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FORENSIC PSYCHIATRY
Dr Kaleem Khan
Assistant Professor
GFIMSR
When you live in the shadow of insanity, the appearance of
another mind that thinks and talks as yours does is sometimes
close to a blessed event.
When you speak to God it's called praying; but when
God speaks to you it's called schizophrenia.
PSYCHIATRY:- It is the branch of medical science
which deals with study, diagnosis, treatment,
prevention of mental illness and behavioral
disorders.
PSYCHIATRY:- It is the branch of medical science
which deals with study, diagnosis, treatment,
prevention of mental illness and behavioral
disorders.
ā€¢ FORENSIC PSYCHIATRY:-
ā€¢ deals with the application of
psychiatry in the
administration of justice.
SOME COMMON PSYCHIATRY TERMS
ā€¢ ABREACTION:-This is a release phenomenon where old, forgotten things or events
are brought into conscious state again.
ā€¢ AFFECT:- It is commonly called mood or feeling.
ā€¢ AMNESIA:- Loss of memory about a person or event is called ā€˜amnesiaā€™.
ā€¢ CONFABULATIONA: Unconscious filling of gaps in memory by imagining experiences or
events that have no basis in fact, commonly seen in amnesic syndrome. Confabulation is
considered ā€œhonest lying,ā€ but is distinct from lying because there is typically no intent to
deceive and the individual is unaware that their information is false.
ā€¢ CIRCUMSTANTIALITY: When a person is not able to answer properly, in a straight manner,
and keeps on giving irrelevant details or wanders off the subject many times in a
conversation, the condition is called circumstantialities.
COMPULSION:-It is a repetitive behavior done by an individual in spite of knowing
that it is not correct. Examples being, repeatedly washing hands, checking locked
premises again and again.
APHASIA
ā€¢ Loss of sensory or
ā€¢ motor ability to express
by use of
ā€¢ speech or
ā€¢ writing is called
ā€˜aphasiaā€™.
ā€¢ FUGUE STATE:The person becomes a wanderer who keeps on
moving from place to place in an altered state of mind. He has
episodes of amnesia. This stage is seen in depression, schizophrenia
and other mental disorders.
ā€¢ ECHOPRAXIA: Repeating the act of another
ā€¢ NEGATIVISM: Doing just the opposite of what he is asked to do.
ā€¢ NEURASTHENIA:A condition arising out of physical or mental
exhaustion.
ā€¢ PHOBIA: is an excessive irrational fear of a particular object or
situation.
ā€¢ PARANOIA: Rare psychiatric syndrome marked by the gradual
development of a highly elaborate and complex delusional system,
generally involving persecutory or grandiose delusions, with few
other signs of personality disorientation or thought disorder.
EMPATHY
ā€¢ The degree to which the
observer is able to enter
into the thoughts and
feelings of the patient and
establish good contact.
ā€¢ PARASUICIDEIt is a conscious often impulsive, manipulative act, undertaken to get
rid of an intolerable situation. (attempted suicide or pseudicide)
ā€¢ STUPOR: Used synonymously with mutism and does not necessarily imply a
disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of
their surroundings.
ā€¢ TWILIGHT STATE: Disturbed consciousness of short duration with hallucination
during which the patient may carry out actions of which he has little or no
subsequent memory.
ā€¢ VEGETATIVE SIGNS: In depression, denoting characteristic symptoms, such as
sleep disturbance(especially early morning awakening), decreased appetite,
constipation, weight loss and loss of sexual response.
ā€¢ ONEIROID STATES: It is a dream like state which may last for days or weeks. the
patient suffers from confusion, amnesia, illusions, hallucination, disorientation
agitation and anxiety.
NEUROSIS AND PSYCHOSIS
Neurosis is when a patient suffers from
emotional or intellectual disorders
which causes subjective distress, but
does not lose touch with reality.
Psychosis is characterized by gross
impairment in reality-testing(with drawl from
reality), as if living in a world of fantasy.
PSYCHOSIS
Psychoses are usually of the following two types:
1. Manic-depressive Psychosis: It is expressed in following two phases:
(a) Mania phase: In this, the person is very active, full of life, talking too much,
mostly irreverent, the mood is elated and he does some action continuously. But
he does not have touch with reality. He can commit any crime during this phase.
Sleep is very less. Appetite is also less.
(b) Depressive phase: It is just the reverse of mania. The person is very sad, mood is
depressed. The person sits alone and may speak very little. Touch with reality is
not there. He may commit suicide. The motor functions are also quite
depressed. A person suffering from manic depressive psychosis may fluctuate
between the two phases of mania and depression. It may be possible that the
person may be normal between the two phases of mania. This may be lucid
interval and the person is completely responsible for his actions.
NEUROSIS
Neurosis is a minor mental illness. It is of following types:
1. Anxiety Neurosis: It is a very common variety. The person remains anxious about future
events, relationships and individuals. His pulse rate may be high, blood pressure raised,
respiratory rate high and he may be sweating. He may be restless, confused and
apprehensive. Treatment usually involves counseling and use of anti-anxiety drugs
ā€¢ Depression: It is the reverse of anxiety. Here, a person would be aloof, sad and withdrawn. His motor
activities would be quite less. He may have a low appetite and may not eat well. However, in chronic
cases of depression, the person may keep on eating the whole day, while withdrawn at home and
hence may gain weight. The following are the types of depression commonly seen:
ā€¢ Reactive depression: It may be due to some event or situation like the death of spouse or a near
one, failure in exam, love, etc. It usually remains there for sometime. Some form of reactive depression
is seen in all individuals. Usually, with counseling and use of anti-depressive drugs, most come out of it.
ā€¢ Endogenous depression: It is more serious as its etiology is not known and develops slowly. Early
morning awakening, loss of appetite and mood depression are quite common. This depression may be
associated with psychosis too, where it carries a bad prognosis. Usually with anti-depressive drugs,
most of the individuals recover.
ā€¢ Puerperal depression: A woman who has recently delivered may have depression commonly called
ā€˜puerperal depressionā€™. She may even kill her infant during this time.
ā€¢ Involution depression: During the age group of 50ā€“60 years, depression may set in. Delusion of
hopelessness and unworthiness may be present. Due to development of hypertension, diabetes or
somatic illness, person may get into depression. Counseling, along with drugs is very useful.
ā€¢ Hypochondriacal depression: In this type of neurosis, the person usually complains of vague aches
and pains and may keep on visiting many physicians but of no avail. Usually no treatment is effective.
3. Obsessive-compulsive Neurosis: As described earlier, obsession is a foolish thought which a
person knows but cannot avoid. But once this thought turns into action, it is called
compulsion and may lead to obsessive-compulsive neurosis. Common examples are
repeated washing of hands to remove dirt, continuous checking of already locked premises,
etc.
ā€¢ Hysterical Neurosis: It is usually seen in females where there may be convulsions or
stoppage of breath. Tonic and clonic convulsions are reported. It should always be
differentiated from epilepsy, which it can be confused with. In hysterical neurosis, the
person will never get hurt or bite the tongue, as it is seen in epilepsy. Some cause or
intention can be found out in hysterical neurosis while in epilepsy usually no cause is found.
Hysterical neurosis can be treated with counseling or correction of the underlying cause
DIFFERENCE BETWEEN NEUROSIS AND PSYCHOSIS
S.NO FEATURE PSYCHOSIS NEUROSIS
1 Contact with reality lost Preserved
2 Interpersonal behavior Marked disturbance in
reality and behavior
Preserved
3 Empathy Absent Present
4 Insight Absence of
understanding current
symptoms
Symptoms are recognised as
undesirable
5 Organic causative
factor
Present absent
6 Symptoms Delusions. Illusions and
hallucinations
Usually physical or psychic
symptoms
7 Dealing with reality Capacity is grossly
reduced
Preserved
8 Examples Dementia, Schizophrenia Anxiety, phobia, depression,
conversion disorder
SOMNAMBULISM
ā€¢ This is also called ā€˜sleep walkingā€™. A
person may move around while
asleep and may commit some crime
or theft, and then come back
normally. He may not be aware that
he has committed a crime.
