ForensicPsychiatryF U N D A M E N T A L S A N DC L I N I C A L P R A C T I C E

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E D I T E D B Y

BASANT K. PURIHammersmith Hospital and Imperial College London, UK

IAN H. TREASADENWest London Mental Health NHS Trust, Southall , UK

ForensicPsychiatryF U N D A M E N T A L S A N DC L I N I C A L P R A C T I C E

CRC PressTaylor & Francis Group6000 Broken Sound Parkway NW, Suite 300Boca Raton, FL 33487-2742

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v

Contents

Preface xi

Contributors xiii

PART 1 BASIC SCIENCES 1

1 Functional neuroanatomy 3Basant K. Puri

2 Neurochemistry 15Basant K. Puri

3 Structural neuroimaging 21Basant K. Puri

4 fMRI and PET 29Basant K. Puri

5 Neurospectroscopy 37Basant K. Puri

6 Psychophysiology 39Yu Gao

7 Sleep science 45Christopher Idzikowski and Irshaad O. Ebrahim

8 Developmental psychology 51Nathalia L. Gjersoe and Catriona Havard

9 Psychology of memory and cognition 63Martin A. Conway, Mark L. Howe, and Lauren M. Knott

10 Psychology of aggression and violence 71Ian H. Treasaden

11 Anthropology 77Kalpana Elizabeth Dein and Simon Dein

12 Culture and forensic psychiatry 87Gurvinder S. Kalra, Dinesh Bhugra, and Nilesh Shah

13 Criminology 99Darrick Jolliffe and Stevie-Jade Hardy

14 Values-based practice 105K. W. M. (Bill) Fulford and Gwen Adshead

15 Epidemiology 111Basant K. Puri

16 Genetics 115Basant K. Puri

PART 2 CLINICAL FORENSIC PSYCHIATRY 123

17 History of forensic psychiatry and mental health law 125Ian H. Treasaden and Basant K. Puri

vi Contents

18 Relationship between mental disorder and crime: An overview 135Ian H. Treasaden

19 Organic mental disorder 143Basant K. Puri

20 Psychosis and violence 153Tom Clark

21 Mood disorders 159Camilla Haw

22 Substance abuse 165Basant K. Puri and Ian H. Treasaden

23 Gambling 173Sanju George and Henrietta Bowden-Jones

24 Personality disorders 181Ian H. Treasaden

25 Psychopathy 197Basant K. Puri

26 Adjustment disorders 203Patricia Casey

27 Malingering and factitious disorder 209James L. Knoll and Phillip J. Resnick

28 Learning disability 217Mike Isweran

29 Asperger’s syndrome 225David Murphy

30 Forensic aspects of ADHD 231Susan Young and Rafael A. González

31 Homicide 237Ian H. Treasaden

32 National confidential inquiry into homicide 245Mohammad Shaiyan Rahman and Jenny Shaw

33 Serial/spree/mass killings 251Jack Levin

34 Violence toward spouse or intimate partner 255Ian H. Treasaden

35 Violence toward children 261Ian H. Treasaden

36 Violence toward older adults 265Susan Mary Benbow and Paul Kingston

37 Violence in the workplace 271Ian H. Treasaden

38 Road rage 277Christine M. Wickens, Robert E. Mann, Jennifer Butters, Reginald G. Smart, and Gina Stoduto

39 Transsexualism 281James Barrett

40 Transvestism 285Anne A. Lawrence

41 Paraphilias 291Ian H. Treasaden

42 Rape 309Ross M. Bartels, Anthony R. Beech, and Leigh Harkins

43 Pornography 315Heather Wood

44 Fire setting (arson) and criminal damage 321Geoffrey L. Dickens and Philip Sugarman

45 Habit and impulse-control disorders, shoplifting, and other forms of acquisitive offending 327Ian H. Treasaden

Contents vii

46 Hostage taking 339David A. Alexander

47 Terrorism 347Simon Dein

48 Morbid jealousy 353Preeti Chhabra

49 Erotomania 359Robin P. D. Menzies

50 Stalking 365David V. James and Rachel D. MacKenzie

51 Munchausen syndrome 371John D. Sheehan

52 Munchausen syndrome by proxy 375Thomas A. Roesler and Carole Jenny

53 Juvenile delinquency 381Sharon Davies and Claire Dimond

54 Adolescent sex offenders 387James Rokop and Douglas P. Boer

55 The clinical care of women in secure hospital services 393Annie Bartlett

56 Elderly offenders 399Graeme A. Yorston

57 Ethnic minority offenders 405David Ndegwa

58 Deaf offenders with mental health needs 411Simon Gibbon, Amy Izycky, and Manjit Gahir

59 Military psychiatry 415Martin Deahl

60 Asylum seekers 421Heather McKee and Ian H. Treasaden

PART 3 LEGAL ASPECTS OF FORENSIC PSYCHIATRY 427

61 The criminal justice system of England and Wales 429Natalie Wortley

62 Police and Criminal Evidence Act 435Kevin Kerrigan

63 Mentally disordered detainees at the police station 441Frank Farnham and David V. James

64 Court diversion and liaison 445John A. Dent

65 Criminal proceedings and sentencing 451Ian H. Treasaden

66 Forensic social work and safeguarding adults at risk of harm 463Ian H. Treasaden

67 The parole board 465Claire Barkley

68 National Probation Service, National Offender Management Service, and Multi-Agency Public Protection Arrangements 471Ian H. Treasaden

69 Fitness to plead 477Tim Exworthy and Penelope Brown

70 Not guilty by reason of insanity (McNaughten rules) 483Rafiq Memon

71 Diminished responsibility 487Ian H. Treasaden

viii Contents

72 The defense of loss of control 495Raana Din

73 Infanticide 501Michael C. Craig

74 Automatism 507Irshaad O. Ebrahim and Christopher Idzikowski

75 Amnesia 511Natalie Pyszora and Michael Kopelman

76 Mutism 517Basant K. Puri and Ian H. Treasaden

77 False confessions and suggestibility 519Gisli H. Gudjonsson

78 Psychiatric aspects of miscarriages of justice 523Adrian Grounds

79 Mental Capacity Act 2005 529Robert Brown

80 Mental Health Act 1983 533Robert Brown

81 Mental health tribunals 539Carole Burrell

82 Care Quality Commission 549Robert Brown

PART 4 ASSESSMENT IN FORENSIC PSYCHIATRY 553

83 Clinical assessment 555Ian H. Treasaden

84 Psychological testing 559Derek Perkins and Daz Bishopp

85 Malingering 567Hannah Crisford and Hayley Dare

86 Drug screening 573Basant K. Puri and Ian H. Treasaden

87 Electroencephalography 577John Lumsden

88 Neuroimaging 583Basant K. Puri

89 Risk assessment: An overview 587Ian H. Treasaden

90 Violence assessment over the short term 597Johann Brink, Christopher D. Webster, Tonia L. Nicholls, Sarah L. Desmarais, and Mary-Lou Martin

91 Sexual violence 603Derek Perkins and Anisah Ebrahimjee

92 Report writing for the criminal court 613John O’Grady

93 Practical aspects of psychiatric report writing for the criminal courts 619Ian H. Treasaden

94 Report writing for the First-tier Tribunal 627Joan Rutherford

95 Report writing for the coroner’s court 635Lorna M. Tagliavini

PART 5 GIVING EVIDENCE 637

96 Expert evidence in criminal and civil courts 639Ian H. Treasaden

Contents ix

97 Giving evidence for the First-tier Tribunal 645Joan Rutherford

98 Giving evidence for the coroner’s court 651Lorna M. Tagliavini

99 Capital punishment 653Clarence Watson, Gregory B. Leong, and Spencer Eth

PART 6 TREATMENT 659

100 High-security hospitals: Ashworth, Broadmoor, and Rampton 661Kevin Murray

101 Medium secure units 667Ian H. Treasaden

102 Low-security and intensive care units 673Stephen Dye, Roland Dix, and Faisil Sethi

103 The UK private sector in forensic psychiatry 679Piyal Sen and Philip Sugarman

104 DSPD units in the hospital 683Geoffrey Ijomah

105 Personality disorder units in prison 693Malcolm Ramsay

106 Forensic mental health nursing 697Anne Aiyegbusi

107 Management of forensic psychiatry facilities 703Nicholas Broughton

108 Community forensic psychiatry 709Ramneesh Puri and Jeremy Kenney-Herbert

109 Managing personality disorder in the community 715Conor Duggan

110 Psychopharmacology: Some medicolegal aspects 721Malcolm Lader

111 Cognitive behavior therapy 727Clive R. Hollin

112 Dialectical behavior therapy in forensic settings 733André Ivanoff and Henry Schmidt III

113 Forensic individual psychotherapy 739Ronald Doctor and Leah Bruer Henen

114 Group psychotherapy 743John Gordon and Gabriel Kirtchuk

115 Interpersonal dynamics in forensic psychiatry 757Gabriel Kirtchuk, David Reiss, and Lakshmiramana Alla

116 Family therapy 765Jo Bownas

117 Sex offender treatment programs 771Jackie Craissati and Caoimhe McAnena

118 Reasoning and rehabilitation and enhanced thinking skills 777Estelle Moore, Catherine Farr, James Tapp, and Gareth Hopkin

119 Aggression management 783Kelly Reynolds and Niamh O’dwyer

PART 7 PRISONS 789

120 Types of prisons and security 791Ian Cumming

121 Prevalence of psychiatric disorder in prisons 797Basant K. Puri

x Contents

122 Suicide in prisons 805Amanda E. Perry

123 Disability in prisons 811Colin Goble and Sally French

124 Women in prisons 815Annie Bartlett and Nadia Somers

125 Psychiatric treatment in prison 823Ian Cumming

126 HMP Grendon 829Mark Morris

127 TBS in the Netherlands 833Corine de Ruiter and John Petrila

PART 8 VICTIMS 839

128 Assessment of psychological sequelae 841Nuri Gene-Cos

129 Post-traumatic stress disorder 847Laura Pratchett and Rachel Yehuda

130 Victims of torture 853Marianne Kastrup

PART 9 CIVIL MATTERS 857

131 Civil aspects of forensic psychiatry 859Ian H. Treasaden

132 Termination of pregnancy 867Patricia Casey

133 Negligence 875Lars Davidsson

134 Coroner’s court and inquests 881Lorna M. Tagliavini

135 The General Medical Council: Fitness to practice procedures and panels 885Eilish Gilvarry

136 Euthanasia 889Basant K. Puri

PART 10 ETHICAL ISSUES 891

137 Consent 893Lars Davidsson

138 Confidentiality 897Lynn Hagger

139 Duty to warn 903Colin Gavaghan

140 Human Rights Act of 1998 909Helen Fenwick and Daniel Fenwick

PART 11 INTERNATIONAL COMPARISONS OF FORENSIC PSYCHIATRY 915

141 International comparisons 917Basant K. Puri

Index 923

xi

Preface

In recent years, the sub-speciality of forensic psychiatry has rapidly developed and its focus has increasingly moved from institutions to the community. An essential element of forensic psychiatry is the interface between psychiatry and the crimi-nal justice system and associated criminal and mental health legislation. Among the many demands made on clinicians is keeping up to date with the ever increasing pace of develop-ments in forensic psychiatry knowledge in the biological and psychosocial spheres, including in criminology and clinical and forensic psychology, as well as developments in law, eth-ics and the criminal justice system. The usual cautionary legal principle that the reader should always refer to the latest pri-mary legislation is rarely realistic in day-to-day practice.

In particular, the basic sciences, including psychology, neuroanatomy, neurophysiology, neuroimaging, genet-ics, biochemistry, pharmacology, neuroscience and epi-demiology, have led to a better understanding of the basic mechanisms underlying clinical disorders seen in forensic psychiatry. This book, in particular, emphasises these devel-opments, which are often missing from previous forensic psychiatry texts, as well as the legal basis of forensic psy-chiatry, which has changed with new mental health and criminal legislation and developing case law.

The aim of this volume is to provide an up-to-date solid evidence-based, or at least informed, text. We have sought to strike a balance between being over inclusive and the need to produce a relatively concise book with key references, containing practical guidance on the assessment, including risk assessment, and management of offenders with men-tal disorder. Many of the contributors are acknowledged international leaders in their respective fields and have been centrally involved in the forefront of shaping forensic psy-chiatry research and practice.

Forensic psychiatrists, who increasingly work in mul-tidisciplinary teams and whose practice is increasingly challenged by other professionals, managers and, indeed, patients and their legal representatives, now have to be able to defend the evidence base to their practice, if they are to maintain their medical leadership role. Clinicians are under pressure to deliver high-quality, cost-effective, patient-focused care based on the best evidence available.

In this book, we aim comprehensively to describe the relevant basic sciences, criminal and mental health legisla-tion and clinical disorders and their treatment, including

all topics covered in the UK MRCPsych syllabus for foren-sic psychiatry, including the forensic aspects of child and adolescent psychiatry, old age psychiatry and disorders of intellectual development. Reference is made, in particular, to legislation in England and Wales, which underpins much mental health legislation worldwide. The clinical disorders described are, of course, universal. We believe that the book will not only cater to the needs of those working or training in forensic or other sub-specialities of psychiatry but also provide a valuable resource for other professionals work-ing within forensic psychiatry, forensic psychology or the criminal justice system.

To facilitate the aim of this project, the book is divided into major sections and chapters in a carefully considered order. Chapters have been standardised and cross-refer-enced and include important up-to-date references and gen-erous use of tables, figures, boxes and pictures. While the book strives to provide an integrated overview of current knowledge, chapters are also designed to stand alone, which inevitably implies some overlap in content between them, which we hope has been kept to an acceptable minimum.

We hope this book will achieve wide acceptance through its succinct, user-friendly and practical approach. While a textbook alone does not make a good forensic psychiatrist, we hope this will provide a sound foundation of theoreti-cal knowledge required for competent practice by clinicians today.

As editors, we would like to acknowledge the input and patience of our contributors and their willingness to update their contributions with the passage of time. We would also like to thank David Cochrane, Head of Forensic Social Work at West London Mental Health NHS Trust, for his advice regarding the chapters on forensic social work and MAPPA, although any errors are our own. We are also most grateful to our original commissioning editor, Caroline Makepeace, and our subsequent commissioning editors, Lance Wobus and George Zimmer, as well as Suzanne Lassandro, Production Manager, and Viswanath Prasanna, Senior Project Manager. We would also like to thank Elizabeth Stapf and Lynda Townsend for their extensive secretarial support.

Basant K. PuriIan H. Treasaden

http://taylorandfrancis.com

xiii

Contributors

Gwen AdsheadFormerly Consultant Forensic PsychotherapistBroadmoor Hospital; Currently Locum ConsultantForensic Psychiatrist Ravenswood HouseHants, UK

Anne AiyegbusiDirector and Consultant NursePsychological Approaches CICHonorary PsychotherapistEast London NHS Foundation TrustVisiting Fellow, Buckinghamshire New University

David A. Alexander MA(Hons) C Psychol PhD FRSM FBPS (Hon)FRCPsych

Emeritus Professor of Mental HealthRobert Gordon UniversityFormer DirectorAberdeen Centre for Trauma ResearchConsultant to the Scottish Police ServiceVisiting LecturerScottish Police CollegeAberdeen, UK

Lakshmiramana AllaConsultant Forensic PsychiatryStockton Hall HospitalPartnerships in CareYork, UK

Claire Barkley MBChB MSc MHSM FRCPsych

Consultant Forensic PsychiatristMedical DirectorSouth Staffordshire and Shropshire Healthcare NHS Foundation TrustPsychiatrist MemberParole Board for England and Wales (2001–2011)Member of GMC Fitness to Practice Panel (2011–present)

James Barrett BSc MSc FRCPsych

Consultant Psychiatrist and Lead ClinicianNational Gender Identity ClinicLondon, UK

Ross M. BartelsSenior Lecturer in PsychologySchool of PsychologyUniversity of LincolnLincoln, UK

Annie BartlettProfessor of Forensic PsychiatrySGUL and CNWL Foundation TrustIMBESt. George’s University of LondonLondon, UK

Anthony R. Beech DPhil FBPsS

Professor in Criminological PsychologyCentre for Forensic and Criminological Psychology School of Psychology University of BirminghamBirmingham, UK

Susan Mary Benbow MB ChB(Hons) MSc PGDip(Family Therapy)

FRCPsych PhD

Visiting Professor of Mental Health and AgeingCentre for Ageing StudiesFaculty of Health and Social CareUniversity of ChesterRiverside CampusChester, UK

Dinesh Bhugra CBE

Emeritus Professor of Mental Health and Cultural DiversityHealth Service and Population Research DepartmentInstitute of PsychiatryKing’s College LondonLondon, UK

Daz Bishopp PhD

Forensic Psychology at the School of PsychologyUniversity of BirminghamBirmingham, UK

Douglas P. Boer PhD

Professor of Clinical PsychologyCentre for Applied PsychologyFaculty of HealthUniversity of CanberraCanberra, Australia

Henrietta Bowden-JonesConsultant Psychiatrist and Lead ClinicianNational Problem Gambling ClinicHonorary Senior LecturerImperial CollegeLondon, UK

xiv Contributors

Jo BownasConsultant Systemic Family TherapistWest London Mental Health TrustForensic ServiceLondon, UK

Johann Brink MBChB FRCPC

Department of PsychiatryUniversity of British ColumbiaForensic Psychiatric Services CommissionProvincial Mental Health and Substance UseVancouver, British Columbia, Canada

Nicholas Broughton MB BChir(Cantab) FRCPsych

Chief Executive and Consultant in Forensic PsychiatristSomerset Partnership NHS Foundation TrustBridgewater, Somerset, UKandFormerly Medical Director West London Mental Health NHS Trust, London, UK

Penelope Brown BSc (Hons) BMBCh LLM MRCPsych

Clinical Research Fellow in Forensic PsychiatrySouth London and Maudsley NHS Foundation Trust and Institute of PsychiatryKings College LondonLondon, UK

Robert BrownSocial WorkerVisiting Fellow at Bournemouth UniversityPoole, UK

Jennifer Butters PhD

Owner, JB Editing Consulting ServicesToronto, Ontario, Canada

Carole BurrellSolicitorSenior LecturerSchool of LawNorthumbria UniversityNewcastle upon Tyne, UK

Patricia CaseyConsultant PsychiatristMater Misericordiae University HospitalandEmeritus Professor of PsychiatryUniversity CollegeDublin, Ireland

Tom ClarkConsultant Forensic Psychiatrist andHonorary Senior Clinical Lecturer in Forensic PsychiatryBirmingham and Solihull Mental Health NHS Foundation Trust and University of BirminghamReaside Clinic, Birmingham Great ParkBirmingham, UK

Preeti Chhabra MA (Cantab) MBBS MRCPsych MSc

Consultant Forensic PsychiatristWest London Forensic ServicesWest London Mental Health TrustLondon, UK

Martin A. ConwayCentre for Memory and LawDepartment of PsychologyCity University LondonLondon, UK

Michael C. Craig PhD FRCOG FRCPsych

Clinical Senior LecturerDepartment of Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology and NeuroscienceKings College LondonLondon, UK

Jackie CraissatiOxleas NHS Foundation TrustLondon, UK

Hannah CrisfordClinical PsychologistMen’s Forensic DirectorateWest London Mental Health TrustLondon, UK

Ian CummingSouth London and Maudsley NHS Foundation TrustInstitute of PsychiatryKings College LondonLondon, UK

Hayley DareConsultant Clinical PsychologistClinical LeadWomen’s Forensic DirectorateWest London Mental Health TrustLondon, UK

Lars Davidsson MRCPsych MEWI

Consultant PsychiatristMedical DirectorPrittlewell HouseEssex, UK

Sharon DaviesConsultant Child and Adolescent PsychiatristCity and Hackney Specialist CAMHSEast London NHS Foundation TrustLondon, UK

Martin Deahl TD MA MPhil FRCPsych

Colonel (TA) RAMC(V)Consultant PsychiatristSouth Staffordshire and Shropshire Partnership Healthcare NHS Foundation TrustStaffordshire, UK

Kalpana Elizabeth Dein MBBS MRCPsych MSc

Consultant Forensic PsychiatristLondon, UK

Simon Dein FRCPsych PhD

Academic Department of PsychiatryUniversity College London Medical SchoolLondon, UK

