FORENSIC PSYCHIATRY

DR KISHOR KUMAR B ASSISTANT PROFESSOR DEPTARTMENT OF FORENSIC MEDICINE YENEPOYA MEDICAL COLLEGE DERALAKATTE

 PSYCHIATRY DEALS WITH STUDY DIAGNOSIS AND TREATMENT OF MENTAL ILLNESS FORENSIC PSYCHIATRY DEALS WITH THE APPLICATION OF PSYCHIATRY IN THE ADMINISTRATION OF JUSTICE. INSANITY OR UNSOUNDNESS OF MIND CAN BE DEFINED AS A DISEASE OF THE MIND IN WHICH THERE IS DERANGEMENT OF THE MENTAL OR EMOTIONAL PROCESSES.
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SYMPTOMS OF MENTAL ILLNESS

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DELUSION
DELUSION IS A FALSE BELIEF IN SOMETHING WHICH IS NOT A FACT, AND THE BELIEF PERSISTS EVEN AFTER ITS FALSITY HAS BEEN CLEARLY DEMONSTRATED.

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TYPES OF DELUSION
GRANDEUR OR EXALTATION PERSECUTION(PARANOID) REFERENCE INFLUENCE INFEDILITY SELF-REPROACH NIHILISTIC HYPOCHONDRIAL OTHER TYPES
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 EROTOMANIA:

IS A DELUSION IN WHICH A PERSON BELIEVES THAT SOMEONE IS DEEPLY IN LOVE WITH HIM/HER. THE EROTOMANIC DEVELOPS AN OBSESSION FOR THE PERSON AND STARTS BELIEVING THAT THE OTHER PERSON IS RECIPROCATING. THE OBJECT IS USUALLY OF A HIGHER STATUS, FAMOUS SUPERIOR AT WORK BUT CAN ALSO BE A COMPLETE STRANGER.
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HALLUCINATION

HALLUCINATION IS A FALSE SENSE OF PERCEPTION, WITHOUT ANY EXTERNAL OBJECT OR STIMULUS TO PRODUCE IT.
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TYPES
VISUAL AUDITARY OLFACTORY GUSTATORY TACTILE

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ILLUSION
ILLUSION IS A FALSE INTERPRETATION OF AN OBJECT OR STIMULUS WHICH HAS A REAL EXISTANCE. eg A MAN SEES A DOG HE MISTAKES IT FOR A LION

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IMPULSE
THIS IS A SUDDEN IRRESISTABLE FORCE COMPELLING A PERSON TO DO THE CONSIOUS PERFORMANCE OF SOME ACTION WITOUT MOTIVE OR FORETHOUGHT. USUALLY SEEN IN EPELEPSY. DEMENTIA, www.similima.com MANIA. ACUTE 10

TYPES
KLEPTOMANIA PYROMANIA MUTILOMANIA DIPSOMANIA SEXUAL IMPULSES INCLUDING SEXUAL PERVERSIONS SUCIDAL AND HOMICIDAL IMPULSES.
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OBSESSION
A SINGLE IDEA, THOUGHT OR EMOTION CONSTANTLY ENTERTAINED BY THE PERSON WHICH HE RECOGNISES AS IRRATIONAL, BUT PERSISTS INSPITE OF ALL EFFORTS TO DRIVE IT OUT OF HIS MIND.
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 PHOBIA: IS AN EXCESSIVE IRRATIONAL FEAR OF A PARTICULAR OBJECT OR SITUATION. AFFECTIVE DISORDER: PSYCHIATRIC DISORDER IN WHICH THE CHIEF FEATURE IS A RELATIVELY PROLONGED AFFECTIVE CHANGE OF AN ABNORMAL DEGREE, eg MANIA, DEPRESSION.
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DELIRIUM
DELIRIUM IS CHARECTERISED BY THE FOLLOWING FEATURES A RELATIVELY ACUTE ONSET CLOUDING OF CONSIOUSNESS AND DISORIENTATION DECREASED ATTENTION SPAN AND DISTRACTABILITY MARKED PERCEPTUAL DISTURBANCES LIKE ILLUSIONS MISINTERPRETATIONS AND HALLUCINATIONS ALSO OCCUR DISTURBANCE OF SLEEP WAKE CYCLE, MOST COMMONLY INSOMNIA AT NIGHT AND DAY TIME www.similima.com DROWSINESS. 14

 DIURNAL VARIATION IS MARKED, USUALLY WORSENING OF SYMPTOMS IN EVENING AND NIGHT.(CALLED SUN DOWNING) THERE IS IMPAIRMENT OF REGISTRATION AND RETENTION OF NEW MEMMORIES. AUTONOMIC DYSFUNCTION IS GENERALISED. SPEECH AND THOUGHT DISTURBANCES LIKE SLURRING OF SPEECH, www.similima.com 15 INCOHERENCE, DYSARTHRIA.

 MOTOR SYMTOMS INCLUDE ASTERIXES, MULTIFOCAL MYOCLONUS, CARPHOLOGIA/FLOCCILLATION (PICKING MOVEMENTS AT COVERSHEETS/CLOTHES), AND OCCUPATIONAL DELIRIUM, TONE AND REFLEX ABNORMALITIES. LABILITY OF AFFECT IS USUALLY PRESENT MOTOR AND VERBAL PERSEVERATION, DYSNOMIA, AGRAPHIA AND IMPAIRED COMPREHENSION ARE ALSO SEEN.
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CAUSES OF DELERIUM METABOLIC CAUSES

HYPOXIA HYPOGLYCEMIA HEPATIC ENCEPHALOPATHY, UREMIC

ENCEPHALOPATHY CARDIAC FAILURE, CARDIAC ARREST, ARRYTHMIAS FLUID AND ELECTROLYTE DISTURBANCES FEVER, HYPOVOLEMIC SHOCK CARCINOID SYNDROME, PORPHYRIA
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 ENDOCRINE CAUSES
HYPO AND HYPER- PITUITARISM HYPO AND HYPER-THYROIDISM HYPO AND HYPER-PARATHYROIDISM HYPO AND HYPER-ADRENALISM