ā€¢ He will not be held responsible if it
is proved that he has done this act
while asleep.
COMMON SYMPTOMS OF PSYCHIATRIC DISORDERS
ļƒ¼Delusion
ļƒ¼Hallucination
ļƒ¼Illusion
ļƒ¼Impulse
ļƒ¼Obsession
DELUSION-ą¤­ą„ą¤°ą¤®
ā€¢ DELUSION IS A FALSE
BELIEF IN SOMETHING
WHICH IS NOT A FACT,
AND THE BELIEF PERSISTS
EVEN AFTER ITS FALSITY
HAS BEEN CLEARLY
DEMONSTRATED.
TYPES OF DELUSIONS
ļƒ¼ GRANDEUR OR EXALTATION
ļƒ¼ PERSECUTION(PARANOID)
ļƒ¼ REFERENCE
ļƒ¼ INFLUENCE
ļƒ¼ INFEDILITY
ļƒ¼ SELF-REPROACH
ļƒ¼ NIHILISTIC
ļƒ¼ HYPOCHONDRIAL
ļƒ¼ OTHER TYPES
DELUSION OF GRANDEUR
OR EXALTATION
The person imagines that he is very
rich, powerful, while in reality he may
be a pauper and may squander away his
money or property. It is usually seen in
mania, and may be associated with
delusion of persecution.
This is a pleasant delusion.
DELUSION OF PERSECUTION/PARANOID
The person imagines that people are
after him and may kill him, poison
him(wife, sons or parents) or harm
him, or someone is going to rob his
property.
The person remains suspicious and
depressed and may commit some
crime. ( He may commit suicide or kill
his family members or innocent person
thinking him/her to be his enemy.)
DELUSION OF REFERENCE
The person believes that everybody is
thinking about him only and is being
referred by all agencies, media and
persons around him in all matters(usually
of negative nature) and this may put him
in conflict with the world.
DELUSION OF
INFLUENCE/CONTROL
The patient complains that his thoughts
processes, feelings and actions are
being influenced and controlled by
some external power,
ā€¢like radio,
ā€¢hypnotism or
ā€¢telepathy.
On the basis of this imaginary
ā€œcommandā€, he may commit an
unlawful act.
DELUSION OF INFEDILITY/JEALOUSY-
OTHELLO SYNDROME
In this, the person thinks that his/her
spouse is not loyal to him/ her. Usually,
males suffer more from this delusion as
compared to females.
The person may commit crime in this
state.
DELUSION OF SELF-REPROCH OR SELF-
CRITICISM
The person criticizes himself for some
imaginary offence or misdeed committed by
him in the past. In serious cases, the person
may punish himself by committing suicide.
NIHILISTIC DELUSION
In this, the person does
not believe in
ā€¢his existence or
ā€¢that the world exists.
They may commit suicide
or kill others.
It is commonly seen in
depression
HYPOCHONDRIAL
DELUSION
The person in this delusion
thinks that he is ill always,
while medically he may be
completely fit.
He keeps on visiting doctors.
Usually the person gives vague
abdominal complaints.
ā€¢ DELUSION OF POVERTY: The patient is convinced that he is, or will be, bereft of
all material possessions.
ā€¢ DELUSION OF DOUBLES (DOPPELGANGER) Patient believes that another person
has been physically transformed into themselves.
ā€¢ EROTOMANIA: In this, a women thinks that a particular person, especially
superior, is in deeply love with her. The erotomanic develops an obsession for
the person and starts believing that the other person is reciprocating
ā€¢ The object is usually of a higher status, famous superior at work but can also be
a complete stranger.
ā€¢ The erotomanic tries to get in close to the person through telephone calls, e-
mails, letters, gifts and visits. More common in women than in men.
HALLUCINATION
ā€¢ It is a false sensory perception which manifests
without any external object or stimulus.
ā€¢ They may occur in :-
ā€¢ Schizophrenia
ā€¢ Affective disorders
ā€¢ Organic mental disorders
ā€¢ They are also seen in insanity and conditions, like
ā€¢ High fever
ā€¢ Drug intoxication
ā€¢ Withdrawal from drug addiction
TYPES OF HALLUCINATION
ļ¶VISUAL
ļ¶AUDITARY
ļ¶OLFACTORY
ļ¶GUSTATORY
ļ¶TACTILE
ļ¶PSYCHOMOTOR
ļ¶LILLIPUTIAN
ļ¶SYNESTHESIA
VISUAL HALLUCINATION
ļ¶ Such hallucinations are quite common
in schizophrenia, epilepsy and drug
withdrawal syndromes.
ļ¶ Visual hallucination may be of
following types:-
ļ¶ Elementary type:-person sees only
flashes of light.
ļ¶ Partly organised:- person sees as
patterns or unformed images.
ļ¶ Completely organised:- person sees as
images, figures or image of people,
animal or object.
AUDITORY HALLUCINATIONS
ā€¢ False perception of sound, usually noises, but also music. Here, the person hears
voices of known or unknown persons without any source. They are quite
common in schizophrenia. In some cases a person hears a command from God
or Satan to do certain acts which may land up the person in conflict with law.
ā€¢ They are also referred as COMMAND HALLUCINATIONS.
ļ¶Elementary type:-person hears only noises.
ļ¶Partly organised:- person hears only music.
ļ¶Completely organised:- person hears hallucinatory voices.
OLFACTORY HALLUCINATIONS
ā€¢ Hallucination primarily involving smell or odors.
ā€¢ There is false sense of smelling (pleasant/
unpleasant/sweet/sour/bitter) without any source.
ā€¢ They are felt in schizophrenia and temporal lobe epilepsy.
OLFACTORY HALLUCINATIONS
ā€¢ Hallucination primarily involving
smell or odors.
ā€¢ There is false sense of smelling
(pleasant/unpleasant/sweet/sour/b
itter) without any source.
ā€¢ They are felt in schizophrenia and
temporal lobe epilepsy
GUSTATORY HALLUCINATIONS
ā€¢ Hallucinations involving taste.
Without any food or drink, the
patient experiences different
taste
TACTILE/HAPTIC HALLUCINATIONS
ļ¶ They are hallucinations of abnormal
touch. They are commonly seen in
cocaine addiction where bugs or
rats seems to be creeping in layers
of skin. (Formication)
ļ¶ Some patients experiences feeling
of cold winds blowing on them or
sensation of heat present over skin;
actually things are not present.
LILLIPUTIAN (MICROPSIA)
HALLUCINATIONS
ā€¢ In this a person perceives
objects to be of a much
smaller size than they actually
are
PSYCHOMOTOR/KINESTHETIC HALLUCINATION
ā€¢ There is feeling of movement of a part of the body, say a
limb, though in reality, there is no such movement.
PSYCHOMOTOR/KINESTHETIC
HALLUCINATION
ā€¢ There is feeling of movement
of a part of the body, say a
limb, though in reality, there
is no such movement.
SYNESTHESIA HALLUCINATION
ā€¢ A stimulus perceived by a sensory organ other than the
one that should actually perceive it. e.g. visualising
music, hearing different colours, etc.
SYNESTHESIA HALLUCINATION
ā€¢ A stimulus perceived by a
sensory organ other than the
one that should actually
perceive it. e.g. visualizing
music, hearing different
colors, etc.