Contributors xv

John A. Dent MBBChir MRCPSych

Consultant PsychiatristWest London Mental Health NHS Trust,London, UK

Sarah L. Desmarais PhD

Department of PsychologyNorth Carolina State UniversityRaleigh, North Carolina

Geoffrey L. Dickens RMN PhD

Abertay UniversityDundee, UK

Claire DimondConsultant Child and Adolescent Forensic PsychiatristWells UnitAdolescent Forensic Service

Raana DinConsultant Forensic PsychiatristKneesworth House HospitalRoyston, Hertfordshire, UK

Roland DixThe Montpellier UnitWotton Lawn HospitalGloucester, UK

Ronald DoctorConsultant Psychiatrist Medical Psychotherapy & Forensic PsychotherapyWest London Mental Health NHS TrustandLakeside Mental Health UnitWest Middlesex HospitalLondon, UK

Conor Duggan MD PhD FRCPsych OBE

Emeritus ProfessorUniversity of NottinghamUniversity ParkNottingham, UK

Stephen DyeConsultant Inpatient Psychiatrist, WoodlandsNorfolk and Suffolk NHS Foundation TrustIpswich Hospital Site

Irshaad O. Ebrahim FRCPsych

The London Sleep CentreLondon, UK

Anisah Ebrahimjee MSc

Maastricht University and Broadmoor HospitalHertfordshire, UK

Spencer Eth MD

Professor and Director of Forensic Psychiatry Fellowship ProgramDepartment of PsychiatryUniversity of Miami Miller School of MedicineChief of Mental Health, Miami, VAHealthcare System, Miami, Florida

Tim Exworthy MBBS LLM FRCPsych DFP

Clinical Director and Consultant Forensic PsychiatristSt. Andrew’s Hospital Northampton NN1 5DGVisiting Senior Lecturer in Forensic Psychiatry Institute of PsychiatryPsychology and Neuroscience Kings College London London, UK

Frank Farnham BSc MBBS FRCPsych

Consultant Forensic Psychiatrist North London Forensic ServiceClinical Lead National Stalking ClinicClinical Lead Fixated Threat Assessment Centre

Catherine Farr CPsychol AFBPsS

Clinical and Forensic PsychologistLead PsychologistPersonality Disorder PathwayBroadmoor HospitalWest London Mental Health TrustSouthall, UK

Daniel FenwickLecturer in LawNorthumbria UniversityNorthumbria Law SchoolNewcastle upon Tyne, UK

Helen FenwickProfessor of LawDurham Law SchoolDurham, UK

Sally FrenchAssociate Lecturer (retired)The Open UniversitySeaford, UK

K. W. M. (Bill) Fulford DPhil FRCP FRCPsych

Fellow of St. Catherine’s College and Member of the Philosophy FacultyUniversity of OxfordandEmeritus Professor of Philosophy and Mental Health University of WarwickandFounder Editor, Philosophy, Psychiatry, and Psychology, and Director of the Collaborating Centre for Values-based Practice, St. Catherine’s CollegeOxford. HealthLondon, UK

Manjit Gahir MBChB MSc MRCPsych

Consultant Forensic PsychiatristLead Clinician, National High Secure Deaf ServiceNottinghamshire Healthcare NHS Foundation TrustRampton HospitalRetford, UK

xvi Contributors

Yu Gao PhD

Associated Professor of PsychologyDepartment of PsychologyBrooklyn College and the Graduate Center of the City University of New YorkBrooklyn, New York

Colin Gavaghan LLB (Hons) PhD

New Zealand Law Foundation Chair in Law and Emerging TechnologiesFaculty of LawUniversity of OtagoDunedin, New Zealand

Nuri Gené-Cos MD FRCPsych PhD

Consultant Psychiatrist and TSS Lead ClinicianSouth London and Maudsley NHS Foundation TrustTraumatic Stress Service Outpatient DepartmentMaudsley HospitalDenmark HillLondon, UK

Sanju GeorgeSenior Consultant PsychiatristRajagiri Hospital, AluvaKerala, India

Simon Gibbon MBBS MRCPsych

Consultant Forensic PsychiatristNottinghamshire Healthcare NHS Foundation TrustArnold LodgeLeicester, UK

Eilish Gilvarry MB, MCh

Clinical Director of Specialties and Forensic ServicesNorthumberland Tyne & Wear NHS Foundation TrustNewcastle upon Tyne, UK

Nathalia L. GjersoeSenior Lecturer in Developmental PsychologyUniversity of BathSomerset, UK

Colin GobleSenior Lecturer in Childhood, Youth and Community StudiesUniversity of Winchester

Rafael A. GonzálezResearch AssociateCentre for PsychiatryImperial College LondonLondon, UK

John GordonPsychoanalyst and Group AnalystHonorary Senior LecturerBuckinghamshire New UniversityandFormer Consultant Adult PsychotherapistForensic Psychotherapy Department andThe Cassel HospitalWest London Mental Health NHS TrustLondon, UK

Adrian GroundsHonorary Research FellowInstitute of CriminologyUniversity of CambridgeCambridge, UK

Gisli H. Gudjonsson CBE FBPsS

Emeritus Professor of Forensic PsychologyDepartment of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceDe Crespigny ParkDenmark HillLondon, UK

Lynn HaggerNon-executive DirectorRotherham NHS Foundation TrustSchool of Law (retired)University of SheffieldSheffield, UK

Stevie-Jade HardyLecturer in Hate StudiesThe Leicester Centre for Hate StudiesDepartment of CriminologyUniversity of LeicesterLeicester, UK

Robert D. Hare Phd

Department of PsychologyVancouver, British Columbia, Canada

Leigh HarkinsAssistant Professor in PsychologyFaculty of Social Science & HumanitiesUniversity of Ontario Institute of TechnologyOntario, Canada

Catriona HavardSenior Lecturer in PsychologyOpen UniversityMilton Keynes, UK

Camilla HawFormer Consultant PsychiatristSt. Andrew’s HealthcareandEmeritus Professor in Mental Health CareSchool of HealthUniversity of NorthamptonNorthampton, UKandHonorary Senior LecturerInstitute of PsychiatryandHonorary Research FellowUniversity Department of PsychiatryWarneford HospitalOxford, UK

Leah Bruer HenenPractitioner in Medical PsychotherapistLondon, UK

Contributors xvii

Clive R. HollinEmeritus ProfessorDepartment of PsychologyUniversity of LeicesterLeicester, UK

Gareth HopkinPsychologistBroadmoor HospitalWest London Mental Health TrustSouthall, UK

Mark L. HoweCentre for Memory and Law, Department of PsychologyCity University LondonLondon, UK

Christopher IdzikowskiSleep Assessment and Advisory ServiceLisburn, Northern Ireland

Mike IsweranConsultant Forensic PsychiatristCommunity Mental Health ServicesHerfordshire Partnership NHS Foundation TrustSt. Albans, UK

André Ivanoff PhD

Columbia University, New York

Amy Izycky BSc(Hons) MSc D.Clin.Psy

HCPC Registered and Chartered Clinical PsychologistBPC Registered Psychodynamic PsychotherapistPrivate PracticeNewcastle upon Tyne, UK

David V. JamesConsultant Forensic PsychiatristTheseus LLP

Carole Jenny MD MBA FAAP

Professor of PediatricsDepartment of PediatricsWarren Alpert Medical School of Brown UniversityProvidence, Rhode Island

Darrick JolliffeCenter for CriminologyUniversity of GreenwichOld Royal Navy CollegeLondon, UK

Gurvinder S. Kalra MD DPM

Staff PsychiatristFlynn Adult Inpatient Psychiatric UnitLaTrobe Regional Hospital Mental Health Services (LRH-MHS)Traralgon, Victoria, Australia

Jeremy Kenney-HerbertConsultant Forensic Psychiatrist and Clinical DirectorSecure Care and Offender HealthBirmingham and Solihull Mental Health NHS Foundation TrustBirmingham, UK

Paul Kingston RNMH RMN RNT PGCert Ed MA PhD ARSH HFRSPH

Professor of Ageing and Mental Health andDirector of the Centre for Ageing StudiesFaculty of Health and Social CareUniversity of ChesterRiverside CampusChester, UKMarianne KastrupCentre Transcultural PsychiatryPsychiatric Center CopenhagenRigshospitaletCopenhagen, DenmarkKevin KerriganExecutive DeanNorthumbria Law SchoolNorthumbria UniversityNewcastle upon Tyne, UKGabriel Kirtchuk MD MRCPsych

Consultant Psychiatrist and PsychoanalystWest London Mental Health NHS TrustLondon, UKJames L. Knoll IV MD

Director of Forensic PsychiatryProfessor of PsychiatrySUNY Upstate Medical CenterSyracuse, New YorkLauren M. KnottCentre for Memory and LawDepartment of PsychologyCity University LondonLondon, UKMichael KopelmanKing’s College LondonLondon, UKMalcolm Lader OBE LLB PhD MD DSc FRCPsych F Med Sci FLS

Emeritus Professor of Clinical Psychopharmacology P056Institute of PsychiatryNeurology and NeuroscienceKing’s College LondonDenmark HillLondon, UK

Anne A. Lawrence MD PhD

Adjunct Associate ProfessorDepartment of PsychologyUniversity of LethbridgeLethbridge, Alberta, CanadaGregory B. Leong MD

Clinical Professor of PsychiatryKeck School of MedicineUniversity of Southern CaliforniaLos Angeles, CaliforniaJack LevinEmeritus Professor of Sociology and CriminologyCo-directorThe Brudnick Center on Violence and ConflictNortheastern UniversityBoston, Massachusetts

xviii Contributors

John LumsdenDepartment of Clinical NeurophysiologyBroadmoor HospitalCrowthorne, UK

Rachel D. MacKenzieVictorian Institute of Forensic Mental HealthSwinburne UniversityVictoria, Australia

Robert E. MannInstitute for Mental Health Policy ResearchCentre for Addiction and Mental Health TorontoandDalla Lana School of Public HealthUniversity of TorontoToronto, Ontario, Canada

Mary-Lou Martin RN MScN MEd

Clinical Nurse SpecialistSt. Joseph’s Healthcare HamiltonForensic Psychiatry ProgramandAssociate Clinical ProfessorMcMaster UniversityHamilton, Ontario, Canada

Caoimhe McAnenaOxleas NHS Foundation TrustLondon, UK

Heather J. McKee* MB ChB BAO MRCPsych LLM

Formerly Consultant NeuropsychiatristRoyal Hospital for NeurodisabilityWest Hill, PutneyLondon, UKand formerly Consultant PsychiatristCharing Cross Hospital, London, UK.

Rafiq Memon MB ChB MRCPsych LLM

Consultant Forensic PsychiatristTamarind CentreBordesley GreenBirmingham, UK

Robin P. D. Menzies MBBS FRCPsych (UK) FRCP (C)

Clinical Associate Professor of PsychiatryDepartment of PsychiatryUniversity of SaskatchewanSaskatoon, Canada

Estelle Moore PhD C.Psychol CSci

Head of Psychological ServicesBroadmoor HospitalCrowthorne, Berks, UKCurrently Strategic and Professional Lead for Psychological TherapiesWest London Mental Health TrustSouthall, UK

* Deceased.

Mark MorrisMedical PsychotherapySt Andrew’s Essex Wickford, UK

David MurphyChartered Forensic and Consultant Clinical NeuropsychologistNeuroscience DepartmentBroadmoor HospitalCrowthorne, UK

Kevin MurrayConsultant Forensic PsychiatristBroadmoor HospitalCrowthorne, Berks, UKDirector of Research and DevelopmentandWest London Mental Health NHS Trust,London, UK

David NdegwaConsultant Forensic PsychiatristSouth London and Maudsley NHS Foundation Trust

Tonia L. Nicholls PhD

Department of PsychiatryUniversity of British ColumbiaForensic Psychiatric Services CommissionBritish Columbia Mental Health and Substance Us ServicesDepartment of PsychologySimon Fraser UniversityVancouver, British Columbia, Canada

Niamh O’dwyerDepartment of PsychologyRoyal Holloway, University of LondonEgham, UK

John O’GradyConsultant Forensic PsychiatristFormerly of Hampshire Partnership NHS Foundation Trust andChair of the Forensic FacultyRoyal College of PsychiatristsLondon, UK

Derek Perkins PhD

Professor of Forensic PsychologyWest London Mental Health NHS Trust,London, UK

Amanda E. Perry CPsychol

Senior Research FellowLead for Forensic Mental Health and Addiction GroupDepartment of Health SciencesUniversity of YorkYork, UK

John Petrila JD

University of South FloridaTampa, Florida

Contributors xix

Laura Pratchett PsyD

Assistant Clinical ProfessorDepartment of PsychiatryMount Sinai School of MedicineOne Gustave L. Levy PlaceandJames J. Peters VA Medical CenterBronx, New York

Basant K. Puri MA PhD MB BChir BSc (Hons) MathSci DipStat MMath

FRCPsych FRSB

Honorary ConsultantImaging DirectorateHammersmith HospitalLondon, UKandHonorary ProfessorDepartment of MedicineImperial College LondonLondon, UKandAdjunct Professor in Neuroimaging and SpectroscopyUniversity of LimerickLimerick, Ireland

Ramneesh Puri MRCPsych, DPM, DCP, MBBS, PG Dip Mental Health Law

Consultant Forensic PsychiatristRampton High Security HospitalandVisiting PsychiatristSouth Yorkshire Cluster of PrisonsNottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK

Natalie PyszoraCommunity Forensic Mental Health ServiceMoore HouseGraylands campusMt Claremont, Australia

Mohammad Shaiyan Rahman MRCPsych

NIHR Clinical Lecturer in Forensic PsychiatryNational Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH)Mancheser, UK

Malcolm RamsayIndependent ResearcherFormerly Ministry of Justice ResearchMember of Hertfordshire Police and Crime Committee, UK

David Reiss MA MB BChir MPhil PgD FRCPsych FAcadMEd

Consultant Forensic PsychiatristWest London Mental Health NHS TrustandHonorary Clinical Senior LecturerImperial College LondonLondon, UK

Phillip J. Resnick MD

Professor and PsychiatryCase Western Reserve University School of MedicineProgram DirectorForensic PsychiatryUniversity Hospital Case Medical CenterCleveland, Ohio

Corine De Ruiter PhD

Professor of Forensic PsychologyMaastricht UniversityMaastricht, The Netherlands

Kelly ReynoldsPrincipal Clinical PsychologistNHS Greater Glasgow and ClydeGlasgow, UK

Thomas A. Roesler MD

Associate Professor of Child and Family PsychiatryDivision of Child PsychiatryDepartment of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidence, Rhode Island

James Rokop PhD

Consulting PsychologistCalifornia Department of Mental HealthSacramento, California

Joan Rutherford FRCPsych

Chief Medical Member of the First Tier Tribunal—Mental Health

Henry Schmidt IIIBehavioral Affiliates, IncSeattle, Washington

Piyal SenConsultant Forensic PsychiatristComplex Needs ServiceSt. Andrew’s EssexVisiting LecturerInstitute of Psychiatry, Psychology and NeuroscienceKing’s CollegeLondon, UK

Faisil SethiConsultant Psychiatrist (PICU)Maudsley HospitalSouth London and Maudsley NHS Foundation TrustLondon, UK

Nilesh ShahProfessor and HeadDepartment of PsychiatryLokmanya Tilak Municipal Medical College and Sion General HospitalMumbai, India

xx Contributors

Jenny ShawProfessor of Forensic Psychiatry and Assistant DirectorNational Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH)Consultant Forensic Psychiatrist Guild LodgeLancashirecare NHS Foundation TrustManchester, UK

John D. Sheehan FRCPI MMedSc MRCPsych

Consultant in Liaison Psychiatry and Senior Clinical LecturerMater Misericordiae University Hospital and University College DublinDublin, Ireland

Reginald G. SmartInstitute for Mental Health Policy ResearchCentre for Addiction and Mental HealthToronto, Ontario, Canada

Nadia SomersClinical PsychologistTavistock and Portman NHS Foundation TrustLondon, UK

Gina StodutoInstitute for Mental Health Policy ResearchCentre for Addiction and Mental HealthToronto, Ontario, Canada

Philip SugarmanFormerly Chief Executive and Medical DirectorSt. Andrew’s HealthcareHonorary Senior LecturerInstitute of PsychiatryVisiting ProfessorUniversity of NorthamptonNorthampton, UK

Lorna M. Tagliavini LLM, Postgrad. Dip. Law, BA (Hons) Dip.

Forensic Medical Sciences, Barrister (E&W) and Attorney-at-Law (NY), PhD

(Research Student)

Assistant CoronerThe Coroner’s Society of England & Wales UK

James Tapp PhD

PsychologistBroadmoor HospitalWest London Mental Health TrustSouthall, UK

Ian H. Treasaden MBBS LRCP MRCS FRCPsych LLM

Honorary Consultant Forensic PsychiatristWest London Mental Health NHS Trust and Imperial College Healthcare NHS TrustandVisiting Senior LecturerBuckinghamshire New UniversityWycombe, UK

Clarence Watson JD MD

Clinical Associate Professor of PsychiatryDirector, Forensic Psychiatry Fellowship ProgramPerelman School of Medicine - University of PennsylvaniaPhiladelphia, Pennsylvania

Christopher D. WebsterPsychiatry, University of Toronto; PsychologySimon Fraser University, Child Development InstituteToronto, Ontario, Canada

Christine M. WickensInstitute for Mental Health Policy ResearchCentre for Addiction and Mental HealthandDalla Lana School of Public HealthUniversity of TorontoToronto, Ontario, Canada

Heather WoodConsultant Adult Psychotherapist and Clinical PsychologistPortman ClinicTavistock and Portman NHS Foundation TrustLondon, UK

Natalie WortleyBarristerPrincipal Lecturer in LawNorthumbria UniversityNewcastle upon Tyne, UK

Rachel Yehuda PhD

Professor of Psychiatry and NeuroscienceDirector, Traumatic Stress Studies DivisionIcahn School of Medicine at Mount SinaiDirector, Mental Health Patient Care CenterJames J. Peters VA Medical Center

Graeme A. Yorston MBBS MSc MRCPsych

Consultant Old Age Forensic PsychiatristVisiting Professor of Ageing and Forensic Mental HealthStaffordshire UniversityStaffordshire, UKandHonorary LecturerInstitute of PsychiatrySt. Andrew’s HospitalNorthampton, UK

Susan YoungClinical Senior Lecturer in PsychologyCentre for PsychiatryImperial College LondonLondon, UKandProfessor of PsychologyReykjavik UniversityReykjavik, IcelandandConsultant Clinical and Forensic Psychologist and Director of Forensic Research & DevelopmentWest London Mental Health Trust and Broadmoor HospitalBerkshire, UK

PART 1

Basic Sciences

1 Functional neuroanatomy 3Basant K. Puri

2 Neurochemistry 15Basant K. Puri

3 Structural neuroimaging 21Basant K. Puri

4 fMRI and PET 29Basant K. Puri

5 Neurospectroscopy 37Basant K. Puri

6 Psychophysiology 39Yu Gao

7 Sleep science 45Christopher Idzikowski and Irshaad O. Ebrahim

8 Developmental psychology 51Nathalia L. Gjersoe and Catriona Havard

9 Psychology of memory and cognition 63Martin A. Conway, Mark L. Howe, and Lauren M. Knott

10 Psychology of aggression and violence 71Ian H. Treasaden

11 Anthropology 77Kalpana Elizabeth Dein and Simon Dein

12 Culture and forensic psychiatry 87Gurvinder S. Kalra, Dinesh Bhugra, and Nilesh Shah

13 Criminology 99Darrick Jolliffe and Stevie-Jade Hardy

14 Values-based practice 105K. W. M. (Bill) Fulford and Gwen Adshead

15 Epidemiology 111Basant K. Puri

16 Genetics 115Basant K. Puri

http://taylorandfrancis.com

References

1 Chapter 1 Functional Neuroanatomy

Table 1.2 Corpus callosal fiber destinations

Part of corpus

callosum Name of fibers (if applicable) Destinations

Splenium Forceps major Occipital lobes

Splenium and posterior body Tapetum Temporal lobes

Body Widespread neocortical areas

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2 Chapter 2 Neurochemistry

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3 Chapter 3 Structural Neuroimaging

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11. B occardi M, Frisoni GB, Hare RD, et al. Cortex andamygdala morphology in psychopathy. Psychiatry Research.2011; 193: 85–92.

