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Cannibalistic behaviour is an exceptionally rare phenomenon in psychiatric practice, particularly when necrophagic acts occur without homicide. Its occurrence raises complex clinical and forensic questions regarding criminal responsibility, risk assessment, and the interface between psychopathology and extreme behaviour. We report the case of a 48-year-old ultra-Orthodox Jewish man with schizoaffective disorder and complex developmental trauma. He presented with post-traumatic stress and psychotic symptoms after volunteering with a disaster victim identification organisation in the aftermath of the October 7th, 2023 terror attack. The clinical course, psychiatric evaluation, and management are described. This case highlights the need to contextualise extreme behaviours within severe psychiatric decompensation. We compared this case with previously reported psychosis-related cannibalism, which more often involves homicide and consuming victims, and with typologies of sadism. This behaviour is best conceptualised as opportunistic necrophagic, psychosis-associated cannibalism with paraphilic features. Such presentations raise important considerations regarding forensic risk assessment and trauma-informed treatment. The case underscores the need for nuanced, formulation-based approaches to cannibalistic behaviour in forensic psychiatry.

Natural toxins represent structurally diverse class of bioactive compounds that pose underrecognized risks extending beyond traditional food safety concerns into chemical security applications. Recent high-profile incidents have highlighted critical gaps in detection capabilities, clinical management, and regulatory frameworks governing these substances. This review discusses the diversity, potency profiles and security implications of natural toxins with a focus on compounds with outstanding acute toxicity, such as batrachotoxin from Phyllobates poison dart frogs (LD50 2-3 μg/kg intravenously), amatoxins from Amanita species (LD50 100-300 μg/kg) and conotoxins from cone snails (LD50 10-100 μg/kg), comparable to synthetic chemical warfare agents. Critical vulnerabilities include the absence of specific antidotes, analytical challenges related to structural diversity and incomplete coverage by routine toxicological screens. Historical examples of intentional intoxications (e.g., ricin assassination of Georgi Markov in 1978 and bioterrorism by mail between 2003 and 2013) illustrate the general availability but also the limitations of this modus operandi. Developments in high-resolution mass spectrometry and computational toxicology offer promising improvements in detection. International regulations under the Chemical Weapons Convention need further improvement to address the growing threat posed by these natural but potentially weaponizable compounds.

Femicide is recognized as one of the most severe expressions of gender-based violence and causes complex assessment issues for both criminal justice systems and forensic psychiatry. This paper assesses the relationship between mental disorder and criminal responsibility of perpetrators of femicide and intimate partner homicide (IPH), through a comparison of clinical-forensic evidence from different national contexts. Four international studies (England and Wales, Sweden, Mexico, and South Africa) and the report of the Italian Parliamentary Commission on femicide for the 2017-2018 biennium were considered. Overall, a substantial proportion of perpetrators present psychiatric symptoms or prior contact with mental health services; however, judicial findings of non-responsibility remain relatively infrequent. In England and Wales, symptoms of mental disorder at the time of the offence are reported in approximately 20% of IPH cases, whereas outcomes closest to findings of non-responsibility concern less than 1%. In Sweden, 41.3% of IPH perpetrators had previous contact with psychiatric services, but major mental disorders at the time of the offence account for approximately 11% of cases. Higher frequencies are observed in samples selected for forensic psychiatric evaluation. In Italy, among 118 cases concluded with sentencing, a mental disorder affecting criminal responsibility was recognized in 24.6% of cases: full insanity in 13.6%, partial insanity in 7.6%, and suspension of proceedings due to incompetence to stand trial in 3.4%. Overall, the findings highlight the need to carefully distinguish between psychiatric diagnosis and legal constructs of criminal responsibility. The presence of a mental disorder does not automatically imply non-responsibility and requires an individualized clinical-forensic assessment, focusing on the nexus between psychopathological condition, capacities at the time of the offence, and the relational context in which the act occurred.

After a brief reflection on the choice of the term femicide, the discussion moves toward a psychoanalytical reading of the phenomenon, starting from the classical texts of Sigmund Freud, Melanie Klein e Jacques Lacan, and extending to contemporary theorization on gender culture and the culture of the neutral. Dynamics of possession are analyzed through the lens of Italian feminism, in an interweaving of psychoanalysis and feminism aimed at assessing the risk and preventive factors of this harrowing phenomenon.