DRUGS
DIGITALIS ALCOHOL BARBITURATES TRICYCLIC ANTIDEPRESSANTS, ANTI

PSYCHOTICS ANTICONVULSANTS SALICYLATES, STEROIDS, INSULIN www.similima.com METHYL ALCOHAL, HEAVY METALS

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 NUTRITIONAL DEFICIENCIES
THIAMINE, NIACIN, PYRIDOXINE ETC PROTEINS

SYSTEMIC INFECTIONS
INTRACRANIAL CAUSES EPILEPSY HEAD INJURY INTRACRANIAL INFECTIONS MIGRAINE STROKE FOCAL LESIONS

MISCELLANEOUS
POST OPERATIVE STATES SLEEP DEPRIVATION
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LUCID INTERVAL
THIS IS A PERIOD OCCURING IN INSANITY DURING WHICH ALL SYMPTOMS OF INSANITY DISAPPEAR COMPLETELY. LUCID INTERVAL IS ALSO SEEN IN HEAD INJURY. DURING THIS PERIOD HE WILL BE HELD RESPONSIBLE FOR HIS CRIMINAL ACTS.
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 HISTORY OF INSANITY PRESENT. PRECEEDING SYMPTOMS OF INSANITY FOLLOWING SYMPTOMS OF INSANITY OCCURRENCE FREQUENT

DIFFERENCE BETWEEN LUCID INTERVAL IN INSANITY AND HEAD INJURY HEAD INJURY INSANITY

HISTORY OF HEAD INJURY PRECEEDING SYMPTOMS OF CONCUSSION FOLLOWING SYMPTOMS OF CEREBRAL IRRITATION AND COMPRESSION OF BRAIN www.similima.com OCCURRENCE ONLY ONCE

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CLASSIFICATION(WHO 1965)
PSYCHOSIS
ORGANIC PSYCHOSIS
SENILE AND PRESENILE DEMENTIA ALCOHOLIC PSYCHOSIS ASSOCIATED WITH INTRACRANIAL INFECTIONS ASSOCIATIED WITH CEREBRAL ARTERIOSCLEROSIS EPILIPSY, INTRACRANIAL TUMORS, DEGENERATIVE DISORDER, BRAIN ANOMALIES

FUNCTIONALPSYCHOSIS
SCHIZOPHRENIA www.similima.com AFFECTIVE TYPE
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 NEUROSIS
ANXIETY NEUROSIS HYSTERICAL NEUROSIS OBSESSIVE COMPULSIVE NEUROSIS DEPRESSIVE DEPERSONALISATION SYNDROME HYPOCHONDRIACAL UNSPECIFIED NEUROSIS

PERSONALITY DISORDERS SEXUAL DEVIATION DRUG DEPENDENCE

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ICD-10 CLASSIFICATION
F00-F09 ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS F10-F19 MENTAL AND BEHAVIORAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE ABUSE F20-F29 SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL 24 www.similima.com DISORDERS

 F31 F39 MOOD(AFFECTIVE DISORDERS) F40-F48 NEUROTIC, STRESSRELATED AND SOMATOFORM DISORDERS F50-F59 BEHAVIORAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS F60-F69 DISORDERS OF ADULT PERSONALITY AND BEHAVIOR F70-F79 MENTAL RETARDATION
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 F80-F89 DISORDERS OF PSYCHOLOGICAL DEVLOPMENT F90-F98 BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY OCCURING IN CHILDHOOD AND ADOLESENSE F99 UNSPECIFIED MENTAL DISORDERS

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SOME COMMON TERMS USED IN PSYCHIATRY

AFFECT: SUBJECTIVE AND IMMEDIATE EXPERIENCE OF EMOTION AT A GIVEN TIME MOOD: PERVASIVE EMOTION OR FEELING WHICH IS SUSTAINED. INSIGHT: IS TO DO WITH AWARENESS OF ONES OWN MENTAL CONDITION. PHOBIA: IS AN IRRATIONAL FEAR OF AN OBJECT, SITUATION OR ACTIVITY. CONFABULATION :IS A FALSE MEMORY THAT THE PATIENT BELIEVES TO BE TRUE.
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 MUTISM: COMPLETE LOSS OF SPEECH. SEEN IN SCHIZOPHRENIA, DEPRESSION, ORGANIC BRAIN LESION AND MALINGERING. PSYCHOPATH: PSYCHOPATH IS A PERSON WHO IS NEITHER INSANE NOR MENTALY ILL, BUT FAILS TO CONFORM TO THE NORMAL STANDARDS OF BEHAVIOR. NEURASTHENIA: IT IS CONDITION OF NERVOUS EXHAUSTION DUE TO PHYSICAL OR MENTAL CONDITIONS.THERE IS ABNORMAL FATIGUE AND IRRITABILITY OF THE NERVOUS SYSTEM. ONEIROID STATES: IT IS A DREAM LIKE STATE WHICH MAY LAST FOR DAYS OR WEEKS. THE PATIENT SUFFERS FROM CONFUSION, AMNESIA, ILLUSIONS, HALLUCINATION,www.similima.com DISORIENTATION

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 PSYCHOSIS: THEY ARE CHARACTERISED BY WITHDRAWAL FROM REALITY, HALLUCINATIONS AND DELUSIONS MAY BE PRESENT. INSIGHT ABSENT. NEUROSIS: THE PATIENT SUFFERS FROM EMOTIONAL OR INTELLUCTUAL DISORDERS BUT HE DOES NOT LOOSE TOUCH WITH REALITY. DEMANTIA: IS A CONDITION IN WHICH THERE IS DEGENERATION OF MENTAL FACULTIES AFTER THEY HAVE BEEN FULLY DEVLOPED. EG: ALZHIMERS DISEASE, PICKS DISEASE, HUNTINGTONS CHOREA, CREUTZFELDT-JACOB DISEASE. www.similima.com