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15. Barkataki I, Kumari V, Das M, et al. Volumetricstructural brain abnormalities in men with schizophreniaor antisocial personality disorder. Behavioural BrainResearch. 2006; 169: 239–47.

16. Narayan VM, Narr KL, Kumari V, et al. Regionalcortical thinning in subjects with violent antisocialpersonality disorder or schizophrenia. The AmericanJournal of Psychiatry. 2007; 164: 1418–27.

17. H optman MJ, Volavka J, Weiss EM, et al. QuantitativeMRI measures of orbitofrontal cortex in patients withchronic schizophrenia or schizoaffective disorder.Psychiatry Research. 2005; 140: 133–45. 18. Puri BK,Counsell SJ, Saeed N, et al. Regional grey mattervolumetric changes in forensic schizophrenia patients: AnMRI study comparing the brain structure of patients whohave seriously and violently offended with that ofpatients who have not. BMC Psychiatry. 2008; 8 Suppl 1:S6. 19. Schiltz K, Witzel J, Northoff G, et al. Brainpathology in pedophilic offenders: Evidence of volumereduction in the right amygdala and related diencephalic

structures. Archives of General Psychiatry. 2007; 64:737–46. 20. Poeppl TB, Nitschke J, Santtila P, et al.Association between brain structure and phenotypiccharacteristics in pedophilia. Journal of PsychiatricResearch. 2013; 47(5): 678–85. 21. H owner K, EskildsenSF, Fischer H, et al. Thinner cortex in the frontal lobesin mentally disordered offenders. Psychiatry Research.2012; 203: 126–31. 22. Muller JL. Are sadomasochism andhypersexuality in autism linked to amygdalohippocampallesion? The Journal of Sexual Medicine. 2011; 8: 3241–9.23. S chleim S. Brains in context in the neurolaw debate:The examples of free will and “dangerous” brains.International Journal of Law and Psychiatry. 2012; 35:104–11. 24. Burns JM, Swerdlow RH. Right orbitofrontaltumor with pedophilia symptom and constructional apraxiasign. Archives of Neurology. 2003; 60: 437–40. 25.Kempermann G, Gast D, Gage FH. Neuroplasticity in old age:Sustained fivefold induction of hippocampal neurogenesisby long-term environmental enrichment. Annals of Neurology.2002; 52: 135–43. 26. Eriksson PS, Perfilieva E,Bjork-Eriksson T, et al. Neurogenesis in the adult humanhippocampus. Nature Medicine. 1998; 4: 1313–7.

4 Chapter 4 fMRI and PET

1. Volkow ND, Tancredi L. Neural substrates of violentbehaviour. A preliminary study with positron emissiontomography. The British Journal of Psychiatry: The Journalof Mental Science. 1987; 151: 668–73.

2. Wong M, Fenwick P, Fenton G, et al. Repetitive andnon-repetitive violent offending behaviour in malepatients in a maximum security mental hospital— Clinicaland neuroimaging findings. Medicine, Science, and the Law.1997; 37: 150–60.

3. Kiehl KA, Smith AM, Hare RD, et al. Limbic abnormalitiesin affective processing by criminal psychopaths as revealedby functional magnetic resonance imaging. BiologicalPsychiatry. 2001; 50: 677–84.

4. Deeley Q, Daly E, Surguladze S, et al. Facial emotionprocessing in criminal psychopathy. Preliminary functionalmagnetic resonance imaging study. The British Journal ofPsychiatry: The Journal of Mental Science. 2006; 189:533–9.

5. Ku mari V, Aasen I, Taylor P, et al. Neural dysfunctionand violence in schizophrenia: An fMRI investigation.Schizophrenia Research. 2006; 84: 144–64.

6. Barkataki I, Kumari V, Das M, et al. Neural correlatesof deficient response inhibition in mentally disorderedviolent individuals. Behavioral Sciences & The Law. 2008;26: 51–64.

7. D olan MC, Fullam RS. Psychopathy and functionalmagnetic resonance imaging blood oxygenationlevel-dependent responses to emotional faces in violentpatients with schizophrenia. Biological Psychiatry. 2009;66: 570–7.

8. Jiang W, Liao J, Liu H, et al. [Functional MRI analysisof deception among people with antisocial personalitydisorders]. Zhong nan da xue xue bao Yi xue ban [Journalof Central South University Medical Sciences]. 2012; 37:1141–6.

9. Dressing H, Obergriesser T, Tost H, et al. [Homosexualpedophilia and functional networks—An fMRI case report andliterature review]. Fortschritte derNeurologie-Psychiatrie. 2001; 69: 539–44.

10. Schiffer B, Paul T, Gizewski E, et al. Functional braincorrelates of heterosexual paedophilia. NeuroImage. 2008;41: 80–91. 11. Poeppl TB, Nitschke J, Dombert B, et al.Functional cortical and subcortical abnormalities inpedophilia: A combined study using a choice reaction timetask and fMRI. The Journal of Sexual Medicine. 2011;8: 1660–74. 12. Sterzer P, Stadler C, Krebs A, et al.Abnormal neural responses to emotional visual stimuli inadolescents with conduct disorder. Biological Psychiatry.2005; 57: 7–15. 13. Herpertz SC, Huebner T, Marx I, etal. Emotional processing in male adolescents withchildhoodonset conduct disorder. Journal of ChildPsychology and Psychiatry, and Allied Disciplines. 2008;49: 781–91. 14. Vloet TD, Konrad K, Huebner T, et al.Structural and functional MRI—Findings in children andadolescents with antisocial behavior. Behavioral Sciences &The Law. 2008; 26: 99–111. 15. Shannon BJ, Raichle ME,Snyder AZ, et al. Premotor functional connectivitypredicts impulsivity in juvenile offenders. Proceedings ofthe National Academy of Sciences of the United States ofAmerica. 2011; 108: 11241–5. 16. Forth AE, Kosson DS,Hare RD. The Hare Psychopathy Checklist: Youth Version.Toronto, Ontario: Multi-Health Systems, 2003. 17. G amerM, Bauermann T, Stoeter P, Vossel G. Covariations amongfMRI, skin conductance, and behavioral data duringprocessing of concealed information. Human Brain Mapping.2007; 28: 1287–301. 18. Fullam RS, McKie S, Dolan MC.Psychopathic traits and deception: Functional magneticresonance imaging study. The British Journal ofPsychiatry: The Journal of Mental Science. 2009; 194:229–35. 19. Dressing H, Sartorius A, Meyer-Lindenberg A.Implications of fMRI and genetics for the law and theroutine practice of forensic psychiatry. Neurocase. 2008;14: 7–14. 20. Langleben DD, Dattilio FM. Commentary: Thefuture of forensic functional brain imaging. The Journalof the American Academy of Psychiatry and the Law. 2008;36: 502–4. 21. Brown T, Murphy E. Through a scannerdarkly: Functional neuroimaging as evidence of a criminaldefendant’s past mental states. Stanford Law Review. 2010;62: 1119–208. 22. Kulich R, Maciewicz R, Scrivani SJ.Functional magnetic resonance imaging (FMRI) and experttestimony. Pain Medicine. 2009; 10: 373–80.

5 Chapter 5 Neurospectroscopy

1. Cox IJ, Puri BK. In vivo MR spectroscopy in diagnosisand research of neuropsychiatric disorders.Prostaglandins, Leukotrienes, and Essential Fatty Acids.2004; 70: 357–60.

2. Puri BK, Counsell SJ, Hamilton G, et al. Cerebralmetabolism in male patients with schizophrenia who haveseriously and dangerously violently offended: A 31Pmagnetic resonance spectroscopy study. Prostaglandins,Leukotrienes, and Essential Fatty Acids. 2004; 70: 409–11.

3. Cox IJ. Development and applications of in vivo clinicalmagnetic resonance spectroscopy. Progress in Biophysicsand Molecular Biology. 1996; 65: 45–81.

4. Puri BK, Hirsch SR, Easton T, Richardson AJ.A volumetric biochemical niacin flush-based index thatnoninvasively detects fatty acid deficiency inschizophrenia. Progress in Neuro-Psychopharmacology &Biological Psychiatry. 2002; 26: 49–52. 5. Puri BK,Richardson AJ, Counsell SJ, et al. Negative correlationbetween cerebral inorganic phosphate and the volumetricniacin response in male patients with schizophrenia whohave seriously and dangerously violently offended: A (31)Pmagnetic resonance spectroscopy study. Prostaglandins,Leukotrienes, and Essential Fatty Acids. 2007; 77: 97–9.6. Seedat S, Videen JS, Kennedy CM, Stein MB. Single voxelproton magnetic resonance spectroscopy in women with andwithout intimate partner violencerelated posttraumaticstress disorder. Psychiatry Research. 2005; 139: 249–58.

25.00 15.00 5.00 –5.00 PPM (a) Pi PME PDE PCr NTPβαγ (b)–15.00 –25.00 –35.00

Figure 5.1 (a) Fitting seven peaks (darker line) to the 31P

spectrum obtained (lighter line). The dotted line shows the

baseline from the broad component, which is also shown in

(b). Chemical shifts are indicated in parts per million(PPM in

the figure). (From Prostaglandins, Leukotrienes, andEssential

Fatty Acids, 70, Puri BK, Counsell SJ, Hamilton G et al.,

Cerebral metabolism in male patients with schizophrenia

who have seriously and dangerously violently offended:

a 31P magnetic resonance spectroscopy study, 409–11,

Copyright 2004, with permission from Elsevier.) NAA Cr Cho4 3 2 1 0 Real Frequency (ppm) Figure 5.2 Representative 1Hspectrum for the anterior cingulate showing the threelargest peaks: NAA, Cr, and Cho. Chemical shifts areindicated in parts per million (ppm). (From PsychiatryResearch: Neuroimaging, 139, Seedat S, Videen JS, KennedyCM, Stein MB, Single voxel proton magnetic resonancespectroscopy in women with and without intimate partnerviolence-related posttraumatic stress disorder, 249–58,Copyright 2005, with permission from Elsevier.)

6 Chapter 6 Psychophysiology

6. Schug RA, Raine A, Wilcox RR. Psychophysiological andbehavioral characteristics of individuals comorbid forantisocial personality disorder and schizophrenia-spectrumpersonality disorder. British Journal of Psychiatry. 2007;191: 408–14.

7. Raine A, Lencz T, Reynolds GP, Harrison G, Sheard C,Medley I, et al. An evaluation of structural and functionalprefrontal deficits in schizophrenia: MRI andneuropsychological measures. Psychiatry Research. 1992;45: 123–37.

8. R aine A, Yang Y. Neural foundations to moralreasoning and antisocial behavior. Social, Cognitive, andAffective Neuroscience. 2006; 1: 203–13.

9. Gao Y, Raine A, Venables PH, Dawson ME, Mednick SA.Association of poor childhood fear conditioning and adultcrime. American Journal of Psychiatry. 2010; 167: 56–60.

10. Eysenck HJ. Crime and Personality. 3rd ed. London:Routledge & Kegan Paul, 1977.

11. Damasio AR. Descartes’ Error: Emotion, Reason, and theHuman Brain. New York: Grosset/Putnam, 1994.

12. V aidyanathan U, Hall JR, Patrick CJ, Bernat EM.Clarifying the role of defensive reactivity deficits inpsychopathy and antisocial personality using startlereflex methodology. Journal of Abnormal Psychology. 2011;120(1): 253–8.

13. Harmon-Jones E. Clarifying the emotive functions ofasymmetrical frontal cortical activity. Psychophysiology.2003; 40: 838–48.

14. Gao Y , Raine A. P3 event-related potential impairmentsin antisocial and psychopathic individuals: A metaanalysis.Biological Psychology . 2009; 82: 199–210. 15. Hicks BM,Bernat EM, Malone SM, Iacono WG, Patrick CJ, Krueger RF,et al. Genes mediate the association between P3 amplitudeand externalizing disorders. Psychophysiology. 2007;44: 98–105. 16. I acono WG. Detection of Deception. In:Handbook of Psychophysiology. 3rd ed. Eds. Cacioppo JT,Tassinary LG, Berntson GG. New York: Cambridge UniversityPress, 2007: 688–703. 17. Raine A, Venables PH, Dalais C,Mellingen K, Reynolds C, Mednick SA. Early educational andhealth enrichment at age 3–5 years is associated with

increased autonomic and central nervous system arousal andorienting at age 11 years: Evidence from the MauritiusChild Health Project. Psychophysiology. 2001; 38: 254–66.18. Raine A, Mellingen K, Liu J, Venables PH, Mednick SA.Effects of environmental enrichment at ages 3–5 years onschizotypal personality and antisocial behavior at ages 17and 23 years. American Journal of Psychiatry. 2003; 160:1627–35. 19. Stadler C, Grasmann D, Fegert JM, Holtmann M,Poustka F, Schmeck K. Heart rate and treatment effect inchildren with disruptive behavior disorders. ChildPsychiatry and Human Development. 2008; 39: 299–309. 20.F ishbein D, Hyde C, Coe B, Paschall MJ. Neurocognitiveand physiological prerequisites for prevention ofadolescent drug abuse. Journal of Primary Prevention.2004; 24: 471–95.

7 Chapter 7 Sleep Science

Table 7.4 Factors considered in NREM/Deep sleep

sleepwalking cases

Factors Legal parallel Putative basis, cause,or (surrogate) marker

Predisposition Internal Genetic

Priming Internal SWS abs/% - spectral analysis, reduceddelta Number of arousals NREM instability Hypersynchronousdelta waves External Sleep deprivation Medication AlcoholFever Stress

Precipitating Internal Sleep-disordered breathing Periodiclimb movement External Noise Proximity/touch

8 Chapter 8 Developmental Psychology

13. Mangelsdorf SC, Schoppe SJ, Buur H. The Meaning ofParental Reports: A Contextual Approach to the Study ofTemperament and Behavior Problems. In: Temperament andPersonality across the Life Span. Eds. Molfese VJ, MolfeseDL. Mahwah, NJ: Erlbaum, 2000: 121–140.

14. Kagan J. Biology and the Child. In: Handbook of ChildPsychology: Vol. 3. Social, Emotional, and PersonalityDevelopment. 5th ed. Ed. Eisenberg N. New York: Wiley,1998: 177–236.

15. K agan J. Behavioral Inhibition as a TemperamentalCategory. In: Handbook of Affective Science. Eds. DavidsonRJ, Scherer KR, Goldsmith HH. New York: Oxford UniversityPress, 2003: 320–331.

16. Kagan J, Saudino KJ. Behavioral Inhibition and RelatedTemperaments. In: Infancy to Early Childhood: Genetic andEnvironmental Influences on Developmental Change. Eds.Emde RN, Hewitt JK. New York: Oxford University Press,2001: 111–119.

17. Snidman N, Kagan J, Riordan L, Shannon DC. Cardiacfunction and behavioral reactivity. Psychophysiology.1995; 32: 199–207.

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9 Chapter 9 Psychology of Memory andCognition

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10 Chapter 10 Psychology of Aggressionand Violence

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14 Chapter 14 Values-based Practice

16. Care Services Improvement Partnership (CSIP) and theNational Institute for Mental Health in England (NIMHE).Workbook to Support Implementation of the Mental HealthAct 1983 as Amended by the Mental Health Act 2007. London:Department of Health, 2008.

17. National Institute for Mental Health in England (NIMHE)and the Care Services Improvement Partnership. 3 Keys to aShared Approach in Mental Health Assessment. London:Department of Health, 2008.

18. P etrova M, Sutcliffe P, Fulford KWM, Dale J. Searchterms and a validated brief search filter to retrievepublications on health-related values in Medline: A wordfrequency analysis study. Journal of the American MedicalInformatics Association. doi:10.1136/amiajnl-2011-000243.19. Colombo A, Bendelow G, Fulford KWM, Williams S.Evaluating the influence of implicit models of mentaldisorder on processes of shared decision making withincommunity-based multidisciplinary teams. Social Science andMedicine. 2003; 56: 1557–70. 20. Marshall T. RestorativeJustice: An Overview. Home Office Research and StatisticsDirectorate. London: Home Office, 1999. FURTHER READINGFulford KWM, Peile E, Carroll H. Essential Values-BasedPractice: Clinical Stories Linking Science with People.Cambridge: Cambridge University Press, 2012.

15 Chapter 15 Epidemiology

1. Carneiro I, Howard N, Bailey L. Introduction toEpidemiology. 2nd ed. Maidenhead, UK: McGraw-Hill/ OpenUniversity Press, 2011.

2. Gadd D, Karstedt S, Messner SF. The Sage Handbook ofCriminological Research Methods. Los Angeles: SagePublications, 2012. 3. Arboleda-Florez J. Forensicpsychiatry and epidemiology: Introduction. InternationalJournal of Law and Psychiatry. 2001; 24: 335–7. 4.Monahan J, Steadman HJ. Crime and Mental Disorder—AnEpidemiological Approach. In: Crime and Justice—An AnnualReview of Research. Eds. Tonry M, Morris N. Chicago:University of Chicago Press, 1983: 145–89. 5. Fazel S,Grann M, Langstrom N. What is the role of epidemiology forforensic psychiatry? Criminal Behaviour and Mental Health:CBMH. 2009; 19: 281–5.

16 Chapter 16 Genetics

1. Bhakta SG, Zhang JP, Malhotra AK. The COMT Met158allele and violence in schizophrenia: A metaanalysis.Schizophrenia Research. 2012; 140: 192–7.

2. Vassos E, Collier DA, Fazel S. Systematic meta- analyses and field synopsis of genetic association studiesof violence and aggression. Molecular Psychiatry. 2014;19: 471–7. 3. L evitt M. Genetics and crime. In:Encyclopedia of Applied Ethics. 2nd ed. Ed. Chadwick R.Boston: Elsevier, 2012: 462–9. 4. Briken P, Habermann N,Berner W, Hill A. XYY chromosome abnormality in sexualhomicide perpetrators. American Journal of Medical GeneticsPart B, Neuropsychiatric Genetics: The OfficialPublication of the International Society of PsychiatricGenetics. 2006; 141B: 198–200. 5. Ficks CA, Waldman ID.Candidate genes for aggression and antisocial behavior: Ameta-analysis of association studies of the 5HTTLPR andMAOA-uVNTR. Behavior Genetics. 2014; 44: 427–44. 6. CaspiA, McClay J, Moffitt TE, et al. Role of genotype in thecycle of violence in maltreated children. Science. 2002;297: 851–4. 7. Gotz MJ, Johnstone EC, Ratcliffe SG.Criminality and antisocial behaviour in unselected menwith sex chromosome abnormalities. Psychological Medicine.1999; 29: 953–62. 8. Levitt M. Crime genes. The Biologist.2014; 61: 25–7. D i s p o s i t i o n t o w a r d v i o l en c e ( z s c o r e s ) 1.2 0.9 0.6 0.3 0 –0.3 A n t i s oc i a l p e r s o n a l i t y d i s o r d e r s y m p t o ms ( z s c o r e s ) 1.2 0.9 0.6 0.3 0 –0.3 n= 108 Low MAOAactivity High MAOA activity (c) Low MAOA activity High MAOAactivity (d) 42 13 180 17179 20 n= 107 39 12 74 18 Nomaltreatment Probable maltreatment Severe maltreatment

Figure 16.8 (Continued) The association between childhoodmaltreatment and subsequent antisocial behavior as a func

tion of MAOA activity. (c) Mean z scores on the DispositionToward Violence Scale at age 26. In a hierarchical ordinary

least squares regression model, the G × E interaction wasin the predicted direction (P = 0.10); the effect ofmaltreatment

was significant in the low-MAOA activity group (P = 0.002)but not in the high-MAOA group (P = 0.17). (d) Mean zscores

on the Antisocial Personality Disorder symptom scale at age26. The G × E interaction was in the predicted direction

(P = 0.04); the effect of maltreatment was significant inthe low-MAOA activity group (P < 0.001) but not in the high

MAOA group (P = 0.12). (Reproduced from Caspi, A. et al.Science, pp. 852, 2002. With permission.)

