Authorities in Romania say a patient at a psychiatric hospital has beaten to death five other patients with a drip stand and wounded several more.
The 38-year-old attacked the patients in the northeastern town of Sapoca on Sunday, killing three people at the scene.
Another person died in a hospital later on Sunday and an 88-year-old woman died on Monday.
Hospital manager Viorica Mihalascu, who resigned after the incident, said "everything happened in less than a minute."
Mihalascu added that "his symptoms did not indicate the tragedy was about to happen."