Forensic - Mentor & more Flashcards
1
Q
What is the prevalence of fire setting in the general population?
A
About 1%
Almost all individuals with a lifetime history of fire setting have lifetime or current psychiatric comorbidity.
2
Q
What was the most prevalent diagnosis found in the NESARC study regarding fire setting?
A
Alcohol use disorder
High rates of antisocial personality disorder were also noted.
3
Q
What did the Bradley Report recommend for addressing mental health in the criminal justice system?
A
82 recommendations for change, including a national network of Criminal Justice Mental Health teams
Suggested to divert individuals towards support services from police stations and courts.
4
Q
What are the three main categories of criminal offences in England and Wales?
A
- Summary offences
- Triable either way offences
- Indictable offences
5
Q
What is the maximum penalty for summary offences?
A
Six months imprisonment and/or a fine of up to 5000 pounds
6
Q
What types of cases do the Crown Court deal with?
A
- Serious criminal cases
- Appeals against Magistrates’ Court decisions
- Cases sent for sentence from Magistrates’ Courts
7
Q
What must be proven for a person to be found guilty of a crime?
A
Actus reus (committed the act) and mens rea (guilty mind)
8
Q
At what age can children be found criminally responsible in England?
A
10 years old
Children under 10 cannot be arrested or charged with a crime.
9
Q
What is the purpose of the McNaughten rules?
A
To determine if a person can be found not guilty by reason of insanity
10
Q
What are the two forms of automatism?
A
- Insane automatism
- Sane automatism
11
Q
What does Diminished Responsibility allow in a murder case?
A
Reduces a normal life sentence to manslaughter
12
Q
What is the DUNDRUM toolkit used for?
A
To distinguish between patients needing different levels of therapeutic security and urgency of need
13
Q
What are the Pritchard criteria for fitness to plead?
A
- Able to instruct solicitor and counsel
- Understand the charges
- Decide on plea
- Follow court proceedings
- Challenge a juror
- Give evidence in defence
14
Q
What is the role of a judge in determining fitness to plead?
A
Decide if a person is fit to plead, not a jury
15
Q
What is the historical context of forensic psychiatry in Great Britain?
A
Expansion in forensic mental health services occurred post-1975 due to the Butler Report
16
Q
What does the HCR-20 assess?
A
Risk of future violence
17
Q
How many items does the HCR-20 consist of?
A
20 items
18
Q
What constitutes violence according to the HCR-20?
A
Actual, attempted, or threatened infliction of bodily harm
19
Q
What are the three categories of homicide defined under the Homicide Act 1957?
A
- Murder
- Manslaughter
- Infanticide
20
Q
What percentage of homicide convictions in the UK were patients under mental health services?
A
11%
21
Q
What is the age-standardised rate for homicide in people with schizophrenia?
A
Around 0.1 / 100,000
22
Q
What is the relationship between mental disorder and homicide?
A
There is a significant association, particularly with schizophrenia and personality disorder
23
Q
What percentage of perpetrators of patient homicide were male according to the review?
A
80%
The mean age of perpetrators was 37.
24
Q
What is filicide?
A
The act of a parent killing their child under the age of 18.
25
What is infanticide?
The killing of an infant by a parent from birth to 12 months.
26
What is neonaticide?
The killing of an infant by a parent within the first 24 hours of life.
27
What term refers to the killing of one's husband?
Mariticide.
28
What is matricide?
The act of killing one's mother.
29
What is patricide?
The act of killing one's father.
30
What is fratricide?
The act of killing one's brother.
31
What is uxoricide?
The act of killing one's wife.
32
What is sororicide?
The act of killing one's own sister.
33
What is the legal definition of infanticide under UK law?
Only a biological mother who kills her own child within 12 months of birth can raise the defence of infanticide.
34
What are common characteristics of neonaticide perpetrators?
Young (under 20), single, living at home, first unintentional concealed pregnancies.
35
What motivates most neonaticides?
The child was unwanted.
36
What is the peak age of offending for girls in the UK?
14 years.
37
What is the peak age of offending for boys in the UK?