18 Chapter 18 Relationship Between MentalDisorder and Crime: An Overview

7. Taylor PJ, Hodgins S. Violence and Psychosis: CriticalTimings. Criminal Behavior and Mental Health. 1994; 4(4):266–89.

8. F arrington DP. The Twelfth Jack Tizard MemorialLecture: The development of offending and antisocialbehaviour from childhood; key findings from the CambridgeStudy in Delinquent Development. Journal of ChildPsychology and Psychiatry and Allied Disciplines. 1995;36: 929–64.

9. A pplebaum PS, Robbins PC, Monahan J. Violence anddelusions: Data from the MacArthur Violence RiskAssessment Study. American Journal of Psychiatry. 2000;157: 566–72. 10. Link BG, Stueve A, Phelan J. PsychoticSymptoms and Violent Behaviors, Probing the Components of“threat/control-override” Symptoms. Social Psychiatry andPsychiatric Epidemiology. 1998; 33 supplement: S55–S60.11. Kvaraceus W. Dangerous Youth. Columbus, OH: ColumbusPress, 1966. 12. Steadman HJ, Mulvey EP, Monahan J, et al.Violence by people discharged from acute psychiatricinpatient facilities and others in the sameneighbourhoods. Archives of General Psychiatry. 1998; 55:393–401. 13. Brockman F, Maguire M. Reducing Homicide:Summary of a Review of the Possibilities. RDS occasionalpaper No.84. London: Home Office, 2003.

19 Chapter 19 Organic Mental Disorder

Table 19.1 The main causes of delirium

Toxic delirium

Medications

Opioid analgesics

Tramadol

Anticholinergics Diphenhydramine Scopolamine Benztropine

Commonly prescribed Baclofen Baclofen withdrawalBenzodiazepines Amantadine Dextromethorphan Metoclopramide

Specific syndromes Serotonin syndrome Neuroleptic malignantsyndrome

Dopaminergics Levodopa Direct-acting dopaminergics

Cardiac medications Amiodarone Digoxin

Immunosuppressants Tacrolimus Cyclosporine

Antimicrobials Acyclovir Ganciclovir VidarabineLevofloxacin Imipenem

Anti-epileptics Valproic acid Carbamazepine Gabapentin

Antidepressants and mood stabilizers AmitriptylineBupropion Lithium Valproic acid

Miscellaneous Propranolol Verapamil Interleukin-2Disulfiram Bismuth

Intoxicants

Cocaine Stimulants Phencyclidine Cannabis InhalantsMethanol Metabolic delirium Specific metobolic derangementsUremic encephalopathy Hepatic encephalopathy Respiratoryfailure Obstructive sleep apnea Hyponatremia HypernatremiaHypoglycemia Hyperglycemia Hypocalcemia HypercalcemiaHypomagnesemia Hypermagnesemia Systemic effects ofinfection Sepsis Pneumonia Urinary tract infection Vitamindeficiencies Wernicke’s encephalopathy Encephalopathicpellagra Substance withdrawal delirium Delirium tremensBenzodiazepine withdrawal delirium Barbiturate withdrawaldelirium Gamma-hydroxybutyric acid 1–4 butanediol and gamma

butyrolactone Gabapentin Delirium secondary to intracranialdisorders Stroke Temporal lobe Thalamus Genu of theinternal capsule Microembolism syndromes ’Shower’ ofmicroemboli Cardiac catheterization Coronary artery bypassgrafting Multiple cholesterol emboli syndrome Fat embolismsyndrome Infectious and reloted disorders Acuteencephalitis Meningitis Cerebral abscess Acute disseminatedencephalomyelitis (Continued)

Table 19.1 (Continued ) The main causes of delirium

Progressive multifocal Ieukoencephalolpathy

Global hypoxic–ischemic disorders

Carbon monoxide intoxication

Post-hypoxic–ischemic encephalopathy

Delayed post-anoxic leukoencephalopathy

Traumatic brain injury

Subdurol hematoma

Radiation encephalopathy

Acute radiation encephalopathy

Early-delayed radiation encephalopathy

Miscellaneous disorders

Tumors

Temporal lobe

Thalamus

Hypothalamus

Hypertensive encephalopathy

Reversible posterior leukoencephalopathy

Thrombotic thrombocytopenic purpura

Central pontine myclinolysis

Post-operative delirium

Other causes

Epileptic disorders

Complex partial status epilepticus

Petit mal status epilepticus

Autoimmune disorders

Systemic lupus erythematosus

Polyarteritis nodosa

Hashimoto’s encephalopathy

Limbic encephalitis

Endocrinologie disorders

Adrenocortical insufficiency

Cushing’s syndrome

Hyperthyroidism (thyroid storm)

Miscellaneous causes

Migraine

Heat stroke

Malaria

Hepatic porphyria

Pancreatitis (‘pancreatic encephalopathy’)

Heavy metal intoxication

Lead

Thallium

Arsenic

Tin

Inherited disorders of urea cycle metabolism with

hyperammonemia

Ornithine transcarbamylasc deficiency

Citrullinemia Celiac disease Marchiafava-Bignami diseaseBehçet’s disease Granulomatous angiitis of the centralnervous system Source: Moore DP and Puri BK. Textbook ofClinical Neuropsychiatry and Behavioral Neuroscience. 3rded. Boca Raton, FL: CRC Press, 2012. Table 19.2 The maincauses of amnesia Episodic anterograde amnesia Transientglobal amnesia Pure epileptic amnesia Blackouts ConcussionTransient ischemic attacks ‘Transient tumor attacks’Chronic anterograde amnesia with a retrograde componentKorsakoff’s syndrome Stroke Temporal lobe Thalamus FornixTumors (see text) Limbic encephalitis Neurodegenerativedisorders Alzheimer’s disease Pick’s disease Frontotemporallobar degeneration Traumatic brain injuryPost-hypoxic–ischemic encephalopathy Encephalitis Statusepilepticus Certain neurosurgical procedures Retrogradeamnesia Epileptic Traumatic brain injury Herpes simplexencephalitis Dissociative amnesia Source: Moore DP and PuriBK. Textbook of Clinical Neuropsychiatry and BehavioralNeuroscience. 3rd ed. Boca Raton, FL: CRC Press, 2012.Table 19.4 The main causes of mania Primary mood disordersBipolar disorder Cyclothymia Primary psychotic disordersSchizoaffective disorder Postpartum psychosis ToxicPrednisone Anabolic steroids Oral contraceptives LevodopaPramipexole Ropinirole Antidepressants BuspironeAlpha-interferon Zidovudine Abacavir (Continued)

Table 19.3 The main causes of depression

Primary mood disorders

Major depressive disorder

Bipolar disorder

Dysthymia

Premenstrual dysphoric disorder

Postpartum blues

Postpartum depression

Primary psychotic disorders

Schizoaffective disorder

Post-psychotic depression in schizophrenia

Toxic depressions

Medication induced Prednisone Alpha-interferon Beta1b-interferon Metoclopramide Tetrabenazine PimozidePropranolol Nifedipine Cimetidine Ranitidine Subdermalestrogen–progestin Alpha-methyl dopa ReserpineLevetiracetam Isotretinoin Bismuth

Substances of abuse or toxins Chronic alcoholism Leadintoxication

Metabolic depressions

Obstructive sleep apnea

Chronic hypercalcemia

Vitamin B12 deficiency

Pellagra

Pancreatic cancer

Medication or substance withdrawal depressions

Cholinergic rebound

Stimulants

Anabolic steroids

Endocrinologic disorders

Hypothyroidism

Hyperthyroidism

Cushing’s syndrome

Adrenocortical insufficiency

Hyperaldosteronism

Hyperprolactinemia Neurodegenerative and movement disordersParkinson’s disease Dementia with Lewy bodies Hereditarymental depression with parkinsonism Huntington’s diseaseAlzheimer’s disease Multi-infarct dementia Other

intracranial disorders Stroke Traumatic brain injuryMultiple sclerosis Epilepsy-associated depression Ictaldepression Interictal depression Tumors Normal pressurehydrocephalus Fahr’s syndrome Systemic lupus erythematosusLimbic encephalitis Tertiary neurosyphilis New-variantCreutzfeldt–Jakob disease Down’s syndrome Source: Moore DP,Puri BK. Textbook of Clinical Neuropsychiatry andBehavioral Neuroscience. 3rd ed. Boca Raton, FL: CRCPress, 2012.

Table 19.4 (Continued ) The main causes of mania

Clarithromycin

Ciprofloxacin

Isoniazid

Topiramate

Phenytoin

Zonisamide

Procyclidine (in high dosage)

Propafenone

Procarbazine

Disulfiram

Aspartame (in high dosage)

Bromide

Mannitol

Metrizamide

Baclofen withdrawal

Tiagabine withdrawal

Reserpine withdrawal

AIpha-methyIdopa withdrawal

Metabolic

Hepatic encephalopathy

Uremia

Endocrinologic

Cushing’s syndrome

Hyperthyroidism

Intracranial disorders

Infarctions

Midbrain

Thalamus

Caudate

Frontal lobe

Temporal lobe

Tumors

Midbrain

Hypothalamus

Thalamus

Frontal lobe

Multiple sclerosis

As part of certain dementing disorders

Alzheimer’s disease

Huntington’s disease

Neurosyphilis

Creutzfeldt–Jakob disease

Metachromatic leukodystrophy

Adrenoleukodystrophy

Miscellaneous

Traumatic brain injury

Epileptic disorders

Ictal mania

Postictal mania Systemic lupus erythematosus Vitamin B12deficiency Sydenham’s chorea Chorea gravidarum Encephalitislethargica Acute disseminated encephalomyelitis Fahr’ssyndrome Dialysis dementia Velocardiofacial syndromeSource: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012. Table 19.5 The main causes ofpsychosis Idiopathic disorders SchizophreniaSchizoaffective disorder Delusional disorder Post-partumpsychosis Obsessive-compulsive disorder Body dysmorphicdisorder Borderline personality disorder Toxic psychosesAmphetamine Cocaine Hallucinogens Phencyclidine CannabisAnabolic steroids Chronic alcoholism (alcoholic paranoia,alcoholic hallucinosis) Neuroleptic-inducedsupersensitivity psychosis (‘tardive psychosis’)Dopaminergics (levodopa, direct-acting dopaminergics,amantadine) Levetiracetam Topiramate VigabatrinPhenylpropanolamine Ephedrine Bupropion FluoxetineDisulfiram Methysergide Manganese intoxication Baclofenwithdrawal Endocrinologic psychoses HypothyroidismHyperthyroidism Cushing’s syndrome Adrenocorticalinsufficiency (Continued )

Table 19.5 (Continued ) The main causes of psychosis

Intracranial disorders

Stroke

Temporal lobe

Frontal lobe

Thalamus

Tumors

Temporal lobe

Corpus callosum

Frontal lobe

Parietal lobe

Multiple sclerosis

Traumatic brain injury

Neurodegenerative disorders

Huntington’s disease

Dentatorubropallidoluysianatrophy

Spinocerebellar ataxia

Miscellaneous

Wilson’s disease

Creutzfeldt–Jakob disease

Fatal familial insomnia

Fahr’s syndrome

Agueductal stenosis

Epileptic psychoses

Ictal psychosis

Postictal psychosis

Chronic interictal psychosis

Psychosis of forced normalization

Encephalitic and post–encephalitic psychoses

Encephalitic

Herpes simplex encephalitis

Infectious mononucleosis

Encephalitis lethargica

Post-encephalitic

Herpes simplex encephalitis

Encephalitis lethargica

Miscellaneous

Vitamin B12 deficiency

Neurosyphilis

Acquired immune deficiency syndrome

Systemic lupus erythematosus

Sydenham’s chorea

Chorea gravidarum

Hepatic porphyria

Metachromatic leukodystrophy

Velocardiofacial syndrome

Vanishing white matter Ieukoencephalopathy

Subacute sclerosing panencephalitis

Prader–Willi syndrome

Source: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012. Table 19.6 The main causes offrontal lobe syndrome Gradual onset Neurodegenerativedisorders Frontotemporal dementia Pick’s diseaseAlzheimer’s disease Amyotrophic lateral sclerosisProgressive supranuclear palsy Corticobasal ganglionicdegeneration Spinocerebellar ataxia FXTAS (fragileX-associated tremor/ataxia syndrome) Metachromaticleukodystrophy Tumors Frontal lobe Corpus callosumMiscellaneous Alcoholic dementia Lacunar dementia Fahr’ssyndrome Neurosyphilis Subacute onset Stroke Frontal lobeCaudate nucleus Thalamus Mesencephalon MiscellaneousTraumatic brain injury Post-viral encephalitis Cerebellarcognitive affective syndrome Source: Moore DP, Puri BK.Textbook of Clinical Neuropsychiatry and BehavioralNeuroscience. 3rd ed. Boca Raton, FL: CRC Press, 2012.Table 19.7 The main causes of nonspecific personalitychange Gradual onset Neurodegenerative disordersFrontotemporal lobar degeneration Alzheimer’s diseaseHuntington’s disease Wilson’s disease Myotonic muscular

dystrophy Tumors Temporal lobe Thalamus Hypothalamus(Continued)

EPILEPSY AND SEIZURES

Epilepsy has historically been associated with vio

lence. 17 The main types of seizure disorders are given in

Table 19.8. Of particular importance in forensic psychi

atry are complex partial seizures of the temporal lobe;

mesial temporal sclerosis is the most common cause of

this (see Figure 19.1). Automatisms can be a feature ofcomplex partial sei

zures. Common stereotyped automatisms are shown in

Table 19.9; rare automatisms may include pelvic thrusting,

genital manipulation, sexual arousal, and orgasm, 1 which

may lead to arrest for sexual offending. Automatism has

been associated with a number of types of other offending

behavior, ranging from driving offenses to violent offenses,

and has been used as a legal defense. 18–21 Causes ofepilepsy

and seizures are given in Table 19.10. Based on theirrecently published extensive review of 176

original cases of various aggressive behaviors in patients

with epilepsy, Pandya and colleagues concluded that

aggressive episodes are stereotyped and repetitive, more

common in the postictal period, and occur more frequently

after a cluster of seizures and in patients with focalepilepsy

(Table 19.11). 22 An International Workshop on Aggressionand Epilepsy

held in Bethesda, Maryland, on March 20, 1980, suggested

five criteria to determine whether in a specific instance a

violent crime was the result of an epileptic seizure; theseare

given in Table 19.12. 22,23 Table 19.8 Types of seizuresSimple partial Complex partial (also known as psychomotor)Petit mal (also known as absence) Grand mal (also known asgeneralized tonic-clonic) Atonic (also known as astaticseizures or ‘drop attacks’) Amnestic Reflex Statusepilepticus Source: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012. Table 19.9 Common stereotypedautomatisms Chewing or lipsmacking Looking around Fumblingwith sheets or clothing, groping, or searching Speaking ormumbling Laughing or crying Sitting or standing up Walkingor running Thrashing or kicking; ‘bicycling’ movementsSource: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012.

Table 19.7 (Continued ) The main causes of nonspecific

personality change

Miscellaneous

Schizophrenia

Normal pressure hydrocephalus

Chronic subdural hematoma

Vitamin B12 deficiency

Limbic encephalitis

New-variant Creutzfeldt–Jakob disease

Mercury intoxication

Manganese intoxication

Subacute onset

Stroke

Miscellaneous

Traumatic brain injury

Post-grand mal status epilepticus

Post-viral encephalitis

Source: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012. Figure 19.1 Coronal magneticresonance imaging scan demonstrating mesial temporalsclerosis on the right. On the T1-weighted scan, atrophyof the hippocampus, indicated by the arrow, is fairlyapparent, with increased signal intensity seen in the samearea on the T2-weighted scan. Reproduced from Hopkins A,Shorvon S, Cascino G. Epilepsy. 2nd ed. London: Arnold,1995.

Table 19.10 Causes of epilepsy and seizures

Idiopathic generalized epilepsias

Childhood absence epilepsy

Juvenile absence epilepsy

Juvenile myoclonic epilepsy

Idiopathic generalized epilepsy with tonic—clonic seizuresonly

Metabolic

Hypoglycemia

Hyperglycemia

Hyponatremia

Hypernatremia

Hypocalcemia

Hypomagnesemia

Uremia

Toxic

Medications Clozapine Phenothiazines Bupropion Tricyclic

antidepressants Lithium Tiagabine Baclofen PenicillinCefipime Isoniazid Busulfan Cyclosporin TacrolimusTheophylline Meperidine Ondansetron Bismuth

Intoxicants Phencyclidine Amphetamine Cocaine

Miscellaneous toxins Iodinated contrast dye Lead Tin Starfruit Domoic acid Aspartame

Alcohol or sedative/hypnotic withdrawal

Alcohol

Table 19.10 (Continued ) Causes of epilepsy and seizures

Von Recklinghausen’s disease

Rett’s syndrome

Tuberous sclerosis

Prader–Willi syndrome

Miscellaneous

Systemic or autoimmune disorders Hypertensiveencephalopathy Reversible posterior leukoencephalopathysyndrome Hashimoto’s encephalopathy Limbic encephalitisSystemic lupus erythematosus Thrombotic thrombocytopenicpurpura Hyperthyroidism Central pontine myelinolysisHepatic porphyria Wernicke’s encephalopathyMarchiafava–Bignami disease Sarcoidosis Behcet’s syndromeWegener’s granulomatosus Whipple’s disease Celiac disease

Autosomal dominant partial epilepsies

Multiple sclerosis

Disorders typically presenting in childhood or adolescenceRasmussen’s syndrome Landau–Kleffner syndrome Sydenham’schorea

Precipitating events Post-anoxic encephalopathy Radiationencephalopathy Dialysis dysequilibrium syndrome Dialysisdementia Eclampsia Post-electroconvulsive therapy

Source: Moore DP, Puri BK. Textbook of ClinicalNeuropsychiatry and Behavioral Neuroscience. 3rd ed. BocaRaton, FL: CRC Press, 2012.

Table 19.11 Previously identified characteristics ofpatients

with epilepsy who have committed violent acts compared

with those epileptic patients who have not done so

Patient

• Male/young age (between 20 and 50 years).

• Seizure onset at childhood or adolescence.

• Refractory epilepsy.

• Presence of organic cerebral disease evident onneurological examination.

• Behavior difficulties in school.

• Lack of mental maturity on psychiatric evaluation. •Unemployed in past 3 years. • Attended church lessfrequently. • Learning disability, low IQ. • Lowsocioeconomic status. • Psychiatric comorbidity includingdepr ession, obsessive disorder, psychosis. Violent actfeatures • Occur suddenly, without evidence of planning. •Short-lived, fragmentary, and unsustained episodes. •Stereotyped aggressive events. • Occur after severe stress.• Can occur hours or days after a seizure. • Usually aftercluster of seizures. • Partial amnesia of event. • Remorseafter episode. • Recurr ent episodes of violence. •Related with alcohol abuse. Source: Pandya NS, Vrbancic M,Ladino LD, Tellez-Zenteno JF. Epilepsy and homicide.Neuropsychiatric Disease and Treatment. 2013; 9: 667–73.Note: The lower half of the table outlines the keyfeatures of the violent act itself. Table 19.12International criteria to determine whether a violentcrime was the result of an epileptic seizure Internationalpanel criteria 1. The diagnosis of epilepsy should beestablished by at least one neur ologist with specialcompetence in epilepsy 2. The pr esence of epilepticautomatisms should be documented by the clinical historyand video-EEG 3. The presence of aggression during anepileptic automatism should be verified in a video-recorded seizure in which ictal epileptiform patterns are also recorded on the EEG 4. The violent act should becharacteristic of the patient’s habitual seiures 5. Aclinical judgment should be made by the neurologist,attesting to the possibility that the act (the allegedcrime) was part of a seizure Source: Pandya NS, Vrbancic M,

Ladino LD, Tellez-Zenteno JF. Epilepsy and homicide.Neuropsychiatric Disease and Treatment. 2013; 9: 667–73.

3. Lipowski ZJ. Delirium (acute confusional states). JAMA:The Journal of the American Medical Association. 1987;258: 1789–92.

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7. Wager NM. Sexual revictimization: Double betrayal andthe risk associated with dissociative amnesia. Journal ofChild Sexual Abuse. 2013; 22: 878–99.

