FORENSIC PSYCHIATRY

CHAPTER: 6 FORENSIC PSYCHIATRY

1. Define forensic psychiatry

2. Define Insanity or Mental illness and classify mental disorders with
etiology
3. Differentiate True and false insanity
4. Define illusion, delusion, hallucination
5. Define Schizophrenia, Delirium, and dementia.
6. Define obsessive compulsive disorder(OCD)
7. Define Anxiety disorder or phobia
8. Define hysteria
9. Define Lucid interval
10.Define depression, mania
11.Describe civil responsibility of insane person
12.Define McNaughton’s rule
13.Describe criminal responsibility of insane person
14.Define Lunacy act /mental health act
15.Differentiate hysteria and epilepsy

Definition:-Psychiatry is a branch of medical science which deals with the study, diagnosis,
treatment & prevention of mental illness and behavioral disorders
Forensic psychiatry: Definition: - this subject deals with the application of knowledge of
psychiatry in the administration of law & justice
Mental illness is also called as insanity or lunacy or mental unsoundness or mental
derangement or mental disorder.
Insanity or unsoundness of mind:
Definition: - Insanity is defined as a disease of mind or personality in which there is
derangement of mental or emotional processes, which affects the mental status, critical
faculties, (Intellectual, memory& understanding) emotional process, personality and
interaction with the social environment.

Mental illness according to mental health care act 2017

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“a substantial disorder of thinking, mood, perception, orientation, or memory that grossly
impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary
demand of life, mental conditions associated with the abuse of alcohol and drugs, but does
not include mental retardation which is a condition of incompleted development of mind of a
person & characterized by sub normality of intelligence”
Mentally ill person: Any person who is in need of treatment by reason of any mental
disorder other than mental retardation.
A person with mental illness is incapable of looking after him or is dangerous to himself or to
community.

Classification of mental disorders

1. Psychosis
2. Neurosis
3. Psychosomatic disorder (somatoform disorders):
4. Mental deficiency

Etiology: - The factors which may be supposed responsible for insanity.

 Constitutional, physical defect, heredity.
 Physiological changes in body at puberty
 Excessive use of Alcohol
 Bad social & cultural environment.
 Marriage disappointment
 Pregnancy & child birth condition
 Psychological factors- loss of money, reputation, job.
 Occupational& work load.
 Failure in examination
 Frustrate life to Love.

Procedure of examination of a case of Insanity

To Perform a Medical Board, to examine a case of insanity.

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Following points are noted for diagnosis of a case of insanity (if connected with a medico
legal problem)
 Family history:- mental condition of parents, grandparents, history of insanity, nervous
disorder, syphilis or suicidal history
 Personal history:- Any changes in behavior, drug addiction, nervous disorder, syphilis
 Physical examination of patient :- with regard to general health like pulse, respiration
rate, temp, blood pressure, appetite, thirst, desire, aversion, tongue, skin, thermal reaction
 Mental condition of patient:- tested by asking simple question, reasoning & judgment of
patient, observed by doctor, find out any delusion, hallucination

 Test for true or false (feigned) insanity.

Difference between True & False Insanity

REAL INSANITY FEIGHNED OR FALSE

INSANITY
Motivation factor or Absent Present
predisposing factor
Exciting factor Present Absent
Onset Gradual Sudden
Facial expression Peculiar & vacant Frequently changing
Sign & symptoms Uniform & continues with Not uniform changing present
or without observation by a only during observation by a
medical man medical man
Insomnia Present Absent
Exertion Can effort exertion for Cannot effort exertion
many days without
exhaustion, fatigue & sleep
Habits Dirty & unhygienic Clean & hygienic
Skin & lips Dry & Rough Normal
On frequent examination Does not mind repeated Always mind & Avoid
examination Examination
If-called Insane Be Angry Be Happy

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 Psychosis
Definition:- It is a group of Major Mental disorder which is characterized by- disconnection
from reality or gross impairment of reality with loss of contact with surrounding, loss of
insight. There is impairment in personality, social, interpersonal, and occupational
functioning. (Withdrawal from reality as if living in own imaginary world)

Types:

There may be Organic & functional Psychosis.

1. Organic Psychosis- It is due to structural defects or physiologic dysfunction of the

brain or Impairment in Brain Tissue function. In this disorder, there is demonstrable
organic cause or lesion related to the brain. Like - Brain pathology or due to systemic
disease or Endocrinal disorder.
2. Functional Psychosis- It is a group of mental disorder in which there is no structural or
functional abnormality present.