17-18 years.
38
What is the male to female ratio of convicted offenders in the UK?
5 to 1.
39
What is the DSM-5's definition of a paraphilia?
Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with consenting partners.
40
What is voyeuristic disorder?
Recurrent and intense sexual arousal from observing an unsuspecting person who is naked or engaged in sexual activity.
41
What is exhibitionistic disorder?
Recurrent and intense sexual arousal from exposing one's genitals to an unsuspecting person.
42
What is frotteuristic disorder?
Recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person.
43
What is sexual masochism disorder?
Recurrent and intense sexual arousal from being humiliated, beaten, bound, or made to suffer.
44
What is sexual sadism disorder?
Recurrent and intense sexual arousal from the suffering of another non-consenting person.
45
What is paedophilic disorder?
Recurrent, intense sexually arousing fantasies or urges involving sexual activity with a prepubescent child.
46
What is fetishistic disorder?
Recurrent and intense sexual arousal from the use of non-living objects or a specific focus on nongenital body parts.
47
What is transvestic disorder?
Recurrent and intense sexual arousal from crossdressing.
48
What is pathological intoxication?
Sudden onset of aggressive behavior after drinking small amounts of alcohol, not typical of the patient while sober.
49
What does Penrose's law relate to?
A cross-sectional study published in 1939 regarding the relationship between mental illness and criminal behavior.
50
What is the term used to describe the sudden onset of aggressive and often violent behaviour after drinking small amounts of alcohol?
Pathological intoxication
## Footnote
This condition is characterized by aggressive behavior not typical of the individual while sober, often followed by amnesia.
51
What relationship did Lionel Penrose demonstrate in his 1939 study regarding mental hospital beds and crime rates?
An inverse relationship
## Footnote
Increasing the number of mental institution beds could reduce serious crimes and imprisonment rates.
52
What are the criteria for antisocial personality disorder according to DSM-5?
* Failure to conform to social norms
* Deceitfulness
* Impulsivity
* Irritability and aggressiveness
* Reckless disregard for safety
* Consistent irresponsibility
* Lack of remorse
## Footnote
The individual must be at least 18 and evidence of conduct disorder must be present before age 15.
53
What is the prevalence estimate of antisocial personality disorder in men?
1%-6%
## Footnote
This varies depending on the measures used.
54
What are the common manifestations of dissociality in antisocial personality disorder?
* Self-centeredness
* Lack of empathy
## Footnote
This includes behaviors like being deceptive, manipulative, and aggressive.
55
What is the first standardized measure of psychopathy developed in 1980?
Hare Psychopathy Checklist, Revised (PCL-R)
## Footnote
It is a 20-item checklist scored out of 40.
56
Fill in the blank: The prevalence of 'any personality disorder' among male remand prisoners is _____%.
78%
## Footnote
This statistic reflects findings from the 1997 survey on prisoner mental health.
57
What percentage of female prisoners were found to have antisocial personality disorder according to the 1997 study?
31%
## Footnote
Antisocial personality disorder was the most common personality disorder in female prisoners.
58
What is the primary focus of the Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)?
Predicting the risk of sex offence recidivism
## Footnote
It includes factors such as past convictions and the age of the offender.
59
What is the main difference between psychopathy and antisocial personality disorder?
Psychopathy includes personality-based symptoms, while APD focuses on behavioral difficulties
## Footnote
Psychopathy is considered a broader concept.
60
What is the prevalence of functional psychosis in male sentenced prisoners according to the 1997 study?
7%
## Footnote
This rate was higher among female prisoners at 14%.
61
What is the main method for assessing risk to others as advocated by the Royal College of Psychiatrists?
Structured professional judgement
## Footnote
This method combines professional judgment with static and dynamic risk factors.
62
What is the purpose of the Historical-Clinical-Risk Management-20 (HCR-20) tool?
To assess violence risk
## Footnote
It consists of 20 items including historical, clinical, and risk management factors.
63
According to a study, what percentage of people convicted for homicide had schizophrenia?