8. G iger P, Merten T, Merckelbach H. [Crime-relatedamnesia: Real or feigned?]. Fortschritte derNeurologie-Psychiatrie. 2012; 80: 368–81.

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Nervenheilkunde und deren Grenzgebiete. 1957; 14: 212–27.15. Nielssen OB, Malhi GS, Large MM. Mania, homicide andsevere violence. Australian and New Zealand Journal ofPsychiatry. 2012; 46: 357–63. 16. L atalova K. Violenceand duration of untreated psychosis in first-episodepatients. International Journal of Clinical Practice.2014; 68: 330–5. 17. Gauffin H, Landtblom AM. Epilepsy andviolence: Case series concerning physical trauma inchildren of persons with epilepsy. NeuropsychiatricDisease and Treatment. 2014; 10: 2183–9. 18. Beaumont G.Automatism and hypoglycaemia. Journal of Forensic andLegal Medicine. 2007; 14: 103–7. 19. McSherry B.Epilepsy, automatism and culpable driving. Medicine andLaw. 2002; 21: 133–53. 20. A shford JW, Schulz C, WalshGO. Violent automatism in a partial complex seizure. Reportof a case. Archives of Neurology. 1980; 37: 120–2. 21. Gunn J, Fenton G. Epilepsy, automatism, and crime. Lancet.1971; 1: 1173–6. 22. Pandya NS, Vrbancic M, Ladino LD,Tellez-Zenteno JF. Epilepsy and homicide. NeuropsychiatricDisease and Treatment. 2013; 9: 667–73. 23.Delgado-Escueta AV, Mattson RH, King L, et al. The natureof aggression during epileptic seizures. Epilepsy &Behavior: E&B. 2002; 3: 550–6.

20 Chapter 20 Psychosis and Violence

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16. Steadman HJ, Mulvey EP, Monahan J, Robbins PC,Appelbaum PS, Grisso T, et al. Violence by peopledischarged from acute psychiatric inpatient facilities andby others in the same neighbourhoods. Archives of GeneralPsychiatry. 1998; 55: 393–401.

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21 Chapter 21 Mood Disorders

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22 Chapter 22 Substance Abuse

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23 Chapter 23 Gambling

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24 Chapter 24 Personality Disorders

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25 Chapter 25 Psychopathy

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27 Chapter 27 Malingering and FactitiousDisorder

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28 Chapter 28 Learning Disability

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29 Chapter 29 Asperger’s Syndrome

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30 Chapter 30 Forensic Aspects of Adhd

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19. Einarsson E, Sigurdsson JF, Gudjonsson GH, Newton AK,Bragason OO. Screening for attentiondeficit hyperactivitydisorder and co-morbid mental disorders among prisoninmates. Nordic Journal of Psychiatry. 2009; 1–7.

20. Ginsberg Y, Hirvikoski T, Lindefors N.attention-deficit hyperactivity disorder (ADHD) amonglonger-term prison inmates is a prevalent, persistent anddisabling disorder. BMC Psychiatry. 2010; 10: 112.

21. G udjonsson GH, Wells J, Young S. Personality disordersand clinical syndromes in ADHD Prisoners. Journal ofAttention Disorders. 2012; 16: 305–14.

22. Rosler M, Retz W, Yaqoobi K, Burg E, Retz-Junginger P.Attention deficit/hyperactivity disorder in femaleoffenders: Prevalence, psychiatric comorbidity andpsychosocial implications. European Archives of Psychiatryand Clinical Neuroscience. 2009; 259: 98–105.

23. Young S, Wells J, Gudjonsson GH. Predictors ofoffending among prisoners: The role of attentiondeficithyperactivity disorder and substance use. Journal ofPsychopharmacology. 2011; 25: 1524–32.

24. Y oung S, Sedgwick O, Fridman M, Gudjonsson GH,Hodgkins P, Lantigua M, González RA. Co-morbid psychiatricdisorders among incarcerated ADHD populations: Ameta-analysis. Psychological Medicine. 2015; 45(12):2499–510.

25. Gonzalez RA, Gudjonsson GH, Wells J, Young S. The roleof emotional distress and ADHD on institutional behavioraldisturbance and recidivism among offenders. Journal ofAttention Disorders. 2016; 20(4): 368–78.

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31 Chapter 31 Homicide

2. Brookman F, Maguire M. Reducing Homicide: Summary of aReview of the Possibilities. RDS occasional paper no. 84.London: Home Office, 2003.

3. Gillies H. Murder in the West of Scotland. BritishMedical Journal. 1965; 111: 1087–94.

4. Nielsen O, Large M. Rates of homicide during the firstepisode of psychosis and after treatment: A systematicreview and meta-analysis. Schizophrenia Bulletin. 2010; 36(4): 702–12.

5. R odway C, Flynn S, Swinson N, Roscoe A, Hunt I M,Windfuhr K, et al. Methods of homicide in England andWales: A comparison by diagnostic group. Journal ofForensic Psychiatry and Psychology. 2009; 20(2): 286–305.

6. L arge M, Smith G, Swinson N, Shaw J, Neeson O.Homicide due to mental disorder in England and Wales over50 years. British Journal of Psychiatry. 2008; 193:130–37.

7. West DJ. Murder Followed by Suicide. London: Macmillan,1965.

8. T reasaden I. Assessment of violence in medium secureunits. Chapter 2 in: Dangerous Patients: A PsychodynamicApproach to Risk Assessment and Management. Ed. Doctor R.London: Karnac Book, 2003; 21–31.

9. Bloom-Cooper L, Grounds A, Guinan P, Parker A, TaylorM. The Case of Jason Mitchell: Report of the IndependentPanel of Enquiry. London: Gerald Duckworth & Co., 1986.

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11. B ennett D. Homicide, inquiries and scapegoating.Psychiatric Bulletin. 1996; 20: 298–300.

12. Taylor PJ, Gunn J. Homicides by people with mentalillness: Myth and reality. British Journal of Psychiatry.1999; 174: 9–14.

13. Appleby L, Shaw J, Amos T, et al. Safer Services:Report of the National Confidential Enquiry into Suicideand Homicide by People with Mental Illness. London:

Stationery Office, 1999. 14. Appleby L, Shaw J, SherrattJ, et al. Safety First: Report of the NationalConfidential Enquiry into Suicide and Homicide by Peoplewith Mental Illness. London: Stationery Office, 2001. 15.Shaw J, Hunt IM, Flynn S, et al. Rates of mental disorderin people convicted of homicide: A national clinicalsurvey. British Journal of Psychiatry. 2006; 188: 143–47.16. S haw J, Amos T, Hunt IM, et al. Mental illness inpeople who kill strangers: Longitudinal study and nationalclinical survey. British Medical Journal. 2004; 328:734–37. 17. Maden A. Treating Violence: A Guide to RiskManagement in Mental Health. Oxford: Oxford UniversityPress, 2007. 18. Webster CD, Douglas KS, Eaves D, Hart SD.HCR-20: Assessing Risk of Violence, version 2. Vancouver:Mental Health, Law and Policy Institute, Simon FraserUniversity, 1997. 19. D epartment of Health. Guidance onthe Discharge of Mentally Disordered People and theirContinuity of Care in the Community. HSG (94) 27. London:NHS Executive, 1994. 20. R itchie J, Dick D, Lingham R.The Report of the Inquiry into the Care and Treatment ofChristopher Clunis. London: HMSO, 1994. 21. D epartmentof Health. The Care Programme Approach for People with aMental Illness Referred to the Specialist PsychiatricServices. London: HMSO, 1990. 22. N HS ManagementExecutive. Introduction to Supervision Registers forMentally Ill People from 1 April 1994. Leeds: NHSME, 1994.23. Burns T, Rugkasa J, Molodynska A, Dawson J, Yeels K,Vazquez-Montes M, Voysey M, Sinclair J, Priebe S.Community Treatment Orders for patients with psychosis(OCTET): A randomised controlled trial. Lancet. 2013;381 (9878): 1627–33.

32 Chapter 32 National ConfidentialInquiry into Homicide

16. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The worldreport on violence and health. The Lancet. 2002;360(9339): 1083–88.

17. NICE. Violence: The Short-Term Management ofDisturbed/Violent Behaviour in In-Patient PsychiatricSettings and Emergency Departments. London: NationalInstitute for Health and Clinical Excellence, 2005.

18. Department of Health. Best Practice in Managing Risk.London: National Risk Management Programme, 2007.

19. Department of Health. Refocusing the Care ProgrammeApproach: Policy and Positive Practice Guidance. London:Department of Health, 2008.

20. Kelly J. “Quiet man” behind the bloodshed. Cumbria,UK: BBC News, 2010.

21. Flynn S, Swinson N, While D, Hunt IM, Roscoe A, RodwayC, et al. Homicide followed by suicide: A cross-sectionalstudy. Journal of Forensic Psychiatry & Psychology. 2009;20(2): 306 –21.

22. S mith K, Flatley J, Coleman K, Osborne S, Kaiza P,Roe S. Homicides, Firearm Offences and Intimate Violence2008/09: Supplementary Volume 2 to Crime in England andWales 2008/09. London: The Home Office, 2010.

23. N ational Confidential Inquiry into Suicide andHomicide by People with Mental Illness. Annual Report:England and Wales. Filicide: A Literature Review.Manchester; The University of Manchester, 2010.

24. F lynn SM, Shaw JJ, Abel KM. Homicide of infants:A cross-sectional study. Journal of Clinical Psychiatry.2007 Oct; 68(10): 1501–9.

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after homicide in England and Wales. Medicine, Science andthe Law. 1998; 38(3): 211. 29. Prins H. Homicide andallied inquiries: In whose best interests? Medicine,Science and the Law. 2010; 50(1): 4–10. 30. M aden T.Treating Violence: A Guide to Risk Management in MentalHealth. Oxford: Oxford University Press, 2007. 31.Eastman N. Inquiry into homicides by psychiatric patients:Systematic audit should replace mandatory inquiries.British Medical Journal. 1996; 313(7064): 1069–71. 32. Walshe K, Higgins J. The use and impact of inquiries in theNHS. British Medical Journal. 2002; 325(7369): 895–900.33. Munro E. Mental health tragedies: Investigating beyondhuman error. Journal of Forensic Psychiatry & Psychology.2004; 15(3): 475–93. 34. Pearson A, Swinson N, Shaw J.Independent investigations after homicide. Mental HealthToday. 2009: 24–9. 35. N ational Confidential Inquiryinto Suicide and Homicide by People with Mental Illness.Independent Investigations after Homicide by PeopleReceiving Mental Health Care (2010). Manchester:University of Manchester. 2010. 36. N ational ConfidentialInquiry into Suicide and Homicide by People with MentalIllness. Independent Homicide Investigations. Manchester:University of Manchester, 2008.

33 Chapter 33 Serial/spree/mass Killings

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2. Fox JA, Levin J. Extreme Killing: Understanding Serialand Mass Murder. 2nd ed. Sage Publications: Thousand Oaks,CA, 2012: 17–26.

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34 Chapter 34 Violence Toward Spouse orIntimate Partner

Table 34.4 Risk factors for homicide of the battered woman

include

A use of weapons in prior abusive incidents

Threats with weapons

Threats to kill

Life-threatening injury in prior abusive incidents

Prior criminal history

Violence outside the home

Fantasies of homicide and suicide

Drug or alcohol abuse

Forced sex of female partner

Extreme jealousy and dominance

Table 34.3 Prediction of homicide of battered women

Approximately 70% of murdered women are killed by a husbandor lover or estranged lover.

Approximately two-thirds of those murdered by intimatepartners or ex-partners had been physically abused beforethey were killed.

A history of female battering is the most usual pattern ofhomicide of a female partner or ex-partner followed bysuicide of the perpetrator.

Women are often most highly at risk for homicide after theyhave left their abusers or when they make it clear to themthat they are leaving them for good.

The majority of battered women eventually do leave theirabusers.

11. Walker LE. Battered woman syndrome: Empiricalfindings. Annals of New York Academy of Science. 2006;1087: 142–57.

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35 Chapter 35 Violence Toward Children

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36 Chapter 36 Violence Toward Older Adults

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Figure 36.1 Spheres of influence on a vulnerable older

person.

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37 Chapter 37 Violence in the Workplace

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38 Chapter 38 Road Rage

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39 Chapter 39 Transsexualism

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40 Chapter 40 Transvestism

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41 Chapter 41 Paraphilias

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42 Chapter 42 Rape

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43 Chapter 43 Pornography

BOX 43.4: Psychological assessment of

Internet sex offenders

Comprehensive psychological assessment of Internet

sex offenders would include the following:

1. Factors apparently associated with risk of contactoffending ●● Offending history ●● Antisocial traits ●● Drugand alcohol abuse ●● Opportunity/access/role with respectto children

2. Use of the Internet to access sexual materials ●● Searchterms—degree of active searching ●● Range or specificity inmaterials sought ●● Efforts to hide Internet history ●●Selective or indiscriminate downloading

Predisposing factors including the following:

3. U nderlying mental health disorders/psychologicalproblems, particularly the following: ●● Psychosis ●●Depression, anxiety, obsessionality ●● Autism spectrumdisorders ●● Personality disorders

4. O ccupational and relationship difficulties

5. Psychosexual development including sexual trauma andabuse, exposure to pornography, and problems in thedevelopment of age-appropriate intimate relationships

14. Wolak J, Finkelhor D, Mitchell, K. Child pornographypossessors: Trends in offenders and case characteristics.Sex Abuse: A Journal of Research and Treatment. 2011; 23(1): 22–42.

15. Quayle E, Jones T. Sexualized images of children onthe Internet. Sexual Abuse: A Journal of Research andTreatment. 2011; 23: 7–21.

16. Taylor M, Quayle E. Child Pornography: An InternetCrime. Hove, UK: Brunner-Routledge, 2003.

17. W ebster S, Davidson J, Bifulco A, et al. EuropeanOnline Grooming Project Final Report. March 2012.Available from:http://www.europeanonlinegroomingproject.com. Accessed 15Feb 2015.

18. Seto MC, Hanson KC, Babchishin KM. Contact sexualoffending by men with online sexual offenses. SexualAbuse: A Journal of Research and Treatment. 2011; 23:124–45.

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44 Chapter 44 Fire Setting (arson) andCriminal Damage

Table 44.3 Potential risk factors for arson recidivism

Early age (childhood) onset of fire setting

History of repeated fire setting

Overall number of charges of arson and reported deliberatefires

Developmental history of violence

Substance abuse

Early onset of other criminal convictions

Relationship problems

Interest in or excitement with fire itself

Severity of psychopathology (especially personalitypathology, schizophrenia)

Motive and intent to do harm underlying previous arson

Evidence of planning in arson (multiple set points, use ofaccelerants)

Post-offense response (positive or negative)

Previous arson endangering life

Inwardly directed hostility, lack of assertiveness, and lowself-esteem

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45 Chapter 45 Habit and Impulse-controlDisorders, Shoplifting, and Other Formsof Acquisitive Offending

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46 Chapter 46 Hostage Taking

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Hammer MR. The S.A.F.E Model for NegotiatingCritical Incidents. In: The Faces of Terrorism. Ed. CanterD. Chichester: John Wiley and Sons Ltd., 2009: 33–58.

Keenan B. An Evil Cradling. The Five Year Ordeal ofa Hostage. London: Hutchinson, 1992.

McClain BU, Callaghan GM, Madrigual DO, et al.Communication patterns in hostage negotiations. Journal ofPolice Crisis Negotiations. 2001; 1: 53–67.

McMains MJ, Mullins WC. Crisis negotiations: Managingcritical incidents and hostage situations in lawenforcement. Waltham, MA: Anderson Publishing, 2014. MisinoDJ. Negotiate and Win. New York: McGraw Hill, 2004. NariaCE, Ossa M. Family functioning, coping and psychologicaladjustment in victims and their families following

kidnapping. Journal of Traumatic Stress. 2003; 16: 107–12.Ostermann BM. Cultural differences make negotiationsdifferent. Journal of Police Crisis Negotiations. 2002; 2:11–20.

47 Chapter 47 Terrorism

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48 Chapter 48 Morbid Jealousy

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5. Easton J, Schipper L, Shackelfor d T. Morbid jealousyfrom an evolutionary psychological perspective. Evolutionand Human Behaviour. 2007; 28(6): 399–402.

6. Mullen PE. Jealousy: The pathology of passion. BritishJournal of Psychiatry. 1991; 158: 593–601.

7. M uzinic L, Goreta N, Jukic V, Djordjevic V, Koic E,Herceg M. Forensic importance of jealousy. CollegiumAntropologicum. 2003; 27: 293–300.

8. Mullen PE, Maack LH. Jealousy, Pathological Jealousyand Aggression. In: Aggression and Dangerousness. Eds.Farrington DP, Gunn J. New York: Wiley, 1985; 103–26.

9. Batinic, Borjanka, Dragana Duisin, and Jasmina Barisic.Obsessive versus delusional jealousy. PsychiatriaDanubina. 2013; 25(3): 1–339.

10. Hoaken PCS. Jealousy as a symptom of psyc hiatricdisorder. Australian & New Zealand Journal of Psychiatry.1976; 10: 47–51.

11. Cobb JP, Marks IM. Morbid jealousy featuring asobsessive-compulsive neurosis: Treatment by behaviouralpsychotherapy. British Journal of Psychiatry. 1979; 134:301–5.

12. T arrier N, Beckett R, Harwood S, Bishay N. Morbidjealousy: A review and cognitive-behavioural formulation.British Journal of Psychiatry. 1990; 157: 319–26.

13. L ane RD. Successful fluoxetine treatment of

pathological jealousy. Journal of Clinical Psychiatry.1990; 51: 345–6.

14. American Psychiatric Association. Diagnostic andStatistical Manual of Mental Disorders. 4th ed., textrevised. (DSM-IV) Washington, DC: American PsychiatricAssociation, 2000. 15. Soyka M, Schmidt P. Prevalence ofdelusional jealousy in psychiatric disorders. Journal ofForensic Science. 2011 Mar; 56(2): 450–2. 16. De Silva D,De Silva P. Morbid jealousy in an Asian country: Aclinical exploration from Sri Lanka. International Reviewof Psychiatry. 1999; 11(2–3): 116–21. 17. Bhugra, Dinesh.Cross-cultural aspects of jealousy. International Reviewof Psychiatry. 1993; 5(2–3): 271–80. 18. Freud, S. SomeNeurotic Mechanisms in Jealousy, Paranoia andHomosexuality. Reprinted (1953–1974) in the StandardEdition of the Complete Psychological Works of SigmundFreud. Vol. XVIII. Ed. Strachey J. London: Hogarth Press,1922. 19. Klein M. Envy and Gratitude. In: The Writings ofMelanie Klein, Vol. 3. London: Hogarth Press, 1957:176–235. 20. Dolan M, Bishay N. The effectiveness ofcognitive therapy in the treatment of non-psychotic morbidjealousy. British Journal of Psychiatry. 1996; 168:588–93. 21. Marazziti D, Poletti M, Dell’Osso L, Baroni S,Bonuccelli U. CNS Spectrums. 2012; 1–9. 22. Graff-RadfordJ, Whitwell JL, Geda YE, Josephs KA. Clinical and imagingfeatures of Othello’s syndrome. European Journal ofNeurology. 2012; 19(1): 38–46. 23. Michael A, Mirza S,Mirza KAH, et al. Morbid jealousy in alcoholism. BritishJournal of Psychiatry. 1995; 167: 668–72. 24. LangfeldtG. The erotic jealousy syndrome: A clinical study. ActaPsychiatrica Scandinavica. 1961; 36(suppl 151): 7–68. 25.Todd J, Mackie JRM, Dewhurst K. Real or imaginedhypophallism: A cause of inferiority feelings and morbidsexual jealousy. British Journal of Psychiatry. 1971; 119:315–8. 26. Mendhekar DN, Srivastav PK. Sildenafil andmorbid jealousy. Indian Journal of Pharmacology. 2004; 36:104–5. 27. Mooney HB. Pathological jealousy andpsychochemotherapy. British Journal of Psychiatry. 1965;111: 1023–42. 28. B yrne A, Yatham LN. Pimozide inpathological jealousy. British Journal of Psychiatry. 1989;155: 386–9. 29. Gross MD. Treatment of morbid jealousy byfluoxetine. American Journal of Psychiatry. 1991;148, 683–4. 30. Stein DJ, Hollander E, Josephson SC.Serotonin uptake blockers for the treatment of obsessionaljealousy. Journal of Clinical Psychiatry. 1994; 55: 30–3.31. Bishay NR, Peterson N, Tarrier N. An uncontrolledstudy of cognitive therapy for morbid jealousy. BritishJournal of Psychiatry. 1989; 154: 386–9.