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CAUSES OF INSANITY
HEREDITARY: eg HUNTINGTONS CHOREA. ENVIORNMENTAL FACTORS PSYCHOGENIC: eg UNSUCCESSFULLY REPRESSED MENTAL CONFLICTS. PRECIPITATING STRESS FACTORS
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ORGANIC MENTAL DISORDERS

DEMENTIA IN ALZHIMERS DISEASE VASCULAR DEMANTIA DEMENTIA IN OTHER DISEASES UNSPECIFIED DEMENTIA DELIRIUM NOT INDUCED BY ALCOHOL OR PSYCHOACTIVE SUBSTANCE ABUSE MENTAL DISORDERS DUE TO BRAIN DAMAGE AND DYSFUNCTION AND TO PHYSICAL DISEASE PERSONALITY AND BEHAVIOURAL DISORDER DUE TO BRAIN DISEASE, DAMAGE AND DYSFUNCTION www.similima.com UNSPECIFIED ORGANIC MENTAL DISORDERS

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ASSOCIATION OF ORGANIC MENTAL DISORDERS WITH OFFENDING BRAIN DAMAGE DUE TO HEAD INJURIES, EVEN IN ABSENCE OF SIGNIFICANT COGNITIVE IMPAIRMENT MAY PRODUCE PROFOUND ALTERATION IN PERSONALITY RESULTING IN EXCESSIVE AGRESSION. BRAIN DAMAGE ALSO REDUCES ALCOHOL TOLERANCE MAY PREDISPOSE TO FURTHER HEAD INJURIES
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 HUNTINGTONS CHOREA MAY PRESENT IN THE EARLY STAGES WITH PSYCHOPATHIC BEHAVIOR. THE PREVELANCE OF EPILEPSY IS HIGHER AMONG PRISONERS THAN IN GENERAL POPULATION EXPLANATIONS INCLUDE
ICTAL PHENOMENAS SUCH AS

AUTOMATISM UNDERLYING ORGANIC MENTAL DISORDERS BEING RESPONSIBLE www.similima.com FOR EPILEPSY AND OFFENDING

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 THE DEVLOPMENT OF EPILEPSY ADVERSLY

AFFECTING THE INDIVIDUALS SELF ESTEEM RESULTING IN SOCIAL REJECTION WHICH INTURN LEADS TO ANTISOCIAL BEHAVIOR
ADVERSE SOCIAL CIRCUMSTANCES

LEADING TO BOTH EPILEPSY AND ANTISOCIAL BEHAVIOR

A TENDENCY TO BE IMPULSIVE AND

ANTISOCIAL LEADING TO OFFENDING AND BRAIN INJURIES THUS POST TRAUMATIC EPILEPSY

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 THE ONSET OF MINOR OFFENDING SUCH AS SHOP LIFTING, MINOR SEX OFFENCES AT A LATE AGE MAY BE DUE TO DEMENTIA FOR EXAMPLE ALZHIMERS DISEASE, OWING TO ITS REDUCTION OF INTELLUCTUAL FUNCTIONING, JUDGEMENT AND NORMAL INHIBITIONS IN SOCIAL BEHAVIOR.

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ASSOCIATION OF MENTAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE ABUSE WITH OFFENDING.

IS OFTEN ASSOCIATED WITH VIOLENCE AS IT CAUSES DISINHIBHITION OF BEHAVIOR AND IMPAIRS JUDGEMENT ALCOHOL DEPENDENCE SYNDROME MAY BE ASSOCIATED WITH MOTORING OFFENCES, DRUNKENNESS AND THEFT TO FINANCE THE ALCOHOL ABUSE THOSE WITH ALCOHOL DEPENDENCE HAVE MORE CONVICTIONS FOR CRIMINAL OFFENCES THAN NORMAL.
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SCHIZOPHRENIA
IT IS CHARACTERISED BY AUDITARY HALLUCINATIONS THOUGHT DISORDERS
THOUGHT INSERTION THOUGHT WITHDRAWAL THOUHT BROADCASTING

SOMATIC PASSIVITY DELUSIONAL PERCEPTION OTHER FEATURES

DELUSIONS, DISORDERS OF

AFFECT, PERSONALITY www.similima.com DETERIORATION

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TYPES
SIMPLE SCHIZOPHRENIA HEBEPHRENIC CATATONIC PARANOID SCHIZOPHRENIA

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ASSOCIATION OF SCHIZOPHRENIA AND DELUSIONAL DISORDERS WITH OFFENDING

SCHIZOPHRENIA ESPECIALLY PARANOID SCHIZOPHRENIA MAY LEAD TO DANGEROUS OFFENDING AND MAY RESULT IN PLANNED ASSAULTS, INCLUDING HOMICIDES WITHOUT APPARENT MOTIVE. ANTISOCIAL BEHAVIOUR IS OCCASIONAL SEEN INE PRODROMAL PHASE OF SCHIZOPHRENIA, WHEN THE CLINICAL FEATURE MAY BE REFERRED TO AS PSEUDOPSYCHOPATHIC SCHIZOPHRENIA. MATRICIDE(KILLING OF ONES OWN MOTHER) www.similima.com IS ASSOCIATED WITH SCHIZOPHRENIA

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MORBID DELUSIONAL JEALOUSY(OTHELLOS SYNDROME) THIS LEADS TO SEVERE AGRESSION TOWARDS AND KILLING OF THE SPOUSE ABOUT WHOM DELUSION OF INFEDILITY ARE HELD THE CONDITION IS ASSOCIATED WITH ALCOHOLISM AND SCHIZOPHRENIA.
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ASSOCIATION OF MOOD DISORDERS (AFFECTIVE DISORDERS) WITH OFFENDING) DEPRESSIVE EPISODE IS MORE ASSOCIATED WITH RISKS OF SUICIDE. RARELY ASSOCIATED WITH HOMICIDE, FOR EXAMPLE ALTRUISTIC HOMICIDE WHERE THE INDIVIDUAL FEELS HIS FAMILY MEMBERS MAY BE BETTER OFF OUT OF THIS WICKED WORLD
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HYPOMANIA OR MANIAC EPISODES

ASSOCIATED WITH ROAD TRAFFIC OFFENCES, IMPULSIVE VIOLENCE, SEXUAL OFFENCES SUCH AS RAPE. SUCH PERSONS SPEND MONEY EXCESSIVELY, OFTEN DUE TO THEIR BELIEF THAT THEY WILL MAKE UP FOR THAT BUT IT CAN ALSO LEAD TO FRAUD.
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MENTAL RETARDATION
"Mental retardation refers to significantly sub average general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period".

