Forensics

Question 1

Assault in ward (history)

Answer 1

History of assault (trigger, planning, weapons, consequences, remorse)
Mental state (PC, mood, hallucinations, delusions, passivity)
Risk (self, others, previous assaults, forensic history)

Question 2

Assault in ward (d/w CCN)

Answer 2

Summary of mental state and risk
Discuss pharmacological treatment (regular, prn, monitoring)
Discuss other management (familiar staff, seclusion, activities)
Fitness to plead (forensic Ax, Police i/v)

Question 3

Fire-setting (history)

Answer 3

History of event (trigger, planning, consequences, remorse)
Mental state (mood, hallucinations, delusions, passivity)
Risk (self, others, forensic history, ongoing intent)
Underlying triggers/childhood
Substance use

Question 4

Morbid jealousy (history)

Answer 4

HPC (onset, duration, triggers, evidence, stalking, future plans)
Risk (self, others, children, weapons, forensic Hx)
Mental state (mood, hallucinations, delusions, passivity)
Substance use
Past relationships

Question 5

Morbid jealousy (explanation)

Answer 5

Clarify diagnosis
Clarify risk (to her, forensic Hx, use of MHA)
Explain pharmacological treatment (antipsychotics)
Explain alternative management (psychology)
Long term management (passes, CMHT)

Question 6

Erotomania and stalking (history)

Answer 6

Explore relationship to victim (contact details, feelings, empathy)
Risk (victim, self, others, weapon, forensic Hx)
Past relationships
Mental state (mood, hallucinations, delusions, passivity)
Substance use

Question 7

Erotomania and stalking (d/w victim)

Answer 7

Summarise assessment
Explain risk (knowledge of address, fantasies etc)
Risk management (alternative accommodation, leave from work, Police)
Patient management (located and detained for assessment)
Other concerns

Question 8

Violence risk assessment (history)

Answer 8

HPC (event, plans, intent, intoxication)
Explore delusions
Hallucinations (quality, content, number, 2nd/3rd person, commentary, commands, insight)
Thought interference and passivity experiences
Risk (self, others, weapons, forensic Hx)
History (psych, medications, FHx)
Substance use

Question 9

Violence risk assessment (d/w consultant)

Answer 9

Summarise history and mental state
Risk assessment
Management (admission, medication, CPN)

Question 10

Sexual offence (history)

Answer 10

Circumstances of arrest
Explore patient’s view (arousal, remorse)
Psychosexual history (current and past relationships, pornography, attraction to children)
Psychiatric history (inc meds and FHx)
Risk assessment (self, others, contact with children, forensic history)
Substances

Question 11

Fitness to plead (assessment)

Answer 11

Understanding of charges
Possible consequences of charges
Difference between guilty/not guilty plea
Ability to instruct counsel
Ability to challenge a juror or witness
Basic understanding of court process

Question 12

Exhibitionism (history)

Answer 12

HPC (event, plans, intent, intoxication)
Patient’s attitude (arousal, remorse)
Psychosexual history (current and past relationships, pornography, attraction to children)
Forensic history
Psychiatric history and current mental state
Explore DDX (memory, personality change, physical Sx)

Question 13

Exhibitionism (collateral history/management)

Answer 13

HPC (witnessed, mood/personality changes)
Risk assessment (previous events, Police involvement)
Management (bloods, CT, cognitive testing, psychology)
Other concerns