49 Chapter 49 Erotomania

9. Menzies RPD, Fedoroff JP, Green CM, Isaacson K.Prediction of dangerous behaviour in male erotomania.British Journal of Psychiatry. 1995; 166: 529–36.

10. Mullen PE, Pathé M, Purcell R. Stalkers and TheirVictims. Cambridge: Cambridge University Press, 2000:9–10, 217, 187–204.

11. McEwan TE, Mullen PE, MacKenzie RD, Ogloff JR.Violence in stalking situations. Psychological Medicine.2009; 39: 1469–78.

12. P urcell R, Pathé M, Mullen PE. A study of women whostalk. American Journal of Psychiatry. 2001; 158: 2056–60.

13. Zona MA, Sharma KK, Lane J. A comparative study oferotomanic and obsessional subjects in a forensic sample.Journal of Forensic Sciences. 1993; 38: 894–903.

14. Purcell R, Moller B, Flower T, Mullen PE. Stalkingamong juveniles. British Journal of Psychiatry. 2009; 194:451–55.

15. M cEwan T, Mullen PE, Purcell R. Identifying risks instalking: A review of current research. InternationalJournal of Law and Psychiatry. 2007; 30: 1–9. 16. McEwanTE, Mullen PE, MacKenzie R. A study of the predictors ofpersistence in stalking situations. Law and HumanBehaviour. 2009; 33: 149–58. 17. Kamphuis JH, EmmelkampPMG, Bartak A. Individual differences in post-traumaticstress following postintimate stalking: Stalking severityand psychosocial variables. British Journal of ClinicalPsychology. 2003; 42: 145–56. 18. M ullen PE, Pathé M.The pathological extensions of love. British Journal ofPsychiatry. 1994; 165: 614–23. 19. Urbach JR, Khalily C,Mitchell PP. Erotomania in adolescence: Clinical andtheoretical considerations. Journal of Adolescence. 1992;15: 231–40. 20. Pathé M. Surviving Stalking. Cambridge:Cambridge University Press, 2002. 21. M cIvor RJ, PetchE. Stalking of mental health professionals: Anunderrecognised problem. British Journal of Psychiatry.2006; 188: 403–404. 22. Munroe A, Mok H. An overview oftreatment in paranoia/delusional disorder. CanadianJournal of Psychiatry. 1985; 40: 616–22. 23. Kelly BD.Epidemiology and management of erotomania. CNS Drugs.2005; 19: 657–69.

50 Chapter 50 Stalking

14. McFarlane J, Campbell JC, Watson K. Intimate partnerstalking and femicide: Urgent implications for women’ssafety. Behavioural Sciences and the Law. 2002; 20(1–2):51–68.

15. Mullen PE, MacKenzie R, Ogloff JRP, Pathé M, McEwan T,Purcell R. Assessing and managing the risks in thestalking situation. Journal of the American Academy ofPsychiatry and the Law. 2006; 34: 439–50.

16. Pathé M. Surviving Stalking. Cambridge: CambridgeUniversity Press, 2002.

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51 Chapter 51 Munchausen Syndrome

and nonpunitive manner. Initially, as collateral information

is gathered, members of the multidisciplinary team may react

with disbelief and anger when lies are uncovered. A multidis

ciplinary team meeting should be held to plan how, where,

and when the patient should be confronted. Previously, con

frontation was thought to be unhelpful. However, new evi

dence suggests that it may be helpful in offering thepatient

an interpretation of his or her behavior and in explainingthat

a management package is available. 18 In my experience, hav

ing a family member present when confronting the patient

is useful. I try to explain that I am aware that thepatient has

distress and seeks care but has used a care-seeking means

that has likely led to rejection, the opposite end resultof what

was desired. Going through the history and highlighting

the discrepancies between what the patient said and what

was discovered from collateral sources is appropriate. The

patient may react angrily and tell more lies. However, keep

ing calm, presenting the condition as a psychological disor

der, and offering a psychological management plan can be

therapeutic. Emphasizing the risk of iatrogenic damage 19and

the desire of the treating team to help rather than rejectthe

patient is important. However, because of the chronic nature

of the condition, the patient may dismiss the intervention,

threaten legal action, and self-discharge. If the patientdoes

accept follow-up, psychotherapy may have a role in manage

ment, which may mean involving the family to set limits.

In some areas support groups have been found to be helpful.

There also is an Internet site that functions as an onlineforum

for patients with Munchausen syndrome.

In terms of overall management, as a psychiatrist, one

has to think about not just the patient, but also thereferring

physician/team. Frequently the referring physician/team

become angry and develop a strong countertransference

toward the patient. Giving them the opportunity to ventilate

can be helpful and educational. Advising conservative careif

future presentations occur is necessary. Minimizinginvestiga

tions and admissions is indicated. In psychiatric Munchausen

syndrome, if a person has been treated by a mental healthteam

for a prolonged period of time, the treating team may disbe

lieve the diagnosis of Munchausen syndrome: team members

find it hard to accept that they have been duped. They may

accept that the patient has an Axis II disorder, though.

One other important aspect of management is inform

ing other healthcare providers about the diagnosis. In my

opinion, because of the serious risk that a patient with

Munchausen syndrome poses to his or her own health as

well as the risk of iatrogenic damage, it is important tonotify

other hospital services such as emergency departments and

general practitioners about the diagnosis. This decision is

based on the principle of having a duty of care to thepatient

and the likelihood of harm occurring to the patient.

PROGNOSIS

The prognosis is generally poor, especially if there issevere

comorbid personality disorder (antisocial or borderline) 20

14. Popli AP, Masand PS, Dewan MJ. Factitious disorderswith psychological symptoms. Journal of ClinicalPsychiatry. 1992; 53: 315–18.

15. H G Pope Jr, JM Jonas, B Jones. Factitious psychosis: Phenomenology, family history, and long-termoutcome of nine patients. American Journal of Psychiatry.1982; 139: 1480–83.

16. Catalina M, Gómez V, de Cos A. Prevalence offactitious disorder with psychological symptoms inhospitalized patients. Actas Españolas de Psiquiatría.2008; 36: 345–49.

17. Mountz JM, Parker PE, Liu HG, Bentley TW, Lill DW,Deutsch G. Tc-99m HMPAO brain SPECT scanning in Munchausensyndrome. Journal of Psychiatry and Neuroscience. 1996;21: 49–52. 18. C atalina M, de Ugarte L, Moreno C. A casereport. Factitious disorder with psychological symptoms.Is confrontation useful? Actas Españolas de Psiquiatría.2009; 37: 57–59. 19. Huffman JC, Stern TA. The diagnosisand treatment of Munchausen’s syndrome. General HospitalPsychiatry. 2003; 25: 358–63. 20. F olks DG. Munchausen’ssyndrome and other factitious disorders. NeurologicClinics. 1995; 13: 267–81.

52 Chapter 52 Munchausen Syndrome by Proxy

10. Schreier H. On the importance of motivation inMunchausen by Proxy: The case of Kathy Bush. Child Abuseand Neglect. 2002; 26: 537–49.

11. E vans D. Covert video surveillance in Munchausen’ssyndrome by proxy. British Medical Journal. 1994;308(6924): 341–42.

12. Yorker BC. Covert video surveillance of Munchausensyndrome by proxy: The exigent circumstances exception.Health Matrix Cleveland. 1995; 5: 325–46.

13. H all DE, Eubanks L, Meyyazhagan LS, et al. Evaluationof covert video surveillance in the diagnosis of Munchausensyndrome by proxy: Lessons from 41 cases. Pediatrics.2000; 105: 1305–12.

14. Southall DP, Plunkett MC, Banks MW, et al. Covertvideo recordings of life-threatening child abuse: Lessonsfor child protection. Pediatrics. 1997; 100: 735–60.

15. Alexander R. The Munchausen by Proxy Family. In:Munchausen Syndrome by Proxy: Issues in Diagnosis andTreatment. Eds. Levin AV, Sheridan MS. New York: LexingtonBooks, 1995: 59–69.

16. Kinscherff R, Famularo R. Extreme Munchausen syndromeby proxy: The case for termination of parental rights.Juvenile and Family Court Journal. 1991: 41–53.

17. Bools C. Fabricated or Induced Illness in a Child by aCarer. Oxford: Radcliffe Publishing, Ltd, 2007.

18. S tirling J, American Academy of Pediatrics Committeeon Child Abuse and Neglect. Beyond Munchausen syndrome byproxy: Identification and treatment of child abuse in amedical setting. Pediatrics. 2007; 119: 1026–30. 19.Roesler TA, Jenny C. Medical Child Abuse:Beyond Munchausen Syndrome by Proxy. Elk Grove Village,IL: American Academy of Pediatrics Press, 2009. 20. BoolsCN, Neale BA, Meadow SR. Co-morbidity associated withfabricated illness (Munchausen syndrome by proxy). Archivesof Diseases of Childhood. 1992; 67: 77–9. 21. Doward J.Ministers told child harm theory was flawed. The Observer,London, posted January 25, 2004. Available from:http://www.guardian.co.uk/uk/2004/jan/25/childrensministry.highereducation. 22. WallLJ. Medical evidence in child abuse cases: Problem areas.

Family Law. 2008; 320–33. 23. Schreier HA. Proposeddefinitional guidelines for Munchausen by proxy: Acautionary note. American Academy of Child and AdolescentPsychiatry News. March/April, 2000: 77–78. 24. R v. LM,Vol QCA 192. Queensland, Australia: Supreme Court ofQueensland, 2004. 25. I n the Matter of Anesia E. A Childunder Eighteen Years of Age Alleged to be Abused byAntoinette W., Respondent. Sangenito I, Whittig T, Fee L.Family Court, Kings County, New York; 2004. Availablefrom: http://law.justia.com/cases/new-york/other-courts/2004/2004-50736.html. 26. N.Y. FCT. LAW§1012: NY Code–Section 1012: Definitions. 27. In theMatter of Anesia E. (Anonymous). Administration forChildren’s Services, respondent; and Antoinetta W.(Anonymous), appellant. Supreme Court of New York,Appellate Division, Second Department; 2005.

53 Chapter 53 Juvenile Delinquency

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Nathan PE, Gormans JM. New York: University Press, 2007.15. Utting D, et al. Interventions for Children at Risk ofDeveloping Anti-social Personality Disorder. London:Policy Research Bureau, 2007. 16. National Institute forHealth and Clinical Excellence (NICE). Anti-socialPersonality Disorder— Treatment, Management and Prevention.London: NICE, 2009.

17. National Audit Office. The Youth Justice System inEngland and Wales: Reducing Offending by Young People.London: National Audit Office, 2010.

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19. Ministry of Justice statistics bulletin. Re-offendingof Juveniles: Results from a 2007 Cohort England andWales. Norwich, UK: National Criminal Justice ReferenceService, 2009. FURTHER READING Moffit TE, Caspi A, RutterM, Silva PA. Sex Differences in Antisocial Behaviour:Conduct Disorder, Delinqency and Violence in the DunedinLongitudinal Study. Cambridge, UK: Cambridge UniversityPress, 2001.

54 Chapter 54 Adolescent Sex Offenders

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9. R yan G, Leversee T, Lane S. Juvenile Sexual Offending:Causes, Consequences, and Correction. 3rd ed. Hoboken, NJ:John Wiley and Sons Inc., 2010.

10. Stinson JD, Sales BD, Becker JV. Sex Offending: CausalTheories to Inform Research, Prevention, and Treatment.Washington DC: American Psychological Association, 2008.

11. Marshall WL, Barbaree HE. An Integrated Theory of theEtiology of Sexual Offending. In: Handbook of SexualAssault: Issues, Theories and Treatment of the Offender.Eds. Marshall WL, Laws DR, Barbaree HE. New York: Plenum,1990: 257–75.

12. Seto MC, Lalumiere ML. What is so special about maleadolescent sexual offending? A review and test ofexplanations through meta-analysis. PsychologicalBulletin. 2010; 136(4): 526–75.

13. Gunby C, Woodhans J. Sexually deviant juveniles:Comparisons between the offender and offencecharacteristics of ‘child abusers’ and ‘peer a busers.’Psychology, Crime, & Law. 2010; 16: 47–64.

14. A ebi M, Plattner B, Steinhausen H-C, Bessler C.Predicting sexual and nonsexual recidivism in aconsecutive sample of juveniles convicted of sexualoffences. Sexual Abuse: A Journal of Research andTreatment. 2011: 23(4): 456–73.

15. Hunter JA, Figueredo AJ, Malamuth NM, Becker JV.Juvenile sex offenders: Toward the development of atypology. Sexual Abuse: A Journal of Research andTreatment. 2003; 15: 27–48.

16. Parks GA, Bard DE. Risk factors for adolescent sexoffender recidivism: Evaluation of predictive factors andcomparison of three groups based upon victim type. Sex

Abuse. 2006; 18: 319–42.

17. Clift RJ, Rajlic G, Gretton HM. Discriminative andpredictive validity of the penile plethysmograph inadolescent sex offenders. Sexual Abuse: A Journal ofResearch and Treatment. 21: 335–62.

18. R ichardson G, Kelly TP, Bhate SR, Graham F. Groupdifferences in abuser and abuse characteristics in aBritish sample of sexually abusive adolescents. SexualAbuse: A Journal of Research and Treatment. 1997; 9:239–57.

19. Center for Sex Offender Management. The Importance ofAssessment in Sex Offender Management: An Overview of KeyPrinciples and Practices. Silver Spring, MD: Center forSex Offender Management, 2007. 20. Viljoen JL, ElkovitchN, Scalora MJ, Ullman D. Assessment of re-offense risk inadolescents who have committed sexual offenses: Predictivevalidity of the ERASOR, PCL:YV, YLS/CMI, and Static-99.Criminal Justice and Behavior. 2009; 36: 981–1000. 21. Fago DP. Evaluation and treatment of neurodevelopmentaldeficits in sexually aggressive children and adolescents.Professional Psychology: Research and Practice. 2003;34(3): 248–57. 22. Bonta J, Andrews DA.Risk-Need-Responsivity Model for Offender Assessment andTreatment (User Report No. 2007-06). Ottawa: Public SafetyCanada, 2007. 23. Worling JR, Bookalam D, Litteljohn A.Prospective validity of the Estimate of Risk of AdolescentSexual Offense Recidivism (ERASOR). Sexual Abuse: AJournal of Research and Treatment. 2012; 24(3): 203-23.doi:1079063211407080. Epub 2011 Oct 3. 24. O lver ME,Stockdale KC, Wormith JS. Risk assessment with youngoffenders: A meta-analysis of three assessment measures.Criminal Justice and Behavior. 2009; 36: 329–53. 25. Hanson RK, Morton-Bourgon KE. Predictors of SexualRecidivism: An Updated Meta-analysis. Ottawa: PublicSafety and Emergency Preparedness Canada, 2004. 26. Viljoen JL, Mordell S, Beneteau JL. Prediction ofadolescent sexual reoffending: A meta-analysis of theJ-SOAP-II, ERASOR, J-SORRAT-II, and Static-99. Law andHuman Behavior. 2012; doi:10.1037/h0093938. 27. V itaccoMJ, Viljoen J, Petrila J. Introduction to this issue:Adolescent sexual offending. Behavioral Sciences and Law.2009; 27: 857–61. 28. W orling JR, Curwen T. Estimate ofRisk of Adolescent Sexual Offense Recidivism (ERASOR;Version 2.0). In: Juveniles and Children Who SexuallyAbuse: Frameworks for Assessment. Ed. Calder MC. LymeRegis, UK: Russell House, 2001: 372–97. 29. Prentky R,Righthand S. Juvenile Sex Offender Assessment Protocol–II

(J-SOAPII) manual (NCJ Publication No. 202316).Washington, DC: Office of Juvenile Justice and DelinquencyPrevention, 2003. Available from:http://www.csom.org/pubs/JSOAP. pdf. 30. E pperson DL,Ralston CA, Fowers D, DeWitt J. Juvenile Sexual OffenseRecidivism Risk Assessment Tool-II (JSORRAT-II). In: RiskAssessment of Youth Who Have Sexually Abused. Ed. PrescottDS. Oklahoma City, OK: Wood N’ Barnes, 2006: 222–36. 31.Cooke DJ, Michie C. Limitations of diagnostic precision andpredictive utility in the individual case: A challenge forforensic practice. Law and Human Behavior. 2010; 34:259–74. 32. Hanson RK, Howard PD. Individual confidenceintervals do not inform decision-makers about the accuracyof risk assessment evaluations. Law and Human Behavior.2010; 34: 275–81.

33. Sreenivasan, S, Weinberger LE, Frances A,Cusworth-Walker S. Alice in actuarial-land: Through thelooking glass of changing Static-99 norms. Journal of theAmerican Academy of Psychiatry and the Law. 2010; 38:400–406.

34. Vincent GM, Chapman J, Cook NE. Risk-needs assessmentin juvenile justice: Predictive validity of the SAVRY,racial differences, and the contribution of needs factors.Criminal Justice and Behavior. 2011; 38: 42–62.

35. E lkovitch N, Viljoen JL, Scalora MJ, Ullman D.Assessing risk of reoffending in adolescents who havecommitted a sexual offense: The accuracy of clinicaljudgments after completion of risk assessment instruments.Behavioral Sciences and Law. 2008; 26: 511–28.

36. Reitzel LR, Carbonell JL. The effectiveness of sexualoffender treatment for juveniles as measured byrecidivism: A meta-analysis. Sex Abuse. 2006; 18: 401–21.

37. W orling JR, Litteljohn A, Bookalam D. 20-yearprospective follow-up study of specialized treatment foradolescents who offended sexually. Behavioral Sciences andthe Law. 2010; 28: 46–57. doi:10.1002/ bsl.912.

38. B engis SM, Cunninggim P. Beyond Psychology:Brain-Based Approaches That Impact Behavior, Learning, andTreatment. In: Current Perspectives: Working with SexuallyAggressive Youth & Youth with Sexual Behavior Problems.Eds. Long RE, Prescott DS. Holyoke, MA: NEARI Press, 2006:45–62.

39. E llerby L, McGrath RJ, Cumming GF, Burchard BL, Zeoli

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41. Hanson RK, Bussière MT. Predicting relapse: Ameta-analysis of sexual offender recidivism studies.Journal of Consulting and Clinical Psychology. 1998;66(2): 348–62.

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Curwen T. Adolescent sexual offender recidivism: Success ofspecialized treatment and implications for risk prediction.Child Abuse and Neglect. 2000; 24(1): 965–82.

55 Chapter 55 The Clinical Care of Womenin Secure Hospital Services

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15. Higgo R, Shetty G. Four years’ experience of aregional secure unit. Journal of Forensic Psychiatry.1991; 2: 202–210.

16. Milne S, Barron P, Fraser K, Whitfield E. Sexdifferences in patients admitted to a regionalsecure unit. Medicine, Science and Law. 1995; 35: 57–60.