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Classification of MR
Level of Retardation Mild retardation Moderate retardation Severe retardation Profound retardation IQ 50-69 35-49 20-34 Below 20
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ASSOCIATION OF LEARNING DISORDERS WITH OFFENDING MAY LEAD TO FRUSTRATION WHICH MAY IN TURN LEAD TO VIOLENCE AND EVEN HOMICIDE MAY COMMIT ARSON SEXUAL OFFENCES

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ASSOCIATION OF DISORDERS OF ADULT PERSONALITY WITH OFFENDING.

THOSE WITH ADULT PERSONALITY WHO OFFEND HAVE FREQUENTLY ABUSED ALCOHOL OR DRUGS OR ARE DEPENDENT ON THEM, AND HAVE CHRONIC NEUROTIC AND STRESS RELATED DISORDERS AS WELL.

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THE MENTAL HEALTH ACT, 1987

An Act to consolidate and amend the law relating to the treatment and care of mentally ill persons, to make better provision with respect to their property and affairs and for matters connected therewith or incidental thereto.
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It replaces the Indian Lunacy Act of 1912 resulting in change of certain terminologies as shown below
Asylum to psychiatric hospital Lunatic to mentally ill person Criminal lunatuc to mentally ill prisoner

The mental health act is divided into 10 chapters consisting of 98 sections. The mental health act came into affect only in April 1993 in all the states and union territories of India. www.similima.com

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THE OBJECTIVES OF THE ACT ARE TO

REGULATE ADMISSION OF THE MENTALLY ILL PATIENT TO A PSYCHIATRIC HOSPITAL OR PSYCHIATRIC NURSING HOME AND TO PROTECT HIS RIGHTS WHILE UNDER DETECTION PREVENT HARM TO HIMSELF AND THE SOCIETY BY THE MENTALLY ILL PERSON PROTECT CITIZENS BEING DETAINED IN PSYCHIATRIC HOSPITALS WITOUT SUFFICIENT www.similima.com CAUSE.

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 FIX LIABILITY FOR MAINTANANCE CHARGES OF MENTALLY ILL PATIENT ADMITTED TO THE HOSPITAL OR NURSING HOME. PROVIDE FACILITIES TO ESTABLISH GUARDIANSHIP OR CUSTODY OF THE MENTALLY ILL PATIENT AND MANAGEMENT OF HIS PROPERTY. ESTABLISH CENTRAL AND STATE AUTHORITY FOR MENTAL HEALTH SERVICES PROVIDE LISENCING AND CONTROL OF PSYCHIATRIC HOSPITALS BY THE STATE GOVERNMENT ENSURE LEGAL AID TO THE MENTALLY IL PERSON AT STATE EXPENSE IN CERTAIN CASES
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CHAPTER I DEALS WITH VARIOUS DEFINITIONS

Mentally ill person" means a person who is in need of treatment by reason of any mental disorder other than mental retardation "mentally ill prisoner" means a mentally ill person for whose detention in, or removal to, a psychiatric hospital, psychiatric nursing home, jail or other place of safe custody. "minor" means a person who has not completed the age of eighteen years;
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medical officer" means a gazetted medical officer in the service of Government and includes a medical practitioner declared, by a general or special order of the State Government, to be a medical officer for the purposes of this Act; "medical officer in charge" in relation to any psychiatric hospital or psychiatric nursing home, means the medical officer who, for the time being, is in charge of that hospital or nursing home; www.similima.com

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psychiatric hospital" or "psychiatric nursing home" means a hospital, or as the case may be, a nursing home established or maintained by the Government or any other person for the treatment and care of mentally ill persons and includes a convalescent home established or maintained by the Government or any other person for such mentally ill persons.. "psychiatrist" means a medical practitioner possessing a post-graduate degree or diploma in psychiatry, recognized by the Medical Council of www.similima.com India.

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reception order" means an order made under the provision of this Act for the admission and detention of a mentally ill person in a psychiatric Hospital or psychiatric nursing home; " relative" includes any person related to the mentally ill person by blood, marriage or adoption;
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CHAPTER II OF MHA DETAILS THE PROCEDURE FOR ESTABLISHMENT OF MENTAL HEALTH AUTHORITIES AT CENTRE AND STATE LEVELS CHAPTER III LAYS GUIDELINES OR ESTABLISHMENT AND MAINTENANACE OF PSYCHIATRIC HOSPITALS AND NURSING HOMES.
PRIVATE PSYCHIATRIC HOSPITALS AND NURSING HOMES CAN BE RUN ONLY ON A VALID LISENCE WHICH HAS TO BE SUBSEQUENTLY RENEWED EVERY 5 YEARS INSPECTING OFFICER WILL PERIODICALLY INSPECT THE HOSPITAL OR NURSING HOME TO CHECK FOR ANY IRREGULARITIES
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CHAPTER IV
LAYS DOWN GUIDELINES FOR PSYCHIATRIC HOSPITALS IN RELATION TO THE ADMISSION, DETENTION, AND DISCHARGE OF THE MENTALLY ILL PATIENTS

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IMMEDIATE RESTRAINT
THIS CAN BE DONE IN CASE OF AN INSANE PERSON WHO IS DANGEROUS TO HIMSELF OR TO OTHERS, OR WHO IS LIKELY TO WASTEFULLY SPEND HIS PROPERTY OR THAT OF OTHERS PERSON SUFFERING FROM DELIRIUM DUE TO DISEASE DELIRIUM TREMENS
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 IMMEDIATE RESTRAINT IS DONE UNDER PERSONAL CARE OF ATTENDENTS.

