Forensic PsychiatryForensic Psychiatry

Dr.V.P.JoglekarDr.V.P.Joglekar

M.D. (Kaya)M.D. (Kaya)

M.D. (Agad)M.D. (Agad)

DefinitionDefinition

Psychiatry is the science which deals Psychiatry is the science which deals

with study, diagnosis and treatment of with study, diagnosis and treatment of

mental illnessesmental illnesses

Forensic Psychiatry is the application of Forensic Psychiatry is the application of

psychiatry in furtherance of justicepsychiatry in furtherance of justice

Branches of Forensic PsychiatryBranches of Forensic Psychiatry

DiagnosticDiagnosticPsychological profiling of criminal from crime Psychological profiling of criminal from crime

scene investigationscene investigation

Evaluation of the accused Evaluation of the accused

Before the crimeBefore the crime

During the crimeDuring the crime

After the crimeAfter the crime

Branches of Forensic PsychiatryBranches of Forensic Psychiatry

TherapeuticTherapeutic

Treatment of the accusedTreatment of the accused

Treatment of the victimsTreatment of the victims

Therapeutic support to relatives and Therapeutic support to relatives and

associates of the victimassociates of the victim

Branches of Forensic PsychiatryBranches of Forensic Psychiatry

AcademicAcademic

Case studiesCase studies

Data basesData bases

ClassificationsClassifications

ProfilingProfiling

Branches of Forensic PsychiatryBranches of Forensic Psychiatry

PreventivePreventive

Legal reformsLegal reforms

Early indicators in childhoodEarly indicators in childhood

Indicators of impending crimesIndicators of impending crimes

Indicators of impending incidents like suicideIndicators of impending incidents like suicide

Indicators of impending negligent behaviorIndicators of impending negligent behavior

Branches of Forensic PsychiatryBranches of Forensic Psychiatry

JurisprudenceJurisprudence

CivilCivil

CriminalCriminal

Restraint of mentally illRestraint of mentally ill

Diagnosis of mental illnessDiagnosis of mental illness

Diagnostic & statistical manual (DSM IV)Diagnostic & statistical manual (DSM IV)

Axis 1 Major mental disordersAxis 1 Major mental disorders

Axis 2 Personality disordersAxis 2 Personality disorders

Axis 3 General medical conditionAxis 3 General medical condition

Axis 4 Psycho-social & environmental factorsAxis 4 Psycho-social & environmental factors

Axis 5 General psychological functioningAxis 5 General psychological functioning

Axis 1 Major mental disordersAxis 1 Major mental disorders

Anxiety disordersAnxiety disorders Panic attacksPanic attacks Generalized Anxiety disorderGeneralized Anxiety disorder PhobiasPhobias Stress relatedStress related

SchizophreniasSchizophrenias Group of disordersGroup of disorders

Axis 1 Major mental disordersAxis 1 Major mental disorders

Mood disordersMood disorders DepressionDepression HypomaniaHypomania ManiasManias

KleptomaniaKleptomania

PyromaniaPyromania

MutilomaniaMutilomania

DipsomaniaDipsomania

Erotomania /Nymphomania etc.Erotomania /Nymphomania etc.

Axis 2 Personality disordersAxis 2 Personality disorders

Cluster ACluster A ParanoidParanoid SchizoidSchizoid SchizotypalSchizotypal

Cluster BCluster B AntisocialAntisocial HistrionicHistrionic NarcissistNarcissist

Cluster CCluster C AvoidantAvoidant DependantDependant Obsessive compulsiveObsessive compulsive

Some important termsSome important terms

IllusionsIllusionsDelusionsDelusionsHallucinationsHallucinationsConfusionConfusionClouding of Clouding of consciousnessconsciousnessDeliriumDeliriumTwilight stateTwilight stateLucid intervalLucid interval

