Forensic Psychiatry
 Forensic psychiatry is a unique field of psychiatry which deals with the
assessment and treatment of mentally disordered offenders.
 It requires sophisticated understanding of the interface between mental
health and the law and therefore knowledge of the law in relation to
clinical practice is central to the work and there is regular involvement
with criminal justice agencies and the courts.
Classification Of Mental Disorders:
Three major groups:
A- FUNCTIONAL
The group is further subdivided into 4 sub-groups:
a- Psychosis:Characterized by withdrawal from reality and living in the world of fantasy.
Examples:
Schizophrenia, Psychosis of epilepsy
b- Psychoneurosis
Characterized by the fact that though the patient suffers from emotional or psychological disorder
but he/she doesn’t lose touch of reality
Examples:
Anxiety neurosis, obsession, hysteria
c- C- Personality Disorders
 Cluster A: Odd or Eccentric Behaviors
Schizoid (Individuals show a restricted range of expressed emotions and are detached from social
relationships. They may be referred as sombers or loners).
Paranoid (typically distrustful and suspicious of others and emotionally “cold” or excessively
serious)
Schizotypal (Isolation and have odd, outlandish, or paranoid beliefs. They may talk to themselves)
 Cluster B: Dramatic, Emotional, or Erratic Behavior
Antisocial (psychopathic or sociopathic; the patients are neither insane nor mentally defective but
doesn’t confirm to normal social standards of behavior)
Borderline(dramatic and abrupt shifts in mood and impulsivity, poor self-image; highly sensitive
to rejection, and fear of being left alone may result in frantic efforts such a suicide threats and
attempts)
Narcissistic (grandiosity, need for admiration, and lack of empathy)
Histrionic(attempt to get attention in unusual ways, such as bizarre appearance or speech)
 Cluster C: Anxious, Fearful Behavior
Avoidant(hypersensitive to rejection and unwilling for getting criticized)
Dependent(needy and submissive behavior, and rely on others to make decisions for them and
are extremely sensitive to criticism or disapproval)
Obsessive-Compulsive/Anankastic(so focused on order and perfection that the lack of flexibility
interferes with productivity and efficiency. They prefer to control the work alone, and are afraid that
work completed by others will not be done correctly)
d- D- Mood Disorders:
Mania: the patient is excited, restless,talkative,violent and dangerous.
Melancholia/Depression: loss of interest in normal activitiesrefusal of food, lack of personal
attwntion and suicidal tendencies
B- ORGANIC
In these disorders brain tissue is physically involved leading to permanent or temporary dysfunction of the
brain
Causes:- Arteriosclerosis, neuropathy, neoplasm, injury, scarring, hemorrhage
Examples:Brain injury caused by trauma, Alzheimer's disease, Huntington's disease, Multiple sclerosis, Parkinson's
disease, Alcohol withdrawal state, Vitamin deficiency (B1, B12, or folate) and etc
C- TOXIC / METABOLIC
Insanity associated with :
Use of alcohol, cannabis indica, barbiturate etc
Exposure to toxic chemicals like lead, cyanide and etc
Some Important Definitions
Delusion:
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A false or firm belief in something, which is not a fact and is out of context with the person’s
educational and cultural background
Not an isolated disorder and indicate deep-seated widespread disorder such as Schizophrenia and
GPI.
Types: 6:1- Hypochondrial
Such delusions are severe fixed thoughts of bodily change due to an illness which is not actually
proven by any objective investigstions, examination or tests.
2- Nihilistic
Ideas that his body or organ does not exist or the world is coming to an end or does not exist all
3- Depressive
Morbid thoughts of guilt, self-blame or futility of life
4- Infidelity
Ideas of cheating, adultery, or having an affair of some loved one with anyone other than
him/her
5- Grandiose
Thoughts of over-estimation of personal qualities, abilities, and finances (as those occurring in
hypomanic illness) may be subtle if the background of the patient is not known
6- Paranoid
Ideas of persecution and injustice incurred on the patient from others out of hatred or jealousy of
his/her personal talents or special abilities or for no clear reason.
7- Passivity
Patients believe there are abnormal influences on their bodily processes by outside agencies
8- Reference
Patient believes they are the center of excessive focus of attention from others, and they are
referred to in other’s speech, thoughts or remarks
Illusion:
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A false interpretation of an external object or stimulus, which has a real existence
Illusions of sight, hearing and other senses may occur
Examples:- Mistaking stick as snake, dog as lion, tree as ghost etc
Hallucination:
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False perception without sensory stimulus
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It means seeing, hearing, smelling, tasting or touching something which is not actually present
Types: 4:1- Visual
2- Auditory
3- Olfactory/Gustatory
4- Tactile
Obsession:
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A thought, image, feeling or movement which an individual feels and compelled to carry out usually
repetitively, in spite of a strong urge to resist
Examples:- Fear of open or closed spaces, animals etc
Automatism:
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Performance of actions without conscious thought or intention
May be a product of disease (epilepsy), external factors (concussion), psychological stress (hysteria)
or drugs (barbiturates, alcohol)
Confabulation :
A pathological loss of memory in which the patient fills the gaps with purely imaginary events. These
fabrications are called confabulation.
Delerium:
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An acute confusional state characterised by cloulding of consciousness, disoriention, incoordination
and abnormal experiences such as hallucination, delusion and illusion lasting from a few hours to
days and weeks and ends with full or varying degree of recovery.