17. M urray K. The use of beds in NHS medium secure unitsin England. Journal of Forensic Psychiatry. 1996; 7:504–524.

18. Coid J, Kahtan N, Gault S, Jarman B. Women admitted tosecure psychiatric facilities: Comparison of men andwomen. Journal of Forensic Psychiatry. 2000; 11(2):275–95. 19. Hassell Y, Bartlett A. The changing climatefor women patients in medium secure units. PsychiatricBulletin. 2001; 25: 340–42. 20. Lelliot P, Audini B,Duffett R. Survey of patients from an inner London healthauthority in medium secure care. British Journal ofPsychiatry. 2001; 178: 62–66. 21. Mezey G, Hassell Y,Bartlett A. Safety of women in mixed-sex and single-sexmedium secure units: Staff and patient perceptions.British Journal of Psychiatry. 2005; 187: 579–82. 22. Harty M, Somers N, Bartlett A. Women’s secure hospitalservices: National bed numbers and distribution. Journal ofForensic Psychiatry and Psychology. 2012;DOI:10.1080/14789949.2012.717300. 23. Department ofHealth. Consultation on Low Secure Services andPsychiatric Intensive Care. London: Department of Health,2012. 24. B artlett A, Somers N, Fiander M, Harty M.Pathways of care of women in secure hospitals: Which womengo where and why. British Journal of Psychiatry. 2014,205: 298–306. DOI: 10.1192/bjp. bp.113.137547. 25. S omersN, Bartlett A. Women’s secure hospital care pathways inpractice: A qualitative analysis of clinicians views inEngland and Wales. BMC Health Services Research. 2014, 14:450. http://www. biomedcentral.com/1472-6963/14/450. 26.Mental Health Strategies. 2009/10 National Survey ofInvestment in Adult Mental Health Services: ReportPrepared for Department of Health. London: Mental HealthStrategies. 2010. 27. D enman C. Sexuality: ABiopsychosocial Approach. Basingstoke, UK: PalgraveMcMillan, 2004. 28. B artlett A, Walker T, Harty M, AbelKM: Health and social care services for women offenders:Current provision and a future model of care. The Journalof Forensic Psychiatry & Psychology. 2014. DOI:10.1080/

14789949.2014.944202. 29. Bartlett A and Somers N: Arewomen really difficult? Challenges and solutions in thecare of women in secure services. The Journal of ForensicPsychiraty & Psychology. 2016.DOI:10.1080/14789949.2016.1244281. 30. Heads TC, TaylorPJ, Leese M. Childhood experiences of patients withschizophrenia and a history of violence: A specialhospital sample. Criminal Behaviour and Mental Health.1997; 7(2): 117–30. 31. Bland J, Mezey G, Dolan B. Specialwomen, special needs: A descriptive study of femalespecial hospital patients. Journal of Forensic Psychiatry.1999; 10(1): 34–45. 32. Bartlett A, Johns A, Fiander M,Jhawar H. London Secure Units Benchmarking Study. London:NHS London, 2007. 33. Heney J, Kristiansen CM. Ananalysis of the impact of prison on women survivors ofchildhood sexual abuse. Women and Therapy. 1997; 20(4):29–44.

34. Henderson D, Scaeffer J, Brown L. Genderappropriatemental health services for incarcerated women: Issues andchallenges. Family and Community Health. 1998; 21(3):42–53.

35. Sarkar J, Di Lustro M. Evolution of secure servicesfor women in England. Advances in Psychiatric Treatment.2011; 17: 323–31.

36. De Vogel V, De Ruiter C. The HCR-20 in personalitydisordered female offenders: A comparison with a matchedsample of males. Clinical Psychology and Psychotherapy.2005; 12(3): 226–40.

37. Long C, Dickens G, Sugarman P, Craig L, Mochty U,Hollin C. Tracking risk profiles and outcome in a mediumsecure service for women: Use of the HoNOS-Secure.International Journal of Forensic Mental Health. 2010;9(3): 215–25.

38. Aitken G. Women and secure settings. The Psychologist.2006; 19(12): 726–29.

39. Long CG, Fulton B, Dolley O, Hollin CR. Dealing withfeelings: The effectiveness of cognitive behavioural grouptreatment for women in secure settings. Behavioural andCognitive Psychotherapy. 2011; 39: 243–47. 40. Departmentof Health. Health Offender Partnerships. Best PracticeGuidance: Specification for Adult Medium Secure Services.London: Department of Health, 2007. 41. Steels M, RoneyG, Larkin E, Jones P, Croudace T, Duggan C. Dischargedfrom special hospital under restrictions: A comparison of

the fates of psychopaths and the mentally ill. CriminalBehaviour and Mental Health. 1998; 8(1): 39–55. 42. CoidJW, Yang M, Zhang T, et al. Patients discharged from mediumsecure forensic psychiatry services: Reconvictions and riskfactors. British Journal of Psychiatry. 2007; 190(3):223–29. 43. Sahota S, Davies S, Duggan C, Clarke M,Huband N, Owen V. Women admitted to medium secure care:Their admission characteristics and outcome as comparedwith men. International Journal of Forensic Mental Health.2010; 9:2, 110–17.

56 Chapter 56 Elderly Offenders

14. Needham-Bennett H, Parrott J, Macdonald AJD.Psychiatric disorder and policing the elderly offender.Criminal Behaviour and Mental Health. 1996; 6: 241–52.

15. Fazel S, Hope T, O’Donnell I, Jacoby R. Health ofelderly male prisoners: Worse than the general population,worse than younger prisoners. Age and Ageing. 2001; 30:403–7.

16. Fazel S, Hope T, O’Donnell I, Jacoby R. Hiddenpsychiatric morbidity in elderly prisoners. British Journalof Psychiatry. 2001; 179: 535–59.

17. Kingston P, LeMesurier N, Yorston G, Wardle S, HeathL. Psychiatric morbidity in older prisoners: Unrecognizedand undertreated. International Psychogeriatrics. 2011;Apr 14: 1–7 [Epub]. 18. W ahidin, A. Older Women and theCriminal Justice System: Running Out of Time. London:Jessica Kingsley, 2004: 168–78. 19. McLeod C, Yorston G,Gibb R. Referrals of older adults to forensic andpsychiatric intensive care services: A retrospectivecase-note study in Scotland. British Journal of ForensicPractice. 2008; 10: 36–40. 20. Y orston G, Taylor PJ.Older patients in an English high security hospital: Aqualitative study of the experiences and attitudes ofpatients aged 60 and over and their care staff inBroadmoor Hospital. Journal of Forensic Psychiatry andPsychology. 2009; 20: 255–67. 21. A day RH. AgingPrisoners: Crisis in American Corrections. Westport:Praeger, 2003: 113–42.

57 Chapter 57 Ethnic Minority Offenders

1. Eric Silver 2006

2. Mulvey et al. 1986

3. 1999 CRE fact sheet

4. 2003 CRE fact sheet

5. 2008 Sainsbury Centre for Mental Health Report

6. 2007 Home Affairs Select Committee Report

7. 2009 reports

8. 2005 Home Office statistics

9. 2007 article in the Guardian

10. Ndegwa 1998

11. Fitzgerald et al. 2003

12. S mith 2008

13. Berthold 1999

14. Lisa Arai et al. 2002

15. Cameron

16. Gayle 2002

17. D Peterson et al. 2008.

18. E mma Lane and Jen L Wood 2010

19. S ingleton N et al. 1998

20. Matt Bruce (personal communication)

21. Coid 2002

22. McCabe et al. 2001 Moffit and Caspi 2001.

23. Meltzer 2000

24. Hodgkins et al. 2007, 2008

25. Hodgins et al. 2011

26. C oid 2002 et al.

27. Hilary Guite 2003

28. Aesop study

29. Kirkbride J et al. 2006.

30. S P Singh et al. 2007.

31. Ndegwa 2002

32. Marsella A J, et al. 1989.

33. M.S Shapley et al. 2001

34. Adebimpe V R et al. 1981 and 1982, Littlewood R et al.1981, Mckenzie K et al. 1995, Mukhejee S et al. 1983,Hickling et al. 1999, Kirov G et al. 1999

35. G. Canimo et al. 1994, 1996, 2008, N Krieger 1987,1999, 2001, 2011, N.Kanami 2011, J.M.Waldram 2006

36. Loring & Powell 1988

37. Spector R. et al. 2001

38. Len Bowers et al. 2011

58 Chapter 58 Deaf Offenders with MentalHealth Needs

2. Austen S, Coleman E. Controversy in Deafness: AnimalFarm meets Brave New World. In: Deafness in Mind: WorkingPsychologically with Deaf People Across the Lifespan. Eds.Austen S, Crocker S. London: Whurr, 2004: Chapter 1.

3. Ladd P. Understanding Deaf Culture: In Search ofDeafdom. Clevedon: Multilingual Matters, 2003.

4. Department of Health. Mental Health and Deafness.Towards Equity and Access. London: Department of HealthPublications, 2005.

5. F ellinger J, Holzinger D, Dobner U, Gerich J,Lehner R, Lenz G. Mental distress and quality of life in adeaf population. Social Psychiatry and PsychiatricEpidemiology. 2005; 40: 737–42.

6. Haskins B. Serving deaf adult psychiatric inpatients.Psychiatric Services. 2004; 55(4): 439–41.

7. Young A, Howarth P, Ridgeway S, Monteiro B. Forensicreferrals to the three specialist psychiatric units fordeaf people in the UK. Journal of Forensic Psychiatry.2001; 12(1): 19–35.

8. M iller K, Vernon M, Capella M. Violent offenders in adeaf prison population. Journal of Deaf Studies and DeafEducation. 2005; 10(4): 417–25.

9. G lickman N. “Do you hear voices?” Problems inassessment of mental status in deaf persons with severelanguage deprivation. Journal of Deaf Studies and DeafEducation. 2007; 12(2): 127–47.

10. H arry B, Dietz P. Offenders in a silent world: Hearingimpairment and deafness in relation to criminality,incompetence and insanity. Bulletin of the AmericanAcademy of Psychiatry and Law. 1985; 13(1): 85–96.

11. O ’Rourke S, Reed R. Deaf People and the CriminalJustice System. In: Deafness and Challenging Behaviour:The 360 o Perspective. Eds. Austen S, Jeffrey, D.,Chichester: Wiley, 2007. 257–74.

12. Y oung A, Monteiro B, Ridgeway S. Deaf people withmental health needs in the criminal justice system: Areview of the UK literature. Journal of Forensic

Psychiatry. 2000; 11(3): 556–70.

13. Miller K, Vernon M. Deaf sex offenders in a prisonpopulation. Journal of Deaf Studies and Deaf Education.2003; 8(3): 357–62.

14. Iqbal S, Dolan M, Monteiro B. Characteristics of deafsexual offenders referred to a specialist mental healthunit in the UK. Journal of Forensic Psychiatry andPsychology. 2004; 15(3): 494–510.

15. O’Rourke S, Grewer G. Assessment of deaf people inforensic mental health settings: A risky business! Journalof Forensic Psychiatry and Psychology. 2005; 16(4):671–84.

16. Izycky A, Gibbon S, Baker K, Gahir M. Application oftherapeutic community principles to a high secure deafservice. Therapeutic Communities. 2007; 28, 372–89.

17. Vernon M, Greenberg S. Violence in deaf andhard-ofhearing people: A review of the literature.Aggression and Violent Behaviour. 1999; 4(3): 259–72. 18.Carvill S, Marston G. People with intellectualdisability, sensory impairments and behaviour d isorders:A case series. Journal of Intellectual DisabilityResearch. 2002; 46(3): 264–72. 19. Adshead S-L, du Feu M.Mental health service provision for the deaf community.Progress in Neurology and Psychiatry. 2005; 9(7), 26–30.20. Shipman S. The British Judicial System—Is it proactivein meeting communication needs of deaf people within avariety of legal settings? Deaf Worlds. 1996; 2(12): 2–8.21. Mischon J, Sensky T, Lindsey M, Cook, S. Report of theIndependent Enquiry Team into the Care and Treatment ofDaniel Joseph, Merton Sutton & Wandsworth HealthAuthority/Lambeth Southwark & Lewisham Health Authority,London. Available from:www.deafinfo.org.uk/policy/the_daniel_joseph_ report.pdf22. D epartment of Health. A Sign of the Times.Modernising Mental Health Services for People Who AreDeaf. London: Department of Health Publications, 2002.23. Gahir M. High Secure Care for Deaf People in Englandand Wales. In: Deafness & Challenging Behaviour: The 360 oPerspective. Eds. Austin S, Jeffery D. Chichester: Wiley &Sons, 2006. 275–91. 24. G ibbon S, Doyle C. Thedevelopment and future of deaf forensic mental healthservices. British Journal of Forensic Practice. 2011;13(3): 191–96. 25. Glickman N. Cognitive-BehavioralTherapy for Deaf and Hearing Person with Language andLearning Challenges. Abington, MA: Routledge, 2009. 26. O

’Rourke S, Gibbon S, Hough W. Standards for Deaf People inSecure Care. London: Royal College of Psychiatrists, 2011.27. Gahir M, O’Rourke S, Monteiro B, Reed R. The unmetneeds of deaf prisoners a survey of p risons in Englandand Wales. International Journal on Mental Health andDeafness. 2011; 1(1): 58–63. 28. H indley P, Kitson N,Leach V. Forensic Psychiatry and Deaf People. In: MentalHealth and Deafness. Eds. Hindley P, Kitson N. London:Whurr, 2000. 206–31. 29. Denmark JC. Crime and DeafPeople. In: Deafness and Mental Health. Ed. Denmark JC.London: Jessica Kingsley, 1994. 112–19. 30. Reed M. “Likea book you cannot close”: Deaf p erspectives on justice.Deaf Worlds. 1996; 1(12): 17–23. 31. Vernon M, Miller K.Obstacles faced by deaf people in the criminal justicesystem. American Annals of the Deaf. 2005; 150(3): 283–91.32. Schneider NR, Sales BD. Deaf or hard of hearinginmates in prison. Disability & Society. 2004;19(1): 77–88. 33. Rickford D, Edgar K. Deaf Prisoners.Troubled Inside: Responding to the Mental Health Needs ofMen in Prison. London: Prison Reform Trust, 2005.

59 Chapter 59 Military Psychiatry

5. Defense Analytic Services and Advice (DASA). UK ArmedForces Mental Health Report 2010— Annual Summary. Ministryof Defense. London: The Stationery Office, 2011. Availablefrom:

6. F innegan A, Finnegan S, McGee P, Srinivasan M, SimpsonR. Predisposing factors leading to depression in theBritish Army. British Journal of Nursing. 25 Nov 2010;19(21): 1355–62.

7. Fear NT, Jones M, Murphy D, Hull L, Iversen AC, CokerB, et al. What are the consequences of deployment to Iraqand Afghanistan on the m ental health of the UK armedforces? A cohort study. Lancet. 2010; 375: 1783–97.

8. Creamer M, Wade D, Fletcher S, Forbes D. PTSD amongmilitary personnel. International Review of Psychiatry.April 2011; 23(2): 160–65.

9. B aggaley M. “Military Munchausen’s”: Assessment offactitious claims of military service in psychiatricpatients. Psychiatric Bulletin. 1998; 22, 153–54.

10. R esnick PJ. Guidelines for Evaluation of Malingeringin PTSD. In: Posttraumatic Stress Disorder in Litigation:Guidelines for Forensic Assessment. 2nd ed. Ed. Simon RI.Washington, DC: American Psychiatric Press, 2003: 187–206.11. Deahl MP. Smoke, mirrors, and Gulf War illness.Lancet. 2005; 365: 635–39. 12. F riedman MJ. Veterans’mental health in the wake of war. New England Journal ofMedicine. 2005; 352: 1287–90. 13. Killgore WDS, CottingDI, Thomas JL, Cox AL, McGurk D, Vo AH, et al. Post-combatinvincibility: Violent combat experiences are associatedwith increased risk taking propensity followingdeployment. Journal of Psychiatric Research. 2008; 42:1112–21. 14. MacManus D, Dean K, Iversen A, Hull L,Jones N, Fahy T, et al. Impact of pre-enlistmentantisocial behaviour on behavioural outcomes among UKmilitary personnel. Social Psychiatry and PsychiatricEpidemiology. 2012; 47(8): 1353–8. 15. Defense AnalyticServices and Advice (DASA). Estimating the proportion ofprisoners in England and Wales who are ex-Armed Forces—further analysis. Ministry of Defence. London:The Stationery Office, 2010. Available from: http://www.dasa.mod.uk/applications/newWeb/www/ index.php?page =48&thiscontent = 550&pubType = 3&date =2010-09-15&PublishTime = 13:00:00. FURTHER READING IversenAC, Greenberg N. Mental health of regular and reserve

military veterans. Advances in Psychiatric Treatment.2009; 15: 100–106.

60 Chapter 60 Asylum Seekers

1. Krupinski, J, Stoller, A, Wallace, L. (1973) PsychiatricDisorders in Eastern European Refugees now in Australia.Social Science and Medicine. 7: 31–49.

2. Tribe, R. (2002) Mental Health of Refugees and AsylumSeekers. BJPsych. Adances 8: 240–247.

3. T aylor-East, R., Rossi A., Carnana, J., Grech, A.(2016) The Mental Health Services for Detained AsylumSeekers in Malta. BJPsych. International 13: 32–35.

4. Robjant, K., Hassan, R., Katona, C. (2009) MentalHealth Implications of Detaining Asylum Seekers;systematic review. BJPsych. 194(4): 306–312.

5. Sen, P. (2016) The Mental Health Needs of AsylumSeekers and Refugees – Challenges and Solutions. BJPsychInternational. Vol. 13 No.2 30–32.

6. Hughes, P. Hijazi, Z., Saeed, K (2016) Improving Accessto Mental Healthcare for Displaced Syrians; case studiesfrom Syria, Iraq and Turkey. BJPsych. International. Vol.13 No. 4 84–86.

7. Christodoulou, G.N., Abou-Saleh, M.T. (2016) Greece andthe Refugee Crisis; Mental Health Context. Vol. 13 No. 489–91.

61 Chapter 61 The Criminal Justice SystemOf England And Wales

12. “Facts about the CPS” (Crown Prosecution Service, 31March 2014). Available from: www.cps.gov.uk/about/facts.html. Accessed 12 June 2015.

13. P rosecution of Offences Act 1985, s.3(2)(a).

14. Prosecution of Offences Act 1985 (SpecifiedProceedings) Order 1999, SI 1999/904 (as amended by SI2012/1635, SI 2012/2067, SI 2012/2681 and SI 2014/1229).

15. Prosecution of Offences Act 1985, s.6.

16. C rown Prosecution Service, The Code for CrownProsecutors (CPS 2013) paras 4.4–4.6.

17. Ibid., 4.7–4.12.

18. Ibid., 4.12(b)

19. Crime and Disorder Act 1998, ss.51 and 51A.

20. An indictment is a formal, written accusation of crime.

21. C rime and Disorder Act 1998, s.51.

22. Interpretation Act 1978, Sch 1.

23. Magistrates’ Courts Act 1980, s.19(3)(a); SentencingCouncil, “Allocation Guideline” in Magistrates’Court Sentencing Guidelines: Definitive Guideline (1 Oct2012).

24. M agistrates’ Courts Act 1980, s.133.

25. Ibid., s.17A.

26. P owers of Criminal Courts (Sentencing) Act 2000, s.3.

27. M agistrates’ Courts Act 1980, s.19.

28. I bid., s.21.

29. Ibid., s.20. 30. CrimPR 2015 r1.1. 31. B ail Act1976, s.4 and sch.1. 32. R v . Pritchard (1836) 7 C. & P.303; R v. M (John) [2003] EWCA Crim 3452; CriminalProcedure (Insanity) Act 1964, s.4. 33. CriminalProcedure and Investigations Act 1995, s.3. 34. Ibid.,

s.3(3). 35. Ibid., ss. 5 and 6A. 36. I bid., s.7A. 37. Woolmington v. DPP [1935] AC 462. 38. R v. Summers [1952] 1All ER 1059. 39. See, for example, Youth Justice andCriminal Evidence Act 1999 Part 2, Chapter 1. 40. Forexample, Police and Justice Act 2006, s.47; CPD I 3F.3 and3G.12-13. 41. Auld LJ, A Review of the Criminal Courts ofEngland and Wales (September 2001) Chapter 10, para 154;R v. Gleeson [2003] EWCA Crim 3357. 42. Criminal JusticeAct 1967, s.9. 43. R v . Galbraith [1981] 1 WLR 1039. 44.Ibid. 45. Criminal Evidence Act 1898, s.1. 46. CriminalJustice and Public Order Act 1994, s.35. 47. I bid.,s.38(3). 48. Ibid., s.35(1)(b). 49. J uries Act 1974,s.17 and CPD VI 39Q.

62 Chapter 62 Police and CriminalEvidence Act

11. O’Hara v. Chief Constable of the Royal UlsterConstabulary [1997] AC 286.

12. H ough v. Chief Constable of Staffordshire [2001]EWCA Civ 39, as long as the officer actually forms asuspicion rather than merely relying on the entry orinstructions from fellow officers (R v. Olden [2007] EWCACrim 726).

