homes. There was no evidence that he had actually committed any homicides. Upon entering the hospital, Mr. X received routine assessment, and the hospital staff conducted case conferences, psychological testing, outside forensic consultation, and a forensic review process before making a diagnosis and planning treatment. Overall, Mr. X had more symptoms of major mental illness than is typical of serial killers and much less psychopathy. Similar to serial killers, however, Mr. X had an obsession with violence, homicidal fantasies, substance abuse, and a possible neurological insult. Although Mr. X was not the typical serial killer, without intervention, he still was at increased risk of killing others while in a psychotic or near psychotic state driven by obsessive rage. Fortunately, Mr. X's psychopathology was amenable to treatment that could prevent violent behavior. Soon after admission to a stable, structured environment, Mr. X received mood-stabilizing medication and antidepressants, as well as psychotherapy. Very early in his 8-month hospitalization, Mr. X reported no further homicidal ideation. The consulting forensic psychiatrist recommended an antipsychotic medication, and Mr. X credited the antipsychotic medication with a marked improvement in his mood. Mr. X also responded to individual cognitive and supportive psychotherapy and group psychotherapy, and he appeared more insightful than did other patients. The patient was discharged after 8 months, being apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. A 4-month follow-up indicated that the patient remained stable and continued to take prescribed medication in a group home, with no evidence of violent behavior. The authors review diagnostic and risk-management issues. Comparisons with known features of typical serial killers are discussed. 23 references