THE CONSENT OF A LAWFUL

GUARDIAN HAS TO BE TAKEN. IF THERE IS NO TIME TO TAKE CONSENT AND THE INSANE PERSON IS DANGEROUS TO HIMSELF AND OTHERS, HE CAN BE IMMEDIATELY RESTRAINED. SUCH RESTRAINT IS LAWFUL ONLY AS LONG AS THE DANGER EXISTS.
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ADMISSION IN PSYCHIATRIC HOSPITAL

Any persons (not being a minor), who considers himself to be a mentally ill person and desires to be admitted to any psychiatric nursing home for treatment, may request the medical officer in charge for being admitted as a voluntary patient. Request by guardian for admission of a ward Where the guardian of a minor considers such minor to be a mentally ill person and desires to admit such minor in any psychiatric hospital or psychiatric nursing home for treatment, he may request the medical officer-in-charge for www.similima.com admitting such minor as a voluntary patient.

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On receipt of a request the medical officer-incharge shall make such inquiry as he may deem fit within a period not exceeding twentyfour hours and if satisfied that the applicant or, as the case may be, the minor requires treatment as an in - patients in the psychiatric hospital or psychiatric nursing home, he may admit therein such application or, as the case may be, minor as a voluntary patient. Every voluntary patient admitted to a psychiatric hospital or psychiatric nursing home shall be bound to abide by such regulations as may be made by the medical officer - in - charge or the licensee of the psychiatric hospital or psychiatric nursing www.similima.com home.

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Admission of mentally ill persons under certain special circumstances

Any mentally ill persons who does not, or is unable to, express his willingness for admission as a voluntary patient, may be admitted and kept as an in-patient in a psychiatric nursing hospital or psychiatric nursing home on an application made in that behalf by a relative or a friend of the mentally ill persons if the medical officers-in-charge is satisfied that in the interest of the mentally ill persons it is necessary to do so.
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The husband or wife of a person who is alleged to be mentally ill or, where there is no husband or wife, or where the husband or wife is prevented by reason of any illness or absence from India or otherwise from making the application, any other relative of such person may make an application to the Magistrate. Where the husband or wife of the alleged mentally ill person is not the applicant, the application shall contain the reasons for the application not being made by the husband or wife and shall indicate the relationship of the applicant with the alleged mentally ill person and the circumstances under which the application is being made.
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Application for reception order

1. An application for a reception order may be made by a. the medical officer-in-charge of a psychiatric hospital or psychiatric nursing home, or b. by the husband, wife or any other relative of the mentally ill person.

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1.

Where a medical officer-in-charge of a psychiatric hospital or psychiatric nursing home in which a mentally ill- person is undergoing treatment under a temporary treatment order is satisfied that the mentally ill person is suffering from mental disorder of such a nature and degree that his treatment in the psychiatric hospital or as the case may be, psychiatric nursing home is required to be continued for more than six months, or It is necessary in the interests of the health and personal safety of the mentally ill person or for the protection of others that such person shall be detained in a psychiatric hospital or psychiatric nursing home.
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a.

b.

He may make an application to the Magistrate within the local limits of whose jurisdiction the psychiatric hospital or, as the case may be, psychiatric nursing home is situated, for the detention of such mentally illperson under a reception order in such psychiatric hospital or psychiatric nursing home, as the case may be.
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No person 1)who is a minor, or 2) who , within fourteen days before the date of the application, has not seen the alleged mentally ill person, shall make an application under this section. Every application under shall be made in the prescribed form and shall be signed and verified in the prescribed manner and shall state whether any previous application had been made for inquiry into the mental condition of the alleged mentally ill person and shall be accompanied by two medical certificates from two medical practitioners of whom one shall be a medical practitioner in the service of Government
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Form and contents of medical certificates

Every medical certificate shall contain a statement -that each of the medical practitioner has
independently examined the alleged mentally ill person and has formed his opinion on the basis of his own observations and from the particulars communicated to him -that in the opinion of each such medical practitioner the alleged mentally ill person is suffering from mental disorder of such a nature and degree as to warrant the detention of such person in a psychiatric hospital or psychiatric nursing home and that such detention is necessary in the interests of the health and personal safety of that person or for the www.similima.com 68 protection of others.

Procedure upon application for reception order

On reception of application, the magistrate must consider the allegations in the petition, and the evidence of mental illness appearing in the medical cerificates.if he is satisfied he may pass a reception order immediately or he may fix a day for consideration of petition.
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 On the date fixed, the petition must be considered in private in the presence only of the petitioner and the alleged mentally ill person and a representative of the alleged mentally ill person and such other persons as the magistrate thinks should be present. If the magistrate is satisfied that it is necessary to detain the alleged mentally ill person, he passes a reception order which is valid for 30 days. If not satisfied he may refuse the application, giving his reasons in writing a copy of which is supplied to www.similima.com the applicant.