5%
## Footnote
This study highlighted characteristics such as gender and previous convictions among those with schizophrenia.
64
What is the common relationship between perpetrators and victims in serious sexual offences?
Partner or ex-partner
## Footnote
Assault by a stranger occurs in approximately 1 in 7 cases for women.
65
True or False: The majority of stalking victims are assaulted.
False
## Footnote
Only 10 to 33 percent of stalking victims are assaulted.
66
What is the estimated percentage of boys who develop symptoms of antisocial personality disorder earlier than girls?
80%
## Footnote
Symptoms typically have their onset before age 8.
67
What is the prevalence of assault by a stranger among women?
Occurs in approximately 1 in 7 women
68
What percentage of male victims experience assault by a stranger?
Approximately 40%
69
Where do most assaults tend to occur?
Either victims' or perpetrators' home
70
In what percentage of assaults is alcohol implicated?
About 40%
71
What percentage of assault victims tell someone about the incident?
70%
72
What percentage of assault victims report the incident to the police?
Close to 15%
73
What is stalking?
A common behavior that causes significant distress to victims
74
What percentage of stalking victims are assaulted?
10 to 33 percent
75
What percentage of stalking victims are explicitly threatened?
Between 30 and 40 percent
76
What is the typical duration of intrusive behavior in stalking situations?
Lasting only a few days and not extending beyond two weeks in nearly 50% of cases
77
What is the risk of being stalked by a patient or a patient's relative over a career?
Around 20%
78
What is the average suicide rate among prisoners per 100,000 population per year for 1999-2000?
133
79
What is the suicide rate for remand prisoners per 100,000 population per year?
339
80
What percentage of suicides occur within 7 days of reception into prison?
32%
81
What is the most common method of suicide among prisoners?
Hanging or self-strangulation (92%)
82
What percentage of prisoners had at least one known psychiatric diagnosis?
72%
83
What is the most common primary diagnosis among prisoners?
Drug dependence (27%)
84
What factors increase the risk of suicide in prisoners?
* Being in a single cell
* Being married
* Being male
* Having a psychiatric illness
* Having a history of substance misuse
* Having a history of previous self-harm or attempted suicide
* Recent suicidal ideation
* Being on remand
85
What is the relationship between mental disorder and violence according to epidemiological studies?
People with mental disorders are more likely to be violent than community controls
86
What significantly increases the risk of violence in people with mental disorders?
Substance misuse
87
What mediates the increased risk of violence in individuals with mental disorders?
Active psychotic symptoms
88
What are the key recommendations for rapid tranquillisation according to NICE?
* P.R.N medication should not be prescribed routinely
* Use IM lorazepam alone or IM haloperidol + IM promethazine
89
What are some environmental risk factors for violence in inpatient settings?
* Lack of structured activity
* High use of temporary staff
* Low levels of staff-patient interaction
* Poor staffing levels
* Poorly defined staffing roles
* Unpredictable ward programmes
* Lack of privacy
* Overcrowding
* Poor physical facilities
* Availability of weapons
90
What is the Violence Risk Appraisal Guide (VRAG)?
The most widely used actuarial tool for violence offence recidivism
91
What are some items included in the VRAG?
* Revised Psychopathy Checklist score (PCL-R)
* Separation from either biological parent by age 16
* Elementary school maladjustment score
* Alcohol problems
* Never married
* Criminal history score for non-violent offences
* Failure on prior conditional release
* Age at index offence
* Most serious victim injury
* Female victim in the index offence
* Meets DSM-III criteria for any personality disorder
* Meets DSM-III criteria for schizophrenia
92
Other measures for child under 10 in the justice system?
- Local child curfew
- Child safety order
93
what is local child curfew?
Police impose a curfew, banning children from public places between 9 pm and 6 am unless accompanied by an adult
94
duration of local child curfew?
90 DAYS
95
what is child safety order?
IMPOSED IF A CHILD COMMITS AN OFFENCE OR BREAKS A CURFEW, PLACING HTME UNDER THE SUPERVISION OF A YOUTH OFFENDING TEAM FOR UP TO 3 MONTHS OR UP T0 12 MONTHS.