SOME COMMON FACTS ABOUT HALLUCINATIONS
ļ¶ Visual hallucinations are the commonest in organic mental disorders (delirium
tremens)
ļ¶ Auditory hallucinations in functional (non-organic) disorders (schizophrenia)
ļ¶ Gustatory hallucinations in temporal lobe epilepsy
ļ¶ Olfactory hallucinations in medical disorders (especially in the temporal lobe)
ļ¶ Tactile hallucinations in cocainism.
ļ¶ Auditory hallucinations are the commonest followed by visual
ļ¶ Hallucinations are not under voluntary control and a person suffering from
unpleasant hallucinations may be incited to commit suicide or homicide
ILLUSION
ā€¢ It is false interpretation by the senses of an external object
or stimulus which has real existence.
ā€¢ Optical illusions are quite common in deserts where water
may be seen at places.
ā€¢ A rope may be seen as a snake at night.
ILLUSION
ā€¢ It is false interpretation by the
senses of an external object or
stimulus which has real existence.
ā€¢ Optical illusions are quite common in
deserts where water may be seen at
places.
ā€¢ A rope may be seen as a snake at
night.
TYPES OF ILLUSIONS
ļ¶ Completion illusion: Where an unfinished pattern is completed by
illusion.
ļ¶ Affect illusion: In this, mood of the person affects the nature of
illusion.
ļ¶ Parabolic illusion: When human faces or images are seen in
illusion.
ā€¢ In illusion, the person may be corrected when confronted with
facts. He realizes that it was a misinterpretation of stimulus.
IMPULSE
ā€¢ This is defined as a sudden and irresistible force which compels a
person to do some action without motive or forethought,
ā€¢ a normal person always tries to analyze his actions whether they
are consistent with law or not.
ā€¢ Once he realises that his action may be contrary to law he stops
it.
ā€¢ But in impulse, a person is not able to control himself.
SOME COMMON TYPES OF IMPULSES
ļ¶ Kleptomania: An irresistible desire to steal things usually of low value.
ļ¶ Pyromania: An irresistible desire to set things on fire.
ļ¶ Mutilomania: An irresistible impulse to maim animals.
ļ¶ Dipsomania: An irresistible impulse to drink at periodic intervals.
ļ¶ Sexual impulses: All sexual perversions.
ļ¶ Homicidal impulses: To kill some persons.
ļ¶ Suicidal impulses: To commit suicide. Impulses are quite commonly seen in
various mental disorders like depression, schizophrenia, mania, etc.
ļ¶ Trichotillomania: It is an irresistible desire to pull out oneā€™s own hair
ļ¶ Oniomania: compulsive desire to shop (shopping addiction)
OBSESSION
ā€¢ An obsession is defined as a persistent and irresistible thought,
image, affect or impulse that cannot be removed by the sufferer
although he knows that this is foolish. He continues to suffer. When
this converts into action, it is called ā€˜compulsionsā€™.
ā€¢
ā€¢ The person keeps on repeating foolish behavior though realizing
that it is untrue.
ā€¢
ā€¢ Normal persons also sometimes have obsessions but they overcome
them over a period of time.
ā€¢ But once it becomes pathological, it may turn into obsessive
compulsive neurosis
SCHIZOPHRENIA
ļ¶ Eugen Bleuler introduced this term. Literally it means disintegration
of mind. Commonly also called ā€˜split personalityā€™.
ļ¶ There is a complete loss of reality.
ļ¶ The exact reason of schizophrenia is not known but it runs in
families. Schizophrenia is a major illness. It is quite common in the
lower strata of society.
SYMPTOMS
Diagnostic symptoms as proposed by Bleuler are summorised
as :-
(They are also called as 4 ā€˜Aā€™ of Bleuler
1. Ambivalence-inability to decide for or against
2. Autism-withdrawal into self
3. Affect disturbances-disturbance of feeling
4. Association disturbance-loosening of association, thought disorder
TYPES OF SCHIZOPRENIA
ā€¢ Simple schizophrenia: It is the commonest type.
ā€¢ It mainly affects the mood of the person.
ā€¢ He remains depressed, talks very little and is withdrawn.
ā€¢ The motor activities are quite less.
TYPES OF SCHIZOPRENIA
ā€¢ Hebephrenia: In this type,
ā€¢ The thought process is primarily deranged.
ā€¢ Incoherence of thoughts, delusions and hallucinations are
reported.
ā€¢ The motor activities are also quite less.
TYPES OF SCHIZOPRENIA
ā€¢ Catatonic: In this type,
ā€¢ The behavior of the person is primarily abnormal.
ā€¢ There is a wild excitement and violent and abusive behaviour.
ā€¢ Homicidal and suicidal tendencies are very high.
ā€¢ The person may assault someone on minor provocations.
ā€¢ Sometimes, the person may be so violent that he needs to be
restrained by force.
TYPES OF SCHIZOPRENIA
ā€¢ Paranoid schizophrenia: Suspicion is the primary thought process
in this type.
ā€¢ The person may be thinking that some persons are behind him and can kill him.
ā€¢ He may have suspicion about his wife, parents, kids, friends and colleagues.
ā€¢ It occurs more in males than in females.
ā€¢ Delusions are very common.
ā€¢ Usually, personality is well preserved and these people are detected as suffering
from mental illness after a long time.
ā€¢ Auditory hallucinations are quite common. He may commit crime as he thinks
people are after him.
INSANITY
ļ¶ The word ā€œinsaneā€ has no technical meaning and is
ļ¶ commonly used to refer to individuals who cannot take care of themselves or adhere to
the social fabric, due to some mental disorder.
ļ¶ It refers to individuals who by virtue of being mentally ill, are not competent to discharge
their legal duties and are not aware of the legal implications of their behaviour.
ļ¶ In the Indian Penal Code, the phrase ā€˜unsoundness of mindā€™ is used as synonymous to
terms such as insanity, lunacy, madness or any mental disorder where a person is not
capable of regulating his behaviour according to the socio-legal system.
ļ¶ A medical officer is often called upon to opine whether a person is insane or not.
CAUSES OF INSANITY
ļ¶ Heredity: Insanity often runs in families. The exact reason
is not known. Usually, most of the mental diseases are not
transmitted genetically but it has been observed that
mental illness runs in families.
ļ¶ Environmental Factors:. Over protection, rejection, unnecessary
peer comparison, or sibling rivalry can cause maladjustment in a
child.
ļ¶ Emotional maladjustment is quite common in adolescent period.
ļ¶ A good sex education is very essential for adolescents to fashion
their personality according to the social fabric.
ļ¶ In adults, domestic quarrels, financial and business losses, failure in
love, death of near ones, unemployment and job pressures can
precipitate mental illness.
ONSET OF INSANITY
ā€¢ The onset of insanity is gradual.
ā€¢ The person may be brought to the medical officer for treatment.
ā€¢ In some cases the person may malinger to avoid punishment.
ā€¢ So, the medical officer has to decide whether insanity is true or
false
Differentiate Between And A True Insane Person And A
Person Who Is Pretending To Be An Insane
S.NO. FEATURES TRUE INSANE FEIGNED INSANE
1. Onset & Motive Usually gradual or rarely
sudden but almost always
without any motive.
Always sudden and there is some motive.
2. Predisposing/exciting
cause
May be present, like h/o
insanity in parents
Not present.
3. Facial expression There are usually a peculiar
characteristic facial expressions
like worried look, agitated
Normal or easily distinguishable.
4. Signs & Symptoms The true insane individual
shows signs and symptoms of
insanity irrespective of his
conduct being observed or not.
A false insane will show signs of insanity
only when he is observed and there is total
absence of symptoms when he thinks that
he is alone or not being watched.
5. Characteristic feature Sign and symptoms usually
point to a particular type of
insanity. ( e.g. schizophrenia,
A non insane person will do whatever
comes in to his mind and his signs and
symptoms don't indicate a particular type
Differentiate Between And A True Insane Person And A
Person Who Is Pretending To Be An Insane
S.NO. FEATURES TRUE INSANE FEIGNED INSANE
7. Mood Excited, depressed or fluctuating May over react to show
abnormality in mood
8. Habits Habits are invariably dirty or filthy. He
may smear his body with stool or
urine.