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After the completion of the proceeding under Magistrate may pass a reception order authorizing the detention of the said person as an in-patient in a psychiatric hospital or psychiatric nursing home a. if the medical officer certifies such person to be a mentally ill person, and b. if the Magistrate is satisfied that the said person is a mentally ill person and that in the interest of the health and personal safety of that person or for the protection of others, it is necessary to pass such order
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Provided that if any relative or friend of the mentally ill person desires that the mentally ill person be sent to any particular licensed psychiatric hospital or licensed psychiatric nursing home for treatment therein and undertakes in writing to the satisfaction of the Magistrate to pay the cost of maintenance of the mentally ill person in such hospital or nursing home, the Magistrate shall, if the medical officer in charge of such hospital or nursing home consents, make a reception order for the admission of the mentally ill person into that hospital or nursing home and detention therein
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Provided further that if any relative or friend of the mentally ill person enters into a bond, with or without sureties for such amount as the Magistrate may determine, undertaking that such mentally ill person will be properly taken care of and shall be prevented from doing any injury to himself or to others, the Magistrate may, instead of making a reception order, hand him over to the care of such relative or friend.
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Order in case of mentally ill person cruelly treated or not under proper care and control
An officer in charge of a police station or any private person can report to magistrate, if he believes that any person is mentally ill and is not kept under proper care and control, or that he is cruelly treated or neglected by any relative or guardian.
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Admission as in-patient after inquisition

1. If any District Court holding an inquisition regarding any person who is found to be mentally ill is of opinion that it is necessary so to do in the interests of such person, it may ,by order, direct that such person shall be admitted and kept as an in-patient in a psychiatric hospital or psychiatric nursing home and every such order may be varied from time to time or revoked by the District court.
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Admission and detention of mentally ill prisoner

An order under Sec. 30 of the Prisoners Act, Sec. 335 of the Code of Criminal Procedure 1973 ( 2 of 1974), directing the reception of a mentally ill prisoner into any psychiatric hospital or psychiatric nursing home, shall be sufficient authority for the admission of such person in such hospital or, as the case may be, such nursing home or any other psychiatric hospital or psychiatric nursing home to which such person may be lawfully transferred for detention therein.

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Detention of alleged mentally ill person pending report by medical officer

When any person alleged to be a mentally ill person appears or is brought before a Magistrate the Magistrate may, by order in writing, authorise the detention of the alleged mentally ill person under proper medical custody in an observation ward of a general hospital or general nursing home or psychiatric hospital of psychiatric nursing home or in any other suitable place for such period not exceeding ten days as.
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CHAPTER V
CHAPTER V DEALS WITH INSPECTION, LEAVE OF ABSENCE, AND REMOVAL OF MENTALLY ILL PERSONS.

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Discharge of a mentally ill person

Voluntary admission patients should be discharged within 24 hrs of receipt of request for discharge made by the patient or guardian. A mentally ill person who is admitted on an application by relative or friend can himself, or a relative or friend can apply to magistrate for discharge.
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 The officer in charge of a psychiatric hospital can order in writing discharge of any in-patient on recommendation of 2 medical practitioners, one of whom shall preferably be a psychiatrist, A mentally ill person detained under reception order made on application, shall be discharged if the person on whose application the admission order was made, applies in writing to the officer in charge. If a person detained on reception order, is subsequently found by judicial inquisition to be of sound mind, he is to be discharged.
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Chapter VI
Judicial Inquisition Regarding Alleged Mentally Ill Person Possessing Property Custody Of His Person Management Of His Property

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 CHAPTER VII DEALS WITH LIABILITY TO MEET COST IF MAINTENANACE OF MENTALLY ILL PERSONS DETAINED IN PSYCHIATRIC HOSPITALS CHAPTER VIII DEALS WITH ISSUES RELATING TO THE PROTECTION OF HUMAN RIGHTS OF MENTALLY ILL PERSONS CHAPTER IX OUTLINES PENALTIES FOR INFRINGEMENT OF GUIDELINES CHAPTER X DEALS WITH MISCELLANEOUS MATTERS www.similima.com

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DIFFERENCES BETWEEN TRUE AND FEIGNED INSANITY

TRUE INSANITY
ONSET GRADUAL MOTIVE ABSENT PRECIPITATING FACTORS PRESENT SIGNS AND SYMPTOMS CONFORMS TO A PARTICULAR TYPE OF DISORDER. UNIFORM AND PRESENT WHETHER THE PERSON IS BEING OBSERVED OR NOT

FEIGNED INSANITY
ONSET SUDDEN MOTIVE PRESENT PRECIPITATING FACTORS ABSENT DOES NOT CONFORM TO A PARTICULAR TYPE OF DISORDER. SYMPTOMS MAY BE ABSENT WHEN THE PATIENT IS NOT UNDER OBSERVATION
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 FACIAL EXPRESSION USUALLY LISTLESS, VACANT AND FIXED INSOMNIA OFTEN PRESENT CAN WITHSTAND EXERTION, FATIGUE, HUNGER FOR PROLONGED PERIODS. DOES NOT PAY ATTENTION TO PERSONAL HYGIENE DOES NOT MIND EXAMINATIONS

FREQUENT CHANGES, EXAGERATED GRIMACES CANNOT WITHSTAND LACK OF SLEEP CANNOT WITHSTAND EXERTION, FATIGUE HUNGER FOR PROLONGED PERIODS. MAY ONLY PRETEND TO BE DISINTERESTED IN APPEARANCE

RESENTS EXAMINATION FOR FEAR OF DETECTION www.similima.com

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CIVIL RESPONSIILITY
MANAGEMENT OF PROPERTY AND AFFAIRS INSANITY AND CONTRACTS INSANITY AND MARRIAGE CONTRACT COMPETENCE OF INSANE TO BE A WITNESS CONSENT AND INSANITY INSANITY AND TESTAMANTARY CAPACITY
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MANAGEMENT OF PROPERTY

