Forensic psychiatry

(insanity / mental illness /

impairment)
Learning objectives

At the end of this presentation, the student should be able to;

• Define insanity

• Briefly describe the different terms used in forensic

psychiatry

• Classify mental disorders

 Introduction

• Psychiatry is that branch of medical science which deals

with the study, diagnosis, treatment, and prevention of
mental illness.

• Forensic psychiatry deals with the correlation and

application of such knowledge to purposes of law for the
administration of justice.
 Insane
• Unable, on account of mental disease, to look after him self
and manage his own affairs or is dangerous to himself and
others.

• This mal adaptation become so serious that insane be

regretted from community and deprived from liberty and
right of citizens.

• Insane is not responsible for its action as per law.

Insanity(Lunacy/unsoundness of
mind/mental derangement/ mental
illness)
• It is a disorder of the mind or personality in which there is
derangement or impairment of mental or emotional
components.
• Terms such as “Insanity” and “Lunacy” must not be used as far
as possible in scientific discussions, though unfortunately they
still find acceptance in legal parlance.
• The term used and accepted today by most psychiatrists is
“mental illness”.
 Mentally ill person
• The legal term ‘ mentally ill person’ means a person who is in

need of treatment by reason of any mental disorder other than

mental retardation.

• Such illness covers psychoses (organic and functional), neurotic

disorders and various organic disorders.

• Legal unsoundness of mind, or certifiable mental illness, refers to

a serious mental disorder sufficient to warrant legal restraint of

the sufferer as provided under the Act.
 Affect
• Outward manifestation of a person’s feelings, tone or mood.
 Confabulation
• Fabrications.
• When there is a pathological loss of memory e.g in
Korsakoff’s psychosis and early stages of dementia.
• The patient fills the gaps with purely imaginary events.
Patient who might have not left the room, talks of his visits
to places during period of lapse.
 Delirium
• This is an acute confusional state.
• It may occur during high fever, as a result of drug or alcohol
intoxication or withdrawal, head injury, metabolic upsets or
mental stress.
• Characterized by clouding of consciousness, disorientation,
incoordination and abnormal experiences such as,
hallucination, delusion and illusions.
• Patient is often impulsive and may commit suicide or some
violent act.
• Under PPC is not responsible for such violent act.
• Condition may lasts from few hours to days and weeks and
ends with full recovery of memory and intellectual function.
 Delusion
• It is a disturbance of thought.

• It is a false but firm belief in something which is not a fact.

• It indicates a serious disorder such as schizophrenia or GPI.

• It affects the conduct and actions of the sufferer and may lead
him to commit suicide, murder or some other crime.
 Types of delusions
• Delusions of Grandeur: The patient believes that he is rich or
famous, is related to ministers, has divine powers though in fact,
his condition is opposite.

• Hypochondriacal delusions: Are common in depression of later

life, for instance patient may say , he has cancer, is unable to
swallow, his bowels are obstructed.

• Paranoid: Term used to describe all delusions of being affected

in some harmful or persecutory way.
• Delusions of persecution: The patient believes that attempts
are being made by his near relatives to poison him or kill
him.

• Delusions of reference: The patient believes that people,

things or events relate or refer to him in some special way.

• Delusions of influence (control): Imagines that his thoughts,

feelings or actions are being controlled by some external
agency (radio, hypnotism) to harm him.
• Nihilistic delusion: The patient is convinced that nothing
exists around him, there is no world, he is dead etc.

• Delusions of infidelity: Imagines that the spouse is

unfaithful although she is chaste.

• Delusions of poverty: The patient states that he is ruined

financially and has no money.
Fugue
• This is a disturbed state of consciousness in which the
affected person performs acts of which he appears to be
conscious but of which on recovery he has no recollection.

• It is encountered in a dissociative disorder (somatisation) and

epilepsy.
Hallucination: A false perception without a sensory stimulus.

• It may be visual, auditory, olfactory, gustatory, tactile.

Illusion: A false interpretation of an external object or

stimulus which has a real existence. E.g. mistaking a stick for
a snake.
Twilight states

• Conditions of diminished awareness of relatively short

duration, during which the patient may carry out actions of
which he has little or no subsequent memory(amnesia).

• Twilight states may occur as somatisation or epileptic

phenomena (Psychomotor automation).
Intelligence Quotient ( I.Q)

• This means the intellectual capacity of an individual in

relation to his chronological age expressed as a percentage.

• For this purpose, the maximum adult age is taken as 16

years. An I.Q. between 90 and 110 is considered normal or
average. It is rare for those with an I. Q. below 50 to look
after them selves independently.
Lucid interval :
• A temporary period of resolution of symptoms in a mentally
unsound individual.

