Mania, homicide and severe violence

Background: Mania has been reported to be a risk factor for aggression and violence in psychiatric hospitals, but the extent of any association between mania and severe interpersonal violence in community settings is not known.Aim: To examine the association between mania and severe violence in a series of patients found not guilty by reason of mental illness (NGMI).Methods: A review of the court documents of those found NGMI of offences involving severe violence, including homicide, attempted homicide and assault causing wounding or serious injury, in New South Wales between 1992 and 2008.Results: Twelve of 272 people found NGMI were in a manic state when they committed a severe violence offence. Ten were diagnosed with schizo-affective disorder and two with bipolar disorder. Three patients were in the depressed phase of schizo-affective disorder and there were no patients in the depressed phase of bipolar disorder.Conclusion: Mania, in particular the manic phase of bipolar disorder, is not strongly associated with severe violence.