IF A PERSON WHO OWNS PROPERTY BECOMES INSANE AND IS INCAPABLE OF MANAGING HIS AFFAIRS WITH SOUND JUDGEMENT, A RELATIVE OR FRIEND CAN APPROACH THE COURT FOR JUDICIAL INQUISITION.THE MEDICAL EVIDENCE IS GIVEN IN THE FORM OF A CERTIFICATE WHICH SHOULD STATE THAT INSANITY IS OF SUCH A DEGREE AS TO MAKE HIM INCAPABLE OF MANAGING HIS PROPERTY. ON ENQUIRE IF ITS FOUND THAT THE PERSON IS INCAPABLE OF MANAGING HIS PROPERTY THE COURT CAN APPOINT A GUARDIAN OR MANAGER DEPENDING ON THE CIRCUMSTANCES. THE COURT MAY ORDER THE SALE OR DISPOSAL OF THE PERSONS PROPERTY, FOR THE PAYMENT OF HIS DEBTS AND EXPENSES. THE COURT MAY ORDER A SECOND INQUISITION, IF ITS REPORTED THAT UNSOUNDNESS OF MIND HAD CEASED.
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BUSINESS CONTRACT
IF IT IS PROVED THAT AT THE TIME OF SIGNING A CONTRACT ONE OF THE TWO PARTIES WAS INSANE, THEN THE CONTRACT BECOMES LEGALLY INVALID. INSANITY DEVELOPING SUBSEQUENTLY TO A LEGAL AGREEMENT WILL NOT NECESSARILY INVALIDATE THE CONTRACT. IF AT THE TIME OF SIGNING, THE FACT THAT ONE OF THE SIGNATORIES TO THE CONTRACT WAS INSANE WAS NOT KNOWN TO THE OTHER PARTY, THE CONTRACT MAY NOT BE DECLARED INVALID. FOR THE PURPOSE OF A CONTRACT, A PERSON IS SAID TO BE OF SOUND MIND IF AT THE TIME OF MAKING THE CONTRACT, HE IS CAPABLE OF UNDERSTANDING IT AND FORMING A RATIONAL JUDGEMENT. www.similima.com 87

MARRIAGE
A MARRIAGE IS CONSIDERED INVALID IF AT THE TIME OF MARRIAGE, EITHER PARTY IS 1) INCAPABLE OF GIVING VALID CONSENT DUE TO INSANITY. 2) THOUGH CAPABLE OF GIVING VALID CONSENT, HAS BEEN SUFFERING FROM SUCH KIND OR DEGREE OF MENTAL DISORDER AS TO BE UNFIT FOR MARRIAGE OR PROCREATION. 3) HAS BEEN SUFFERING FROM RECURRENT ATTACKS OF INSANITY.
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THE COMPETENCE OF INSANE TO BE A WITNESS

AN INSANE PERSON IS NOT COMPETENT TO GIVE EVIDENCE, IF HE CANNOT UNDERSTAND THE NECESSITY OF TELLING THE TRUTH DUE TO INSANITY. A PERSON OF UNSOUND MIND WHO SUFFERS FROM DELUSIONS, BUT IS CAPABLE OF TELLING WHAT HE HAS SEEN AND WHO UNDERSTANDS THE IMPORTANCE OF AN OATH,IS COMPETENT TO GIVE EVIDENCE AN INSANE PERSON IS COMPETENT TO GIVE EVIDENCE DURING THE LUCID INTERVAL.

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CONSENT AND INSANITY

CONSENT TO CERTAIN ACTS LIKE, SEXUAL INTERCOURSE OR HURT IS NOT VALID, IF SUCH A CONSENT IS GIVE BY A PERSON WHO DUE TO UNSOUNDNESS OF MIND IS UNABLE TO UNDERSTAND THE NATURE AND CONSEQUENCES OF THE ACT.

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TESTAMENTART CAPACITY
TESTAMENTARY CAPACITY REFERS TO THE CAPACITY OF A PERSON TO MAKE A VALID WILL. A WILL IS A DOCUMENT DETAILING THE DISPOSITION OF PROPERTY OWNED BY A PERSON, WHICH IS PERPARED BY HIM DURING HIS LIFETIME BUT TAKES EFFECT ONLY AFTER HIS DEMISE. THE PERSON WHO MAKES THE WILL IS REFERRED TO AS THE TESTATOR. IT CAN BE REVOKED OR CHANGED www.similima.com ANY NUMBER OF TIMES

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 ELIGIBILITY FOR MAKING A WILL:

AS PER INDIAN SUCCESSION ACT 59, THE FOLOWING PERSONS ARE ELIGIBLE TO MAKE A VALID WILL EVERY PERSON OF SOUND MIND WHO IS OVER AGE OF 18 YEARS AN INSANE PERSON CANNOT WRITE A VALID WILL UNLESS HE IS IN A LUCID INTERVAL. AN INTOXICATED PERSON CANNOT MAKE A WILL, UNLESS IT IS CERTIFIED BY A DOCTOR THAT HE WAS UNDER HIS SENSES A DEAF DUMB OR BLIND PERSON CAN MAKE A WILL IF HE CAN COMMUNICATE EFFECTIVELY CONVICTS ARE NOT DEBARRED FROM MAKING A WILL.
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 PROCEDURE: THE WILL MUST

ALWAYS BE IN WRITING,THE ONLY EXCEPTION PROVIDED UNDER LAW IS FOR MEMBERS OF THE ARMED FORCES WHO ARE OUT ON EXPEDITION OR ENGAGED IN WARFARE. THEY CAN MAKE AN ORAL WILL (PRIVILAGED WILL).ALSO MUSLIMS ARE PERMITED TO MAKE AN ORAL WILL BY THEIR PERSONAL LAW.
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 THERE IS NO PARTICULAR FORMAT FOR A WILL. IT NEED NOT BE EVEN ON A STAMP PAPER. THE TESTATOR CAN WRITE A WILL HIMSELF USING A FOUNTAIN OR BALL PEN (HOLOGRAPHIC WILL). THE WILL MUST BE ATTESTED BY ATLEAST 2 WITNESSES, NEITHER OF THEM CAN BE BENIFICIARIES. IT IS PREFERABLE THAT ONE OF THEM SHOULD BE A DOCTOR. THE SIGNATURE OR THUMB IMPRESSION OF THE TESTATOR IS MANDATORY THE WILL COMES INTO EFFECT ONLY ON THE DEATH OF THE TESTATOR.
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CONDITIONS: THE PERSON MAKING A WILL SHOULD HAVE A SOUND DISPOSING MIND HAVE THOROUGH KNOWLEDGE ABOUT HIS WEALTH AND PROPERTY BE FREE FROM UNDUE INFLUENCE, OR FRAUD DO IT VOLUNTARILY
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CRIMINAL RESPONSIBILITY
A PERSON MAY PLEAD INSANITY TO AVOID TRAIL WHEN ACCUSED IS INSANE AND CANNOT PLEAD CONVICTION WHEN THE ACUSED WAS INSANE WHEN THE ALLEGED CRIME WAS COMMITTED SENTENCE OF CAPITAL PUNISHMENT WHEN THE CONDEMNED PRISONER IS INSANE.
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INSANITY AND MURDER

