Forensic psychiatryد

Forensic psychiatryد.وليد العميدي

Forensic psychiatry:
It is a specialty of psychiatry , it encompasses the interface between law and psychiatry .
A forensic psychiatrist provide services (such as determination of competency to stand trial) to a court of law to facilitate the adjudicative process.
Crime :
it an act committed or omitted in violation of a law forbidding or commanding it and for which punishment is imposed upon conviction.
Causes of crime:
? Genetic and physiological factors:
-Twin studies suggested that concordance rates were substantially greater in monozygotic twin than in dizygotic twin.
-The way in which genetic factors might mediate the increased risk of criminal offending could involve the hyperactivity and low IQ which are risk factors in children for subsequent adult offending.
-Low brain 5-HT function has been associated with impulsive aggression which can be either self or other directed.
? Psychosocial factors:
-Individual factors:
1. Hyperactivity and impulsivity.
2. Low intelligence.
3. Child rearing : poor supervision and harsh discipline.
4. Parental conflict.
5. Criminal parents.
6. Large family size.

-Social factors:
1. Socio-economic deprivation.
2. Peer influences.
3. School influences.
4. Community influences.


Patterns of offending:
? Peak age of offending is: 14 in girls; there is another peak around the menopause
17-18 in boys
? 50% of all indictable crimes are committed by people under the age of 21
? The sex ratio of convicted men to women is approximately 5:1


Psychiatric issues in the assessment of offenders
Fitness to be interviewed
• factors to be considered include:
1. Does the detainee understand the police caution after it has been explained to
him or her?
2. Are they able to understand the consequences of their answers

Mental state at the time of the offence
Before anyone can be convicted of a crime, the prosecution must prove the
following:
1. He carried out an unlawful act (actus reus)
2. He had at the time the state of mind necessary to commit a crime (mens rea)

? the categories of mens rea (loosely translated as meaning a ‘guilty mind’) are:
1.Intent -the person perceives and intends that his act of omission will produce unlawful consequences.
2. Recklessness -‘is the deliberate taking of an unjustifiable risk’
3. Negligence -‘a man acts negligently when he brings about a consequence which a reasonable and prudent man would have foreseen and avoided’
4. Blameless inadvertence -a man may reasonably fail to foresee the consequence of his act.

Criminal responsibility
? in England and Wales, it starts at the age of 10 - children under 10 are excluded because they are deemed incapable of criminal intent
? in Scotland, it begins at the age of 8 .

Fitness to plead: In determining fitness to plead, it is necessary to determine how far the defendant can:
1. Understand the nature of the charge
2. Understand the difference between pleading guilty and not guilty
3. Instruct counsel
4. Challenge jurors
5. Examine a witness
6. Follow the proceedings in court

Psychiatric defenses
A defence can be made that the person is not culpable because he did not have a sufficient degree of mens rea due to:
1. Not guilty by reason of insanity
2. Diminished responsibility (not guilty of murder, but guilty of manslaughter,which requires a lesser degree of criminal intent.
3. Incapacity to form an intent because of an automatism
4. If a mother kills her child in the first year of life, she is not usually held legally responsible for murder, but for the lesser charge of infanticide.
Not guilty by reason of insanity
• embodied in the McNaghten rules (in 1842 Daniel McNaghten, from Glasgow, shot and killed Edward Drummond, private secretary to the PrimeMinister, Sir Robert Peel)
• To establish a defence on the ground of insanity, it must be clearly proved that, at the time of committing the act, the party accused was labouring 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 what he was doing was wrong
Diminished responsibility
? Not sufficient sever to meet the strict criterion of the Mcnaughten rules , But sufficient substantially to diminish responsibilty.
• It is only available in relation to the charge of murder (in english low) , and defined as : where a person kills or is party to a killing of another person , he shall not be convicted of murder if he was suffering from such abnormality of mind as substantially impaired his mental responsibility for his act and omissions in doing or being party to the killing.
• So , it reduces murder to manslaughter.


Infanticide
? Infanticide: It is the killing of a baby aged under 12 months by its mother, the balance of whose mind is disturbed at the time by the effects of childbirth.
? In recent years there have been fewer than five infanticides per year.
? Infants were most at risk on the first day of life , then the risk decreased steadily thereafter until by the final quarter of the first year the risk of homicide was the same as that of the general population.
? Some result from a psychiatric disorder such as depression, and rarely a psychotic illness, while others seem to follow a loss of temper by the mother in relation to an aspect of the baby s behaviour.

Automatism
If a person has no control over an act, he cannot be held responsible for it – the concept is similar to being ‘briefly insane’. It is a legal term, and has no connection with epileptic automatisms
legal classification includes:
Sane automatism:
? Leads to a full acquittal
? Seen to be due to an ‘external cause’ ,includes: hypoglycemia , night terrors and dissociative states.
Insane automatism:
Automatism thought to arise from a ‘disease of the mind’ – the appropriate defense is then insanity and the McNaghten rules apply are due to an ‘internal cause’ because the conditions may reoccur includes:
? Epileptic automatism
? Hyperglycaemia
? Sleep-walking
? Arteriosclerosis.









Crime & Mental Illness
? Schizophrenia: risk of being arrested for violent offence was greater in those who had been hospitalized for schizophrenia
? Organic psychosis: risk of being arrested for violent offence was greater in those who had been hospitalized for organic psychosis
? Affective psychosis: patients show increased risk of offending (may be under effect of alcohol or substance)
? Alcohol and substance misuse: also increase risk of violent offending .
? Antisocial PD: increase risk of violent offending
? Antisocial PD and substance misuse have greater association with offending than the psychotic illness.

Risk factors for violence in the mentally ill:
1. Substance use (most important factor).
2. Previous violence .
3. Male gender .
4. Young age .
5. Low socio-economic status.
6. Acute psychotic symptoms(command hallucination and delusion).


Clinical risk factors for violence in schizophrenia:
1. Fear and loss of self control with non systematized delusions
2. Systematized paranoid delusions (enemies must be defended against)
3. Irresistible urges
4. Command hallucinations (instructions)
5. Dual diagnosis particularly substance misuse
6. Strong negative affect (depression, anger, agitation

Alcohol and crime:
1. Alcohol intoxication may lead to charges related to public drunkenness or to driving offences.
2. Intoxication reduces inhibitions and strongly associated with crimes of violence , including murder.
3. The neuropsychiatric complications of alcohol like alcohol amnesia or blackouts.