FORENSIC PSYCHIATRY

BY
Dr. AWDHESH KUMAR
Associate PROFESSOR
DEPARTMENT OF FORENSIC MEDICINE
SARASWATI MEDICAL COLLEGE UNNAO
 FORENSIC PSYCHIATRY
• Delirium
• Delusion
• Illusion
• Lucid interval
• Mc Naughton rule
• Insanity and making valid will
• True and false (feigned) insanity
 FORENSIC PSYCHIATRY
DIFNITION
• Forensic psychiatry is a subject dealing with
application of knowledge of psychiatry in the
administration of justice.
• The IPC employs the term unsoundness of
mind =insanity.
• The unique feature that distinguishes Homo
sapiens from the other creatures that inhibit
the planet earth is the degree of
development of those higher nervous system
functions that humans subsume under the
construct of mind.
 MENTAL HEALTH ACT

• MENTAL HEALTH ACT, (MHA) 1987 is an Act to

consolidate and amend the law relating to the
treatment and care of mentally ill persons, to
make better provision with respect to their
property and affairs and for matters connected
therewith .
• This replaced the Indian Lunacy Act, 1912,
• which had earlier replaced the Indian Lunatic
Asylum Act of 1958.
1. To regulate- admission to psychiatric
hospital.
2. To protect society- from the presence of
mentally ill persons who have become
danger to others;
3. To protect citizens - from being detained in
psychiatric hospitals without sufficient cause;
4. To regulate responsibility - for maintenance
charges of mentally ill persons who are
admitted to psychiatric hospitals;
5. To provide facilities - for establishing
guardianship or custody of mentally ill persons
who are incapable of managing their own
affairs;
6. To provide for the establishment of Central
Authority and State Authorities for Mental
Health Services;
7. To regulate the powers of the Government
for establishing, licensing and controlling
psychiatric hospitals;
8. To provide for legal aid to the mentally ill
persons at State expense in certain cases.
 Showing change in terminologies according to the Mental Health Act, 1987

Outmoded New terms

term
1. Asylum Psychiatric hospital

2. Lunatic Mentaly ill person

3. Criminal Mentally ill prisoner

lunatic
 DISORDER OF PERCEPTION

• Delirium
• Delusion
• Hallucinations
DELIRIUM
Definition:
• Delirium is defined as an acute confusional state.
• Causes:
-Drugs - Atropine
-Alcohol intoxication
-Head injury,
-High fever,
-Stress, etc.
 Clinical features:

- Clouding of consciousness,
- Disorientation,
- Inco-ordination,
- Getting abnormal experiences - such as
hallucinations, delusions, illusions, etc.
- Impulsive acts - such as suicide, homicide,
etc.
 MEDICOLEGAL IMPORTANCE
• It may last for a few hours, days or weeks and
may end with varying degree of recovery

• As per Section 84 of IPC—A person is not

punishable, if he or she commits any offence
in delirium.
 DELUSION

DEFINITION-
Delusion is defined as a false, but firm belief in something that is not a
fact.
CLASSIFICATION -
• Hypochondriacal delusion: Person feels that something is wrong
(disease) in his or her body, though he or she is healthy.

• Delusion of poverty: Person thinks he or she is poor/pauper, though

he or she is rich.

• Nihilistic delusion: Person declares that he or she does not exist and
the world also has no existence, etc.

• Delusion of grandeur: Person imagines that he is rich/and famous,

wherein he is actually poor/and inconsequential.
 …DELUSION
• Delusion of persecution (paranoid delusion):
Person thinks that his or her nearest and
dearest relatives are trying to poison or kill
him or her.

