insanity - presentation, forensic medicine

PSYCHIATRY;
Deals with etiology,
diagnosis and treatment of mental disorders.
FORENSIC PSYCHIATRY;
Application of psychiatry in providing
justice.
It encompasses the interface between
law and psychiatry .
Forensic psychiatrist provides services -
such as determination of competency
to stand trial - to a court of law to
facilitate the adjudicative process.

MENTALLY ILL PERSON:
person who is in need of treatment
due to any mental disorder.
INSANE :
This term is applicable to those people of
community who are unable to take care of
themselves or manage affairs and may cause
danger to others, on account of any mental
illness.
LEGAL INSANITY:
Certifiable mental illness due to any
serious mental disorder sufficient to
warrant legal restraint of the sufferer as
provided under mental health act.

CAUSES OF MENTAL
ILLNESS;
•Hereditary
• Environmental factor
•Psychogenic cause
•Organic cause
Or maybe unknown

CLASSIFICATION OF MENTAL DISORDERS:
1) ORGANIC MENTAL DISORDER:
There is demonstrable organic cause or lesion related to brain
1)primary (brain pathology)
2)Secondary (brain dysfunction due to systemic disease)
ORGANIC MENTAL DISORDER (Sub-classification):
• Delirium
• Dementia
•Organic amnestic syndrome
•Other organic mental disorder

TYPES;
• DELIRIUM;
It is an acute confusional state. May occur after any surgery ,high grade fever as a result of drug or
alcohol ,can also be cause by head injury metabolic upset or mental stress.
It is characterized by clouding of consciousness, disorientation ,incoordination and abnormal experiences
such as hallucination , delusions and illusions.
DEMENTIA;
Forgetfulness or stage of brain after which it starts degenerating.
Particularly ; decline in inetellectual function of memory , comprehension and reasoning ability.
Example; parkinso disease and alzeihmerS.
AMENTIA;
Mental developmental disorder.

2) DISORDERS DUE TO
PSYCHOACTIVE
SUBSTANCES USED
•Acute intoxication
• Withdrawal state
•Dependence syndrome
•Harmful use
*Alcohol; Korsakoff psychosis
characterized by loss of memory ,
ataxia , dissociation , confusion.
{Delirium tremens ; toxic confessional
state.}
*Morphine ; loss of intellectual
function and self respect.
*Cocaine ; delusion of
persecution ,hallucination,visual and
tactile) and mental deterioration.
*Cannabis indica ; hashish insanity-
hallucination , delusion of persecution ,
sexual crimes of homicidal nature.

3) MOOD (AFFECTIVE) DISORDER
• •Mania
• •Depression
• •Bipolar mood disorder
• •Persistent mood disorder
• • Recurrent depressive disorder
• •Other mood disorders
Mania; the patient is excited, restless, talkative, violent and dangerous. The most severe and extreme degree of mania
is known as delirious mania. In this condition, there is clouding of consciousness with disorientation and impulsiveness.
Auditory and visual hallucinations are usually present and are often associated with the delusions of grandeur followed
by delusions of persecution, and the patient may commit suicide or homicide under the influence of the latter.
Depression; Refusal of food, lack of personal attention and suicidal tendencies may be present. Hallucinations and
delusions are very common and the patient constantly feels the presence of imaginary evil or danger.
Bipolar personality disorder; This form of insanity includes both mania and depression (melancholia). These are
different manifestations of the same disorder. At different times throughout life, the patient gets attacks of either form
of insanity. More commonly, however, an attack of maniacal excitement alternates with an attack of depression with a
lucid interval between the two. This is known as CIRCULAR INSANITY.

4)CONFUSIONAL STATE;
Acute infections any trauma or illness may cause confusional insanity and may end in serious condition like
suicide or depression.
It is characterized by; restlessness, insomnia,confusion and mistaken ideas.
5)PERSONALITY DISORDER;
This term describes the whole person including attitudes moods, characteristic behaviour,etc .
Four main types of personality are recognised.
,-Obsessional (very demanding)
-Hysterical (very showy)
-Schizoid (withdrawn)
-Paranoid (suspicious)

5)HALLUCINATION;
• This means a false perception without a sensory stimulus, or means seeing, hearing, smelling,
tasting or touching something that is not actually present
A)VISUAL HALLUCINATION;
Usually occur in states of altered consciousness and epilepsy. They may consist of flashes of light,
frightening faces, wild animals, or scenes, which are well defined, detailed, and frequently terrifying .
B)AUDITORY HALLUCINATIONS;
Occur most frequently in schizophrenia and severe depressive disorders.
C)OLFACTORY & GUSTATORY HALLUCINATIONS[OF TASTE AND SMELL];
May occur in Schizophrenia & temporal lobe epilepsy . The patient states that his room has an
unpleasant smell and his food has a specific taste . Such hallucinations often act as a basis for
persecutory delusions.
D)TACTILE HALLUCINATIONS;
May be found in states of altered consciousness (i.e. organic psychosis) and schizophrenia. They
occur very characteristically in cocaine psychosis . As a result of hallucinations, the patient ma
commit some violence act.

