Forensic – 2

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18 Forensic – 2

	T	F
1. Adversarial cases are always tried by jury.
2. The patient has the right to object to a Court of Protection order.
3. Consent to operate on a severely mentally handicapped person may be given by a doctor.
4. In overtly aggressive patients, it is dangerous to interpret the patient’s anger.
5. Medicolegal reports requested by the Court should always be revealed to both parties.
6. Regarding medical reports in litigation cases, the psychiatrist is in a contractual relationship with the litigant for the report.
7. Fitness to plead is affected by amnesia for the criminal event.
8. Compensation neurosis is particularly common after accidents involving loss of consciousness.
9. Two-thirds of juvenile offenders have a family history of high crime rate.
10. Indecent exposure is most likely to be directed at teenagers.
11. Aetiological possibilities in a 65-year-old male with a good pre-morbid personality who exposes himself in public for the first time include pneumonia.
12. In sex offenders with learning disabilities the ineffectiveness of preventative work is indicated by the increasing number of hospital orders.
13. People with learning difficulties are more likely to commit serious acts of violence.
14. A full history and mental state examination will in most cases result in disclosure of intra-familial abuse.
15. The accounts of patients who report memories of sexual abuse for the first time during or after psychological therapy are usually reliable.
16. Young girls are twice as likely as young boys to be targeted by paedophiles.
17. Erotomania is the commonest delusion in stalkers.
18. A 50-year-old woman with no previous offences is convicted of shoplifting. It is likely that she was depressed at the time of the offence.
19. Arsonists are over-represented among learning-disabled offenders.
20. A conviction of arson leads to a compulsory custodial sentence.
21. Alcohol is frequently associated with crimes of murder.
22. McNaughton was acquitted of murder on grounds of insanity.
23. In homicide followed by suicide, there are more likely to be multiple murders.
24. Mothers who kill their children within 24 h of birth would usually have gone through their pregnancy with denial or dissociation.
25. XYY is present more often in forensic settings.

ANSWERS

1. Adversarial cases are always tried by jury.

False: The adversarial system is adopted in all criminal and civil courts in England. Juries are involved only in Crown Courts, not in Magistrates’ Courts (Stone et al 2000, p. 25).

2. The patient has the right to object to a Court of Protection order.

True: The Court of Protection in England is an office of the Supreme Court. It can take total control over the property and affairs of a mentally incapable person. It appoints a Receiver, who could be a close relative, or a solicitor, or a local authority, to look after the patient’s property. There are provisions for the patient or his solicitor to apply to the Court for discharge, with a supporting medical report. The Royal College of Psychiatrists has published guidelines for doctors preparing medical reports for the Court of Protection (Chiswick & Cope 1995, p. 320; Gunn & Taylor 1993, p. 199).

3. Consent to operate on a severely mentally handicapped person may be given by a doctor.

False: The doctor cannot consent on behalf of a person who lacks the capacity to consent. However, the doctor can take the decision to operate for emergency treatment in order to save the patient’s life or to alleviate serious suffering.

4. In overtly aggressive patients, it is dangerous to interpret the patient’s anger.

False: The patient might have set off a maladaptive violent response as a result of an automatic thought. Interpreting the patient’s anger could help to arrest that violent response (Bluglass & Bowden 1990, p. 666).

5. Medicolegal reports requested by the Court should always be revealed to both parties.

True: A medicolegal report may be requested from a psychiatrist in criminal or civil cases. The request could come from the Court, from the Crown Prosecution Service or the defending solicitor. The report requested by the Court or by the Crown Prosecution Service will be disclosed in open Court to both parties. A report requested by the defence solicitor, on the other hand, may be retained by the solicitor if it does not help his client.

6. Regarding medical reports in litigation cases, the psychiatrist is in a contractual relationship with the litigant for the report.

False: The psychiatrist has a contractual relationship with the Court and no other body for the purpose of the report.

7. Fitness to plead is affected by amnesia for the criminal event.

False: The test of fitness to plead derives from R vs. Pritchard (1836). The test is of the following:

• To plead with understanding to the indictment,

• To comprehend the course of proceedings to make a proper defence,

• To know that he might challenge a juror,

• To comprehend the details of evidence and

• To be able to instruct legal advisors.

There is no connection with amnesia for the criminal event (Gunn & Taylor 1993, p. 44; Johnstone et al 2004, p. 717; Stone et al 2000, p. 55).

8. Compensation neurosis is particularly common after accidents involving loss of consciousness.

False: The level of psychological damage is more important than the severity of the injury. There is no correlation with the nature and severity of injuries (Gunn & Taylor 1993, p. 415).

9. Two-thirds of juvenile offenders have a family history of high crime rate.

False: There is undoubtedly a family link but the influence is not as high as two-thirds. Other mediating factors like schooling, neighbourhood and life experiences need to be taken into account.

10. Indecent exposure is most likely to be directed at teenagers.

True: The victims are often pubescent or pre-pubescent girls (Gunn & Taylor 1993, p. 547; Stone et al 2000, p. 215).

11. Aetiological possibilities in a 65-year-old male with a good pre-morbid personality who exposes himself in public for the first time include pneumonia.