Habits are not usually dirty or
filthy.
9. Physical
manifestation
Dry harsh skin, furred tongue,
constipation, anorexia (loss of
appetite)
Not present
10. Repeated
examination
Not worried about being repeatedly
examined
Shows dislike for repeated
examinations.
11. Insomnia Present Cannot persist, patient
usually sleeps after a day or
two
12. Dressing up Carelessly dressed Dressed reasonably properly
MENTAL RETARDATION
ā€¢ "Mental retardation refers to significantly sub average
general intellectual functioning existing concurrently with
deficits in adaptive behavior, and manifested during the
developmental period".
MENTAL HANDICAP
It refers to mental sub normality in an individual, acquired at the time
of birth or early childhood. Intelligent quotient is low.
It is usually of the following types:
IDIOCY
ā€¢ Here, I.Q. level is around 20.
ā€¢ The person is mentally retarded severely.
ā€¢ He may be associated with some other genetic problems too.
ā€¢ He may need physical and mental rehabilitation to lead a normal life.
ā€¢ Usually, idiots remain cheerful as their achievement goals are almost
absent and they can lead their life easily on a survival basis.
IMBECILE
ā€¢ Their I.Q. level is between 20 and 50.
ā€¢ They are incapable of managing their affairs themselves.
ā€¢ They also require physical and mental rehabilitation by a
therapist to lead a normal life.
FEEBLE MINDEDNESS
ā€¢ Their I.Q. level is between 50 and 75.
ļ¶ They appear normal but their mental faculties, especially
intelligence, is less as compared to a normal person.
ļ¶ They are usually school dropouts.
ļ¶ They do not fare well in academic and financial career. T
ļ¶ hey may get easily involved in criminal activities
CLASSIFICATION OF MR
Level of Retardation IQ
Mild retardation
50-69
Moderate retardation
35-59
Severe retardation 20-34
Profound retardation
< 20
THE MENTAL HEALTH ACT, 1987
It replaces the Indian Lunacy Act of 1912 resulting in change
of certain terminologies as shown below
ļ¶ Asylum to psychiatric hospital
ļ¶ Lunatic to mentally ill person
ļ¶ Criminal lunatic to mentally ill prisoner
The mental health act came into affect only in April 1993 in all
the states and union territories of India.
OBJECTIVES OF THE ACT
ļ¶ Regulate admission of the mentally ill patient to a psychiatric hospital or
psychiatric nursing home and to protect his rights while under detection
ļ¶ Prevent harm to himself and the society by the mentally ill person
ļ¶ Protect citizens being detained in psychiatric hospitals without sufficient cause.
ļ¶ Fix liability for maintenance charges of mentally ill patient admitted to the
hospital or nursing home.
ļ¶ Provide facilities to establish guardianship or custody of the mentally ill patient
and management of his property.
ļ¶ Establish central and state authority for mental health services
ļ¶ Provide licensing and control of psychiatric hospitals by the state government
ļ¶ Ensure legal aid to the mentally ill person at state expense in certain cases
MENTAL DISORDER AND RESPONSIBILITY
ļ¶ CIVIL RESPONSIBILITY
The question of civil responsibility arises in following conditions:-
ļ¶ Management of property and affairs
ļ¶ Insanity and contracts
ļ¶ Insanity and marriage contract
ļ¶ Competence of insane to be a witness
ļ¶ Consent and insanity
ļ¶ Insanity and testamentary capacity
MANAGEMENT OF PROPERTY AND AFFAIRS
ļ¶ If a person who owns property becomes insane and is incapable of managing his affairs with sound
judgment, a relative or friend can approach the court for judicial inquisition.
ļ¶ The medical evidence is given in the form of a certificate which should state ā€œthat insanity is of such a
degree as to make him incapable of managing his property.ā€
ļ¶ On enquire if itā€™s found that the person is incapable of managing his property the court can appoint a
guardian or manager depending on the circumstances.
ļ¶ The court may order the sale or disposal of the personā€™s property, for the payment of his debts and
expenses.
ļ¶ The court may order a second inquisition, if itā€™s reported that unsoundness of mind had ceased.
BUSINESS CONTRACT
ļ¶ If it is proved that at the time of signing a contract one of the two
parties was insane, then the contract becomes legally invalid.
ļ¶ Insanity developing subsequently to a legal agreement will not
necessarily invalidate the contract.
ļ¶ If at the time of signing, the fact that one of the signatories to the
contract was insane was not known to the other party, the contract
may not be declared invalid.
MARRIAGE
A marriage is considered invalid if at the time of marriage, either party is
ļ¶ Incapable of giving valid consent due to insanity.
ļ¶ Though capable of giving valid consent, has been suffering from such kind or
degree of mental disorder as to be unfit for marriage or procreation.
ļ¶ Has been suffering from recurrent attacks of insanity.
THE COMPETENCE OF INSANE TO BE A WITNESS
ļ¶ An insane person is not competent to give evidence, if he cannot
understand the necessity of telling the truth due to insanity.
ļ¶ A person of unsound mind who suffers from delusions, but is
capable of telling what he has seen and who understands the
importance of an oath, is competent to give evidence
ļ¶ An insane person is competent to give evidence during the lucid
interval.
TESTAMENTARY CAPACITY
ļ¶ Testamentary capacity refers to the capacity of a person to make a valid will. The
law defines it as possession of a sound disposing mind (corpus mentis) which
must be certified by a doctor.
ļ¶ A will is a document detailing the disposition of property owned by a person,
which is prepared by him during his lifetime but takes effect only after his
demise.
ļ¶ The person who makes the will is referred to as the testator.
ļ¶ Will written by the testator in his own handwriting is called ā€œHolograph willā€.
ļ¶ It can be revoked or changed any number of times
CRIMINAL RESPONSIBILITY OF THE INSANE
MCNAUGHTON'S RULE
That to establish a defense on the ground of insanity, it must be clearly
proved that
ā€œat the time of committing the act, the accused was laboring under such
a defect of reason, from disease of the mind, as not to know the
nature and quality of the act he was doing, or, if he did know it, that
he did not know he was doing what was wrong.ā€
In India, Section 84 of the I.P.C. defines the legal test or criminal responsibility of the
insane, as:
ā€œNothing is an offence which is done by a person who, at the time
of doing it, by reason of unsoundness of mind, is incapable of knowing the
nature of the act, or that he is doing what is either wrong or contrary to law.ā€
Section 85 of the I.P.C. defines legal responsibility of a person under intoxication. If it
is proved that a person was given intoxication without his knowledge or against
his will, and due to intoxication he lost mental reasoning and then committed
the crime, he will not be held responsible for it. Drunkenness caused by
voluntary use of alcohol or drugs offers no excuse for committing the crime.
DURHAM RULE (1954)
The Durham rule states that an accused is not criminally responsible if his unlawful act was the
product of mental disease or mental defect.
The Durham rule was eventually rejected by the federal courts, because it cast too broad a
net. Alcoholics, compulsive gamblers, and drug addicts had successfully used the defense
to defeat a wide variety of crimes.
The federal insanity defense, established by the Comprehensive Crime Control Act, now
requires the defendant to prove, by "clear and convincing evidence," that "at the time of
the commission of the acts constituting the offense, the defendant, as a result of a severe
mental disease or defect, was unable to appreciate the nature and quality or the
wrongfulness of his acts".
CURRENā€™S RULE (1961)
ļ¶ An accused person will not be held criminally responsible, if at the
time of committing act, he did not have the capacity to regulate his
conduct to the requirement of law, as a result of mental disease or
defect.