6) OTHERS:
A) OBSESSION:
This is a thought,image,feeling,impulse,or movement which an
individual feels compelled to carry out,usually repetitively,inspite
of strong urge to resist.
B) SOMNAMBULISM;
• Walking during sleep• They commit crime but has no
recollection of the events
C)SOMNOLENCIA;
• Sleep drunkness just after epileptic attack • Midway between
sleep and walking
D)IMPULSE: Sudden forcefull feeling to do something.
E)CALLATOMANIA: steal small things.
F)PYROMANIA:Impulse to burn.
G)DIPSOMANIA:Impulse to drink.
H)MULTOMANIA:To keep pet.

6)DELUSION;
False but firm believe in something which is
not a fact.

9)SCHIZOPHRENIA;
represents a group of
disorders characterised by
disintegration of emotional
stability of the patient and his
withdrawal from reality.As the
disease progresses, there is an
increasing emotional
indifference to duties, former
pleasures, and dearest friends.

HOW TO CONFIRM?
DAIGNOSIS;
•History : Interview of
patient/relatives
•Personal history
•Antenatal
/prenatal/postnatal history
•Past psychiatric and
treatment history
•Family history
•Social history
EXAMINATIOM;
• Symptoms
• Mental status
• General appearance and
behavior
• Speech
• Thoughts
•Mood and emotion
• Perception
• Cognition
• Judgment
INVESTIGATIONS;
Drug level examination
Ct scan ,mri.

RIGHTS OF A MENTALLY ILL PERSON:
• •Right to treatment
• •Right to refuse treatment
• •Visitation right
• •Communication right
• •Right to privacy
• •Economic rights

RESPONSIBILITIES;
• LUCID INTERVAL; This is the period in the course of mental disease in which person
has a sound mind and can judge his acts, there is complete cessation of
symptoms of insanity , can make a evidence or will.
CIVILRESPOSABILITIES:
• • Management of property and custody of his person
• • Consent
• • Business contracts
• • Evidence
• • Guardianship
• • Testamentary capacity----possession of sound mind [compos mentis]
• • Marriage
• • Transfer of property
• • Adoptation

CRIMINAL RESPONSIBILITY;
• The law assumes that a person who is proved to be insane is not
responsible for his actions, as he is devoid of free will, intelligence
and knowledge of the act.
• THE LEGAL TEST :
The test for insanity which precludes responsibility for the commission
of crime has the following requirements.
1.There should be some evidence of mental disease or defect.
2.This mental disease or defect must exist at the time of the
commission of the crime.
3.It should be of such a degree that the person is unable to
understand that the act is wrong and/or contrary to law.

M'NAGHTEN RULE;
•Excuses a defendant
who, by virtue of a defect
of reason or disease of
the mind, does not know
the nature and quality of
the act, or, if he does,
does not know that the
act is wrong.
*FACTORS AFFECTING
• Emotional factor
• Ability of individual to
control the impulse• Loss

DURHAM RULE;
• states "that an
accused is not
criminally
responsible if his
unlawful act was
the product of
mental disease or
defect

• CURRENTLY MENTAL HEALTH ACT,2001 IS BEING FOLLOWED IN
RELATION TO MENTAL HEALTH.

BCQS:
1) Chief complication of chronic alcoholism is?
A)PEPTIC ULCER
‘B)DELIRIUM TREMENS
C)CIRRHOSIS
D)WERNICKE ENCEPHALOPATHY
2)Which of following help differentiate true insanity from feigned?
‘A)ONSET GRADUAL
B)ONSET SUDDEN
C)OBJECTS REPEATED EXAMINATION
D)TIRED AFTER VIOLENT EXERTION

BCQS
• 3)Pyromania is irresistible desire to?
• ‘A)SET THINGS ON FIRE
• B)STEAL THINGS OF LOW VALUE
• C)DRINK WATER AT PERIODIC INTERVAL
• D)WASH HAND REPEATEDLY
IMPULSE: Sudden forcefull feeling to do something.
CALLATOMANIA: steal small things.
PYROMANIA:Impulse to burn.
DIPSOMANIA:Impulse to drink.
MULTOMANIA:To keep pet.

BCQS
• 4)Feature which is not seen in a case of delirium tremens?
‘A)SLEEPINESS
B)INSANITY
C)SUICIDAL TEDENCY
D)HOMOCIDAL TEDENCY
5) Present law in relation to mental health:
A)Lunacy asylum act of 1858
‘B) Mental Health Ordinance of 2001
C) Lunacy act of 1912-
D) Lunacy act 1912 with last amendment in the year 1973

BCQS
6)A student living in hostel got up from his bed in the middle of the night, and then
put his hands in the pocket of others. Students handed him over to the police. He
pleaded amnesia during that period which was accepted. This condition is called:
а)Delerium
b)Somnolenlia
c)Impulse
d)Somnambulism
7)An ovenwhelming urge do perform an irrational act is called:
a)Compulsion
‘:b)Obsession c)Abreaction :d) Exaltation

BCQS
• 8. Lucid interval is a period in which the person has:
A)Aggravation of symptoms of insanity
‘B)Complete cessation of symptoms of insanity
C)Inability to make a will
D)Unawareness of his deeds.
9) Which of the following is not the feature of true insanity?
A) Dry harsh skin
B).Gradual onset Insanity
‘C) Resent repeated examinations
D)Withstand violent exertion for several hour

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