Attempt of posthomicidal suicide of a patient with psychotic depression after having coronaviral infection (clinical case)

The COVID-19 pandemic has led to a deterioration in mental health and an increase in suicidal activity among the population. The most vulnerable groups were the elderly and lonely people, patients with mental and somatoneurological diseases, who lost their jobs, relatives and friends, who found themselves in a difficult life situation. The article describes an attempt of post-homicidal suicide of an elderly 69-year-old man who had recovered from a coronavirus infection with a severe depressive episode and psychotic symptoms congruent to affective disorder. He wanted to kill his wife and himself by self-immolation, and only by a happy coincidence of circumstances this was avoided. The development of his depression was facilitated by polysegmental pneumonia with 40% lung damage, acute respiratory distress syndrome and comorbid somatoneurological pathology, fear of death from infection, persistent sleep disturbances, negative media exposure and misconceptions about COVID-19, manifestations of self-stigmatization (stigma), character traits (sensitive features). Pathological conclusions arose in him against the background of a lowered mood, which can be attributed to the holotim (affectogenic) delusion of contempt of those who had had coronavirus infection (he considered himself, along with his wife, "lepers", carrying the threat of infection to the people around them and therefore unworthy of life). The combined use of antidepressants and antipsychotics contributed to the complete reduction of psychotic depression with a critical assessment of what happened. The described case of a post-homicidal suicide attempt deserves attention due to the rather rare occurrence of self-immolation as a post-homicidal suicide, planned by an elderly man in a sober state and declared insane by a forensic psychiatric examination. Careful consideration should be given to the mental health of older people who have had COVID-19 and to warn family members of vulnerable individuals who are at potential risk of (post-homicidal) suicide due to their illness and anxiety.