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Forensic Psychiatry 2

The document discusses various states of altered consciousness in forensic psychiatry, including stupor, oneiroid state, and fugue, highlighting their characteristics and medico-legal significance. It also covers disturbances of attention, perception, and thinking, detailing conditions such as hallucinations and delusions, which are indicative of significant psychiatric disorders. The implications of these conditions in legal contexts, particularly regarding violent behavior and criminal acts, are emphasized.

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Dree Dersh
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17 views25 pages

Forensic Psychiatry 2

The document discusses various states of altered consciousness in forensic psychiatry, including stupor, oneiroid state, and fugue, highlighting their characteristics and medico-legal significance. It also covers disturbances of attention, perception, and thinking, detailing conditions such as hallucinations and delusions, which are indicative of significant psychiatric disorders. The implications of these conditions in legal contexts, particularly regarding violent behavior and criminal acts, are emphasized.

Uploaded by

Dree Dersh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORENSIC PSYCHIATRY

BY

DR.GHAAZAAN KHAN

(FORENSIC PSYCHIATRIST,NMC)
MBBS, FCPS(Psychiatry)
STUPOR
• Stupor refers to a condition

in which the patient is immobile, mute and unresponsive, but

appears to be fully conscious in that the eyes are usually open

and follow external objects Reflexes are normal and

resting posture is maintained.


ONEROID STATE
• Oneiroid state is dream-like state characterized by

narrowing of consciousness i.e. restricted awareness of a

person towards environment although the person is

not asleep; if prolonged, this may be called a twilight state.

• Torpor is a state in which the patient appears drowsy,

readily falls asleep, and shows evidence of slow

thinking and narrowed range of perception.


• Twilight state may occur in epilepsy, brain trauma,

dissociative disorders and alcoholism.

Medico legal significance:


• During twilight, the patient may become violent and so may

come in contact with the legal system.


• Coma is the most extreme form of impaired consciousness.

The patient shows no external evidence

of mental activity and little motor activity other than

breathing. He does not respond even to strong painful

stimuli.
FUGUE
• Fugue is a state of altered awareness during which an

individual forgets part or whole of his past life, leaves home

and wanders away. There is complete amnesia for the period of

wandering. To escape from a stressful situation, a new identity

is assumed.
DISTURBANCES OF ATTENTION AND CONCENTRATION

• Attention is the ability to focus on the matter in hand.

• Concentration is the ability to maintain that focus.

• Both may be impaired in a wide

variety of psychiatric disorders, including depressive

disorders, mania, anxiety disorders and schizophrenia .


SIGNS/SYMPTOMS RELATED TO DISTURBANCES OF PERCEPTION

• Perception is the process of becoming aware of what is


presented through the sense organs.

• There are 2 types of perceptual abnormalities namely:

• illusion
• Hallucination
HEARING
VOICES/
HALLUCINATION
illusion
Illusions are misperceptions of external stimuli. They occur:
• when the general level of sensory stimulation is reduced
Forexample, at dusk the outline of a bush may be perceived at
first as that of a man.

• when one is anxious

• During severe fatigue

• when the level of consciousness is reduced, as in delirium


HALLUCINATIONS

• A hallucination is a percept that is experienced in the absence

of an external stimulus to the corresponding sense organ.

• They can affect any sensory system and can be auditory, visual

tactile, gustatory and olfactory.

• Hallucinations are generally indications of significant


psychiatric disorder
• olfactory and gustatory hallucinations ( hallucinations

involving smell and taste respectively) occur in organic brain

disorders particularly complex Partial seizures, schizophrenia.

and in major depression as odors of decay and rotting.


Visual hallucinations are seen in various

neuropsychiatric disorders (e.g. brain tumors and complex

partial epilepsy), delirium and schizophrenia.

• In alcoholic delirium tremens, Lilliputian hallucinations of

small/ dwarf human beings are seen.


• Tactile/haptic hallucinations involve touch sensations

and may occur in patients of cocaine intoxication in which

one feels as if bugs are crawling over one’s skin( fornication).


• Auditory hallucinations (hearing voices) may be seen in

schizophrenia, psychotic mood disorders, delirium, and

various drug intoxications .


• Auditory hallucinations may be 2nd person( the voices

directly address the person as you are a failure) and 3rd

person ( the voices indirectly talk to one another about the

person as he is a sinner or she is washing hands etc.)

3rd person hallucinations strongly indicate schizophrenia.


• Medico legal Significance : Some schizophrenic patients

hears voices commanding them to do certain acts like jump

off the roof or kill your wife etc. Some patients act upon these

voices thereby indulging in crime.


SIGNS AND SYNPTOMS RELATED TO DISTURBANCES OF
THINKING
• Retarded thinking also called poverty of thoughts

occurs in depression in which thinking slows down;

the patient has a few thoughts, and these lack

variety and richness and seem to move

slowly through the mind.

•
• In pressure of speech, the amount and speed of thinking

become increased. It is seen in mania.


• In flight of ideas, thoughts and speech move quickly from one

topic to another so that one train of thought is not carried

to completion before another takes its place. It is seen in


mania.
Thought blocking is a sudden break in the train of thoughts

which is seen in patients of schizophrenia. He believes that

the ‘missing’ thoughts have been taken away by some outside

agency.
• Thought withdrawal is seen in schizophrenia in which the

patient feels that some external force/body had removed the

thoughts from his brain.


WHAT IS DELUSION?
• Delusion A delusion is a belief that is firmly held on

inadequate grounds, that is not affected by rational

argument/evidence and that is not a conventional belief that

the person might be expected to hold given their educational,

cultural, and religious background.

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