Example includes
It consist-
 disorientation of Time, Place& person,
 absence of understanding
 contact with reality lost, Poverty of Attention,
 Inability to grasp
 Illusion

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  delusion
 hallucination
 delirium
 Dementia,
 Schizophrenia,
 Depression,
 Mania
 Involutional Psychosis

Illusion

Definition: it is the false or wrong interpretation by sense organ for any external object or
stimulus which is present or has a real existence.
In a sane person illusion can be correct by showing the mistake or by argument; reasoning
but insane person continues to believe in the illusion.
Illusions are a feature of psychoses, particularly of the organic type.
Eg.- A rope or stick may be interpreted to be a snake, shadow to be a ghost.

Delusion
Definition: It is a false belief in something which is not a fact & the false belief is persist
even after demonstration. It is seen in Schizophrenia
In which mentally ill person accept false belief as real.
It is a perversion of judgment. .
Types
 Grandeur Delusion- Sufferer think he is very rich man & very power ful man
 Persecution Delusion- sufferer think his wife, son or parents wants to kill him by
poisoning so do not take any thing by them, his wife is unfaithful to him.
 Hypochondrical Delusion- sufferer person think he is having serious disease( like
cancer)
 Reference Delusion- sufferer thinks that all people are talking about him, News, in
radio, T.V. always referring about him.
 All his actions are influenced by super natural power- Telepathy, Hypnotism.

Hallucination

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Definition:-It is false perception by the sense organs without existence of any external object
or stimulus which is not present. They are seen in insanity and in other conditions like- high
fever, drug intoxication and during drug withdrawal conditions from drug addiction.
Types
 Auditory- Hearing of voice of lion, singer when there is absolute silence.
 Visual-(sight) One may see a tiger without presence.
 Olfactory-(smell) He may perceive pleasant or unpleasant smell.
 Tactile- (Touch) He may feel insect , ants are creeping all over his skin this is seen in
chronic cocaine poisoning(cocaine bug)
 Gustatory- ( taste) feel good or bad taste in mouth
Hallucination may be seen in poisoning by cannabis Indica, Dhatura, Cocaine. It is not
definite sign of mental illness patient should be treated properly & kept under
observation.

Delirium

Definition: it is a type of Acute reversible mental disorder characterized by confusion and

impairment of consciousness, disorientation ,illusion, hallucination, irrational or violent
behavior.
Etiology: in high temperature, over work, mental stress, acute ppisoning (dhatura), chronic
alcoholic or drug intoxication.
A delirious person may become impulsive and violent and may commit suicide. Such person
is not responsible for his acts.

Schizophrenia
Definition: It is a type of psychotic disorder Characterized by- Psychological disturbance in
thinking, emotion & behavior. It occurs between 15 to 30 years of age.
Etiology-Heredity & genetic factors are important predisposing factors. In this condition the
person cannot bear any strain of life & mentally imbalance & he with draw himself from his
surrounding 7 there is splitting of personality or psychic quality.
Types-
 Simple Schizophrenia- In this condition person become socially un responsible with
thinking disturbance
 Hebephrenic Schizophrenia- disturbance with childish behavior
 Catatonia Schizophrenia- behavior & thinking disturbance
 Paranoid Schizophrenia- excessive suspicious.
Clinical Feature-
 Loss of interest in life
 Loss of memory
 Childish behavior
 Irritable & talkative.
 Delusion, hallucination
 Loss of self control
 Suspicious

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 Depression (Melancholia)
Definition: - It is a type of mental disorder Characterized by-sad ness of mood, poorty of
ideas, psycho motor retardation& feeling of guiltiness.
It is stage of mental depression where thinking power & motor impulses are inhibited.
Clinical Feature-
 Insomnia, anorexia, dyspepsia, irritability, gastric upset.
 Constant headache & fear of imaginary evil.
 Loss of interest in life.
 Loss of interest in all things.
 Delusion, hallucination, avoids talking & playing.
 Suicidal & homicidal impulses.
 Severe mental depression.
 Thought of violence.
 Fear of germs & contamination.
 80% suicidal cases related to (mood) maniac disorder.