THE PLEA OF INSANITY MAY BE RAISED BY WAY OF DEFENCE TO ANY CRIMINAL CHARGE, BUT FOR MORE PRACTICAL PURPOSES, SUCH PLEAS ARE CONFINED TO CHARGES OF MURDER.

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WITH INSANE PERSON THE CRIME IS PURPOSELESS OR MOTIVELESS IN NATURE COMMITED UPON PERSONS USUALLY HELD DEAR BY THE CULPRIT, OR OCASSIONALLY UPON THOSE WHO ARE STRANGERS TO HIM. ITS PERPETRATION IS WITHOUT ANY PREPAREDNESS, ACCOMPLICES OR SECRECY
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 NATURE OF CRIME: THE INSANE PERSON BY

REASON OF UNSOUNDNESS OF MIND, IS UNABLE TO UNDERSTAND THE NATURE OF HIS ACTION, AND THEREFORE THERE IS NO MOTIVE WHEN HE COMMITS VIOLENCE OR MURDER. VICTIMS OF CRIME: AN INSANE PERSON ATTACKS ANYONE- FRIEND, RELATION, STRANGER OR ENEMY, EVEN WITHOUT PROVOCATION. HIS TARGET IS NOT DEFINITE. HE MAY THEREFORE COMMIT MULTIPLE MURDERS. PERPETRATION OF CRIME: BECAUSE OF UNSOUNDNESS OF MIND, THE ATTACK BY THE INSANE PERSON IS SPONTANEOUS. THERE ARE NO ACCOMPLICES. THERE IS NO SELECTION OF TIME AND PLACE.THERE IS NO ATTEMPT TO RUN AWAY FROM THE SCENE OF CRIME OR KEEP ANYTHING SECRET.
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TESTS FOR DETERMINING INSANITY

MC NAUGHTEN RULE: AN ACCUSED PERSON IS NOT LEGALLY RESPONSIBLE IF IT IS CLEARLY PROVED THAT AT THE TIME OF COMMITING THE CRIME HE WAS SUFFERING FROM SUCH A DEFECT OF MIND THAT HE DID NOT KNOW THE NATURE AND QUALITY OF THE ACT HE WAS DOING AND THAT WHAT HE WAS DOING WAS WRONG.
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SECTION84 IPC
NOTHING IS AN OFFENCE WHICH IS DONE BY A PERSON, WHO, AT THE TIME OF DOING IT, BY REASON OF UNSOUNDNESS OF MIND, IS INCAPABLE OF KNOWING THE NATURE OF THE ACT, OR THAT HE IS DOING WHAT IS EITHER WRONG OR CONTRARY TO LAW.
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 DURHAM RULE: AN ACCUSED

PERSON IS NOT CRIMINALLY RESPONSIBLE IF AT THE TIME OF COMMITING THE ACT, HE DID NOT HAVE THE CAPACITY TO REGULATE HIS CONDUCT TO THE REQUIREMENTS OF THE LAW AS A RESULT OF MENTAL DISEASE OR DEFECT.

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IRRESSISTABLE IMPULSE TEST: AN ACCUSED PERSON IS NOT CRIMINALLY RESPONSIBLE, IF HE KNOWS THE NATURE AND QUALITY OF HIS ACT AND KNOWS THAT IT IS WRONG, IF HE IS INCAPABLE OF RESTRAINING HIMSELF FROM COMMITING THE ACT BECAUSE THE FREE AGENCY OF HIS WILL HAS BEEN DESTROYED BY MENTAL DISEASE.
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THE AMERICAN LAW INSTITUTE TEST: A PERSON IS NOT RESPONSIBLE FOR HIS CRIMINAL CONDUCT IF AT THE TIME OF SUCH CONDUCT AS A RESULT OF MENTAL DISEASE OR DEFECT, HE LACKS ADEQUATE CAPACITY EITHER TO APPRECIATE THE CRIMINALITY OF HIS CONDUCT TO THE REQUIREMENTS OF LAW.

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CRIMINAL RESPONSIBILTY IN SOME SPECIAL SITUATIONS

AUTOMATISM: AUTOMATISM IS A A CONDUCT OF A PERSON WHOSE CONSIOUSNESS IS IMPAIRED TO SUCH AN EXTENT THAT HE IS FULLY NOT AWARE OF HIS ACTIONS. THE MAIN FACTORS PRODUCIING AUTOMATISM RECOGNISED BY CRIMINAL COURTS ARE : EPILEPSY, CONCUSSION, HYPOGLYCEMIA, SOMNABULISM
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 SOMNABULISM SOMNOLENTIA IMPULSE HYPNOTISM OR MESMERISM DELIRIUM DRUNKENNESS

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REFERENCES
TEXT BOOK OF FORENSIC MEDICINE AND TOXICOLOGY BY DR NARAYAN REDDY TEXT BOOK OF FORENSIC MEDICINE AND TOXICOLOGY BY V.V PILLAI PARIKHS TEXT BOOK OF MEDICAL JURISPRUDENCE FORENSIC MEDICINE AND TOXICOLOGY TEXT BOK OF PSYCHIATRY BY B.K PURI, P.J. LAKING, I.H. TREASADEN www.disabilityindia.org/mentalact.cfm
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