For example drug or alcohol intoxication or withdrawl , head injury, metabolic upset s or mental
stess.
The patient is therefore often impulsive and may commit sucide or some violent act.
Fugue:
This is a disturbed state of consciousness in which the affected person performs acts of which he appears
to be consious but of a which on recovery he has no recollection.
It is encountered in a dissociative disorder( hysteria) and epilepsy.
Neurosis:
The patient suffers from emotional or intellectual disorder but does not lose touch with reality.
Stupor :
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A state of complete suppression of speech, movement and action not accounted for, by profound
disturbances of conciousness.
Common in schizophrenia,depression,hysteria,epilepsy,metabolic upset,opium poisoning and certain
diseases of CNS
Twilght state:
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Conditons of diminised awareness of relatively short duration during which the patient may carry
out actions of which he has little no subsequent memory
Occurs in hysteria and epilepsy
Dementia:
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Decline of intellectual function of memory, comprehension and reasoning ablity and emotional
changes
Types three
1-Organic
Due to some diseease of brain
Restlessness ,irratability and delerium  progressive mental deterioration with marked memory loss,
disorientation in time place and person and general childishness
2-Senile
Caused by onset of old age and cerebral arteriosclerosis
Memory loss and childish and perverted in bahaviour
3-Dementia Paralytica/GPI
Loss of interest,negligence, loss of control of sex instense and violent bahiour
Mentally Ill Person:
A person who is in need of treatment by reason of any mental disorder other than mental retradation.
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Non-Compos Mentis
Means Person of unsound mind
A magistrate/judge may probe into whether the person before court is mentally sound or not and can
order his/her psychiatric exam
Diagnosis
An RMP in order to diagnose mental illness in a patient must follow in detail the following steps:1-Family History
2-Personal History
3-Physical Examination
4-Mental Condition
General appearance and behaviour, gait, talk,mannaers and content,subject statecontent of thoughts,
perception, contact with reality, sensoriun and formal intelligence, insight and judgement,
handwriting
5-Lab Investigations:- Blood and urine tests, CSF Exam,EEG
Insanity
a-Legal Insanity
Patient suffers from a serious and certifiable mental illness
 Difference between :-
a- Legal / True Insane
b-Feigned Insane
Patient suffers from a serious and certifiable mentalThe assumption of a mental disorder for the
Illness. The disorder is sufficient to warrant legalpurposes of evasion, deceit or the diversion of
Of the sufferersuspicion
Onset is usually gradual and without any motive
Onset is sudden with some motive
Predisposing cause is usually present
Predisposing cause usually not persent
Precellular facial expression Normal facial expression
S/S of insanity present all the time and particularly S/S of insanity present only when pt is
Point to a particular mental illnessobserved and are particularly uniform
Pt is usually dirty or filthy and may become violent Not usually dirty but may give a false
for several hrs/days without exhaustion
impression of being dirty and amay get
exhausted after a short episode of violent
behaviour
Examined once
May be examined repeatedly
b-Impulsive Insanity
Sudden and irresistible force compelling the person to the conscious performance of acts without motive or
forethought, e.g., a mentally sound person may not put his finger in fire while an insane may put his finger in
fire due to irresistible impulse
Types:-Klepto-Mania:-Stealing articles of little value
Pyro-Mania:-Setting fire to things
Multilo-Mania:-Maiming animals/lame
Sexual-Mania.
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Lucid Interval:
In course of a mental disease, the period during which there is complete cessation of symptoms of
insanity and the patient can judge his acts soundly and legally responsible for his deeds, make a valid
statement and can give a valid evidence
MC’ Naughten’s Rule
-To establish defense on grounds of insanity, it must be shown clearly that:
 At time of committing the act, the accused was laboring under such defect of reason, from disease of
mind as not to know the nature and quality of what he was doing, OR,
 At time of committing the act, the accused was laboring under such defect of reason, from disease of
mind as not to know that whatever he was doing was right or wrong
-Limitation: Psychiatrists thought that emphasis is on reason as the main factor in determining an
individual’s behavior while ignoring the potent effect of emotions, delusions, belief and hallucinations
Durham’s Formula
Accused is not criminally responsible if his unlawful act was the product of mental disease or mental
defect.
Testamentary Capacity
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Testamentary capacity refers to the ability of a person to make a valid will.
Law defines it as compose-mentis which must be confined by a doctor
For a will to become valid, the testator must:
 Be a major
 Have a sound disposing mind at the time of making a will
 Understand the nature and consequences of his act
 Know what property he has, to whom and why he is giving his property
 Execute it voluntarily and without any undue influence by any other person
 Sign the will in the presence of two trustworthy witnesses out of which one must be a doctor
and none of the witnesses should be a beneficiary from the will
To invalidate a will on the ground of insanity of the testator, it must be proved that at the time of
making of will the testator was mentally incapacitated to a certain extent so that: He didn’t know the nature of his act
 Was not fully aware of consequences
 Had made the disposal of property which he didn’t have
Section 59 Of Succession Act
 Every major person of sound mind may dispose his property by will.
 An insane may make a will during the Lucid Interval.
 Presence of sound mind usually depends upon the ability to:-Make true and factual mental perception about his/her property
-Form a rational judgement
-Exercise the will power in accordance with rational thinking
-Make the will without any undue influence by any other person
The doctor determines that whether the person is in sense or not or whether he is under the effect of
some drug or not