Psychiatry

It deals with the study, diagnosis, and treatment of mental illness.

Forensic psychiatry

It deals with the application of psychiatry in the administration of justice.

Forensic psychiatry is involved to determine responsibility for crimes, sexual psychopathy (rape), and other sexual problems, such as homosexuality, transvestism, pedophilia, fetishism, competence in contract actions, competence to testify, ability to give informed consent to treatment, competency to stand trial, testamentary capacity, malingering, etc.

PERSONALITY:

Personality is considered as an integrated organization of attitudes, perceptions, emotions, behaviors and habits that characterize a person's distinctive way of relating to others and to himself.

 

Insanity: (Mental illness/unsoundness of mind)

Insanity can be defined as “a disease of mind or personality in which there is derangement of mental or emotional process and impairment of the behavior control.”

 

Classification of insanity:

Medical Classification

1. Mental defect (Amentia)

2. Dementia

3. Functional insanities (Psychosis)

4. Insanity or Psychosis associated with organic diseases

5. Insanity due to alcohol or other drugs

 

Medicolegal Classification

True insanity and False (feigned) insanity

 

The World Health Organization has recommended in the International Classification ofDiseases (1992) the following.

A) Organic mental disorders Dementia in Alzheimer's disease, vascular dementia and dementia in other diseases, Organic amnesic syndrome, Delirium not induced by alcohol and other mental, personality and behavioral disorders due to brain disease, damage or dysfunction.

B) Mental and behavioral disorders due to psychoactive substance use

C) Schizophrenia

D) Mood disorders

E) Neurotic stress-related and somatoform disorders.  1) Anxiety disorders.  2) Obsessive-compulsive disorder.  3) Reaction to stress and adjustment disorders.  4) Dissociative (conversion) disorder.  5) Somatoform disorders.

F) Behavioral syndromes associated with physiological disturbances and physical factors.  1) Eating disorders.  2) Non-organic sleep disorders.  3) Sexual dysfunction not caused by organic disorder or disease.  4) Mental and behavioral disorders associated with puerperium.  5) Abuse of non-dependence producing substances.

(G) Personality disorders.  1) Specific personality disorders.  2) Habit and impulse disorders.  3) Gender identity disorders.  4) Disorders of sexual perversion.

H) Mental retardation.

I) Disorders of psychological development.

 

Causes of insanity:

 

Intrinsic factors  A. Genetic: 1. Specific gene 2. Chromosomal anomalies 3. Biochemical anomalies   B. Constitutional: 1. Physical/physique of subject 2. Personality  3. Temperament 4. Autonomic reaction

Extrinsic factors  A. Physical: 1. Intoxication 2. Injury 3. Infection 4. Malnutrition 5. Others   B. Psycho-social: 1. Early upbringing  2. Adversities 3. Mental confusion 4. Personal/familial loss 5. Psycho-social stress 6. Cultural background of the society

 

Differences between true insanity and false insanity:

 

Traits	True insanity	False insanity
Onset	Gradual	Sudden
Motive	Absent e.g., no H/O crime	Present e.g., commission of crime
Predisposing factor	Present	Absent
Sign/symptoms	Uniform and present whether the patient is being observed or not	Present when conscious of being observed
Activity	Careless	Carefully does something to indicate insanity
Insomnia	Present	Absent (With effort may pass 1-2 sleepless nights only
Mood	Excited, depressed or fluctuating	May overact to show abnormality in mood
Physical Exhaustion	Minimum, even with continuous over activity	Get exhausted like a normal people
Habit	Dirty and filthy	Not so
Facial expression	Peculiar	No peculiarity
Skin and lips	Dry and harsh	Normal
Keeping under observation	Does not mind	Does not like
Frequent examination	Does not mind	Presents for fear of detection

 

Delirium

It is a disturbance of consciousness in which orientation is impaired, the critical faculty is blunted or lost and though content is irrelevant or inconsistent.

Causes:

1. Disease I.e. high fever

2. Psychological factors

3. Overwork

4. Drug intoxication

5. Mental stress

6. In acute poisoning cases, as in datura poisoning

 

Signs & symptoms

Restless, uneasy, and sleepless and may become violent, impulsive.

Completely loses self-control, becomes excited, and talks furiously.

Suffers from insomnia, hallucinations & disoriented

Fails to recognize known things & knowns persons.

 

Medicolegal Importance of Delirium

In delirium, a person may commit some unlawful, destructive act for which he is not legally responsible because delirium is considered as a state of definite mental abnormality.

 

Delusion

It is a false believes in something which is not a fact and which persists even after its falsity has been clearly demonstrated.

 

Types of Delusion: 

1. Grandeur/exaltation:
A man Imagines himself to be very rich while in reality he is a pauper.

2. Persecution (Paranoid):
The person imagines that attempts are being made to poison him by his nearest relatives like wife, sons or parents.

3. Reference:
The person believes that people, things, events, etc., refer to him in a special way. He believes hat even strangers in the street are looking at him d are talking about him

4. Influence:
The person complains that his thoughts, feelings and actions are being influenced and controlled by some outside agency like radio, hypnotism, telepathy, etc.

