Slaying suspect’s mental health may be key to investigation

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BY TRACEY O’SHAUGHNESSY

REPUBLICAN-AMERICAN

NAUGATUCK — The arrest warrant for alleged baby killer Christopher Francisquini details the horrific scene police discovered, as well as interviews with family members as the investigation unfolded after 11-month-old Camilla Francisquini suffered a violent, unimaginable death in November.

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Christopher Francisquini is suspected of killing his infant daughter.

Deep in the 35-page document, the baby’s mother and other family members reportedly told police Francisquini has mental problems — that he was often inexplicably angry, and that he has been prescribed medication based on that diagnosis, according to the warrant.

Police asked about Francisquini’s mental health as part of their investigation, which at that point involved a search for the alleged killer. He has since been caught, is in custody, and briefly appeared in Waterbury Superior Court where a request for a probable cause hearing was stayed until next month.

The mention of mental health raises questions both about Francisquini and about bipolar disorder. Bipolar disorder affects only a fraction of the population, and is often overdiagnosed or misdiagnosed, local psychiatrists say. It also is among the most treatable of mental health disorders, doctors say, and does not tend to be a condition which inspires violence.

“People will sometimes say, ‘I think I’m bipolar. One minute I’m angry and another minute I’m sad.’ That is not bipolar,” said Dr. Bob McWilliam, a psychiatrist in Woodbury.

To be diagnosed as bipolar, patients must have experienced an intense, nearly euphoric period of mania for at least a week and be depressed for two weeks. The diagnosis is made clinically. As with most psychiatric disorders, there’s no neuroimaging or blood test that can diagnose bipolar disorders, said Dr. Javeed Sukhera, chairman of psychiatry at the Institute of Living in Hartford.

“Both bipolar disorder and major depressive disorder are overdiagnosed due to the lack of understanding, and the pathologization of normal human emotions,” said Sukhera.

“So, someone’s having mood swing or intense reactive emotions. That could be a normal thing. Someone feeling an intense level of sadness. That, too could be normal,” he said. “There’s a clear difference between bipolar disorder, which is largely genetic and biologically determined, and emotional reactivity and mood swings.”

Mania is characterized by euphoria and feelings of grandiosity, coupled with racing thoughts and speech patterns and an inability to sleep, McWilliam said. “It’s a positive, revved-up mood. There’s grandiosity in their thinking. People sometimes feel they have special powers, special insight.

In peaks of mania, people can be psychotic, people might feel they are the second coming of Christ. A common feature is getting involved in activities that potentially have very dangerous consequences.” These include hypersexuality and increased spending, Sukhera said.

About 80% of bipolar conditions are related to genetics, the highest level of heritability among all psychiatric disorders, Sukhera said. It is diagnosed equally in men and women. Formerly called manic depression, bipolar disorder is uncommon. Only about 2.8% of the population suffer from the disorder, according to the National Institutes of Mental Health.

The mother of the victim, Kristyl Nieves, told police that Francisquini was diagnosed with bipolar disorder and “heard voices,” according to the warrant.

Hundreds of locals turned out for during a vigil to remember Camilla Francisquini on what would have been her first birthday Dec. 3 on the Naugatuck Green. Camilla was killed two weeks ago by her biological father Christopher Francisquini who was apprehended Friday in Waterbury.
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Nieves also said Francisquini wasn’t taking his medication. Francisquini’s sister told police the alleged killer was taking the antipsychotic Seroquel, according to the warrant. The drug can be used in the treatment of bipolar disorder, schizophrenia and major depression.

Given privacy laws is impossible to know whether Francisquini was actually diagnosed with bipolar disorder, whether the diagnosis was correct, what type of other medications he may have been prescribed, in what doses.

Medical information is protected information and unavailable for public inspection.

Psychiatrists stress that those suffering from the disorder are at a far greater risk to themselves than others.

Although several studies have found that those with bipolar disorder committed violent crime more than the general population, the risk was largely associated with substance abuse, and it was minimal in patients who did not have substance abuse problems.

It is not know if Francisquini has any drug addictions. There is a mention of him having marijuana in the police interviews spelled out in the warrant.

The disorder, which can include auditory hallucinations, “it’s very treatable,” McWilliam said. “There are medications that have very few to low side effects. There are very many, high functioning people who have bipolar disorder. There’s a high correlation with creativity.” The composer Robert Schumann and the writer Virginia Woolf both suffered from the disorder, he said.

Despite its long history, very little is known about why and how the disorder manifests, Sukhera said.

In addition to talk therapy, physicians often will prescribe mood stabilizers, such as lithium, antipsychotics, antidepressants, antidepressant-antipsychotics and antianxiety medications such as benzodiazepines.

“The real goal of treatment is to get someone on a mood stabilizer or more than one mood stabilizer,” McWilliam said.

A variety of studies have found anywhere from 40% to half of all those with bipolar disorder do not take their medication as prescribed.

Last year, a British review of 57 studies involving 33,000 patients found six reasons for non-compliance, including side effects, difficulty remembering to take medication and a lack of support from family, friends and health care professionals.

Part of the problem may be the disorder itself, Sukhera said. “One of the tricky things about bipolar is that people don’t have insight. They don’t think that they have a problem. They are over the moon happy. People often feel great, especially in a first episode.”

Non-compliance often leads “to relapse, hospitalization and increased suicide risk,” according to the 2021 British study.

However, not taking medication at all or the way it is directed is widespread among all Americans. The National Institutes of Health reports that 75% of Americans have trouble taking their medicine as directed. Among those with chronic conditions, only 50% adhere to their doctor’s directions, which is believed to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year, according to a 2018 study in the Permanente Journal.

Those who believe they are witnessing a manic episode need to call emergency services, Sukhera said.

“The most important thing is to be compassionate,” he said. “When we see behavior like that, it makes us uncomfortable. Be respectful. Understand it’s their brain that’s doing that. If it’s a manic episode it’s an emergency.”