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Forensic Psychiatry

Dr.V.P.Joglekar
M.D. (Kaya)
M.D. (Agad)
Definition

Psychiatry is the science which deals


with study, diagnosis and treatment of
mental illnesses
Forensic Psychiatry is the application of
psychiatry in furtherance of justice
Branches of Forensic Psychiatry
Diagnostic
Psychological profiling of criminal from crime
scene investigation
Evaluation of the accused
Before the crime
During the crime
After the crime
Branches of Forensic Psychiatry

 Therapeutic
 Treatment of the accused
 Treatment of the victims
 Therapeutic support to relatives and
associates of the victim
Branches of Forensic Psychiatry

Academic
 Case studies
 Data bases
 Classifications
 Profiling
Branches of Forensic Psychiatry

Preventive
 Legal reforms
 Early indicators in childhood
 Indicators of impending crimes
 Indicators of impending incidents like suicide
 Indicators of impending negligent behavior
Branches of Forensic Psychiatry

Jurisprudence
 Civil
 Criminal
 Restraint of mentally ill
Diagnosis of mental illness

Diagnostic & statistical manual (DSM IV)


 Axis 1 Major mental disorders
 Axis 2 Personality disorders
 Axis 3 General medical condition
 Axis 4 Psycho-social & environmental factors
 Axis 5 General psychological functioning
Axis 1 Major mental disorders
Anxiety disorders
 Panic attacks
 Generalized Anxiety disorder
 Phobias
 Stress related
Schizophrenias
 Group of disorders
Axis 1 Major mental disorders
Mood disorders
 Depression
 Hypomania
 Manias
Kleptomania
Pyromania
Mutilomania
Dipsomania
Erotomania /Nymphomania etc.
Axis 2 Personality disorders
Cluster A
 Paranoid
 Schizoid
 Schizotypal
Cluster B
 Antisocial
 Histrionic
 Narcissist
Cluster C
 Avoidant
 Dependant
 Obsessive compulsive
Some important terms
Illusions Fugue
Delusions Stupor
Hallucinations Amnesia
Confusion  Retrograde
 Anterograde
Clouding of
consciousness Memory
Delirium  Recent
 Remote
Twilight state
Attention
Lucid interval
Mental retardation
Level I.Q. Mental age Capacities

Moron 50-70 6-11 Self


supportive
Imbecile 35-49 3-6 Supervision
needed
Idiotic 20-34 3 Nursing
needed
Idiot <20 <3 No
capacities
Civil Significance
Property Drunkenness
Contracts
Cruelty
Marriage
Witness Divorce
Consent Dying declaration
Testamentary Dying deposition
capacity
Mental retardation
Criminal significance

Mens rea
– The intent behind illegal acts is more
important than
Actus reus
– The illegal act itself
Criminal significance

 Murder  Thefts

 Suicide  Drug abuse

 Sexual offences  Cruelty

 Anti social behavior  Battered wife

 Violence  Battered child


Hawaii declaration
No procedure against will
Except when threat to others
Retroactive informed consent presumed
Compulsory treatment in the best interest of
patient over reasonable period
Independent and neutral body for review
Patient must be informed of review body
Restraint of Mentally Ill
Immediate
– When there is danger to himself or others
– Must cease with subsidence of symptoms
Admission to hospital
– Voluntary
In case of minor by guardian
Review every 90 days
By application (friends/relatives)
2 certificates, at least one by govt.hospital
Review every 90 days
Restraint of Mentally Ill
Reception order on petition to magistrate
– Petition by
Spouse
Doctor
Friend / relative

– 2 certificates + travel fitness certificate


– Review every 30 days
– Bond for expenses
Restraint of Mentally Ill
Reception order on production before magistrate
– Wandering and dangerous persons
Police take charge
Within 24 hours
Bond for expenses
– Neglected persons
Police or private persons
Court may appoint guardian
– Review every 30 days
Restraint of Mentally Ill
Reception order of prisoner
Reception order of escaped prisoner
– Police or hospital staff
– Not required within 1 month
Reception order on judicial inquisition
– In case of huge property
– District or high court orders inquisition
Discharge from Psychiatric hospital

Voluntary admissions
– On request
Others
– On review of recovery
– On order of magistrate on reassurance by
relatives
– On judicial reinquisition
Certification of Mental Illness
Section 21 Mental Health Act 1987
– Prescribed form
– 2 different Psychiatrists should examine
separately
– At least 1 must be from government service
– Application for restraint at least 10 days after
examination
– Specify nature & severity of illness
– Specify Safety of pt. or others
Rights of Mentally Ill
Right to receive treatment
Right to refuse treatment
Choice of least restrictive alternative
Visitation and privacy rights
Right to communicate
Economic rights
Habeas corpus
True and feigned insanity
Feature True Feigned

Onset Gradual Sudden

Motive Absent Present

Predisposing Present Absent


causes
Facial expression Peculiar normal`

Signs and Particular type mixed


symptoms
True and feigned insanity
Feature True Feigned
Habits Usually dirty Leaves clean space for
sleeping
Effect of Nil Bring on symptoms
observation
Repeated Dose not resents
exam mind
Exertion Not Gets exhausted
exhausted
Civil Responsibilities of Mentally Ill
Management of property
Contracts invalid except in lucid interval
Marriage invalid if insane at the time
No grounds for divorce if later
Competency as witness only in lucid interval
Consent to certain acts invalid
Civil Responsibilities of Mentally Ill
Civil rights lost
Cannot hold driving license
Cannot hold public office
Cannot vote
Cannot adopt a child
Cannot be a legal guardian
Testamentary capacity only in lucid interval
Criminal Responsibility of insane
Legal tests
Mcnaghten’s rule
Inability to know nature and quality of act due to illness
Durham rule
Act resulting from illness
Currens rule
No capacity to regulate behavior to the requirements of
law
Criminal Responsibility of insane
American law institute test
Capacity to appreciate wrongfulness of the act
Capacity to confirm to law
Norwegian system
Insanity or unconsciousness at the time of crime
Doctrine of partial responsibility
Applicable in some states like depression, paranoia,
obsess ional state
Other pleas in murder
Delirium Somnambulism
Drunkenness Somnolentia
– Only involuntary or Automatism
insanity due to toxicity – Epilepsy
Hypnotism – Concussion
Irresistible impulse – Hypoglycemia
– Valid only if inability to – Cerebral disease
distinguish right and
wrong
Some provisions in MHA 87
Hospital only on obtaining license
License renewal every 5 years
Government visitors every month to review all
cases
Punishment for illegal restraint 2 years
Legal aid at state expenses