ļ¶ As per Currenā€™s rule, it was contested that, at the time of
committing the criminal act, a person may have the knowledge
that what he was doing was wrong but he neither had the capacity
nor the will to control (adjust) his act. Therefore such person
should not be held responsible.
AMERICAN LAW INSTITUTE TEST. (1970
ā€¢ A person is not responsible for his criminal conduct if at the time of
such conduct as a result of mental disease or defect, he lacks
substantial capacity either to appreciate the wrongfulness of his
conduct or to adjust his conduct to the requirement of law.

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Forensic psychiatry

  • 1. FORENSIC PSYCHIATRY Dr Kaleem Khan Assistant Professor GFIMSR
  • 2. When you live in the shadow of insanity, the appearance of another mind that thinks and talks as yours does is sometimes close to a blessed event.
  • 3. When you speak to God it's called praying; but when God speaks to you it's called schizophrenia.
  • 4. PSYCHIATRY:- It is the branch of medical science which deals with study, diagnosis, treatment, prevention of mental illness and behavioral disorders.
  • 5. PSYCHIATRY:- It is the branch of medical science which deals with study, diagnosis, treatment, prevention of mental illness and behavioral disorders. ā€¢ FORENSIC PSYCHIATRY:- ā€¢ deals with the application of psychiatry in the administration of justice.
  • 6. SOME COMMON PSYCHIATRY TERMS ā€¢ ABREACTION:-This is a release phenomenon where old, forgotten things or events are brought into conscious state again. ā€¢ AFFECT:- It is commonly called mood or feeling. ā€¢ AMNESIA:- Loss of memory about a person or event is called ā€˜amnesiaā€™. ā€¢ CONFABULATIONA: Unconscious filling of gaps in memory by imagining experiences or events that have no basis in fact, commonly seen in amnesic syndrome. Confabulation is considered ā€œhonest lying,ā€ but is distinct from lying because there is typically no intent to deceive and the individual is unaware that their information is false. ā€¢ CIRCUMSTANTIALITY: When a person is not able to answer properly, in a straight manner, and keeps on giving irrelevant details or wanders off the subject many times in a conversation, the condition is called circumstantialities.
  • 7. COMPULSION:-It is a repetitive behavior done by an individual in spite of knowing that it is not correct. Examples being, repeatedly washing hands, checking locked premises again and again.
  • 8. APHASIA ā€¢ Loss of sensory or ā€¢ motor ability to express by use of ā€¢ speech or ā€¢ writing is called ā€˜aphasiaā€™.
  • 9. ā€¢ FUGUE STATE:The person becomes a wanderer who keeps on moving from place to place in an altered state of mind. He has episodes of amnesia. This stage is seen in depression, schizophrenia and other mental disorders. ā€¢ ECHOPRAXIA: Repeating the act of another ā€¢ NEGATIVISM: Doing just the opposite of what he is asked to do. ā€¢ NEURASTHENIA:A condition arising out of physical or mental exhaustion. ā€¢ PHOBIA: is an excessive irrational fear of a particular object or situation. ā€¢ PARANOIA: Rare psychiatric syndrome marked by the gradual development of a highly elaborate and complex delusional system, generally involving persecutory or grandiose delusions, with few other signs of personality disorientation or thought disorder.
  • 10. EMPATHY ā€¢ The degree to which the observer is able to enter into the thoughts and feelings of the patient and establish good contact.
  • 11. ā€¢ PARASUICIDEIt is a conscious often impulsive, manipulative act, undertaken to get rid of an intolerable situation. (attempted suicide or pseudicide) ā€¢ STUPOR: Used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings. ā€¢ TWILIGHT STATE: Disturbed consciousness of short duration with hallucination during which the patient may carry out actions of which he has little or no subsequent memory. ā€¢ VEGETATIVE SIGNS: In depression, denoting characteristic symptoms, such as sleep disturbance(especially early morning awakening), decreased appetite, constipation, weight loss and loss of sexual response. ā€¢ ONEIROID STATES: It is a dream like state which may last for days or weeks. the patient suffers from confusion, amnesia, illusions, hallucination, disorientation agitation and anxiety.
  • 12. NEUROSIS AND PSYCHOSIS Neurosis is when a patient suffers from emotional or intellectual disorders which causes subjective distress, but does not lose touch with reality. Psychosis is characterized by gross impairment in reality-testing(with drawl from reality), as if living in a world of fantasy.
  • 13. PSYCHOSIS Psychoses are usually of the following two types: 1. Manic-depressive Psychosis: It is expressed in following two phases: (a) Mania phase: In this, the person is very active, full of life, talking too much, mostly irreverent, the mood is elated and he does some action continuously. But he does not have touch with reality. He can commit any crime during this phase. Sleep is very less. Appetite is also less. (b) Depressive phase: It is just the reverse of mania. The person is very sad, mood is depressed. The person sits alone and may speak very little. Touch with reality is not there. He may commit suicide. The motor functions are also quite depressed. A person suffering from manic depressive psychosis may fluctuate between the two phases of mania and depression. It may be possible that the person may be normal between the two phases of mania. This may be lucid interval and the person is completely responsible for his actions.
  • 14. NEUROSIS Neurosis is a minor mental illness. It is of following types: 1. Anxiety Neurosis: It is a very common variety. The person remains anxious about future events, relationships and individuals. His pulse rate may be high, blood pressure raised, respiratory rate high and he may be sweating. He may be restless, confused and apprehensive. Treatment usually involves counseling and use of anti-anxiety drugs
  • 15. ā€¢ Depression: It is the reverse of anxiety. Here, a person would be aloof, sad and withdrawn. His motor activities would be quite less. He may have a low appetite and may not eat well. However, in chronic cases of depression, the person may keep on eating the whole day, while withdrawn at home and hence may gain weight. The following are the types of depression commonly seen: ā€¢ Reactive depression: It may be due to some event or situation like the death of spouse or a near one, failure in exam, love, etc. It usually remains there for sometime. Some form of reactive depression is seen in all individuals. Usually, with counseling and use of anti-depressive drugs, most come out of it. ā€¢ Endogenous depression: It is more serious as its etiology is not known and develops slowly. Early morning awakening, loss of appetite and mood depression are quite common. This depression may be associated with psychosis too, where it carries a bad prognosis. Usually with anti-depressive drugs, most of the individuals recover. ā€¢ Puerperal depression: A woman who has recently delivered may have depression commonly called ā€˜puerperal depressionā€™. She may even kill her infant during this time. ā€¢ Involution depression: During the age group of 50ā€“60 years, depression may set in. Delusion of hopelessness and unworthiness may be present. Due to development of hypertension, diabetes or somatic illness, person may get into depression. Counseling, along with drugs is very useful. ā€¢ Hypochondriacal depression: In this type of neurosis, the person usually complains of vague aches and pains and may keep on visiting many physicians but of no avail. Usually no treatment is effective.
  • 16. 3. Obsessive-compulsive Neurosis: As described earlier, obsession is a foolish thought which a person knows but cannot avoid. But once this thought turns into action, it is called compulsion and may lead to obsessive-compulsive neurosis. Common examples are repeated washing of hands to remove dirt, continuous checking of already locked premises, etc. ā€¢ Hysterical Neurosis: It is usually seen in females where there may be convulsions or stoppage of breath. Tonic and clonic convulsions are reported. It should always be differentiated from epilepsy, which it can be confused with. In hysterical neurosis, the person will never get hurt or bite the tongue, as it is seen in epilepsy. Some cause or intention can be found out in hysterical neurosis while in epilepsy usually no cause is found. Hysterical neurosis can be treated with counseling or correction of the underlying cause
  • 17. DIFFERENCE BETWEEN NEUROSIS AND PSYCHOSIS S.NO FEATURE PSYCHOSIS NEUROSIS 1 Contact with reality lost Preserved 2 Interpersonal behavior Marked disturbance in reality and behavior Preserved 3 Empathy Absent Present 4 Insight Absence of understanding current symptoms Symptoms are recognised as undesirable 5 Organic causative factor Present absent 6 Symptoms Delusions. Illusions and hallucinations Usually physical or psychic symptoms 7 Dealing with reality Capacity is grossly reduced Preserved 8 Examples Dementia, Schizophrenia Anxiety, phobia, depression, conversion disorder
  • 18. SOMNAMBULISM ā€¢ This is also called ā€˜sleep walkingā€™. A person may move around while asleep and may commit some crime or theft, and then come back normally. He may not be aware that he has committed a crime. ā€¢ He will not be held responsible if it is proved that he has done this act while asleep.
