Chapter 28: Forensic Psychiatry

**Forensic psychiatry**

a subject dealing with the application of knowledge of psychiatry in the administration of justice

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The terminology of ______ or unsoundness of mind covers all disorders of the mind.

Mental Health Act

an Act to consolidate and amend the law relating to the treatment and care of mentally ill persons, to make better provisions with respect to their property and affairs, and for matters connected therewith or incidental thereto.

**Medical officer**

Refers to a Gazetted Medical Officer in government service appointed by the State Government to be a Medical Officer for purpose of this Act.

**Medical practitioner**

Refers to a person with recognized medical qualification under the provisions of the Act.

**Mentally ill person**

A person suffering from mental disorders other than mental retardation, needing treatment.

**Mentally ill prisoner**

A person ordered for detention in a psychiatric hospital, jail, or other safe custody.

**Psychiatric hospital**

 A hospital for mentally ill persons, maintained by the Government or private party with facilities for outpatient treatment and registered with appropriate Licensing authority.

**Psychiatrist**

Refers to a medical practitioner possessing a postgraduate degree or diploma in psychiatry recognized by IMC declared by the State Government for the purpose of this Act.

**Reception order**

Refers to an order for admission and detention of a mentally ill person in a psychiatric hospital or nursing home.

**Relative**

includes any person related to a mentally ill person by blood, marriage, or adoption.

**Chapter II of MHA**

Provides the procedures for the establishment of mental Health Authorities at the Centre and State.

**Chapter III of MHA**

Lays down the guidelines for the establishment and maintenance of psychiatric hospitals and nursing homes.

**Chapter IV of MHA**

Provides the procedures for the admission and detention of a mentally ill patient in a psychiatric hospital or nursing home.

**Chapter V** **of MHA**

Provides formalities for inspection, discharge, leave of absence, and removal of mentally ill persons

**Chapter VI of MHA**

Provides methods of judicial inquisition regarding alleged mentally ill persons possessing property, and how such property be managed.

**Chapter VII of MHA**

Provides procedures for the protection of the human rights of mentally ill persons.

**Chapter IX of MHA**

Provides the penalties for infringement of guidelines.

**Chapter X of MHA**

Deals with miscellaneous matters under the Mental Health Act.

**Affect**

the outward manifestation of a person’s feelings, emotions, tone or mood.

**Abreaction**

a process of bringing to conscious awareness, previously suppressed unconscious conflicts and emotions.

**Aphasia**

the loss of ability to express meaning by the use of speech or writing or to understand spoken or written languages.

**Cognition**

refers to higher mental functions, e.g. memory, intelligence, concentration, orientation, etc

**Confabulation**

purely imaginary events or fabrications that fill the gap of pathological loss of memory. In other words, it comprises of false memory that the patient believes to be true.

**Delirium**

defined as an acute confusional state.

**Delusion**

Defined as a false, but firm belief in something that is not a fact.

**Hypochondriacal delusion**

A person feels that something is wrong in his or her body, though he or she is healthy.

**Delusion of poverty**

A person thinks he or she is poor/pauper, though he or she is rich.

**Nihilistic delusion**

A person declares that he or she does not exist and the world also has no existence, etc.

**Delusion of grandeur**

The person imagines that he is rich/and famous, wherein he is actually poor/and inconsequential.

**Delusion of persecution**

A person thinks that his or her nearest and dearest relatives are trying to poison or kill him or her.

**Delusion of reference**

A person believes that people, things, or events happening around him or she is referred to him or her in a special or indirect way.

**Delusion of influence**

A person feels that he or she is controlled by an outside power, agency, radio, hypnotized telepathy, etc.

**Delusion of self-accusation**

A person keeps on blaming himself/ herself for trivial incidents that happened in the past.

**Erotomania**

Common among females, in which she is convinced that a particular individual, especially her superior officer or her employer, etc is in love with her.

**Pseudologia phantastica**

A variation of this is Munchausen’s syndrome, in which the person is convinced that he/she is seriously ill, and visits doctor-to-doctor, hospital-to-hospital in a vain attempt to diagnose the non-existing illness.

**Bizarre delusion**

an outrageous delusion, which can take various forms.

**Dèjá vu**

a sense of familiarity with unfamiliar surroundings.

**Disorientation**

an impairment of the understanding of temporal, spatial or personal relationships

**Fugue**

a state of disturbed consciousness with which a patient performs some acts.

**Hallucination**

defined as a false perception without sensory stimulus.

**Visual hallucinations**

Person imagines that a lion or a tiger, etc attack him or her when none of them exists in front of him or her.

**Auditory hallucinations**

A person hears voices or imagines that another person is speaking to him or her when no one is present.

**Olfactory hallucinations**

A person smells pleasant or unpleasant odors when nothing exists in reality.

**Gustatory hallucinations**

A person feels a good or bad taste in the mouth, though no food is actually served.

**Tactile hallucinations**

A person imagines that insects are crawling under his or her skin or bed when actually there are none.

**Illusion**

a false interpretation of an external object or stimulus, which has a real existence of its own, e.g. mistaking a stick for a snake.

**Insight**

awareness of one's own mental condition, characterized by significant basic changes in future behavior and personality.

**Intelligence quotient**

the intellectual capacity of an individual in relation to his or her chronological age. It is expressed as a percentage.

**Lucid interval**

as a period in the course of mental illness during which there is a complete cessation of symptoms of insanity and the person is considered perfectly normal mentally.

**Mood**

the pervasive emotion or feeling, which is sustained.

