Forensic Psychiatry Forensic psychiatry Application of knowledge of psychiatry for the purpose of law Mentally ill Unable to look

after himself or is dangerous to himself / others due to mental i llness Needs treatment due to mental disorder except mental retardation Certifiable Mental Disorder is a Serious Mental Disorder - Restraint of the sufferer is justified. Mental Retardation Incomplete / Abnormal mental development (Congenital or Acquired) Present at Birth / Early childhood Graded as Mild, Moderate, Severe.

Neurosis Patient suffers from Emotional or Intellectual disorder does not lose touch from reality. Psychosis: Pt. loses touch from reality (lives in the world of fantasy) He may suffer from delusions and hallucinations. Confabulation: Pathological loss of memory Patient fills the gap with imaginary events. These fabrications are called confabulations.

Classification of Mental Disorders 1 Mental Retardation 2 Organic Psychoses (a) Dementia (b) Drug induced Psychoses (C) Confusional state & Psychosis (epilepsy, trauma, child birth) 3 Functional Psychoses (a) Schizophrenia (b) Paranoid state (C) Affective disorder (Mania, Depression) 4 Neurotic Disorders 5 Personality Disorder 6 Sexual Deviations

DELIRIUM Acute Confusional state, Clouding of consciousness, Disorientation, In-coordination, Hallucination, Delusion & illusions Pt is Impulsive & may become Violent. May occur in - High fever, Drug / Alcohol intoxication or withdrawal, Head injury, metabolic disorder or mental stress Lasts for few hours to days or wks

DELUSION False BUT Firm Belief in something, which is NOT a Fact. He may commit crime due to delusion. It indicates a serious disorder like Schizophrenia. Hypochondriacal Delusion Pt believes that he has some medical problem, which actually is NOT there. He says that he has Cancer, Obstructed bowels etc. Delusion of Poverty Pt believes that he is very poor & has no money. Nihilistic Delusion Pt believes - There is NO world, he does not exist or s dead. Delusion of Infidelity Pt suspects the Fidelity of his wife & may assault her. Common in Chronic alcoholism & Schizophrenia Delusion of Grandeur Pt believes that he is very wealthy, related to ministers Has divine power Occurs in mania & schizophrenia Delusion of Persecution Pt. believes something bad is going to happen, friends want to kill him. People, things or events refer to him in a special way (delusion of Reference) His thoughts / actions are influenced via radio (delusion of influence) Occurs in - Schizophrenia, Mood disorders (mania, depression), Alcoholic & Drug psychosis HALLUCINATION: False Perception without Sensory Stimulus Seeing, hearing, smelling, tasting or touching something which is NOT actually p resent Visual hallucinations (flash of light, frightening faces) In Altered Consciousness & Epilepsy Auditory hallucinations - In Schizophrenia & Severe Depression Olfactory & Gustatory H. - In Schizophrenia & Temporal lobe Epilepsy Tactile Hallucination - Organic Psychosis, Schizophrenia, Cocaine Psychosis ILLUSION False interpretation of an Object / Stimulus, which has real existence Interpreting Stick as Snake or Dog as Lion May occur in Delirium, Old Age, During night. Lucid Interval: Time Period in the course of mental disease during which there is complete absence of symptoms of insanity During this period he can judge his actions soundly & is legally responsible for his actions. He can make Valid Will & can give Evidence. Common in Bipolar disorders

Psychopath (Sociopath) Personality disorder Neither Mentally ill nor Mentally defective Does not confirm to normal social behavior Feelings of love, affection, sympathy - Absent Anger & Impulsive behavior - Without sufficient provocation. Failure to learn from experience or punishment

Dementia Mind has reached a normal acceptable stage of development and then shows signs of deterioration. Manifests as - Decline in intellectual functions of memory, Comprehension & Reasoning ability Organic Dementia Due to some lesion in the brain Early stage - Restlessness & irritability with delirium, excitement or depression (These may pass off) Later stage - Progressive mental deterioration, marked loss of memory, Confusion as to time, place & person Senile dementia Progressive Mental deterioration due to old age Pt losses his memory, becomes childish, silly, perverted behavior. Delusions may be present. Dementia Paralytica or GPI Loss of interest, negligent & apathetic Blunting of moral sense Loss of control on sexual instinct Impulsive outburst of violence

SCHIZOPHRENIA (Thought Disorder) Misinterpretation of reality due to hallucinations, illusions, & delusions Disintegration of emotional stability Changes in the behavior. Split personality (split between thought & emotion) Pt lives in a world of his own. Schizophrenia simplex Begins in early adolescence. As the disease progresses he withdraws from environment, lacks ambition, gives up hobbies & is indifferent to surroundings. Hebephrenic Schizophrenia Begins in adolescents. Thinking process is disturbed. Wild excitement, illusions, hallucinations & delusions are present. Conduct is impulsive. Ultimately the whole personality disintegrate. Catatonic Schizophrenia it may manifest as stupor marked suppression of speech, movement & activity & al ternate with rigidity and excitement. Stupor may lead to suicidal attempt.