  • 19. COMMON SYMPTOMS OF PSYCHIATRIC DISORDERS ļƒ¼Delusion ļƒ¼Hallucination ļƒ¼Illusion ļƒ¼Impulse ļƒ¼Obsession
  • 20. DELUSION-ą¤­ą„ą¤°ą¤® ā€¢ DELUSION IS A FALSE BELIEF IN SOMETHING WHICH IS NOT A FACT, AND THE BELIEF PERSISTS EVEN AFTER ITS FALSITY HAS BEEN CLEARLY DEMONSTRATED.
  • 21. TYPES OF DELUSIONS ļƒ¼ GRANDEUR OR EXALTATION ļƒ¼ PERSECUTION(PARANOID) ļƒ¼ REFERENCE ļƒ¼ INFLUENCE ļƒ¼ INFEDILITY ļƒ¼ SELF-REPROACH ļƒ¼ NIHILISTIC ļƒ¼ HYPOCHONDRIAL ļƒ¼ OTHER TYPES
  • 22. DELUSION OF GRANDEUR OR EXALTATION The person imagines that he is very rich, powerful, while in reality he may be a pauper and may squander away his money or property. It is usually seen in mania, and may be associated with delusion of persecution. This is a pleasant delusion.
  • 23. DELUSION OF PERSECUTION/PARANOID The person imagines that people are after him and may kill him, poison him(wife, sons or parents) or harm him, or someone is going to rob his property. The person remains suspicious and depressed and may commit some crime. ( He may commit suicide or kill his family members or innocent person thinking him/her to be his enemy.)
  • 24. DELUSION OF REFERENCE The person believes that everybody is thinking about him only and is being referred by all agencies, media and persons around him in all matters(usually of negative nature) and this may put him in conflict with the world.
  • 25. DELUSION OF INFLUENCE/CONTROL The patient complains that his thoughts processes, feelings and actions are being influenced and controlled by some external power, ā€¢like radio, ā€¢hypnotism or ā€¢telepathy. On the basis of this imaginary ā€œcommandā€, he may commit an unlawful act.
  • 26. DELUSION OF INFEDILITY/JEALOUSY- OTHELLO SYNDROME In this, the person thinks that his/her spouse is not loyal to him/ her. Usually, males suffer more from this delusion as compared to females. The person may commit crime in this state.
  • 27. DELUSION OF SELF-REPROCH OR SELF- CRITICISM The person criticizes himself for some imaginary offence or misdeed committed by him in the past. In serious cases, the person may punish himself by committing suicide.
  • 28. NIHILISTIC DELUSION In this, the person does not believe in ā€¢his existence or ā€¢that the world exists. They may commit suicide or kill others. It is commonly seen in depression
  • 29. HYPOCHONDRIAL DELUSION The person in this delusion thinks that he is ill always, while medically he may be completely fit. He keeps on visiting doctors. Usually the person gives vague abdominal complaints.
  • 30. ā€¢ DELUSION OF POVERTY: The patient is convinced that he is, or will be, bereft of all material possessions. ā€¢ DELUSION OF DOUBLES (DOPPELGANGER) Patient believes that another person has been physically transformed into themselves. ā€¢ EROTOMANIA: In this, a women thinks that a particular person, especially superior, is in deeply love with her. The erotomanic develops an obsession for the person and starts believing that the other person is reciprocating ā€¢ The object is usually of a higher status, famous superior at work but can also be a complete stranger. ā€¢ The erotomanic tries to get in close to the person through telephone calls, e- mails, letters, gifts and visits. More common in women than in men.
  • 31. HALLUCINATION ā€¢ It is a false sensory perception which manifests without any external object or stimulus. ā€¢ They may occur in :- ā€¢ Schizophrenia ā€¢ Affective disorders ā€¢ Organic mental disorders ā€¢ They are also seen in insanity and conditions, like ā€¢ High fever ā€¢ Drug intoxication ā€¢ Withdrawal from drug addiction
  • 33. VISUAL HALLUCINATION ļ¶ Such hallucinations are quite common in schizophrenia, epilepsy and drug withdrawal syndromes. ļ¶ Visual hallucination may be of following types:- ļ¶ Elementary type:-person sees only flashes of light. ļ¶ Partly organised:- person sees as patterns or unformed images. ļ¶ Completely organised:- person sees as images, figures or image of people, animal or object.
  • 34. AUDITORY HALLUCINATIONS ā€¢ False perception of sound, usually noises, but also music. Here, the person hears voices of known or unknown persons without any source. They are quite common in schizophrenia. In some cases a person hears a command from God or Satan to do certain acts which may land up the person in conflict with law. ā€¢ They are also referred as COMMAND HALLUCINATIONS. ļ¶Elementary type:-person hears only noises. ļ¶Partly organised:- person hears only music. ļ¶Completely organised:- person hears hallucinatory voices.
  • 35.
  • 36. OLFACTORY HALLUCINATIONS ā€¢ Hallucination primarily involving smell or odors. ā€¢ There is false sense of smelling (pleasant/ unpleasant/sweet/sour/bitter) without any source. ā€¢ They are felt in schizophrenia and temporal lobe epilepsy.
  • 37. OLFACTORY HALLUCINATIONS ā€¢ Hallucination primarily involving smell or odors. ā€¢ There is false sense of smelling (pleasant/unpleasant/sweet/sour/b itter) without any source. ā€¢ They are felt in schizophrenia and temporal lobe epilepsy
  • 38. GUSTATORY HALLUCINATIONS ā€¢ Hallucinations involving taste. Without any food or drink, the patient experiences different taste
  • 39. TACTILE/HAPTIC HALLUCINATIONS ļ¶ They are hallucinations of abnormal touch. They are commonly seen in cocaine addiction where bugs or rats seems to be creeping in layers of skin. (Formication) ļ¶ Some patients experiences feeling of cold winds blowing on them or sensation of heat present over skin; actually things are not present.
  • 40. LILLIPUTIAN (MICROPSIA) HALLUCINATIONS ā€¢ In this a person perceives objects to be of a much smaller size than they actually are
  • 41. PSYCHOMOTOR/KINESTHETIC HALLUCINATION ā€¢ There is feeling of movement of a part of the body, say a limb, though in reality, there is no such movement.
  • 42. PSYCHOMOTOR/KINESTHETIC HALLUCINATION ā€¢ There is feeling of movement of a part of the body, say a limb, though in reality, there is no such movement.
  • 43. SYNESTHESIA HALLUCINATION ā€¢ A stimulus perceived by a sensory organ other than the one that should actually perceive it. e.g. visualising music, hearing different colours, etc.
  • 44. SYNESTHESIA HALLUCINATION ā€¢ A stimulus perceived by a sensory organ other than the one that should actually perceive it. e.g. visualizing music, hearing different colors, etc.