• Delusion of influence (control): Person feels

that he or she is controlled by an outside
power, agency, radio, hypnotized telepathy,
etc.
 …DELUSION
• Delusion of infidelity: Person imagines that his/her spouse is
unfaithful.
• Delusion of self-accusation: Person keeps on blaming himself/
herself on trivial incidents that happened in the past.
• Erotomania (Clerambault-Kandinsky Complex): Common
among the females, in which she is convinced that a
particular individual, especially her superior officer or her
employer, etc is in love with her.
• Pseudologia phantastica: A variation of this is the
Munchausen’s syndrome, in which the person is convinced
that he/she is seriously ill, and visits doctor-to-doctor,
hospital-to-hospital in a vain attempt to diagnose the non-
existing illness.
 MEDICOLEGAL IMPORTANCE
• It is not an isolated disorder but only
indicates a deep-seated mental disorder such
as schizoma. For this reason the patient
cannot be held fully responsible for antisocial
acts.
• It can affect the conduct and action of the
patients, which may lead to the commission
of suicide or homicide or other crimes
 HALLUCINATION
• DEFINITION:
-Hallucination is defined as a false perception
without sensory stimulus.
• CLINICAL FEATURES:
- Clinically the patient will see, hear, smell, taste
and touch things, which are not there in reality.
• CAUSES
- Altered state of consciousness (organic psychosis)
- Schizophrenia,
- epilepsy, drugs,
- Depressive disorders, etc.
 …HALLUCINATION
CLASSIFICATION/TYPES
• VISUAL HALLUCINATIONS: (more common)
Person imagines that a lion or a tiger, etc attack
him or her when none of them exists in front of
him or her.
• AUDITORY HALLUCINATIONS: Person hears
voices or imagines that another person is
speaking to him or her when no one is present.
• OLFACTORY HALLUCINATIONS: Person smells
pleasant or unpleasant odors when nothing
exists in reality.
 …HALLUCINATION
• Gustatory hallucinations: person feels a good
or bad taste in mouth, though no food is
actually served.
• Tactile hallucinations: person imagines that
insects are crawling under his or her skin or
bed when actually there are none.
• Trichotillomania: person has an irresistible
urge to pluck his/her own hairs.
 Medico legal importance:
Hallucinating patients may commit some
violent acts.
 ILLUSION
DEFINITION:
-Illusion is defined as a false interpretation of
an external object, which has a real existence
of its own, e.g. mistaking a stick for a snake.
CAUSES:
-Aging,
- Bereaved,
- Delirious state.
 MEDICOLEGAL IMPORTANCE

-It is not indicative of insanity.

 LUCID INTERVAL

Definition:
-Lucid interval is defined as a period in the
course of mental illness during which there is
a complete cessation of symptoms of
insanity, and the person is considered
perfectly normal mentally.
- Insanity and making valid will.
 …LUCID INTERVAL

Causes:
- Depressive mania- commonly seen
-Head injury (extradural hemorrhage).
MEDICO LEGAL IMPORTANCE -
• Testamentary capacity - to make a valid will,
• Give evidence in court, validly.
• In criminal cases, it is difficult to decide if
some mental aberration was there or not at
the time of the commission of a crime. Thus,
it is advisable to regard the person as insane.
 DIFFERENCES BETWEEN TRUE AND FALSE INSANITY
Feature True insanity Feigned insanity

1 Onset Gradual and Abrupt and dramatic

insidious
2 Motive Absent Present (Commission of offence)
3 Precipitating May be present- Absent
(stress, financial

4 Symptomatology Conforms to a Usually does not conform

particular type of
psychiatric disorder

5 Facial expression fixed Frequent changes

6 Insomnia Present Cannot -pretend insomnia for more than a night
7 Personal hygiene Do not pay attention Not so
8 Exertion Can withstand Cannot withstand prolonged fatigue hunger for
prolonged fatigue, more than 1-2 days
hunger

9 Frequent Will not mind Resents, as he is afraid of getting

examination
 McNaghten’s Rule (The right or wrong test, Legal test)
section 84 IPC.
• English court, in dealing with the responsibility
of insane in criminal case are guided by the
rules laid down after the McNaghten’s trail in
1843.
• An accused person is not criminally responsible
, if it is proved at the time of committing the
crime that he was suffering from such a defect
of reason from disease of mined that he did not
know the nature and quality of act he is doing.
• This legal test has also been accepted in India as
the law of criminal responsibilities under
section 84 IPC.
• Defect in McNaghten’s Rule only intellectual
factor are considered but emotions, delusion
and control of impulse are ignored.
END