True: The commonest illnesses in elderly offenders are affective illnesses, dementia, poor physical health and alcoholism. Though rare, this could represent disturbed behaviour in the context of delirium secondary to pneumonia (Gunn & Taylor 1993, p. 325).

12. In sex offenders with learning disabilities the ineffectiveness of preventative work is indicated by the increasing number of hospital orders.

False: Preventative work, e.g. sex education and counselling, is strongly indicated, along with supervision. Hospitalization is indicated only for the rare serious cases (Chiswick & Cope 1995, p. 74).

13. People with learning difficulties are more likely to commit serious acts of violence.

False: There is an association between learning difficulty and sexual offences, particularly exposure in males, and arson. No other crime is closely associated with learning disabilities. There is no specific evidence for increased incidence of murder or other acts of violence (Bouras 1999, p. 233; Gelder et al 2006, p. 735).

14. A full history and mental state examination will in most cases result in disclosure of intra-familial abuse.

False: Not unless there is good rapport and one asks for it specifically. Even then, disclosure is notoriously difficult.

15. The accounts of patients who report memories of sexual abuse for the first time during or after psychological therapy are usually reliable.

True: The incidence of false allegation, even in cases of custody battles, where there is clear evidence of advantage in court from the disclosure, is about 2%.

16. Young girls are twice as likely as young boys to be targeted by paedophiles.

True: According to a MORI survey of the population of Great Britain, the number of women sexually abused before the age of 16 was approximately twice that of men (Bluglass & Bowden 1990, p. 740).

17. Erotomania is the commonest delusion in stalkers.

True: Erotomanic delusions are the commonest in stalkers. However, delusions of jealousy, persecutory delusions, querulant delusions and misidentification syndromes are also encountered. The erotomanic delusions may be due to primary erotomania, or may be a feature of other disorders, such as schizophrenia, bipolar disorder or major depression (Gelder et al 2006, p. 742; Johnstone et al 2004, p. 708).

18. A 50-year-old woman with no previous offences is convicted of shoplifting. It is likely that she was depressed at the time of the offence.

False: Most shoplifting has no association with any mental disorder. Only a minority suffer from psychiatric disorders. They include depressives, those with substance misuse who may steal because of economic necessity, those with eating disorders who steal food impulsively, those with organic mental disorders who are confused, distracted or forgetful and those who may run out of the shop without paying in a panic attack. An association between shoplifting and depression is largely derived from historical literature. Folklore and anecdote point to an association between shoplifting and depression in the elderly, but the evidence is poor (Gelder et al 2000, p. 2052; Johnstone et al 2004, p. 715; Wright et al 2005, p. 469).

19. Arsonists are over-represented among learning-disabled offenders.

True: People with learning difficulties are more likely to commit fire-setting offences or sexual offences. The reasons may include conflicts that are difficult to verbalize, displaced passive aggression, or a sense of power or excitement. Arson is a common index offence among people with learning difficulties in secure hospitals (Gelder et al 2000, p. 2047; Stone et al 2000, p. 203; Johnstone et al 2004, p. 715).

20. A conviction of arson leads to a compulsory custodial sentence.

False: Only a tiny proportion of arsonists receive a psychiatric disposal in court. There is no mandatory sentence (Johnstone et al 2004, p. 715).

21. Alcohol is frequently associated with crimes of murder.

True: In a Scottish sample of 400 individuals charged with murder, 58% of males and 30% of females were intoxicated at the time of the crime. Over a third of the victims also were abusing alcohol (Gelder et al 2000, p. 2047).

22. McNaughton was acquitted of murder on grounds of insanity.

True: A verdict of Not Guilty by Reason of Insanity (NGRI) is based on the McNaughton Rules. This states that ‘to establish a defence on the grounds of insanity, it must be clearly proved that at the time of committing the act, the accused party was labouring under such a defect of reason, resulting from disease of the mind, so as not to know the nature and quality of the act he was doing, or if he did know it, that he did not know that what he was doing was wrong’ (Gelder et al 2000, p. 2092).

23. In homicide followed by suicide, there are more likely to be multiple murders.

True: Killers who commit suicide are more likely to be responsible for several killings at one time. The majority kill their relatives. Spousal murder–suicide is the commonest type (Gelder et al 2006, p. 739; Gunn & Taylor 1993, p. 516).

24. Mothers who kill their children within 24 h of birth would usually have gone through their pregnancy with denial or dissociation.

False: D’Orban (1979) found that most offenders who attempted to kill children within 24 hours of birth had no demonstrable psychiatric abnormality (Chiswick & Cope 1995, p. 120).

25. XYY is present more often in forensic settings.

False: Up to 3% of patients in maximum security hospitals may have XYY karyotype. This was considered disproportionately high. It was also thought to reflect the dull-normal IQ along with judges taking a more serious view of an offender with above-average height. However, it is now known that the prevalence of XYY karyotype is much higher in the general population than previously thought (Bluglass & Bowden 1990, p. 376; Gelder et al 2000, p. 932; Johnstone et al 2004, p. 548).