This editorial summarizes the 2025 Sapienza University conference on femicide, emphasizing a multidisciplinary approach. Femicide is defined as a structural "crime of power" rooted in gender inequality and the drive for domination, rather than isolated pathology. Risk factors include possessiveness, jealousy, and male identity crises triggered by female autonomy. Research identifies it as the terminal stage of relational violence, often involving "overkilling". Prevention requires early recognition of warning signs and "upstream" educational interventions to address aggression in schools. The authors call for a cultural transformation and institutional accountability to dismantle stereotypes that normalize violence. Ultimately, femicide is framed as a social problem needing coordinated clinical, legal, and cultural action across society.

In the United States, homicides continue to be a public health problem. Overall, U.S. homicide rates have fluctuated in recent years, but little research has examined patterns and variation across homicide types. This analysis describes characteristics of single-, multiple- (2-3 victims), and mass homicides (≥4 victims) in order to help inform prevention strategies. Data from the National Violent Death Reporting System from 2018 to 2023 were analyzed to describe single and multi-victim homicides, to examine patterns across homicide types. The system uses information from death certificates, coroner/medical examiner reports, and law enforcement reports to provide a complete picture of violent deaths. Single- and multi-victim homicides disproportionately affected young non-Hispanic (NH) Black males, particularly those aged 18-34. The highest proportion of mass homicide victims were NH White. Intimate partner and family relationship problems often precipitate mass homicides. Arguments and other precipitating crimes are commonly associated with all three types of homicide. Mass homicide victims were often killed by family members or strangers. These findings can help inform the development of strategies to prevent homicide. Implementing violence prevention strategies, including addressing risk factors, can help prevent or mitigate the effects of single-, multi-, and mass homicides.

To elucidate potential economic pathways that may improve violence prevention among Black youth and young adults, we estimated the association of state minimum wage and annual firearm mortalities from 2000 to 2020 among Black individuals aged 10 to 34 using data from the National Vital Statistics System. Two-way fixed effects models were used to analyze the relationship between state minimum wage and overall firearm deaths, as well as firearm deaths by category, including homicide and suicide. Additionally, models were stratified by age group. We found that a $1 increase in state minimum wage was associated with a 5% decrease (RR = 0.95, 95% CI [0.92, 0.98]) in overall, annual firearm mortality and a 6% decrease (RR = 0.94 [0.91, 0.98]) in annual homicides caused by firearms, adjusted for covariates and state and year fixed effects. Our findings in overall and homicide mortalities held true across all age groups. For the association between minimum wage and suicide among Black youth and young adults, the results were roughly null overall (RR = 0.99 [0.96, 1.02]). These estimates, however, were not robust to additional analyses examining the plausibility of the parallel trends assumption. Re-estimation of models including 1- and 2-year leads and lags suggest that changes in firearm mortality preceded changes in the minimum wage. Thus, the decrease in firearm deaths is likely due to a myriad of socioeconomic shifts that coincide with, but were not directly caused by, minimum wage increases. This research emphasizes the importance of further evaluating the complex relationship between economic policies and firearm violence and prevention.

Family court care proceedings are instigated to remove children at risk of harm from parental care. Limited information is available on the health of mothers involved in care proceedings. We assessed maternal mortality and causes of death within 10 years of first birth, comparing first-time mothers with and without care proceedings. Using linked, administrative hospital and family court data, we followed a whole-population cohort of first-time mothers delivering between 2007 and 2017 up to 10 years. We calculated mortality rates comparing mothers with and without care proceedings. We examined proportions of deaths potentially preventable (suicide, homicide, drugs/alcohol or injury) and identified factors associated with death after care proceedings. Of 2&#x2009;775&#x2009;835 first-time mothers contributing 21&#x2009;856&#x2009;503 person-years of observation, 28&#x2009;405 (1.0%) had proceedings. Following proceedings, 314 (1.1%) died, compared with 5103 (0.2%) among mothers without care proceedings (age-standardised mortality ratio 21.0, 95%&#x2009;CI 14.3 to 27.7). Mortality ratios were lowest among first-time mothers aged <20 years (4.5, 95%&#x2009;CI 3.5 to 5.9) and highest for those aged 30-34 years (28.3, 95%&#x2009;CI 21.3 to 37.5). Among mothers who died after proceedings, 73% of deaths were potentially preventable compared with 28% among mothers without proceedings. Factors associated with death were older maternal age at proceedings, health conditions and court orders related to child removal. First-time mothers with care proceedings had 21 times the risk of dying within 10 years than similar-aged mothers. Healthcare, social care and family courts must address the extreme health vulnerability of mothers before, during and after proceedings.

