Clinical and Forensic Characteristics of Homicide Offenders With Bipolar Disorder: A Retrospective Study From a National Forensic Psychiatry Center

Objective: To characterize the clinical and forensic features of individuals with bipolar disorder who committed homicide and to examine factors associated with prior criminal history. Methods: This retrospective, single-center study included 62 individuals with bipolar disorder who underwent criminal responsibility evaluation for homicide at the First Board of the Council of Forensic Medicine in Türkiye (2021–2025). Sociodemographic, clinical, and criminological variables were extracted from forensic psychiatric records. Participants with and without prior criminal history were compared using appropriate statistical tests. Results: The sample was predominantly male (88.7%) and showed a high prevalence of lifetime psychotic symptoms (91.9%), most commonly paranoid or persecutory delusions. At the time of the offense, residual or subthreshold psychopathological features were frequently documented; however, a causal link with the homicidal act was not established in most cases in terms of criminal responsibility. Most homicides were impulsive in nature (72.6%) and involved victims known to the offender. Alcohol or substance use at the time of the offense was documented in 17.7% of cases (alcohol: 12.9%; substance: 4.8%) and was not a predominant feature of the sample. A history of prior criminal offenses was observed in more than half of the cases (58.1%). Compared with participants without prior criminal history, those with prior criminal history more frequently exhibited a history of manic episodes, self-harm behavior, comorbid personality disorder, and a higher number of psychiatric hospitalizations, whereas sociodemographic characteristics and treatment adherence were broadly similar between groups. Conclusion: Homicidal behavior in bipolar disorder appears to be more closely associated with impulsivity and interpersonal or situational stressors than with severe, responsibility-abolishing psychopathology. Recurrent offending was linked to markers of illness severity, underscoring the need for sustained psychiatric follow-up and continuity of care in forensic populations. Cite this article as: Aslıyüksek H, Yılmaz ME, .zbakır SD, et al. Clinical and forensic characteristics of homicide offenders with bipolar disorder: A retrospective study from a national forensic psychiatry center. Neuropsychiatr Invest. 2026, 64, 0084, doi: 10.5152/NeuropsychiatricInvest.2026.25084.