  • 45. SOME COMMON FACTS ABOUT HALLUCINATIONS ļ¶ Visual hallucinations are the commonest in organic mental disorders (delirium tremens) ļ¶ Auditory hallucinations in functional (non-organic) disorders (schizophrenia) ļ¶ Gustatory hallucinations in temporal lobe epilepsy ļ¶ Olfactory hallucinations in medical disorders (especially in the temporal lobe) ļ¶ Tactile hallucinations in cocainism. ļ¶ Auditory hallucinations are the commonest followed by visual ļ¶ Hallucinations are not under voluntary control and a person suffering from unpleasant hallucinations may be incited to commit suicide or homicide
  • 46. ILLUSION ā€¢ It is false interpretation by the senses of an external object or stimulus which has real existence. ā€¢ Optical illusions are quite common in deserts where water may be seen at places. ā€¢ A rope may be seen as a snake at night.
  • 47. ILLUSION ā€¢ It is false interpretation by the senses of an external object or stimulus which has real existence. ā€¢ Optical illusions are quite common in deserts where water may be seen at places. ā€¢ A rope may be seen as a snake at night.
  • 48. TYPES OF ILLUSIONS ļ¶ Completion illusion: Where an unfinished pattern is completed by illusion. ļ¶ Affect illusion: In this, mood of the person affects the nature of illusion. ļ¶ Parabolic illusion: When human faces or images are seen in illusion. ā€¢ In illusion, the person may be corrected when confronted with facts. He realizes that it was a misinterpretation of stimulus.
  • 49. IMPULSE ā€¢ This is defined as a sudden and irresistible force which compels a person to do some action without motive or forethought, ā€¢ a normal person always tries to analyze his actions whether they are consistent with law or not. ā€¢ Once he realises that his action may be contrary to law he stops it. ā€¢ But in impulse, a person is not able to control himself.
  • 50. SOME COMMON TYPES OF IMPULSES ļ¶ Kleptomania: An irresistible desire to steal things usually of low value. ļ¶ Pyromania: An irresistible desire to set things on fire. ļ¶ Mutilomania: An irresistible impulse to maim animals. ļ¶ Dipsomania: An irresistible impulse to drink at periodic intervals. ļ¶ Sexual impulses: All sexual perversions. ļ¶ Homicidal impulses: To kill some persons. ļ¶ Suicidal impulses: To commit suicide. Impulses are quite commonly seen in various mental disorders like depression, schizophrenia, mania, etc. ļ¶ Trichotillomania: It is an irresistible desire to pull out oneā€™s own hair ļ¶ Oniomania: compulsive desire to shop (shopping addiction)
  • 51.
  • 52. OBSESSION ā€¢ An obsession is defined as a persistent and irresistible thought, image, affect or impulse that cannot be removed by the sufferer although he knows that this is foolish. He continues to suffer. When this converts into action, it is called ā€˜compulsionsā€™. ā€¢ ā€¢ The person keeps on repeating foolish behavior though realizing that it is untrue. ā€¢ ā€¢ Normal persons also sometimes have obsessions but they overcome them over a period of time. ā€¢ But once it becomes pathological, it may turn into obsessive compulsive neurosis
  • 53. SCHIZOPHRENIA ļ¶ Eugen Bleuler introduced this term. Literally it means disintegration of mind. Commonly also called ā€˜split personalityā€™. ļ¶ There is a complete loss of reality. ļ¶ The exact reason of schizophrenia is not known but it runs in families. Schizophrenia is a major illness. It is quite common in the lower strata of society.
  • 54. SYMPTOMS Diagnostic symptoms as proposed by Bleuler are summorised as :- (They are also called as 4 ā€˜Aā€™ of Bleuler 1. Ambivalence-inability to decide for or against 2. Autism-withdrawal into self 3. Affect disturbances-disturbance of feeling 4. Association disturbance-loosening of association, thought disorder
  • 55. TYPES OF SCHIZOPRENIA ā€¢ Simple schizophrenia: It is the commonest type. ā€¢ It mainly affects the mood of the person. ā€¢ He remains depressed, talks very little and is withdrawn. ā€¢ The motor activities are quite less.
  • 56. TYPES OF SCHIZOPRENIA ā€¢ Hebephrenia: In this type, ā€¢ The thought process is primarily deranged. ā€¢ Incoherence of thoughts, delusions and hallucinations are reported. ā€¢ The motor activities are also quite less.
  • 57. TYPES OF SCHIZOPRENIA ā€¢ Catatonic: In this type, ā€¢ The behavior of the person is primarily abnormal. ā€¢ There is a wild excitement and violent and abusive behaviour. ā€¢ Homicidal and suicidal tendencies are very high. ā€¢ The person may assault someone on minor provocations. ā€¢ Sometimes, the person may be so violent that he needs to be restrained by force.
  • 58. TYPES OF SCHIZOPRENIA ā€¢ Paranoid schizophrenia: Suspicion is the primary thought process in this type. ā€¢ The person may be thinking that some persons are behind him and can kill him. ā€¢ He may have suspicion about his wife, parents, kids, friends and colleagues. ā€¢ It occurs more in males than in females. ā€¢ Delusions are very common. ā€¢ Usually, personality is well preserved and these people are detected as suffering from mental illness after a long time. ā€¢ Auditory hallucinations are quite common. He may commit crime as he thinks people are after him.
  • 59. INSANITY ļ¶ The word ā€œinsaneā€ has no technical meaning and is ļ¶ commonly used to refer to individuals who cannot take care of themselves or adhere to the social fabric, due to some mental disorder. ļ¶ It refers to individuals who by virtue of being mentally ill, are not competent to discharge their legal duties and are not aware of the legal implications of their behaviour. ļ¶ In the Indian Penal Code, the phrase ā€˜unsoundness of mindā€™ is used as synonymous to terms such as insanity, lunacy, madness or any mental disorder where a person is not capable of regulating his behaviour according to the socio-legal system. ļ¶ A medical officer is often called upon to opine whether a person is insane or not.
  • 60. CAUSES OF INSANITY ļ¶ Heredity: Insanity often runs in families. The exact reason is not known. Usually, most of the mental diseases are not transmitted genetically but it has been observed that mental illness runs in families. ļ¶ Environmental Factors:. Over protection, rejection, unnecessary peer comparison, or sibling rivalry can cause maladjustment in a child. ļ¶ Emotional maladjustment is quite common in adolescent period. ļ¶ A good sex education is very essential for adolescents to fashion their personality according to the social fabric. ļ¶ In adults, domestic quarrels, financial and business losses, failure in love, death of near ones, unemployment and job pressures can precipitate mental illness.
  • 61. ONSET OF INSANITY ā€¢ The onset of insanity is gradual. ā€¢ The person may be brought to the medical officer for treatment. ā€¢ In some cases the person may malinger to avoid punishment. ā€¢ So, the medical officer has to decide whether insanity is true or false
  • 62. Differentiate Between And A True Insane Person And A Person Who Is Pretending To Be An Insane S.NO. FEATURES TRUE INSANE FEIGNED INSANE 1. Onset & Motive Usually gradual or rarely sudden but almost always without any motive. Always sudden and there is some motive. 2. Predisposing/exciting cause May be present, like h/o insanity in parents Not present. 3. Facial expression There are usually a peculiar characteristic facial expressions like worried look, agitated Normal or easily distinguishable. 4. Signs & Symptoms The true insane individual shows signs and symptoms of insanity irrespective of his conduct being observed or not. A false insane will show signs of insanity only when he is observed and there is total absence of symptoms when he thinks that he is alone or not being watched. 5. Characteristic feature Sign and symptoms usually point to a particular type of insanity. ( e.g. schizophrenia, A non insane person will do whatever comes in to his mind and his signs and symptoms don't indicate a particular type
  • 63. Differentiate Between And A True Insane Person And A Person Who Is Pretending To Be An Insane S.NO. FEATURES TRUE INSANE FEIGNED INSANE 7. Mood Excited, depressed or fluctuating May over react to show abnormality in mood 8. Habits Habits are invariably dirty or filthy. He may smear his body with stool or urine. Habits are not usually dirty or filthy. 9. Physical manifestation Dry harsh skin, furred tongue, constipation, anorexia (loss of appetite) Not present 10. Repeated examination Not worried about being repeatedly examined Shows dislike for repeated examinations. 11. Insomnia Present Cannot persist, patient usually sleeps after a day or two 12. Dressing up Carelessly dressed Dressed reasonably properly
  • 64. MENTAL RETARDATION ā€¢ "Mental retardation refers to significantly sub average general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period".