Understanding the psychological factors that influence the quality of life among patients with forensic psychiatric disorders admitted to inpatient care units is of principal importance in enhancing their well-being and rehabilitation outcomes. This study investigates hope as a mediator in the relationship between self-esteem and quality of life in this unique population. This study was conducted among male forensic psychiatric inpatients admitted following homicide offenses at the forensic ward of Razi Psychiatric Hospital. A total of 58 participants were selected using census method. Data collection involved administering Rosenberg's Self-Esteem Scale, Snyder's Adult Hope Scale, and the World Health Organization Quality of Life-BREF questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS-26), including correlation analysis, univariable regression analysis, multivariable regression analysis, and mediation analysis. In a simple regression model, Self-esteem positively associated with quality of life (coef. = 12.9, p <.001). Hope also positively linked to quality of life (coef. = 6.1, p <.001). Self-esteem positively associated with hope (coef. = 1.9, p <.001). Hope mediated the relationship between self-esteem and quality of life, including general health, physical health, mental health, social relationships, and environmental factors. The indirect effect of self-esteem on quality of life through hope was significant (11.2, 95% CI: 5.2 to 17.7), while the direct effect was non-significant (1.7, 95% CI: -5.1 to 8.5). 47% of the quality of life score variance was explained by self-esteem and hope. Both self-esteem and hope are significant predictors of quality of life in this population, with hope playing a mediating role in the relationship between self-esteem and various aspects of well-being. Interventions targeting self-esteem and fostering hope may prove beneficial in enhancing the overall quality of life for these patients.

Cerebral cavernous malformations (CCMs) are vascular lesions that can cause focal epilepsy due to local hemosiderin deposition, gliosis, and cortical irritation. Epileptic seizures attributable to CCMs contribute significantly to morbidity and often require long-term management with antiseizure medications (ASMs), but the psychiatric side effect profiles of ASMs remain underreported in the literature. Herein, we present a case report of a patient with homicidal ideation following zonisamide use and uptitration following an Epilepsy Monitoring Unit (EMU) stay. Detailed is his hospitalization for this side effect and transition to another ASM so that he could return to a normal life outside the hospital. To contextualize this case, a literature review was conducted using PubMed from 1990 to 2026 using combinations of the terms "zonisamide," "antiepileptic drugs," "homicidal ideation," and "psychiatric adverse effects." Relevant articles were manually reviewed and no prior cases explicitly describing homicidal ideation associated with zonisamide were identified. Homicidal ideation should be contextualized within a spectrum of ASM-associated psychiatric adverse effects (PAEs). Zonisamide may have contributed to symptom emergence in a susceptible individual within a multifactorial neuropsychiatric context. To our knowledge, this is the first case report explicitly documenting homicidal ideation as an adverse event of zonisamide.

Forensic burials are used by perpetrators to dispose of evidence, including victims of homicide, as well as drugs, weapons, and other relevant evidence. There are many search techniques available that can increase the chances of locating these forensic burials, each with their own set of indicators that allow the grave to be identified. It is important as an investigator to understand not only the search technique being used, but what makes the grave detectable using that technique, depending on the time since burial and the contents of the grave. The aim of this pilot project was to aerially document the timelapse visible grave-related surface changes of three simulated forensic burials - full-sized pig cadaver (to mimic human remains), plastic cast teaching skeleton (to mimic other kinds of evidence), empty grave (to act as a control). The methods include systematically surveying the graves over a one-year period using a DJI Mini Pro 4, including uncrewed aerial vehicle (UAV)-photography, used to document the grave surface changes, and UAV-photogrammetry, used to quantify the subtle and localised grave elevation changes. The results showed that the lack of plant life over the grave areas and the backfill halo were the most helpful grave surface changes, however, they ceased being identifiable on days 328 and 93 post burial, respectively. While vegetation regrowth occurred at a similar rate across the different burial types (day 328 for the cadaver grave and 366 for empty and non-cadaver graves), the only burial to demonstrate an elevation change was the cadaver grave which mounded at first, reaching its peak on day 8 and slowly and continually depressing until it was flattened on day 233. The study implications include demonstrating cost-effective UAV drone-based grave documentation, providing specific intelligence on useful grave indicators for forensic burial searches.

