He Amok's syndrome Is a condition in which the individual becomes temporarily erratic and irrational, loses control and attacks violently and unjustifiably against the people or objects that are within reach.
It is an infrequent, supposedly cultural syndrome prevalent in Malaysia, Puerto Rico and the Philippines, although there have also been cases in modernized cultures.
Before the episode, it is typical that the person enters a period of social withdrawal that can last for days or weeks. The outburst appears suddenly, with no apparent cause.
The individual can attack any person or object that gets in his way, be it friends, family or bystanders. This outburst of violence can last for hours until the person is arrested, and in some cases his death is necessary.
Characteristics of Amok's syndrome
In some cases, the person suffering from this set of symptoms may end up committing suicide. After the episode, the individual usually enters a state of stupor or dream that can last days. When she wakes up, the amnesia About the event and the persistence of social withdrawal.
Although multiple and suicidal homicidal episodes committed by individuals with mental disorders are relatively frequent today, there are no recent discussions in the medical literature about the recognition or treatment of those who suffer from Amok syndrome before these suicidal behaviors occur. Homicidal
The DSM-V, which constitutes the consensus opinion in the diagnosis of mental disorders, describes the Amok syndrome as a cultural phenomenon that is not very frequent at present.
Amok's syndrome is believed to develop as a result of the geographic isolation of tribes and their spiritual practices. However, characterizing this syndrome as"cultural"ignores the fact that similar behaviors have been observed in western and eastern cultures, where there is no geographic isolation.
In addition, despite the belief that this syndrome occurs infrequently today, it is a fact that in modern societies there are now more episodes of these violent behaviors than in the primitive cultures where they were observed for the first time.
Historical background
In English,"running Amok"is a common expression that describes a wild, uncontrolled way of behaving. The term"amok", also written"amuck"or"amuko", is originally from Malaysia and describes the mental state of the amucos, ancient warriors who carried out maniac, uncontrolled and delirious attacks, killing anyone who interfered on their way.
According to Malay mythology, these acts were involuntary and were caused by a spirit that entered the body of the warriors and forced them to behave violently without being aware of what they were doing.
Most of these cases, whose origins date back to 1770, have been historically observed in the Malay, Filipino and Puerto Rican tribes. Incidence in tribes reinforced the belief that the cultural factors associated with them caused the syndrome, making culture the most accepted explanation of its origin.
Over the next two centuries, the incidence and psychiatric interest in Amok's syndrome decreased. The lower incidence of the episodes was attributed to Western influence on primitive tribes, which eliminated many of the cultural factors.
However, as mentioned earlier, while declining cases in tribes, they increased in more modern societies. At present, there are many descriptions of multiple homicide cases comparable with cases that occurred in primitive tribes.
Historically, observers described two forms of the syndrome, but the DSM makes no distinction between the two. The most common form, beramok, was associated with a personal loss and preceded by a period of Depressed mood And melancholic. The most infrequent form, amok, was associated with rage, a perceived insult, and a need for revenge that preceded the attack.
Based on this description, the first of the forms could be linked to a mood disorder and the second would be related to the psychosis Or some personality disorders .
Psychosocial profile of affected persons
Researchers have described a psychosocial profile characteristic of individuals suffering from Amok syndrome today.
These people are usually young or middle-aged men who Have recently suffered a loss Or have received insults to his person. Often they have been discharged from the army recently, their education is poor and they come from a low socio-economic context.
Many times they are individuals seen as quiet, quiet and withdrawn. Some earlier behavior patterns often include immaturity, impulsivity, poorly controlled emotionality, or social irresponsibility. This profile is consistent among individuals in Malaysia and other ethnic groups who have suffered Amok syndrome.
Prevention
Today, this syndrome should be seen as one of the possible outcomes of a psychiatric condition (especially psychotic or personality disorder) without diagnosis and / or treatment.
Considering the large number of people suffering from psychotic disorders, mood disorders and personality disorders, Amok's syndrome is statistically uncommon.
However, the emotional damage it causes to victims, families and communities is very extensive and has a lasting effect. Since it is impossible to stop an attack of one of these people without risking one's life, prevention is the only method to avoid the damage it causes.
This new perspective discards the common perception that violent episodes are random and unpredictable and, therefore, can not be prevented.
Characterizing Amok's syndrome as the end result of a psychiatric condition reveals that, as with suicidal behavior, there are risk factors that can be used to assess a patient's potential to develop the syndrome and to plan a treatment.
To prevent episodes of Amok syndrome requires an early recognition of the individuals susceptible to develop it and an immediate treatment for the underlying psychological condition.
Medical intervention is impossible once the syndrome is occurring, and the result of violent behavior is not unlike what it was two hundred years before the arrival of psychiatric diagnosis and modern treatments.
The first step in the intervention is to identify those individuals whose psychosocial or psychological conditions predispose them to developing the syndrome.