Stage of excitement may lead to impulsive homicidal attacks. Paranoid Schizophrenia Distortion of thought with persecutory / grandiose delusion & hallucination Most of the personality is preserved. Dangerous state of morbid jealousy referred to as Othello syndrome is an example of paranoid schizophrenia Person has delusion of infidelity of his wife & may kill her.

MENTAL HEALTH ACT 1987 OBJECTIVES 1. Regulate admission of Mentally ill to Psychiatric hospital & protect his Rights while under detention. 2. Protect Citizens from being detained in hospital without reason. 3. Fix liability for maintenance charges of mentally ill pt 4. Establish Guardianship & Manage Property of mentally ill. 5. Establish Central & State authority for Mental Health Services. 6. Licensing & Control of Psychiatric Hospitals. 7. Ensure legal aid to Mentally ill.

DUTIES 1. 2. 3. 4. ent 5. Pt he

of a doctor in issuing Certificates Certificate issued on Prescribed Form Pts examination - Not earlier than 10 days before application Two certificates are required 1 must be from a Dr. in govt. service Each Dr. examines the pt separately ( without consulting each other & form his independ opinion). Each certificate should clearly state: is suffering from mental disorder of such a nature & degree that needs detention in psychiatric hospital.

6. If, not possible to give an opinion Pt. is kept under observation for 10 days, extendable to max of 30 days.

CIVIL Responsibility of Mentally ill Management of Property Court may appoint guardian to take care of mentally ill appoint manager to manage the property Contract Contract is INVALID if - one of the parties is incapable to understand it (due to mental illness) Contract during Lucid Interval Legally Valid. Contract with mentally ill is binding if the other party can show that: he was unaware of the mental illness & the contract is fair. Marriage & divorce Marriage can be declared NULL & VOID if: at the time of marriage one of the parties is incapable to understand the nature of contract. Mental illness occurring subsequent to marriage - NOT a ground for divorce Competency as Witness Mentally ill person is NOT competent to give evidence if due to his mental illness he is unable to understand the questions asked He is can give evidence during lucid interval Validity of Consent Sec 90 IPC- Consent in INVALID if it is given by a person who due to unsoundness of mind or intoxication is unable to understand the nature & consequences of the act to which given consent. TESTAMENTARY CAPACITY Capacity of a person to make a valid will It is the possession of Sound Mind {COMPOS MENTIS} which must be certified by a doctor. A will is Valid if : 1) Testator is a Major 2) Sound Mind at the time of making a will 3) Understands the nature & consequences of his act 4) Executes it voluntarily & without influence of others 5) In presence of 2 witnesses. 6) Witness is NOT beneficiary of the will

he has

Criminal Responsibility Law presumes Every person is Sane unless contrary is proved. Insane person - NOT responsible for his actions. But following conditions should be fulfilled: Evidence of mental disorder. Mental Disorder - Present at the time of Crime. It should be of such a degree that: pt is unable to understand that the act is wrong/co ntrary to law.

Sec 84 IPC Nothing is an offence which is done by a person who at the time of doing it, due to unsoundness of mind, incapable of to understand the nature of act and that it is wrong / contrary to law.

INSANITY & MURDER Plea of insanity is taken as defense against the charge of murder. Crime is without any motive Target is not definite - may attack friends or stranger without any provocation. Attack is spontaneous and without any preparation. No attempt is made to run away after the crime.

Mc Naghten Rule McNaghten under the delusion of Persecution shot Mr. Drummond, Secretary to P. M . of London Robert Peel in mistake for the later. A judgment of NOT Guilty due to Insanity was given. Public reacted strongly against the acquittal. House of Lords put questions to all 14 Judges Based on the answers given by them McNaghten Rule was framed to fix Criminal responsibility of insane.

To establish defense on the ground of insanity it must be shown that at the time of committing the act he was under such defect of reason due to mental disorder that he did not know the nature & consequences of the act & that the act was wrong. Criticism of McNaghten Rule Criterion for deciding that a person is insane is purely an intellectual one. NO consideration of emotional factors or ability of person to control impulses. Impulse: Sudden & irresistible performance of Kleptomania: Stealing articles Pyromania: Setting fire to force compelling the person to conscious act without motive or forethought. of little value. things

Most of the crimes are result of impulses like rage, jealousy that are not resis ted & such unresisted Impulses are NOT excusable by law. If a person can differentiate b/w right & wrong & understand the nature & conseq uences of act then plea of impulse as defense is not accepted. Admission and Discharge of Mentally ill TRUE INSANITY Onset: FALSE INSANITY Onset: Sudden

Sudden/ rarely gradual without any motive with some motive

Predisposing cause - may be present Absent Facial expression - Peculiar may pretend to be mad Generally normal,

S/S of insanity present irrespective of being observed Pretends to be insane only when observed. S/S usually indicate particular type of mental illness S/S do not indicate particular type of insanity can tolerate exertion for several hours Gets exhausted Habits - Dirty. Habits - not dirty may pretend to be dirty Physical features of insanity dry skin, constipation, anorexia, insomnia PRESENT ABSENT Not worried about repeated examination Dislikes repeated examination