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Forensic Psychiatry: Classification of Mental Disorders
Forensic Psychiatry: Classification of Mental Disorders
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 activitiesrefusal 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
Illusion:
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:
False perception without sensory stimulus
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:
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:
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:
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 :
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:
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:
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
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.
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
Durham’s Formula
Accused is not criminally responsible if his unlawful act was the product of mental disease or mental
defect.
Testamentary Capacity
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