**Neurosis**

an emotional disorder in which the patient does not lose touch with reality.

**Obsession**

A person will have a symptom of a single idea, thought, or emotion entertained constantly and continuously, which persists in spite of recognizing it as irrational and all efforts being made to drive it from the mind.

**Panic**

an acute, intense, overwhelming episode of anxiety associated with feelings of impending doom.

**Phobia**

an excessive or irrational fear of an object, situation, or activity.

**Psychopath**

a personality disorder, wherein the person is neither mentally ill nor defective but does not conform to be normal due to failure to adopt normal ethical standards of behavior in society.

**Psychosis**

 mental disorder, which is severe and characterized by withdrawal from reality and living as if in another world, a world of fantasy with delusions and hallucinations.

**The Psychotic Killer**

Such a person is incapable of knowing the nature of his act or his judgment is faulty due to delusion and hallucinations.

**The Psychopathic Killer**

The killing may be unintentional due to loss of control.

**Stupor**

a state of akinesis and mutism, with complete suppression of speech, movement, and action with no disturbance of consciousness.

**Trance**

a state of altered consciousness often with the absence of voluntary movement or automation as in hypnotism/epilepsy.

**Twilight state**

a state of diminished awareness of acts of relatively short duration; the actions performed during the state leaves little or no subsequent memory.

**Undue influence**

physical or mental pressure of such degree that a person is deprived of his or her privilege to exercise his free will, e.g. a son refusing to give his father a painkiller to relieve the pain of surgical amputation unless he signs the will be bequeathing all his property to his name.

**Dementia**

a type of organic psychosis, wherein the mind, after reaching a certain stage of development, begins to deteriorate

**Organic Dementia**

Dementia due to localized or diffuse brain lesions.

**Senile Dementia**

Dementia due to old age and cerebral arteriosclerosis.

**Confusional State Psychoses**

The patient presents with a state of confusion and various causes leading to this disorder are excess of physical/mental fatigue, acute infectious diseases, epilepsy, childbirth and other stresses of life, and trauma (head injury).

**Pre-epileptic confusional state**

* It may commence a few days before onset of the fit development of convulsions.
* Mood irritability
* Clouding of consciousness
* Delusions and hallucinations under which, he/she may perform a crime.

**Masked/psychomotor epilepsy**

Here the patient does not show any convulsions. He or she undergoes a mental disturbance, which replaces the convulsion completely, and these mental disturbances may bring about certain outrageous acts such as the murder of a person who is usually a stranger.

**Post-epileptic automatism**

It commences after convulsions, for instance in petitmal epilepsy, the patient will have a lapse of consciousness, and performs acts without volition, which cannot be recollected after gaining consciousness.

**Schizophrenia**

a type of functional psychosis, is said to be a disorder of thought and disintegration of emotional stability.

**Schizophrenia simplex**

The patient will show all clinical findings described above, but the symptoms that help in diagnosing the type are by observing his/her reactions to happenings of great importance as if they are not concerned with him/her.

**Hebephrenic schizophrenia**

The patient is very much disorganized by hallucinations, illusions, and delusions, etc., that he or she may become impulsive and commit crimes.

**Paranoid schizophrenia**

In this type, the patient will retain much of the original personality but will suffer from distortion of thought with persecutory or grandiose delusions and hallucinations to such an extent that he/she will pose a distorted view of the world around.

**Catatonic schizophrenia**

In this type, patients will have mood disorders characterized by rigidity stupor, agitation, bizarre posturing, and repetitive imitation of movements or speech of other people. They are at risk of malnutrition, exhaustion, and self-injury.

**Othello Syndrome**

a dangerous state of morbid jealousy.

**Undifferentiated schizophrenia**

In this type, the patient will have characteristic positive and negative symptoms of schizoma but do not meet the specific criteria of other subtypes.

**Paranoid state**

a type of functional psychosis.

**Paranoia**

This type is common in males. This is a rare illness of the mind, wherein the patient develops gradual delusions of persecution of systematized nature, having a grave criminal association.

**Paraphrenia**

This is a rare type of mental illness, wherein the patient develops systematized delusions, ideas of reference, and vivid hallucinations of auditory type, commonly.

**Cognition assessment**

A test done by looking for consciousness, orientation, attention, concentration, abstract thinking, etc.

**Insight assessment**

A test that assess the degree of awareness and understanding of the patient regarding his illness.

**Feigned insanity**

a condition wherein a person is pretending to be insane.

**Restraint of the mentally ill**

defined as keeping a dangerous insane person under lawful restraint in a mental hospital.

**Voluntary or Direct Restraint**

Here the mentally unsound person submits a written application directly to the officer in-charge of the hospital for admission and treatment.

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**Petition**

It is an application to the magistrate in a prescribed form by a relative or a friend, who is taking care of the patient at least for a period of 14 days prior to date of petition writing.

**Reception after Judicial Inquisition**

It is one who is mentally ill and has committed a crime or become mentally ill after being imprisoned. For such a patient’s reception presiding officer of the court issues order.

Reception of Mentally Ill Criminal

It is one who is mentally ill and has committed a crime or become mentally ill after being imprisoned. For such a patient’s reception presiding officer of the court issues order.

Reception of the Escaped Mentally Ill

Such a patient can be readmitted to mental hospital by a police officer or any officer or servant of the hospital.

**Legal test**

Defined as the test for insanity, which precludes responsibility for the commission of a crime.

Please on somnambulism

It is a dissociated consciousness and crime committed during this is usually not willful or pre-planned.