5. Infidelity:
A man imagines his wife to be unfaithful while in fact she is chaste.

6. Self-approach:
The person lames himself for the past failures and misdeeds which are often of no importance.

7. Nihilistic:
The person declares that he does not exist or that ere is no world, etc.

8. Hypochondriacal:
The person believes that there is something wrong with his body, though he is healthy.

9. Other types are of jealousy, of religion, etc.

 

Medicolegal Importance:

Delusion is never an isolated disorder but is merely an indication of a deep-seated, widespread disorder. For this reason, such a person cannot be regarded as fully responsible for his satisocial acts.

Suicide is a major risk.

There may be a combination of murder and suicide.

 

Illusion

It is a false interpretation by the sense of external object or stimulus which has a real existence, e.g., when a person sees a dog and mistakes it for lion, or hears the notes of birds and imagines them to be human voices

 

Medicolegal Importance of illusion:

A criminal act committed by a sane person, due to illusion will make him responsible for his act and he will be liable to be punished.

If an insane person, out of illusion, commits the act then he may not be held partially responsible or may be held partially responsible for the act.

 

Lucid interval

Lucid interval: This is a period occurring in insanity, during which all the symptoms of insanity disappear completely.

It varies from person to person and from time to time in the same person and as much one can't be certain about the time when a person passes again in the state insanity. Therefore if he commits an offense, he cannot be completely held responsible, because it is very difficult to know, whether he was suffering from some mental abnormality at the time of committing the offense.

 

Medicolegal importance of Lucid Interval

The individual is able to judge his acts soundly, and he becomes legally liable for his acts.

The person can give valid evidence in a court of law.

Dying declaration or dying deposition given in this period is valid

The person can give valid will.

 

Hallucination

It is a false sense of perception without any external object or stimulus produces it.

For example, a person imagines of being attacked by a lion when no lion exists.

Types of Hallucination:

1. Visual

2. Auditory

3. Command (most dangerous)

4. Olfactory 

5. Gustatory

6. Tactile

7. Psychomotor

8. Microptic/macrotopic

9. Sexual 

 

Visual hallucinations are the commonest in organic mental disorders, while the auditory hallucinations are the commonest in functional disorders.

 

Command hallucination

The patient is ordered with the listening voice to do any things or acts which may be frightening and dangerous.

 

OBSESSION:

In this, a single idea thought, or emotion is constantly entertained by a person which he recognizes as irrational, but persists in spite of all efforts to drive it from his mind. It is a disorder of content of thought. Any attempt to resist makes them appear more insistent, and yielding is the almost inevitable outcome. It is a borderline between sanity and insanity.

These ideas are usually associated with some sort of dread or fear. The person experiences anxiety and to control anxiety, he indulges in repetitive acts, i.e. compulsive acts. A wife may continuously believe her husband to be unfaithful in spite of proof to the contrary. A person may go to bed at night after securely bolting the door of his room, but he soon gets up to see he has done so.

 

PHOBIA:

It is an excessive or irrational fear of a particular object or situation. Phobias may develop to almost any object or situation.

Types of Phobia:

Acrophobia is morbid fear of high places.

Agoraphobia is fear of being in a large open space. Nyctophobia is morbid fear of darkness.

Claustrophobia is fear of staying in a closed or confined space. Mysophobia is morbid fear of filth or contamination. Xenophobia is fear of strangers.

 

PSYCHOSIS:

It is a condition characterized by a withdrawal from reality; a living in a world of fantasy.

There is deterioration in the personality and progressive loss of contact with reality. Such persons incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality), even in the face of contrary evidence. Delusion and hallucinations are common.

Certain drugs such as alcohol, heroin, morphine, cannabis, cocaine, and LSD used habitually may produce psychosis. Psychosis may occur in epilepsy, cerebral tumor, cerebral trauma, pregnancy/childbirth.

 

Dementia:

DEMENTIA is a condition in which there is degeneration of mental faculties after they have been fully developed. Memory, intellect and judgement are impaired.

Types of Dementia:

1. Presenile dementia

2. Senile Dementia

3. Epileptic Dementia

4. Arteriosclerotic Dementia

5. Dementia following head injury

6. Dementia resulting from organic diseases

 

NEUROSIS:

The patient suffers from emotional or intellectual disorders, but he does not lose touch with reality. They occur mostly in the form of anxiety, depression or hysteria.

 

Empathy

The degree to which the observer is able to enter into the thoughts and feelings of patient and establish good contact.

 

Mc Naughten rule

An accused person is not legally responsible if it is clearly proved that the time of committing the crime, he was suffering from such defects of the region from abnormality of mind that he did not know the nature and quality of the act he is doing or that what he was doing was wrong.

 

Automatism

Automatism is conduct that is performed by a person whose consciousness is impaired to such an extent, that he is not fully aware of his actions.

 

SCHIZOPHRENIA:

It is a condition of split personality. in which the patient loses his contact with his environment. It is primarily a disorder of thinking (cognition).

Disorders of behavior, Disorders of thought, Disorders of affect, Delusions, Hallucinations, Personality deterioration

 

Types of schizophrenia:

SIMPLE SCHIZOPHRENIA

HEBEPHRENIA

CATATONIA

PARANOID SCHIZOPHRENIA

SCHIZO-AFFECTIVE PSYCHOSIS

PSEUDO-NEUROTIC SCHIZOPHRENIA

 

Testamentary Capacity (Testament - will)

It s the mental capacity of a person to make a valid will