DEFINITION
Forensic Psychiatry is the branch of psychiatry that deals with the application of psychiatry in the administration of justice both in civil and criminal cases, whenever and wherever it is required.
Insanity: Insanity is a condition in which the patient suffers some defect or disease of the mind that affects his personality, mental status, critical faculties, emotional process, and reaction to his immediate and total social environment.
MEDICOLEGAL IMPORTANCE
Criminal Cases:
• When a defense attempted to prove that a person has committed the crime in a state of mental unsoundness to avoid conviction.
• When a defense attempted to lessen the punishment on the grounds of mental unsoundness of the accused.
• For deciding to give capital punishment.
• When a bail petition has been filed showing one as a mentally ill patient.
• When a person may plead insanity to avoid trial.
• In connection with the abatement of suicide in an insane person.
• When it is claimed that a person has committed suicide due to the effect of mental unsoundness.
Civil Cases
• Testamentary capacity or capacity to make a valid will.
• Continuance or dissolution of business contact.
• In connection with the nullity of marriage.
• In connection with divorce.
• Regarding the capacity to act as a witness.
• Regarding the validity of consent given by an insane.
• Appointment of a curator or caretaker for the property or an account of a mentally unsound person.
• Discharge, continuance, or appointment in a job.
CRIMINAL RESPONSIBILITY
Mac Naughten’s Rule (1843):“Nothing is an offense if it is committed by a person who, at the time of doing it, due to unsoundness of mind, is incapable of knowing the nature of the act, or that it is either wrong or contrary to the law.” – (PM- Robert Peel, PS- Edward Drumond)
Durham’s Rule (1954) states that an accused person is not criminally responsible if his unlawful act is the product of a mental disease or defect.
Curren’s Rule (1964) states that an accused person is not criminally responsible if, at the time of his conduct, he could not regulate it to the requirement of law as a result of mental disease or defect.
American Law Institute Recommendation: “”A person is not responsible for his criminal conduct if, at the time of a such conduct, as a result of mental disease or defect, they lack adequate capacity either to appreciate the criminality of their conduct or to conform their conduct to the requirements of the law.”
CIVIL RESPONSIBILITY
• Management of property—The District Court will appoint a manager who will do what is best for the management of the property.
• Business Contract—If the person is insane before the contract, it will be null and void. If it occurs after the contract, the second party may continue or cancel it without malice.
• Marriage Contract– If the person is insane before marriage, the marriage will be null and void.
• Question of Divorce– If insanity occurs after marriage, the wife may continue or sue for divorce if he is not well after two years of Rx.
• Testamentary Capacity- A sound disposing mind or mental state is necessary to prepare a valid will or testament.
• Competency as Witness- An insane person cannot disclose evidence.
• Consent- Consent given by a mentally ill patient stands invalid.
• Guardianship- An insane person can not be a legal guardian of a minor.
• In Service- A mentally ill person is not eligible for getting a service. Even if he becomes ill later on, he may be dismissed as per the Rule.
CAUSES OF MENTAL ILLNESS
BIOLOGICAL
Genetic–
• Gene defect
• Chromosomal abnormality
Biochemical
• ↓Dopamine
• ↓Noradrenaline
• ↓Seretonine
Constitutional
• Pyknic- short, rotund build- MDP
• Leptosomic/Asthenic- thin, tall – Schizophrenia
• Dysplastic- Normal
• Athletic- Normal
Physical
• Diseases
• Malnutrition
• Injury
• Senility
• Degenerative
• Metabolic
• Infection
• Addiction
• Drug
SOCIAL CAUSES
Unhappy Family
• Broken Family
• Frequent Quarrel
• Lack of trusts
• Loneliness Social Stresses
• Bereavement
• Loss of love
• Poverty
• Unemployment
• Injustice
• Insecurity
• Competition
• Underachievement
RESTRAINT OF AN INSANE
Restraint may be two types-
– Immediate
– Admission to an asylum
Immediate Restraint-
- Who is dangerous to himself or others
- Delirium
Admission to Asylum
• Admission voluntarily
• Admission under exceptional circumstances
• – for 90 days
– application is made by his relative or friend
– two medical certificates
– one should be from govt. doctor
– if not available, two doctors from that Hospital
• Reception Order on Application to the Magistrate by a relative or Officer-In-charge of that Hospital
– if Rx should be continued for >06 months
– two medical certificates
• Reception Order on the production of the patient before the Magistrate
CLASSIFICATION
Major Mental Illness (Psychoses)
• Organic
– Acute- Delirium
– Chronic- Dementia, Substance use
• Functional
– Schizophrenia
– Depression
– Mania
Minor Mental Illness (Neuroses)
• Anxiety disorder
• Phobic disorder
• Obsessive disorder
• Hysteria {Dissociative (conversion) disorder}
• Hypochondriasis (Somatoform)
• Sexual perversion
• Drug addiction
• Personality disorder(Psychopathic disorder)
Mental Retardation
• Imbecile
• Idiot
• Feeble minded
OTHER CLASSIFICATION
According to ICD-10
Stress Related Disorder
– Acute stress disorder
– Adjustment disorder
– Post-traumatic stress disorder
Anxiety Disorders
– Generalized anxiety
– Phobic disorder
– Panic disorder
– Obsessive-compulsive disorder
Affective (mood) Disorders
– Mania
– Depression
– Bipolar disorder
Schizophrenia Substance Misuse
Personality Disorders
Eating Disorders
– Anorexia nervosa
– Bulimia nervosa
Somatoform Disorders
– Dissociative (hysteric conversive) Disorders
– Pain disorder
– Body dysmorphic disorder
– Autonomic dysfunction Disorders
– Hypochondriasis
Neurasthenia
Puerperal
Organic
– Delirium
– Dementia
COMMON TERM OF PSYCHIATRY
Behavior– Behavior is any activity the living organism performs that can be observed, recorded, and measured.