Mania
(Manic, Mood disorder)
Definition: It is a type of mental disorder .It is just reverse to depression characterized by:-
 Elevation of mood.
 Flight of ideas
 Increased psychomotor activities
 Person feels euphoria ( he is on the top of the world)
It is a form of insanity where emotional & intellectual qualities are affected in which increase
physical & mental activities.
Clinical features:-
 Lack of concentration.
 Gastric upset, Loss of body weight
 Violence, impulsive, destructive & emotional in fully established case
 Pupil dilated
 Delusion & hallucination

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 Dementia
Definition: This is a form of insanity of acquired origin. Mental faculties degenerate after
complete development. Patient become irritable mentally & degraded morally. Behave like
an idiot or imbecile with sign of depression later mental faculties lost gradually-
 loss of memory
 loss of emotional control

Senile dementia- decay of brain above 60 years.

Amentia
Definition: - It is congenital mental sub normality it is the result of congenital defective
development of mental faculties. Two types-
Idiocy-He is incapable of express himself in language. It is called - idiocy
Imbecility- It is like idiocy but he can speak in articulated language & capable of doing some
mechanical act if taught well. Intellectually extremely poor. Mental age likes a child of 3- 7
years

Involutional psychosis
Definition: It is a type of Psychological disorder which occurs for the 1st time in the patients’
life at the period of involution (complicacy) between 45-55 years.

In female- at menopausal age.

In male- at the time of retirement.

Impulse
Definition: This is a Sudden & irresistible desire or force compelling a person to the
conscious performance of some action without any Motive or forethought.

Types:-
 Kleptomania, Irresistible desire to steal articles of small value.
E.g. - pen, book.
 Suicidal impulse: often intoxication may led to suicidal impulse
 Homicidal impulse: with certain chronic intoxication, e.g. cannabis. (Run amok) etc.
A sane person is capable of controlling an impulse but an insane person having no
judgment power may do thing on impulse

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 2. Neurosis

Definition:- it is a type of chronic apprehension mental illness in which patient suffers

from emotional or intellectual disorders which causes subjective distress,

But does not lose touch with reality and the symptoms does not interfere with his
capacity for judgment. There is usually presence of insight and presence of symptoms
causes distress to the patient. The Personality and contact with surrounding is preserved.

Example includes:-
It consist
 Anxiety disorders (anxiety neurosis)
 Phobic disorders
 Conversion disorder
 Hysteria
 Obsessive Compulsive disorder (OCD

 Anxiety disorder
Definition: It is a type of commonest disorder in psychiatry.
Anxiety is defined as feeling of apprehension caused by possibility (anticipation) of danger.
It becomes pathological when it causes significant distress and impairment in functioning of
the person.
Clinical features:- physical & psychological symptoms appears:-
 restlessness, tremors, muscle twitching,
 palpitations, sweating, dyspnea,
 Dryness of mouth, diarrhea and dizziness.
 blurring of vision, Palpitation, breathlessness
 Frequency of maturation.
 Apprehension, Fearfulness, Nervousness,
 irritability, insomnia,

 Phobic reaction (fear)

It is excessive unexplained & irrational morbid fear about living or non living object like
darkness, light, ghost, fear of closed space, fear of death.

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 Hysteria
Definition:-It is a type of neurotic disturbances which occurs usually in female in the adult
age due to emotional excitement & there is personal inadequacy.
Clinical features: - psychogenic in region
 Changes with different examines & different places
 Symptoms increased when sympathy is shown
 Attack does not occur when patient is alone
 There is absent of organic disease.

 Obsessive compulsive reaction

Definition:-
It is a type of neurotic
Disturbances. There is the persistent recurrence of unwelcome ideas, so patient does not
enjoy by those ideas but feels very guilty & wants to remove them but cannot do it
Eg- Ideas are around sex, religion, bacteria
Compulsion & irresistible urging to carrying out the meaningless & irrational activities if he
does not carry out the impulse he feels very discomfort & his tension relieved when he has
followed the ideas.