• During this period he will be held responsible for criminal

acts, but it cannot be proved and it is advisable to regard the
person as insane.
• Neurosis: This is a condition in which the patient suffers
form emotional or psychological disorder but does not lose
touch with reality.

• Psychosis: This is a disorder characterized by withdrawal

from reality, as if living in another world, a world of fantasy,
as shown b the presence of delusions and hallucinations.
Psychopath (sociopath)
• Term applied to person who is neither insane nor mentally
defective but, does not conform to normal social standards of
behavior, even does not observe ethical principles.
• It is characterized by:
1. Lack of normal conscience.
2. Absence of normal feelings i.e. love, affection
consideration, sympathy etc
3. Temper outbursts and impulsive behavior with verbal or
physical attacks without sufficient provocation.
4. Failure to learn from experience or punishment.
• The impulsive outbursts known as short circuit reactions or
psychotic episodes indicate that the psychopath feels much
better after an outburst though his victim ma be devastated.
Stupor
• Medically, this term is used to signify a degree of
unconsciousness in which the patient will still respond to a
painful stimulus.
• In psychiatry, it is a state of complete suppression of speech,
movement and action not accounted for by profound
disturbances of unconsciousness.
• Stupor is common in, schizophrenia, depression, Hysteria,
epilepsy, metabolic upsets, opium poisoning and certain
diseases of CNS.
Classification of mental disorders
• Some of the mental disorders that are liable to lead the
sufferer into conflict with the law can be conveniently
classified and discussed under the following headings :
1. Mental retardation (mental sub normality, mental
handicap).
2. Organic psychoses
a) Dementia
b) Drug induced psychoses
c) Confusional states and psychoses following epilepsy,
pregnancy and child birth, trauma, and general diseases.
3. Functional psychoses
a) Schizophrenia
b) Paranoid states
c) Affective disorders (Mania, depression)
4) Neurotic disorders
5) Personality disorders
(e.g. sociopathic personality)
6) Sexual deviations
 Mental Retardation
• The term mentally retarded is used to signify a person with
low intelligence and also impaired social functioning.
• The impaired social functioning is characterized by
abnormally aggressive and seriously irresponsible
(impulsive) conduct.
• The impairment in social behavior ma require the court to
appoint a legal guardian
Dementia
• The term dementia denotes cases in which the mind has
reached a certain, usually normal or acceptable, stage of
development and then shows signs of deterioration.
• The principal forms of dementia are
a) Organic dementia
b) Senile dementia
c) Dementia paralytica
Mental health ordinance, 2001
1) Regulate admission of the mentally ill patient to a
psychiatric hospital or psychiatric nursing home and to
protect his rights while under detention.
2) Prevent harm to himself and the society by the mentally ill
person.
3) Protect citizens from being detained in psychiatric
hospitals without sufficient cause.
4) Fix liability for maintenance charges of mentally ill
patient admitted to the hospital or nursing home.
5) Provide facility to establish guardianship or custody of the
mentally ill patient and management of his property.
6) Establish central and state authority for Mental Health Services
7) Provide for licensing and control of psychiatric hospitals by the
state government, and Ensure legal aid to the mentally ill patient
at state expense in certain cases.
 True and feigned insanity
S.No TRUE INSANITY
1 Onset is usually gradual or
rarely sudden but always
without a motive.
2 Predisposing or exciting
cause may be present e.g.
family history, grief etc
3 There is usually a peculiar
facial expression
4 The individual shows signs
and symptoms irrespective of
his conduct being observed
FEIGNED INSANITY
Onset is always sudden and not
without some motive
No predisposing or exciting cause
is present
Facial expression is generally
normal
The individual pretends to be
insane only when he is observed
S.NO. TRUE INSANITY FEIGNED INSANITY

5 Signs and symptoms usually point to a Signs and symptoms are not uniform and do not
particular type of mental illness. indicate any particular type of mental illness

6 A truly insane person can stand violent Violent exertion necessary to feign maniacal frenzy
exertion for several hours or days without (with is generally imitated by impostors) leads to
exhaustion, or sleep. exhaustion, and sleep.

7 Habits invariably dirty or filthy. An insane Habits usually not dirty or filthy, though a false
may smear his body with stool or urine. show may be up to that effect

8 Physical manifestations of true insanity, viz , Physical manifestations of true insanity, viz, dry,
dry harsh skin furred tongue, constipation, harsh skin, furred tongue, constipation, anorexia ,
anorexia, and insomnia are present. and insomnia are not present.

9 Not worried about being repeatedly Dislike for repeated examination is obvious.
examined.