Perception– it is the process of selection, organization, and interpretation of sensation
Thought– a person’s belief may be temporary or permanent in connection with any matter or activity.
Emotion is the state of mind associated with physiological arousal, which occurs in response to internal or external events.
Consciousness- A state of awareness of self and the environment
Memory is the ability to store information to be recalled and used later.
Affect- Emotion felt at the moment that can be observed.
Personality- A unique behavior and mental process pattern characterizes an individual’s reaction to the environment.
Attitude-Positive or negative evaluation of people, objects, ideas, or events.
Intelligence- Capacity to act purposefully, reason, and deal effectively with the environment.
Mood- Sustained emotional state.
Feeling- it is the subjective component of emotion.
Insight- judgment of one’s condition and its effect on himself and other
DISORDER OF PERCEPTION
Illusion and Hallucination are the two central disorders of perception. They may occur temporarily for a short period, but after seeing logic and fallacy, they go away. These are physiological. However, they may remain permanently and not wash out from the mind even after showing all types of logic and examples. Then, they are regarded as pathological and demand treatment. They may exist as a single entity, i.e., psychological disease, or they may present as a symptom of any other mental illness.
• Illusion: Misinterpreting sensory stimuli due to misperception or physical distortion of stimuli.Such as thinking of a rope as a snake.
• Hallucination: False perception without sensory stimuli but has real perceptual quality.
– Visual– seeing anything without its actual existence
– Auditory– Hearing of anything without its actual existence
– Olfactory– Getting the smell of anything without its actual existence
– Gustatory– Getting of taste of anything without it is the actual existence
– Tactile– Getting of sensation of anything without it is actual existence
– Psychomotor– Feeling of movement in some part of the body.
DISORDER OF THOUGHT
Identical to disorders of perception, Delusions and obsession may occur temporarily for a small period, which, after seeing logic and fallacy, go away. These are physiological conditions. However, these may remain permanently and not wash out from the mind even after showing all types of logic and examples. Then, these are regarded as pathological and demand treatment. They may exist as a single entity, i.e., psychological disease, or they may present as a symptom of any other mental illness.
• Obsession- Recurrent, persistent, senseless ideas, thoughts, images, or impulses that enter the mind despite a person’s effort to exclude them. For example, one can think his hands are not cleaned well after thoroughly washing. Then he again washes his hands. Still, he thinks his hands are not cleaned well and does it repeatedly for several periods.
• Compulsion- Repetitive and seemingly purposeful behavior in response to an obsession a person feels compelled to carry out.
• Kleptomania– to steal articles may be of small value or no use
• Dipsomania– to take alcoholic drinks
• Pyromania– to set fire to things
• Mutilomania– to injure and mutilate animal
• Bulimia Nervosa- to take food
• Delusion– False, unshakable belief despite evidence to the contrary, which is out of keeping with the patient’s social, educational, and cultural status.
• Delusion of Grandeur– the feeling of greatness, power, and wealth.
• Delusion of persecution– something terrible is going to happen to him
• Delusion of Influence– all thoughts and activities are controlled by others.
• Delusion of Reference– all agencies are referring to him
• Delusion of Nihilism– no belief in the existence of earthly matter
• Delusion of Infidelity– his wife is not faithful to him
• Erotomania- believes that someone is deeply in love with him/her
DISORDER OF EMOTION
Apathy- Lack of emotion.
Dysphoria- An unpleasant mood
Euphoria– An exaggerated feeling of a healthy being
Anxiety– Apprehension, tension, or uneasiness that stems from the anticipation of danger, which may be internal or external
Agitation– Feeling of inner tension expressed with excessive motor activity.
Cyclothymia- Periodic change of mood from depression to elevation.
Phobia-Persistent, irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the phobic stimulus.
- Agoraphobia– fear of open space
- Claustrophobia– fear of closed space
- Nyctophobia– fear of darkness
- Numerophobia– fear of number
- Arachnophobia– fear of spider
- Hydrophobia– fear of water
- Hippopodomonstroquilanophobia– fear of the significant word