FugueFugueStuporStuporAmnesiaAmnesia RetrogradeRetrograde AnterogradeAnterograde

MemoryMemory RecentRecent RemoteRemote

AttentionAttention

Mental retardationMental retardation

LevelLevel I.Q.I.Q. Mental ageMental age CapacitiesCapacities

MoronMoron 50-7050-70 6-116-11 Self Self supportivesupportive

ImbecileImbecile 35-4935-49 3-63-6 Supervision Supervision neededneeded

IdioticIdiotic 20-3420-34 33 Nursing Nursing neededneeded

IdiotIdiot <20<20 <3<3 No No capacitiescapacities

Civil SignificanceCivil Significance

PropertyProperty

ContractsContracts

MarriageMarriage

WitnessWitness

ConsentConsent

Testamentary Testamentary capacitycapacity

DrunkennessDrunkenness

CrueltyCruelty

DivorceDivorce

Dying declarationDying declaration

Dying depositionDying deposition

Mental retardation Mental retardation

Criminal significanceCriminal significance

Mens reaMens rea

–The intent behind illegal acts is more The intent behind illegal acts is more

important thanimportant than

Actus reusActus reus

–The illegal act itselfThe illegal act itself

Criminal significanceCriminal significance

MurderMurder

SuicideSuicide

Sexual offencesSexual offences

Anti social behaviorAnti social behavior

ViolenceViolence

TheftsThefts

Drug abuseDrug abuse

CrueltyCruelty

Battered wifeBattered wife

Battered childBattered child

Hawaii declarationHawaii declaration

No procedure against willNo procedure against willExcept when threat to othersExcept when threat to others

Retroactive informed consent presumedRetroactive informed consent presumedCompulsory treatment in the best interest of Compulsory treatment in the best interest of

patient over reasonable periodpatient over reasonable periodIndependent and neutral body for reviewIndependent and neutral body for reviewPatient must be informed of review bodyPatient must be informed of review body

Restraint of Mentally IllRestraint of Mentally Ill

ImmediateImmediate– When there is danger to himself or othersWhen there is danger to himself or others– Must cease with subsidence of symptomsMust cease with subsidence of symptoms

Admission to hospitalAdmission to hospital– VoluntaryVoluntary

In case of minor by guardianIn case of minor by guardian

Review every 90 daysReview every 90 days

By application (friends/relatives)By application (friends/relatives)2 certificates, at least one by govt.hospital2 certificates, at least one by govt.hospital

Review every 90 daysReview every 90 days

Restraint of Mentally IllRestraint of Mentally Ill

Reception order on petition to magistrateReception order on petition to magistrate

– Petition by Petition by

SpouseSpouse

DoctorDoctor

Friend / relativeFriend / relative

– 2 certificates + travel fitness certificate2 certificates + travel fitness certificate

– Review every 30 daysReview every 30 days

– Bond for expensesBond for expenses

Restraint of Mentally IllRestraint of Mentally Ill

Reception order on production before magistrateReception order on production before magistrate

– Wandering and dangerous personsWandering and dangerous persons

Police take chargePolice take charge

Within 24 hoursWithin 24 hours

Bond for expensesBond for expenses

– Neglected personsNeglected persons

Police or private personsPolice or private persons

Court may appoint guardianCourt may appoint guardian

– Review every 30 daysReview every 30 days

Restraint of Mentally IllRestraint of Mentally Ill

Reception order of prisonerReception order of prisoner

Reception order of escaped prisonerReception order of escaped prisoner

– Police or hospital staffPolice or hospital staff

– Not required within 1 monthNot required within 1 month

Reception order on judicial inquisitionReception order on judicial inquisition

– In case of huge propertyIn case of huge property

– District or high court orders inquisitionDistrict or high court orders inquisition

Discharge from Psychiatric hospitalDischarge from Psychiatric hospital

Voluntary admissionsVoluntary admissions

– On requestOn request

OthersOthers

– On review of recoveryOn review of recovery

– On order of magistrate on reassurance by On order of magistrate on reassurance by

relativesrelatives

– On judicial reinquisitionOn judicial reinquisition

Certification of Mental IllnessCertification of Mental Illness

Section 21 Mental Health Act 1987Section 21 Mental Health Act 1987– Prescribed formPrescribed form– 2 different Psychiatrists should examine 2 different Psychiatrists should examine

separatelyseparately– At least 1 must be from government serviceAt least 1 must be from government service– Application for restraint at least 10 days after Application for restraint at least 10 days after

examinationexamination– Specify nature & severity of illnessSpecify nature & severity of illness– Specify Safety of pt. or othersSpecify Safety of pt. or others