Most individuals who exhibit violent behaviors similar to Amok's have had recent contact with physicians. Many of these patients often consult the family doctor rather than a psychiatrist or psychologist because of the stigma that is often linked to consulting a mental health specialist, either because of the denial of a mental disorder or fear of Validate their suspicion that they suffer from some.
Risk factor's
The limited literature on Amok syndrome concludes that some psychiatric conditions, personality, pathology and recent personal loss are important factors in the origin of the disease.
However, none of the reports have determined what specific conditions or specific personality disorders are responsible for that susceptibility. Based on psychiatric reports and evidence based on contemporary cases of violent behavior, factors that should be considered at risk for developing the syndrome are as follows:
- A history of psychiatric conditions
- Previous episodes of violent behavior Or violent threats
- Recent personal losses
- Violent suicide attempts
- Significant features or personality disorders
The more risk factors the patient has, the greater the potential to act violently.
Each of the risk factors should be evaluated through a complete patient history, supplemented by information provided by family members and others in significant patient environments: friends, neighbors, co-workers...
Previous medical history provided by other health professionals is also useful for observing the precursors of the syndrome's own behaviors.
Patients with psychotic disorders may not be able to provide reliable and consistent information, while those with personality disorders may minimize or disguise their violent impulses and their past problematic behaviors.
An interpersonal conflict that is occurring at the time in the patient's life should be viewed as a significant danger sign for a potential Amok episode.
Many of the risk factors for this syndrome are similar to those of suicide. It is common for both behaviors to converge when the individual tries to kill himself after a homicidal episode.
Treatment of underlying psychological conditions
The second step in the intervention is to treat the patient's psychiatric condition or personality disorder so that the Amok episode does not occur. Physicians can initiate a pharmaceutical intervention in patients susceptible to develop Amok syndrome, but should always be combined with psychological evaluation and treatment.
Involuntary psychiatric hospitalization is an option for those patients who are about to commit suicide or homicide imminently as a result of their mental condition.
For patients whose risk factors do not include a significant mental illness, involuntary treatment is not necessary. This is the typical case of patients suffering from personality disorders.
Proper treatment for a patient with risk factors requires the clinician to make an accurate diagnosis that can be used to determine which treatment modalities will be best for each patient.
To date, there is no medication specifically addressing the violent behavior of Amok's syndrome and, since violence is the result of multiple factors, it is unlikely that such medication will develop in the near future.
The mass violence observed in Amok's syndrome may be caused by a variety of psychiatric conditions, and medical treatment should therefore be directed to a disorder or condition that can be diagnosed.
In general, depressive disorders can be treated with Antidepressants Y psychotherapy support.
Antidepressants are effective in alleviating the symptoms of the disorder in 85% of cases. The patient should be monitored for symptom improvement. Serotonin reuptake inhibitors are often the most commonly chosen antidepressants because of their rapid therapeutic response compared to tricyclic antidepressants.
In addition, it has been demonstrated that Serotonin Is a neurotransmitter that plays an important role in violent and suicidal behavior.
The goal of psychotherapy is to prevent violent behavior. To do this, the clinician should take an active role in therapy and get help from the patient's family and their social networks.
If the patient exhibits symptoms of psychosis along with depressive disorder, an initial period of treatment may be necessary with Antipsychotic drugs Until the mood-elevating effect of antidepressants is achieved. With the exception of patients with psychotic symptoms or with suicidal or homicidal impulses, it is often easy to deal with most of them in out-of-hospital settings.
Patients with psychotic disorders such as paranoid schizophrenia or Delusional disorder Can be treated with antipsychotic medication. These drugs are effective in reducing thinking disorders, hallucinations and delusions in schizophrenia, manic episodes, and other non-specific psychotic disorders.
However, these drugs are only modestly effective in controlling violent behavior resulting from non-psychotic conditions such as borderline personality disorder and Antisocial disorder .
Anticonvulsive medication has been used and is effective in controlling violent behavior in some patients. However, its use, like other medications that have been used to treat violent behavior, is still considered experimental and not entirely appropriate.
The only exception to the general statement regarding the misuse of anticonvulsants to treat violent behavior occurs when used because this behavior is associated with mania. He lithium , An antimaniac agent, remains the main treatment for the Bipolar disorder And mania.
Hospitalization may be necessary to prevent patients from doing harm to themselves or to those around them. After hospitalization, a useful method for monitoring patient behavior and adjusting medication is partial hospitalization.
conclusion
To summarize, it is arguable that the Amok syndrome is still linked to culture today. A more modern and useful approach is to consider that this syndrome represents an extreme form of violent behavior that occurs as a result of a mental or personality disorder or of psychosocial stressors.
Early recognition of risk factors and immediate treatment of the psychological condition underlying the syndrome are the best options to prevent it.