Physicians' decision-making in end-of-life care involves many challenging ethical, legal, medical and psychological aspects including the possibility of hastening death. Hastened death is a complex ethical issue as it may cover both intentional assistance in death through euthanasia or physician-assisted suicide and the possibility of unintentional hastening of death through intensive management of suffering (the doctrine of double effect). The research question in our study was: Do views on unintentional or intentional hastening of death, and the factors behind them, change during the first 6 years as a physician? The same questionnaire, including hypothetical patient scenario, was answered by 227 Finnish physicians twice: at the time of their graduation in 2015 and after 6 years as a physician in 2021. The scenario presented in this study was a cancer patient requesting to increase his morphine dose to a potentially lethal level. The responders were asked whether they accepted this increment or not. Opinions on euthanasia, assisted suicide and several other attitudes were asked separately with a visual analogue scale. General life values and background factors were queried as well. The proportion of physicians accepting the increase in morphine dosing was 25% in 2015 and 31% in 2021 (P=0.06). No significant change in the opinion about the reprehensibility of euthanasia and assisted suicide was found. However, withdrawal of life-sustaining treatments was considered less reprehensible in 2021. In regression analysis, male gender, being single, believing in God, not considering assisted suicide reprehensible, and not feeling burned out were associated with the acceptance of increased morphine dosing in 2021. Acceptance of intentional or unintentional hastening of death presented in the survey did not significantly change after the first 6 years working as a physician, although a nonsignificant trend towards more accepting views was seen. Nevertheless, physicians' attitudes on this issue seemed to remain divided. Our results highlight the need for respectful discussion and education on ethics among medical profession to help physicians struggling with this demanding topic starting from medical school.

Exposure to mass public shootings is associated with adverse mental health outcomes, yet little is known about suicidal thoughts and behaviors among survivors. This study examines the prevalence and timing of suicidal ideation, preparation, and suicide attempts, as well as variation across subgroups. Data were drawn from a survey of 167 individuals directly and indirectly exposed to mass public shootings in the United States. Suicidal ideation, preparation, and suicide attempts were assessed using items from the Self-Injurious Thoughts and Behaviors Interview. Descriptive analyses examined prevalence, timing, and subgroup variation. Half of respondents reported suicidal ideation (50.9%), while 16.8% reported preparation and 7.8% reported suicide attempts. The more common time frame for all three outcomes was more than 1&#x2009;year prior, although some respondents reported recent experiences. Variation across exposure and victimization groups was observed descriptively, while differences by race/ethnicity were limited. Suicidal thoughts and behaviors are present among a substantial proportion of mass shooting survivors, with respondents reporting experiences across multiple timeframes. Findings highlight the importance of ongoing identification and intervention efforts.

Skeletonized remains pose unique forensic identification challenges, particularly in resource-limited settings where concealment attempts complicate medicolegal investigation. This retrospective descriptive study analyzed 19 skeletonized autopsy cases, assessing gender/age via anthropological methods, PMI from decomposition stage, cause/manner of death from family/police/post-mortem records. Four cases (21%) revealed deliberate concealment through cremation/burial to evade detection, highlighting disposal challenges in Indian contexts. Conventional anthropological techniques proved feasible despite resource constraints, through PMI estimation remained imprecise without advanced tools. Thus, we document patterns of skeletonized cases in India, highlighting infrastructure gaps, documentation needs and the need for multidisciplinary collaboration to achieve optimal medicolegal outcomes.

Faced with the crime of infanticide, all nations seek justice for both mothers and their infants. The psychopathology of childbirth and infanticide are among the most complex in human experience. This review takes the example of English law, and traces its evolution during four epochs, as knowledge increased and public attitudes changed. The combination of the 1922 Infanticide Act, recognizing the special circumstances of parturition, and the 1957 Homicide Act, with its concept of diminished responsibility, offer a solution worthy of consideration by other nations.