Rights of Mentally IllRights of Mentally Ill

Right to receive treatmentRight to receive treatmentRight to refuse treatmentRight to refuse treatmentChoice of least restrictive alternativeChoice of least restrictive alternativeVisitation and privacy rightsVisitation and privacy rightsRight to communicateRight to communicateEconomic rightsEconomic rightsHabeas corpusHabeas corpus

True and feigned insanityTrue and feigned insanity

FeatureFeature TrueTrue FeignedFeigned

OnsetOnset GradualGradual SuddenSudden

MotiveMotive AbsentAbsent PresentPresent

Predisposing Predisposing causescauses

PresentPresent AbsentAbsent

Facial expressionFacial expression PeculiarPeculiar normal`normal`

Signs and Signs and symptomssymptoms

Particular typeParticular type mixedmixed

True and feigned insanityTrue and feigned insanity

FeatureFeature TrueTrue FeignedFeigned

HabitsHabits Usually dirtyUsually dirty Leaves clean space for Leaves clean space for sleepingsleeping

Effect of Effect of observationobservation

NilNil Bring on symptomsBring on symptoms

Repeated Repeated examexam

Dose not Dose not mindmind

resentsresents

ExertionExertion Not Not exhaustedexhausted

Gets exhaustedGets exhausted

Civil Responsibilities of Mentally IllCivil Responsibilities of Mentally Ill

Management of propertyManagement of propertyContracts invalid except in lucid intervalContracts invalid except in lucid intervalMarriage invalid if insane at the timeMarriage invalid if insane at the timeNo grounds for divorce if laterNo grounds for divorce if laterCompetency as witness only in lucid intervalCompetency as witness only in lucid intervalConsent to certain acts invalidConsent to certain acts invalid

Civil Responsibilities of Mentally IllCivil Responsibilities of Mentally Ill

Civil rights lostCivil rights lostCannot hold driving licenseCannot hold driving licenseCannot hold public officeCannot hold public officeCannot voteCannot voteCannot adopt a childCannot adopt a childCannot be a legal guardianCannot be a legal guardianTestamentary capacity only in lucid intervalTestamentary capacity only in lucid interval

Criminal Responsibility of insaneCriminal Responsibility of insane

Legal testsLegal testsMcnaghten’s ruleMcnaghten’s rule

Inability to know nature and quality of act due to illnessInability to know nature and quality of act due to illness

Durham ruleDurham ruleAct resulting from illnessAct resulting from illness

Currens ruleCurrens ruleNo capacity to regulate behavior to the requirements of No capacity to regulate behavior to the requirements of

lawlaw

Criminal Responsibility of insaneCriminal Responsibility of insane

American law institute testAmerican law institute testCapacity to appreciate wrongfulness of the actCapacity to appreciate wrongfulness of the actCapacity to confirm to lawCapacity to confirm to law

Norwegian systemNorwegian systemInsanity or unconsciousness at the time of crimeInsanity or unconsciousness at the time of crime

Doctrine of partial responsibilityDoctrine of partial responsibilityApplicable in some states like depression, paranoia, Applicable in some states like depression, paranoia,

obsess ional stateobsess ional state

Other pleas in murderOther pleas in murder

DeliriumDelirium

DrunkennessDrunkenness– Only involuntary or Only involuntary or

insanity due to toxicityinsanity due to toxicity

HypnotismHypnotism

Irresistible impulseIrresistible impulse– Valid only if inability to Valid only if inability to

distinguish right and distinguish right and wrongwrong

SomnambulismSomnambulism

SomnolentiaSomnolentia

AutomatismAutomatism– EpilepsyEpilepsy– ConcussionConcussion– HypoglycemiaHypoglycemia– Cerebral diseaseCerebral disease

Some provisions in MHA 87Some provisions in MHA 87

Hospital only on obtaining licenseHospital only on obtaining license

License renewal every 5 yearsLicense renewal every 5 years

Government visitors every month to review all Government visitors every month to review all casescases

Punishment for illegal restraint 2 yearsPunishment for illegal restraint 2 years

Legal aid at state expensesLegal aid at state expenses