Forensic Psychiatry Flashcards
What is the difference between
a) Filicide
b) Neonaticide
c) Infant homocide
a) Kiling of child < 18 year
b) Killing of baby < 24hrs old
c) Killing of infant in first year of life
Outline some characteristics of perpetrators of neonaticide
- Mothers > Fathers
- Unwanted pregnancy –> mother try and get rid of the baby and carry on with her life
- Death may be violent but also neglect
- Not always mentally ill
- No sex difference in neonate
Outline some characteristics of perpetrators of infant homocide?
Risk factors
- Boys > Girls
- Past abuse of children
- Younger infants
- FHx of violence
- Personality disorder and/or depression
Outline the Pritchard criteria (1836 case law) dictating fitness to plead?
6 criteria:
- Must be able to instruct his solicitor
- Must understand the charge
- Must be able to decide whether to plead guilty or not guilty
- Must be able to follow court proceedings
- Must know they can challenge a juror
- Must be able to give evidence for their own defence
n.b
- If raised by the defence it must be established on a balance of probability
- If raised by the judge it must be established beyond reasonable doubt
- Originally devised for cases of intellectual impairment or disability however now only a third tend to have LD - majority have schizophrenia
How is a patient managed if they are unfit to plead?
Criminal procedures act (1991):
- Trial of facts
- Flexible disposition if facts are found however if murder charge mandatory admission to hospital
- Complete acquittal if no facts
Only a biological mother who kills her child < 12 months can be charged with or use BLANK as a defence
Neonatacide
When is a crime of murder committed?
A person of:
- Sound mind
- Unlawfully kills (not self defence of other justified killing)
- Any reasonable human creature
- In being (born alive and breathing through its own lungs)
- In the Queens Peace
- With intent to kill or cause GBH
Outline the ways manslaughter can be committed?
Voluntary:
1) Killing with intent for murder but partial defence applies - loss of control / killing in suicide pact / diminished responsibility
Involuntary:
2) Grossly negligent given risk of death and did kill - gross negligence or medical manslaughter
3) Conduct resulting in unlawful act involving a danger of some harm, that resulted in death, is manslaughter (‘unlawful and dangerous act manslaughter’)
What is pathological intoxication
Mania a potu
- Rare legal defence raised when someone drinks small amount (that would not get others intoxicated) of alcohol becomes very intoxicated and acts out of character and has partial or complete amnesia
No slurred speech, no diplopia, no ataxia or moto-incoordination
Outline DSM-V criteria of antisocial personality disorder?
A pervasive pattern of disregard for and violation of the rights of others occuring since age 15 as manifested by 3 of:
- Failure to conform to social norms with respect to lawful behaviours
- Deceitfulness as indicated by repeated lying or conning of others for pleasure or personal profit
- Impulsivity or failure to plan ahead
- Reckless disregard for the safety of self or others
- Irresponsibility to sustain work or financial obligations
- Lack of remorse as indicated by indifference to hurting others or stealing
The individual must be 18
There must be evidence of conduct disorder before 15
What score of the Hare Psychopathy checklist indicates psychopathy?
30/40
Includes two broad factors and four domains
Interpersonal/Affective
- Interpersonal
- Affective
Social Deviance
- Lifestyle
- Anti-social
Outline some findings from the Psychiatric Morbidity Survey of Prisoners (1997)
Personality disorders
- Any male on remand 78%, sentenced 64% vs. 50% female prisoners
- Anti-social personality disorder most common followed by paranoid (63% male remand, 49% male sentenced, 33% female sentenced) followed by paranoid for men/borderline for female
Self-harm and suicidal ideation:
- Self-harm and suicide attempts more common for remanded > sentenced prisoners
- Females > Males
Psychosis:
- Functional psychosis 14% males on remand, 10% males sentenced, 7% females
Most prisoners are male:
- 46,872 male sentenced prisoners (76%)
- 12,302 male remand prisoners
- 2,770 female prisoners (<5%)
How is violence defined in HCR-20?
Actual, attempted or threatened bodily harm that is wilful (or reckless if aware of potential consequences)
Includes: physical + psychological harm + threats
Excludes: self-defence, legally sanctioned violence e.g. sports/law enforcement, damage to property or animals except in an attempt to cause fear
Describe the domains and their individual factors on the HCR-20?
Historical (static)
H1 Violence (previous)
H2 Other antisocial behaviour
H3 Relationships (instability)
H4 Employment (problems)
H5 Substance use problems
H6 Major mental disorder (psychotic and mood)
H7 Personality disorder
H8 Traumatic experiences
H9 Violent attitudes
H10 Treatment or supervision response (prior supervision failure)
Clinical (dynamic)
C1 Lack of insight
C2 Violent ideation or intent
C3 Active symptoms of Major Mental Illness
C4 Instability (affective, behavioural, or cognitive)
C5 Treatment response (compliance and responsiveness)
Risk management (dynamic)
R1 Professional services and plans (are plans feasible)
R2 Living situation (exposure to destabilizers)
R3 Lack of personal support
R4 Treatment or supervision response
R5 Stress or coping
W
Each item is scored:
- 0: not present or not relevant to risk of violence
- 1: partially present - not fully present or inconclusive evidence
- 2: clearly present and relevant to their risk of violence
What type of risk assessment tool is HCR-20?
Structured professional judgement
What rate of individuals with psychosis commit homicide each year?
1 in 10,000
The peak age of offending for men and women is?
14 years & 40 - 50 years - women
17 - 18 years men
50% of indictable crimes are of perpetrators < aged 21
5M : 1F ratio for crimes
How much of UK serious crime is due to arson?
1% - rape and homicide and 3 x more common
80% are men
Higher frequency with LD and alcohol use
40% of arsons are started deliberately
For old age prisoners how many have a psychiatric diagnosis?
53%
30% had depressive disorder
30% had a personality disorder (8% ASPD)
1% had dementia
What percentage of men and women are victims of serious sexual offence in the last 12 month (inc. assault and rape)?
0.5% Women
0.1% Men
41% of sexual offences are for assault (inc. attempt), 30% for rape and others include voyerism, sexual offences with a minor
90% of the most serious sexual offences knew the perpetrator
What crimes do individual with LD typically commit?
Property damage (sexual offences and arson also over-represented by individuals with LD)
Typically those with mild + moderate LD as less individuals generally have severe LD and crimes that involve planning are harder to arrange
What is the DUNDRUM tool?
A group of structured professional judgement tools that help to decide what level of therapeutic security is needed for forensic patients
Created at Central Mental Hospital in Dundrum
Dangerousness, Understanding, Recovery, Urgency, Manual
DUNDRUM-1Triage Security
DUNDRUM-2 Triage Urgency
DUNDRUM-3 Programme Completion
DUNDRUM-4 Recovery Items