  • 65. MENTAL HANDICAP It refers to mental sub normality in an individual, acquired at the time of birth or early childhood. Intelligent quotient is low. It is usually of the following types:
  • 66. IDIOCY ā€¢ Here, I.Q. level is around 20. ā€¢ The person is mentally retarded severely. ā€¢ He may be associated with some other genetic problems too. ā€¢ He may need physical and mental rehabilitation to lead a normal life. ā€¢ Usually, idiots remain cheerful as their achievement goals are almost absent and they can lead their life easily on a survival basis.
  • 67. IMBECILE ā€¢ Their I.Q. level is between 20 and 50. ā€¢ They are incapable of managing their affairs themselves. ā€¢ They also require physical and mental rehabilitation by a therapist to lead a normal life.
  • 68. FEEBLE MINDEDNESS ā€¢ Their I.Q. level is between 50 and 75. ļ¶ They appear normal but their mental faculties, especially intelligence, is less as compared to a normal person. ļ¶ They are usually school dropouts. ļ¶ They do not fare well in academic and financial career. T ļ¶ hey may get easily involved in criminal activities
  • 69. CLASSIFICATION OF MR Level of Retardation IQ Mild retardation 50-69 Moderate retardation 35-59 Severe retardation 20-34 Profound retardation < 20
  • 70. THE MENTAL HEALTH ACT, 1987 It replaces the Indian Lunacy Act of 1912 resulting in change of certain terminologies as shown below ļ¶ Asylum to psychiatric hospital ļ¶ Lunatic to mentally ill person ļ¶ Criminal lunatic to mentally ill prisoner The mental health act came into affect only in April 1993 in all the states and union territories of India.
  • 71. OBJECTIVES OF THE ACT ļ¶ Regulate admission of the mentally ill patient to a psychiatric hospital or psychiatric nursing home and to protect his rights while under detection ļ¶ Prevent harm to himself and the society by the mentally ill person ļ¶ Protect citizens being detained in psychiatric hospitals without sufficient cause. ļ¶ Fix liability for maintenance charges of mentally ill patient admitted to the hospital or nursing home. ļ¶ Provide facilities to establish guardianship or custody of the mentally ill patient and management of his property. ļ¶ Establish central and state authority for mental health services ļ¶ Provide licensing and control of psychiatric hospitals by the state government ļ¶ Ensure legal aid to the mentally ill person at state expense in certain cases
  • 72. MENTAL DISORDER AND RESPONSIBILITY ļ¶ CIVIL RESPONSIBILITY The question of civil responsibility arises in following conditions:- ļ¶ Management of property and affairs ļ¶ Insanity and contracts ļ¶ Insanity and marriage contract ļ¶ Competence of insane to be a witness ļ¶ Consent and insanity ļ¶ Insanity and testamentary capacity
  • 73. MANAGEMENT OF PROPERTY AND AFFAIRS ļ¶ If a person who owns property becomes insane and is incapable of managing his affairs with sound judgment, a relative or friend can approach the court for judicial inquisition. ļ¶ The medical evidence is given in the form of a certificate which should state ā€œthat insanity is of such a degree as to make him incapable of managing his property.ā€ ļ¶ On enquire if itā€™s found that the person is incapable of managing his property the court can appoint a guardian or manager depending on the circumstances. ļ¶ The court may order the sale or disposal of the personā€™s property, for the payment of his debts and expenses. ļ¶ The court may order a second inquisition, if itā€™s reported that unsoundness of mind had ceased.
  • 74. BUSINESS CONTRACT ļ¶ If it is proved that at the time of signing a contract one of the two parties was insane, then the contract becomes legally invalid. ļ¶ Insanity developing subsequently to a legal agreement will not necessarily invalidate the contract. ļ¶ If at the time of signing, the fact that one of the signatories to the contract was insane was not known to the other party, the contract may not be declared invalid.
  • 75. MARRIAGE A marriage is considered invalid if at the time of marriage, either party is ļ¶ Incapable of giving valid consent due to insanity. ļ¶ Though capable of giving valid consent, has been suffering from such kind or degree of mental disorder as to be unfit for marriage or procreation. ļ¶ Has been suffering from recurrent attacks of insanity.
  • 76. THE COMPETENCE OF INSANE TO BE A WITNESS ļ¶ An insane person is not competent to give evidence, if he cannot understand the necessity of telling the truth due to insanity. ļ¶ A person of unsound mind who suffers from delusions, but is capable of telling what he has seen and who understands the importance of an oath, is competent to give evidence ļ¶ An insane person is competent to give evidence during the lucid interval.
  • 77. TESTAMENTARY CAPACITY ļ¶ Testamentary capacity refers to the capacity of a person to make a valid will. The law defines it as possession of a sound disposing mind (corpus mentis) which must be certified by a doctor. ļ¶ A will is a document detailing the disposition of property owned by a person, which is prepared by him during his lifetime but takes effect only after his demise. ļ¶ The person who makes the will is referred to as the testator. ļ¶ Will written by the testator in his own handwriting is called ā€œHolograph willā€. ļ¶ It can be revoked or changed any number of times
  • 78. CRIMINAL RESPONSIBILITY OF THE INSANE MCNAUGHTON'S RULE That to establish a defense on the ground of insanity, it must be clearly proved that ā€œat the time of committing the act, the accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or, if he did know it, that he did not know he was doing what was wrong.ā€
  • 79. In India, Section 84 of the I.P.C. defines the legal test or criminal responsibility of the insane, as: ā€œNothing is an offence which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act, or that he is doing what is either wrong or contrary to law.ā€ Section 85 of the I.P.C. defines legal responsibility of a person under intoxication. If it is proved that a person was given intoxication without his knowledge or against his will, and due to intoxication he lost mental reasoning and then committed the crime, he will not be held responsible for it. Drunkenness caused by voluntary use of alcohol or drugs offers no excuse for committing the crime.
  • 80. DURHAM RULE (1954) The Durham rule states that an accused is not criminally responsible if his unlawful act was the product of mental disease or mental defect. The Durham rule was eventually rejected by the federal courts, because it cast too broad a net. Alcoholics, compulsive gamblers, and drug addicts had successfully used the defense to defeat a wide variety of crimes. The federal insanity defense, established by the Comprehensive Crime Control Act, now requires the defendant to prove, by "clear and convincing evidence," that "at the time of the commission of the acts constituting the offense, the defendant, as a result of a severe mental disease or defect, was unable to appreciate the nature and quality or the wrongfulness of his acts".
  • 81. CURRENā€™S RULE (1961) ļ¶ An accused person will not be held criminally responsible, if at the time of committing act, he did not have the capacity to regulate his conduct to the requirement of law, as a result of mental disease or defect. ļ¶ As per Currenā€™s rule, it was contested that, at the time of committing the criminal act, a person may have the knowledge that what he was doing was wrong but he neither had the capacity nor the will to control (adjust) his act. Therefore such person should not be held responsible.
  • 82. AMERICAN LAW INSTITUTE TEST. (1970 ā€¢ A person is not responsible for his criminal conduct if at the time of such conduct as a result of mental disease or defect, he lacks substantial capacity either to appreciate the wrongfulness of his conduct or to adjust his conduct to the requirement of law.