96
WHAT DOES non-compliance of child safety order results in?
child being taken into care
97
age 10 - 17 which court are they dealth with?
dealth with in youth courts
98
how are sentences different on 10-17
focus on rehabilitation
99
are 10-17 sent to adult prisons?
to secure centres for young people
100
are 18 and over dealth with with same court of adults?
yes
101
are 18 and over sent to the same priison of adults?
no to special facilities for 18-25
102
macnaughten rule?
did not understand the quality or nature of the act
did no know what they were doing was wrong
did not percieve it because of delution?
103
complete defense?
Self defence
Defence of others
Insanity
Automatism
104
how is unfitness to plead is dealt with if raised by defence?
it bears the burden to establish that the accused is under a disability on a balance of probabilities
105
how is unfitness to plead is dealt with if raised by judge or prcecutions?
It has to be proved beyond a reasonable doubt
106
amnesia can make someone unfit to plead. True of false
false
107
what is HCR-20?
combination of structured professional judgement and an actuarial tool
108
scoring on HCR-20?
0= factor not present
1= factor partially present or possible
2=factor present
109
what does total score on HCR-20 do?
informs a professional judgement
110
Historial items (static) on HCR-20?
VORESM PT VT
Violence
Other antisocial behaviors
Relationships
Employment
Substance abuse
Major mental disorder
Personality disorder
Traumatic experience
Violent atittude
Treatment or supervision response (previous failure)
111
Clinical (dynamic-present)
LATIV
Lack of insight
Active symptoms of major mental disorder
Treatment respons
Instability (affective, behavioural or cognitive)
Violence
112
Environmental (dynamic -future)
Professional services and plans (feasible?)
Living situation
Lack of personal support
Treatment or supervision
Stress or copping
113
Risk factors for homicide for infants older than 1 day?
younger
Male
Family Hx of violence
Evidence of past abuse or neglect of child
Violence in current relationship
Personality disorder
114
what crimes are predominantly seen in learning disability?
Property damages
115
what crimes are overrepresented in learning disability?
sexual offence and arson
116
what severity of LD is more likely to commit offence?
Mild LD
117
---- in 20 or ----% of patient with mental illness commit violent crime
1/20
5%
118
what is voluntary manslaugter?
killing with purpose of murder but where a partial defence applies such loss of control, diminished responsibility, killing pursuant to a suicide
119
infanticide is treated as .......
manslaughter (not murder)
120
which paraphilic disorder are not separated by ICD 11?
masochism
transestic disorder
fetishistic
121
age specification for paedophilia in dsm 5?
The individual must be at least 16 and more than 5 years older than the victim
122
duration required for all paraphilc disorders on DSM -5 vs ICD11
dsm - 6 months
icd not specified
123
age limitation for voyerism in dsm -5 vs icd 11?
dsm 18 years
icd not specified
124
Treatment modalities for the paraphilias have ---
limited scientific evidence to support their use.
Psychological therapy (especially CBT) is often used (with extremely variable results).
125
Pharmacological options for paraphilia
SSRI
Data from small studies has shown some benefit in reduction of thoughts, urges, and behaviour
125
harmacological options for paraphilia
Naltrexone
Data from small study showed some reduction of thoughts, urges, and behaviour
126
harmacological options for paraphilia
Antipsychotic
Small studies have shown only weak treatment effects
127
harmacological options for paraphilia
GnRH agonists
Reduce testosterone.
Have been shown to reduce paedophilic sexual thoughts/urges/desire and masturbatory frequency.
Bone demineralisation along with hot flushes are potential side-effects.
Relapse after stopping is consistently reported across different studies
128
harmacological options for paraphilia
Anti-androgens and progestational drugs (e.g. cyproterone acetate)
Reduce testosterone. Has been shown to reduce sexual outlet scores, spontaneous daytime erection and/or orgasm during masturbation in sex offenders. That said, responses are highly variable
129
harmacological options for paraphilia
130
mania a potu
pathological intoxication