Femicide represents the most extreme expression of violence against women. This article aims to frame femicide through a shared medico-legal definition and to illustrate its distinctive forensic characteristics, highlighting their relevance for prevention, while also addressing the convergence between forensic evidence and the recent legal recognition of femicide in Italy. The paper integrates conceptual analysis with empirical evidence derived from a nationwide forensic case-series conducted in Italy, involving 27 university Institutes of Forensic Medicine. Femicide cases were identified according to a shared medico-legal definition grounded in the violation of the victim's right to self-determination. Circumstantial, relational, and lesional patterns were systematically analyzed and interpreted within an interdisciplinary framework. Femicide emerged as a distinct form of female homicide, predominantly occurring in intimate or domestic contexts and characterized by recurrent forensic features, including overkillng, involvement of identity-related body areas such as the face and erogenous zones, and the use of multiple or combined methods of attack. These patterns were significantly less frequent in other female homicides and challenge narratives centered on psychopathology of the perpetrator. Findings support the recognition of femicide as a specific and identifiable phenomenon rooted in the denial of women's self-determination. The medico-legal approach provides objective elements that not only facilitate post hoc classification but also offer valuable insights for risk assessment and prevention. Knowledge, shared definitions, and awareness are essential tools to recognize violence early and to prevent its lethal escalation.

Femicide represents an unparalleled criminal phenomenon both in Italy and worldwide, characterized by tolerance and substantial impunity rooted in a culture shared even by institutions. With Law No. 181 of 2025, Italy stands among the few European countries to have included the crime of femicide into the penal code, clearly defining the discriminatory structure of a crime too often romanticized and reduced to a private matter. Article 577-bis punishes anyone who causes the death of a woman with life imprisonment when the crime is committed as an act of hatred, discrimination, abuse, control, possession or domination on a woman. WHO data show that 35% of women experience violence, especially within the family, and that the leading cause of death for women aged 16 to 44 is murder by their partner or ex-partner. Globally, 137 femicides occur every day, approximately 50,000 per year. Only 10.5% of victims report to authorities. The Italian Commission of Inquiry found that 90% of 211 femicides were committed in an affective and familial context, and only in 15% of cases women had previously reported abuse. Male violence against women is systematic and discriminatory in every social, cultural and economic context. Binding supranational sources (CEDAW, ECHR, Istanbul Convention, EU Directives) are based on the assumption that these crimes are rooted in unequal relations between the sexes. The psychiatrisation of femicide perpetrators represents an interpretive distortion that makes invisible the discriminatory nature of the crime. International scientific evidence confirms that only a small percentage of femicides are committed by subjects with diagnosed mental disorders.

There is a pressing need for more knowledge about the experiences of children bereaved by domestic homicide and how society responds to their needs. This scoping review explores what is currently known about these children's experiences and examines the broader social and professional responses that influence their recovery, including societal attitudes, professional interventions, and decision-making processes that shape their everyday lives. We identified 40 relevant publications via a systematic search of 4 databases and additional methods. We searched for all articles that tackled the consequences of intimate partner homicide for children, including societal responses, professional interventions, and decision-making processes. The scoping review revealed several areas that have been the focus of children bereaved by domestic violence: intrapersonal themes such as behavioral and mental health consequences; complex feelings of identity, and a series of societal responses and challenges were also discussed; challenges in placement and care; stigma and social reactions; and support and institutional barriers. This review underscores the complex interplay between children's exposure to parental intimate partner homicide, the caregiving relationships that follow, societal attitudes, and the role of professional systems. Despite important advances, substantial gaps remain in full understanding how these factors interact to shape bereaved children's coping and long-term outcomes. Addressing these gaps is crucial for developing evidence-based policies and interventions that better support children through their grief and beyond.

The COVID-19 pandemic and its associated public health measures significantly altered the social, economic, and psychological landscape of communities worldwide. In South Africa, the post-COVID-19 period has been marked by a notable surge in homicide rates and interpersonal and community violence. Using a combined structural and social disorganisation framework, this qualitative study critically explores community members' perceptions of the socio-structural factors contributing to community violence, in the context of COVID-19. Utilising data from in-depth interviews and focus group discussions, this study examines the lived experiences of residents in a marginalised high-risk South African community, unpacking the interplay between structural inequities, social disintegration, and community violence. Community violence emerged not as periodic or individual, but as structurally generated, geographically concentrated, and socially normalised. The findings demonstrate that community violence is perceived as being embedded in cycles of survival, where long-standing systemic inequality, economic precarity, spatial disadvantage, and institutional neglect and inequity generate contexts in which community violence becomes normalised and self-reinforcing. The study findings advocate for interventions that not only address immediate catalysts of violence but also the deeper historical and structural determinants of violence in the post-pandemic era, while ensuring preparedness for effective violence prevention during future pandemics.