Epilepsy
Definition: Epilepsy is a neurological condition. A symptom of some disorder in the brain.
The name of this condition comes from Greek word – seizure.
Seizure itself is the sign of abnormal release of energy within brain due to Irregular supply of
electricity due to over activity of nerve cells produce seizures (sudden attack)
Nerve cell builds up a supply of electricity through the action of chemicals they contain. Each
cell has its own storage battery which it discharges at the proper moment & then recharges
instantaneously. Whenever cells becomes over active & fire off irregularly this disturbance
when spread it produce seizure.
3. Psychosomatic disorder (somatoform disorders)
Definition: - it is characterized by repeated physical symptoms (abdominal pain, nausea,
vomiting, numbness, and itching, tingling, dysmenorrhea.) which do not have adequate
physical basis and not explained by the presence of other psychiatric disorder

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4. Mental deficiency (mental retardation) it is characterized by: sub average general
intellectual functioning that originates in the developmental period and associated with
impaired maturation, learning and social maladjustment.
It is commonly defined in term of IQ. And Recognized by delayed milestone and absence of
speech. 1. mild-IQ 50-70. 2. Moderate: 35- 50, Severe: 20- 35 and Profoud IQ less than 20

Difference between Epilepsy & Hysteria

Epilepsy Hysteria

Definition Epilepsy is a neurological It is a type of neurotic

condition. A symptom of disturbances which occurs
some disorder in the brain usually in female in the adult
age
Etiology Due to irregular supply of due to emotional excitement
electricity due to over & there is personal
activity of cells. inadequacy
Periodicity Present Absent
Incontinence of urine & very common NO Incontinence
stool
Tongue bite Present Absent
Corneal reflex Not Present Present
In Sex Both sex male & female In female

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 Lucid interval
(Means- Temporary regaining of consciousness)
Definition: This is a period in the course of insanity during which all the sign & symptoms of
insanity disappear completely & the mentally ill person behavior is like a normal person.
In this period ill person temporary return to mental health & he is able to judge his acts
soundly & become responsible for all his acts performed during the period of lucid interval.
An insane person can make a valid will and can give evidence which is valid during the
period of Lucid-Interval.
Lucid interval occurs commonly in connection with Mania or Melancholia
If he commit a crime during lucid interval then he cannot be held fully responsible for the act.
He may take the plea of previous insanity, because it is difficult to know whether he was
suffering from some mental illness at the time of committing the crime.

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 Civil responsibility of (insane) mentally ill person
Civil responsibility of mentally ill person considered in relation to following conditions:-

1. Management of property:- Mental health act 1987 provides for protection of mentally ill
person & his property court may appoint a guardian & manager to take care of person &
manage the property of ill person.

2. Contract:- under section 12 of Indian contract act a contract is invalid if one of the parties
at the time of making it mentally ill & incapable of understanding it.
(Mentally ill person is liable for contract during lucid interval)
3. Marriage:-
Marriage is regarded as a contract by Divorce act 1869 it can be declared invalid if at the time
of ceremony any parties was in capable of understanding the nature of the contract& the
duties & responsibilities.
4. Competency as a witness:-under section- 118 of IEAct mentally ill person is not
competent (power authority) to give evidence (proof)
(but during lucid interval he is competent to give evidence.)
5. Validity of consent - under section 90 of IPC Consent by a person is not valid if the
person is under intoxication & unsoundness of mind& unable to understand the nature and
consequence of that to which he gives consent.
6.Testamentary capacity: - The capacity of a person to make a valid will.
A will(be queath) is the last deed (signed agreement bout owner ship or rights) of gift
executed (carry out) by a person giving his/ her property to another.
A will or Testament (declaration) will become valid when it fulfills the following condition-
 A Testator (declarant) must be adult
 Conscious & soundness of mind at the time of making will
 He is able to understand the nature & consequences (result) of his act
 He must fully aware of his properties & belongings
 He should be able to sign the will in presence of at least two person &one must be a
medical man, they must attest & sign the documents
 The will should not be written under influence of any person.
 An insane person can make a valid will during lucid interval

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Criminal responsibility of insane person (McNaughton’s rule)
According to law every Adult person is sane & responsible for any criminal act done by him
& accountable for his action.
Section -84 IPC- deals with criminal responsibility of the mentally ill person in India.
The law assumes (take as true before there is proof) that a person who is proved to be
mentally ill is not responsible for his action.
It follows- Nothing is an offence which is done by a person who is unsoundness of mind at
the time of doing it or he did not know the nature & quality of the act he was doing.
An insane person is ordered to be kept under care in psychiatry hospital, jail or other suitable
place of safe custody.
The present legal test on the defense plea of insanity is based on McNaught’s rule.
McNaughton’s was an accused in a criminal case. Evidence of insanity & a verdict of “Non
guilty be reason of insanity” was given by him.

According to McNaughton’s rule- An accused person is not legally responsible if is clearly

proved that at the time of committing crime he was suffering from severe mental illness or
unsoundness of mind & unknown about the nature of crime.

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