Forensic Psychiatry-1

LT COL SANDEEP BANSAL

DEPT OF FORENSIC MEDICINE & TOXICOLOGY
 Study, diagnosis, treatment of mental illness-
Psychiatry

 Application of psychiatry in administration of

justice - Forensic psychiatry
 Unsoundness of mind

Disease of the mind/personality in which there is

derangement of mental/emotional processes &
impairment of behaviour control
 Causes of unsoundness of mind

 Hereditary -Huntington’s chorea , Amaurotic family idiocy

 Environmental - faulty parental attitude
 Psychogenic - repressed mental conflicts
 Precipitating - affairs of home, work, finance, relations
 Organic - head injury, atherosclerosis, senile degeneration,
myxoedema, pernicious anaemia
 COMPOS MENTIS – SOUND MIND
 Terms in Psychiatry

 Affect - emotion, mood or inner feeling at a particular point

of time, subjective

 Mood-pervasive emotion, feeling ,sustained

 Abreaction - reviving forgotten, traumatic experiences,

repressed emotions
 Aphasia - loss of ability to express meaning, motor
aphasia, sensory/auditory aphasia

 Empathy - degree to which observer enters thoughts,

feelings of patient, establish good contact
 Fugue-state of altered awareness, forgets part /whole of
life, forgets own identity
Ex – Agatha Christie

 Insight - awareness of one’s own mental condition

 Phobia - irrational fear

 Confabulation - false memory which patient believes to
be true

 Mutism - complete loss of speech

 Neurasthenia - condition of nervous exhaustion, abnormal

fatigue, irritability of nervous system
 Symptoms of mental illness

 Delusion
 Hallucination
 Illusion
 Impulse
 Obsession
 Phobia
 Oneroid states
 DELUSION

FALSE BELIEF IN SOMETHING WHICH IS NOT

A FACT, PERSISTS AFTER FALSITY HAS
BEEN CLEARLY DEMONSTRATED
 Secondary delusion - morbid experience

 Delusion in an insane person-symptom of organic

disease- epileptic, affective, schizophrenic psychosis

 Not found in neurotic illness

 TYPES OF DELUSION

 Grandeur/exaltation - seen in
mania, delirium tremens, may
be associated with persecution
 TYPES OF DELUSION

 Persecution - enemy,
seen in paranoid
schizophrenia,
dementia, depression
 TYPES OF DELUSION

 Reference
 TYPES OF DELUSION

 Infidelity (Othello syndrome)

 TYPES OF DELUSION

 Nihilistic
 TYPES OF DELUSION
 Influence/control-
external power, seen in
schizophrenia
 Hypochondriacal -
unrealistic interpretations
of signs, symptoms
 TYPES OF DELUSION

• Erotomania
 EROTOMANIA

 Belief that somebody is in love with them

 de Clerambault’s syndrome
 Person usually of higher status, fame, superior
 Can also be a complete stranger
 Tries to get close to the person by various means
 Otherwise normal
 Self reproach/self criticism-suicidal tendencies
 Delusion of doubles (doppelganger)
 Capgras syndrome - replacement of significant others
 Delusion of disguise (Fregoli’s syndrome)-
strangers are familiar
 Folie a deux - common delusion shared by two
persons
 Cotard delusion-dead, putrefied, lost blood,
internal organs
MEDICOLEGAL IMPORTANCE

 Not an isolated disorder

 Deep seated ,widespread
 Not fully responsible for antisocial acts
 Suicide-major risk
 Combination of murder and suicide
HALLUCINATION
 HALLUCINATION

FALSE SENCE PERCEPTION WITHOUT ANY

EXTERNAL OBJECT/STIMULUS TO
PRODUCE IT
 TYPES OF HALLUCINATIONS
 Visual
 Auditory
 Olfactory
 Gustatory
 Tactile
 Psychomotor
 Command hallucinations
 Visual - common in organic mental disorders
 Auditory- in schizophrenia, delirium, psychotic mood
disorders, toxic, metabolic encephalopathies
 Gustatory-in organic brain disorders, temporal lobe
epilepsy
 Olfactory-in organic brain disorders, major depression
 Tactile/haptic-in cocaine poisoning, chronic alcoholism

 Psychomotor-feeling of a movement of some part

 Command hallucinations
 Fevers, intoxication, insanity
ILLUSION
 ILLUSION

FALSE INTERPRETATION OF SENSES OF AN EXTERNAL

OBJECT/STIMULUS WHICH HAS A REAL EXISTENCE
 Features of psychosis of organic type

 Distortion of perception

 Sane person corrects it, insane continues to believe

 IMPULSE

SUDDEN IRRESTIBLE FORCE COMPELLING A

PERSON TO CONSCIOUS PERFORMANCE OF
SOME ACTION WITHOUT MOTIVE/FORETHOUGHT
 Seen in imbecility, dementia, acute mania, epilepsy
 Types
Kleptomania

Pyromania

Mutilomania

Dipsomania
 Oniomania

 Trichotillomania

 Suicidal impulse

 Homicidal impulse
 OBSESSION

IDEA/THOUGHT/EMOTION CONSTANTLY
ENTERTAINED BY A PERSON,WHICH HE
RECOGNISES AS IRRATIONAL,PERSISTS INSPITE
OF ALL EFFORTS TO DRIVE IT FROM HIS MIND
 Disorder of content of thought
 Borderline between sanity and insanity
 Usually in neurotic people
 Associated with some sort of dread/fear
 Indulges in repetitive acts to control anxiety
 PHOBIA

EXCESSIVE, IRRATIONAL FEAR OF A

PARTICULAR OBJECT/SITUATION
 Acrophobia - high places
 Agarophobia - open places
 Nyctophobia - darkness
 Claustrophobia - closed places
 Mysophobia - filth/contamination
 Xenophobia - strangers
 PSYCHOPATH
 PSYCHOPATH IS A PERSON WHO IS NEITHER INSANE NOR
MENTALY ILL, BUT FAILS TO CONFORM TO THE NORMAL
STANDARDS OF BEHAVIOR.
 Abnormal lack of empathy, lack of conscience.
 Amoral conduct
 Appears perfectly normal outside
 Low EQ
 No remorse, no regret for illegal act
 Plea for diminished responsibility - unable to appreciate moral
implications of their actions
 LUCID INTERVAL
 Period of clarity of thought between 2 subsequent bouts
of mental illness in which all symptoms of insanity
disappear completely
 Able to judge acts soundly
 Legally liable for his acts
 Varies from person to person & from time to time in the
same person
 Lucid interval in head injury
 ONEROID STATES

 Dream like state

 Clouding of consciousness
 Lasts for days/weeks
 Suffers from mental confusion, amnesia, illusions,
hallucinations, disorientation, agitation, anxiety
 Occurs in delirium, early schizophrenia, drugs,
prolonged sleep deprivation
 TWILIGHT STATE
 State of diminished awareness
 State between wakefulness & complete unconsciousness
 Experience visual & auditory hallucinations
 Unaccustomed automatic acts in a aggressive way
 For relatively short duration
 No recollection
 Usually seen in epilepsy
 Seen in certain anaesthesia