13. Hayes v. Chief Constable of Merseyside Police [2011]EWCA Civ 911. But see B v Chief Constable of NorthernIreland [2015] EWHC 3691 (Admin), which confirmed that“necessity” connotes more than merely desirable or moreconvenient. An offer by suspects to be interviewed undercaution at a police station in England meant an arrest notnecessary for prompt and effective investigation inNorthern Ireland.

14. PACE Section 28.

15. The requirement is to convey in simple, nontechnicallanguage the essential legal and factual grounds forarrest, but detailed outlines of the case against thesuspect are not required: Taylor v Chief Constable ofThames Valley [2004] 1 W.L.R. 3155.

16. Code of Practice C Section 10.4 (and see Code GSection 3) in addition requires the officer to caution asuspect on arrest in relation to his or her right toremain silent, although failure to do so will not ofitself make the arrest unlawful.

17. W ilson v. Chief Constable of Lancashire Constabulary[2000] Po.L.R. 367.

18. T he current version of Code B (Section 1.3–1.3A)emphasizes the importance of the rights to privacy andpersonal property so that powers of entry, search, andseizure should be fully and clearly justified and officersshould consider if the necessary objectives can be met byless intrusive means. It goes on to say that powers mustbe used fairly, responsibly, and with respect foroccupiers.

19. This power has been significantly extended by Sections50–52 of the Criminal Justice and Police Act 2001, whichcreates a seize now, sort later power whereby the police

can take large amounts of material that may contain itemsthey can search for but where it is not reasonablypracticable to ascertain their relevance in situ. Theycan even take items they have no power to seize if theycannot reasonably be separated from material that thepolice are lawfully seizing. 20. PACE Section 39 and seeCode C, particularly Section 3. 21. PACE Section 37(2).22. R v . Samuel (1988) 87 Cr App R 232. 23. C ode CAnnex B paragraph 3. 24. Code C paragraphs 8 and 9. 25.PACE Code C paragraphs 3.6–3.10. See also College ofPolicing Authorized Professional Practice on riskassessment:

63 Chapter 63 Mentally DisorderedDetainees at The Police Station

1. Bather P, Fitzpatrick R, Rutherford M. Police andMental Health (Briefing 36). London: Sainsbury Centre forMental Health, 2008.

2. Docking M, Grace K, Bucke T. Police Custody as a “Placeof Safety”: Examining the Use of Section 136 of the MentalHealth Act 1983. (IPCC Research and Statistics Series:Paper 11). London: Independent Police ComplaintsCommission, 2008.

3. NHS Information Centre for Health and Social Care.In-patients Formally Detained in Hospitals under theMental Health Act 1983 and Patients Subject to SupervisedCommunity Treatment: 1998–99 to 2008–09. Leeds: NHSInformation Centre for Health and Social Care, 2009.

4. Revolving Doors. The Management of People with MentalHealth Problems by the Paddington Police. London:Revolving Doors Agency, 1994.

5. Robertson G, Pearson R, Gibb R. The entry of mentallydisordered people to the criminal justice system. BritishJournal of Psychiatry. 1996; 169: 172−80. 6. Payne-JamesJJ, Wall IJ, Bailey C. Patterns of illicit drug use inpolice custody in London, UK. Journal of Clinical ForensicMedicine. 2005; 12: 196–98. 7. Scott D, MacGilloway S,Donnelly M. The mental health needs of people with alearning disability detained in police custody. Medicine,Science and the Law. 2006; 46: 111–14. 8. BaksheevGN, Thomas SDM, Ogloff JRP. Psychiatric disorders andunmet needs in Australian police cells. Australian and NewZealand Journal of Psychiatry. 2010; 44(11): 1043–51. 9.Hampson M. Raising standards in relation to Section 136 ofthe Mental Health Act 1983. Advances in PsychiatricTreatment. 2011; 17: 365–71. 10. Bradley Rt Hon Lord. LordBradley’s Review of People with Mental Health Problems orLearning Disabilities in the Criminal Justice System.London: House of Lords, 2009. 11. Reed J. Review ofMental Health and Social Services for Mentally DisorderedOffenders and Others Requiring Similar Services: Vol. 1:Final Summary Report. London: HMSO Cm. 2088, 1992. 12.British Medical Association. Health Care of Detainees inPolice Stations: Guidance from the BMA Medical EthicsDepartment and the Faculty of Forensic and Legal Medicine.London: British Medical Association, 2009. 13. VentressMA, Rix KJB, Kent JH. Keeping PACE: Fitness to beinterviewed by the police. Advances in Psychiatric

Treatment. 2008; 14: 369–81. 14. Kent J, Gunasekaran G.Mentally disordered detainees in the police station: Therole of the psychiatrist. Advances in PsychiatricTreatment. 2010; 16: 115–23. 15. Nemitz T, Bean P.Protecting the rights of the mentally disordered in policestations: The use of the appropriate adult in England andWales. International Journal of Law and Psychiatry. 2001;24: 595–605. 16. James DV. Police station diversionschemes: Role and efficacy in central London. Journal ofForensic Psychiatry. 2000; 11(3), 532−55. 17. Chung MC,Cumella S, Wensley J, Easthope Y. A description of aforensic diversion service in one city in the UnitedKingdom. Medicine, Science and the Law. 1998; 38: 242−50.18. Riordan S, Wix S, Kenny-Herbert J, Humphreys M.Diversion at the point of arrest: Mentally disorderedpeople and contact with the police. Journal of ForensicPsychiatry. 2000; 11(3): 683−90. 19. Steadman HJ,Stainbrook KA, Griffin P, Draine J, Dupont R, Horey C. Aspecialized crisis response site as a core element ofpolice-based diversion programs. Psychiatric Services.2001; 52(2): 219−22. 20. J ames DV. Diversion of mentallydisordered people from the criminal justice system inEngland and Wales: An overview. International Journal ofLaw and Psychiatry. 2010; 33(4): 241–48.

64 Chapter 64 Court Diversion and Liaison

6. HM Chief Inspector of Prisons for England and Wales.Annual Report 2008–09. London: HMIP, 2010: 21–2.

7. J oseph P, Potter M. Mentally disordered homelessoffenders – Diversion from custody. Health Trends. 1990;22: 51–53.

8. Spurgeon D. Diversionary tactics. Safer Society(NACRO). 2005 (summer): 26.

9. Lord Bradley. Lord Bradley’s Review of People withMental Health Problems or Learning Disabilities in theCriminal Justice System. London: Department of Health,2009. 10. James D, Farnham FR, Moorey H, et al. Outcome ofpsychiatric admission through the courts. ResearchDevelopment and Statistics Occasional Paper 79. London:Home Office, 2002: 85. 11. F orrester A, Henderson C,Wilson S, Cumming I, Spyrou M, Parrott J. A suitablewaiting room? Hospital transfer outcomes and delays fromtwo London prisons. Psychiatric Bulletin. 2009;33: 409–12. 12. Isherwood S, Parrott J. Audit of transfersunder the mental Health Act from prison—The impact oforganization change. The Psychiatrist. 2002; 26: 368–70.

66 Chapter 66 Forensic Social Work andSafeguarding Adults at Risk of Harm

1. Department of Health. No Secrets: Guidance onDeveloping and Implementing Multi-Agency Policies andProcedures to Protect Vulnerable Adults from Abuse.London: Department of Health, 2000.

2. Flynn M. South Gloucestershire Safeguarding AdultsBoard. Winterbourne View Hospital: A Serious Case Review.Bristol: South Gloucestershire Council, 2012.

3. Francis R. Report of the Mid Staffordshire NHSFoundation Trust Public Enquiry. London: The StationeryOffice, 2013.

4. NHS Information Centre, Social Care Team. Abuse ofVulnerable Adults in England 2010–11. ExperimentalStatistics Final Report. London: Health and Social CareInformation Centre, 2012.

68 Chapter 68 National Probation Service,National Offender Management Service, andMulti-agency Public ProtectionArrangements

1. Young S, Gudjonsson GH, Needham-Bennett H. Multi-agencypublic protection panels for dangerous offenders: OneLondon forensic team’s experience. Journal of ForensicPsychiatry and Psychology. 2005; 16(2): 213–327.

2. Taylor R, Yakely J. Working with MAPPA: Guidance forPsychiatrists in England and Wales. Royal College ofPsychiatrists’ Faculty of Forensic Psychiatry: FacultyReport FR/FP/O1. London. 2013.

69 Chapter 69 Fitness to Plead

13. Scott-Moncrieff L, Vassall-Adams G. Capacity andunfitness to plead: A yawning gap. Counsel. 2006; Oct:2–3.

14. R ogers T, Blackwood N, Farnham F, et al.Reformulating fitness to plead: A qualitative study.Journal of Forensic Psychiatry and Psychology. 2009; 20:815–34. 15. Owen G, Richardson G, David AS, et al. Mentalcapacity to make decisions on treatment in people admittedto psychiatric hospitals: Cross sectional study. BritishMedical Journal. 2008; 337: 40–42. 16. L aw Commission.Unfitness to Plead: A Consultation Paper. CP No. 197.Norwich: The Stationery Office, 2010.

70 Chapter 70 Not Guilty by Reason ofInsanity (McNaughten Rules

1. The Queen against Daniel M’Naghten (1843), 4 St. Tr.(n.s.) 847.

2. Dalby JT. The case of Daniel McNaughton: Let’s get thestory straight. American Journal of Forensic Psychiatry.2006; 27:17–32.

3. M’Naghten’s Case (1843), 10 Cl & F 200.

4. R v. Kemp (1957), 1 QB 399.

5. R v. Clarke (1972), 56 Cr App R 225.

6. R v. Kopsch (1925), 19 Cr App Rep 50.

7. R v. Sullivan (1984), AC 156.

8. R v. Burgess (1991), 2 QB 92.

9. R v . Hennessy (1989), 89 Cr App R 10.

10. R v. Quick (1973), QB 910.

11. R v. Codere (1916), 12 Cr App R 21.

12. R v. Windle (1952), 2 QB 826.

13. Rex v. Rivett (1950), 34 Cr App R 87.

71 Chapter 71 Diminished Responsibility

16. R v. Sutcliffe (1981) The Times and Guardian, May.

17. R v. Byrne (1960) 2 QB 396.

18. P rice R. The Times. December 22, 1971. 19. R v . Gray(1965) 129 JPN 819.

20. R v. Jones (1079) Times December the 4th.

21. R v. Smith (1982) Crim LR 531.

22. R v. Seers (1984) 79 CR App R261 (CA).

23. R v. Sanderson (1994) 98 CR App R 32 (CA).

24. R v. Vinagre (1979) 69 CR App R 104 (CA). 25. R v .Martin (Anthony) (2012) 1 CR App R 27. 26. R v . Reynolds(1988) Crim LR 679 (CA).

27. R v. Ahluwalia (1992) 4 All ER 889 (CA). 28. Wooton B.Diminished Responsibility: A Layman’s View. Law QuarterlyReview. 1960; 76.244. 29. R v. Dietschmann (2003) UK HL10. 30. R v . Tandy (1989) 1 WLR 350. 31. R v . Wood(2008) EWCA Crim 1305. 32. R v. Stewart (James) (2009)EWCA Crim 593. 33. R v. Lloyd (1967) 1 All ER 107. 34.Law Commission (2005) CP 177 para. 6.26. 35. Royal Collegeof Psychiatrists. Child Defendants. Occasional Paper OP56. 2006. 36. R eport of the Royal Commission on CapitalPunishment. CMD 8932. 1953.

72 Chapter 72 The Defense of Loss ofControl

1. R v. Bruzas (1972), Crim LR 367.

2. R v . Marks (1998), Crim LR 676.

3. R v . Whitfield (1976), 63 Cr App R39.

4. R v . Duffy (1949), 1 All ER 932n.

5. R v. L Chun Chen (1963), AC 220.

6. R v. Rolle (1965), 1 WLR 1341.

7. R v. Smith (Morgan) (2000), 4 All ER 289.

8. R v. Ahluwalia (1992), 4 All ER 889.

9. R v . Thornton (1996), 2 All ER 1023 CA.

10. R v . Smith, J.C. (1992), Crim LR 194.

11. Law Commission. Report No. 290. Partial Defences toMurder. London: Law Commission, 2004. 12. Law Commission.Report No. 304. Murder, Manslaughter and Infanticide (“TheMurder Report”). London: Law Commission, 2006. 13.Ministry of Justice and Home Office. Murder, Manslaughterand Infanticide. Proposals for Reform of the Law. London:Ministry of Justice and Home Office, 2008. 14. R v.Doughty (1986), 83 Cr App R 319, CA. 15. Attorney-Generalfor Jersey v. Holley (2005), UK PC 15th June. 16. R v.Luc Thiet Thuan (1997), AC 131. 17. D PP v. Camplin(1978), 2 All ER 168, HL. 18. R v. Newell (1980), 71 Cr App R 331. 19. R v . Morhall (1996), AC 90 HL.

73 Chapter 73 Infanticide

3. Levene S, Bacon CJ. Sudden unexpected death and coverthomicide in infancy. Archives of Disease in Childhood.2004; 89(5): 443–47.

4. P orter T, Gavin H. Infanticide and neonaticide:A review of 40 years of research literature on incidenceand causes. Trauma Violence Abuse. 2010; 11(3): 99–112.

5. Marks MN, Kumar R. Infanticide in England and Wales.Medicine, Science, and the Law. 1993; 33(4): 329–39.

6. P itt SE, Bale EM. Neonaticide, infanticide, andfilicide: A review of the literature. Bulletin of theAmerican Academy of Psychiatry and the Law. 1995; 23(3):375–86.

7. Criminal Statistics. London; 1976.

8. I nfanticide Act 1938. Ch 36. Available at: legislation.gov.ukukpga/Geo6/1-2/36/contents.

9. Laughlin CD. Pre- and perinatal anthropology III: Birthcontrol, abortion and infanticide in cross culturalperspective. Pre- and Perinatal Psychiatry Journal. 1994;9(1): 85–101.

10. K ellet RJ. Infanticide and child destruction—Thehistorical legal and pathological aspects. ForensicScience International. 1992; 53: 1–28.

11. F reeman MMR. A social and ecologic a nalysis ofsystematic female infanticide among the Netsilik Eskimo.American Anthropologist. 1971; 73: 1011–18.

12. E mber M. Warfare, sex ratio and polygamy. Ethnology.1974; 13: 197–206.

13. D ’Orban PT. Women who kill their children. BritishJournal of Psychiatry. 1979; 134: 560–71.

14. Gummersbach K. Die kriminalpsychologischePersonlichkiet der Kindes modernnen und ihre Wertung imgerichtsmedizinischen Gutachten. Weiner MedizinischeWochenschrift. 1938; 88: 1151.

15. Putkonen H, Collander J, Weizmann-Henelius G, EronenM. Legal outcomes of all suspected neonaticides in Finland1980–2000. International Journal of Law and Psychiatry.

2007; 30(3): 248–54.

16. Atkins EL, Grimes JP, Joseph GW, Liebman J. Denial ofpregnancy and neonaticide during adolescence: Forensic andclinical issues. American Journal of Forensic Psychology.1990; 17(1): 5–33.

17. Wilkins AJ. Attempted infanticide. British Journal ofPsychiatry. 1985; 146: 206–8.

18. Jenkins A, Millar S, Robins J. Denial of pregnancy—A literature review and discussion of ethical and legalissues. Journal of the Royal Society of Medicine. 2011;104(7): 286–91.

19. B rezinka C, Huter O, Biebl W, Kinzl J. Denial ofpregnancy: Obstetrical aspects. Journal of PsychosomaticObstetrics and Gynecology. 1994; 15(1): 1–8.

20. Brockington I. Pregnancy and Mental Health.In: Motherhood and Mental Health. Brockington I. Oxford:Oxford University Press, 1996: 61–134. 21. Gerchow J. Diearzlich-forensische Beurteilung von Kindesmorderinnen.Halle, Germany: Carl Morlag Verlag, 1957. 22. Finnegan P,McKinstry E, Robinson GE. Denial of pregnancy andchildbirth. Canadian Journal of Psychiatry. 1982; 27:672–74. 23. Hatters Friedman S, Resnick PJ. Child murderby mothers: Patterns and prevention. World Psychiatry.2007; 6(3): 137–41. 24. Meyer C, Oberman M. Mothers WhoKill Their Children: Understanding the Acts of Moms fromSusan Smith to the “Prom Mom.” New York: NYU Press, 2001.25. Marks MN, Kumar R. Infanticide in Scotland. Medicine,Science and the Law. 1993; 36(4): 299–305. 26. SadoffRL. Mothers who kill their children. Psychiatric Annals.1995; 25(10): 601–5. 27. E mery JL. Infanticide, filicideand cot death. Archives of Disease in Childhood. 1985; 60:505–7. 28. E berhard-Gran M, Eskild A, Tambs K,Samuelsen SO, Opjordsmoen S. Depression in pos tpartumand non-postpartum women: Prevalence and risk factors.Acta Psychiatrica Scandinavica. 2002; 106(6): 426–33. 29.Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, MortensenPB. New parents and mental disorders: A population-basedregister study. Journal of the American MedicalAssociation. 2006; 296(21): 2582–89. 30. O ’Hara MW,Swain AM. Rates and risk of postnatal depression—Ameta-analysis. International Review of Psychiatry. 1996;8: 37–54. 31. K auppi A, Kumpulainen K, Vanamo T,Merikanto J, Karkola K. Maternal depression and filicide:Case study of ten mothers. Archives of Women’s MentalHealth. 2008; 11: 201–6. 32. Lewis CF, Baranoski MV,

Buchanan JA, Benedek EP. Factors associated with weaponuse in maternal filicide. Journal of Forensic Science.1998; 43(3): 613–18. 33. Krischer MK, Stone MH, SeveckeK, Steinmeyer EM. Motives for maternal filicide: Resultsfrom a study with female forensic patients. InternationalJournal of Law and Psychiatry. 2007; 30(3): 191–200. 34.Daly M, Wilson W. Homicide. New York: Aldine de Gruyter,1988. 35. Xie L, Yamagami A. How much of child murderin Japan is caused by mentally disordered mothers?Internal Medicine Journal. 1995; 2(4): 309–13. 36.Paulson JF, Bazemore SD. Prenatal and postpartum depressionin fathers and its association with maternal depression: Ameta-analysis. Journal of the American MedicalAssociation. 2010; 303(19): 1961–9.

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38. G oldstein RD. Risk factors for infant homicide. NewEngland Journal of Medicine. 1999; 340(11): 895.

39. Lester D. Roe v Wade was followed by a decrease inneonatal homicide. Journal of the American MedicalAssociation. 1992; 267: 3027–28.

40. Slayton RI, Soloff PH. Psychotic denial ofthirdtrimester pregnancy. Journal of Clinical Psychiatry.1981; 42: 471–73.

41. Briscoe M. Identification of emotional problems inpostpartum women by health visitors. British MedicalJournal (Clinical Research Ed.). 1986; 292: 1245–47.

42. Cox JL, Holden JM, Sagovsky R. Detection of postnataldepression: Development of the ten-item Edinburghpostnatal depression scale. British Journal of Psychiatry.1987; 150: 782–86. 43. Olds D, Eckenrode J, Henderson CR.Longterm effects of home visitation on maternal lifecourse and child abuse and neglect: Fifteen year follow-up of a randomized trial. Journal of the AmericanMedical Association. 1997; 278: 637–43. 44. Brenner RA,Overpeck MD, Trumble AC, DerSimonian R, Berendes H. Deathsattributable to injuries in infants, United States,1983–1991. Pediatrics. 103(5): 968–74. 45. O verpeck MD,Brenner RA, Trumble AC, Trifiletti LB, Berendes H. Riskfactors for infant homicide in the United States. NewEngland Journal of Medicine. 1998; 339(17): 1211–41. 46.Southall DP, Plunkett MCB, Banks MW, Falkov AF, SamuelsMP. Covert video recordings of life- threatening child

abuse: Lessons for child protection. Pediatrics. 1997;100(5): 735–60.

74 Chapter 74 Automatism

1. Fenwick P. Somnambulism and the law: A review.Behavioral Sciences and the Law. 1987; 5: 343–57.

2. Fenwick P. Automatism and the law. Lancet. 1989;2: 753–54.

3. Fenwick, P. Sleep and sexual offending. Medicine,Science and the Law. 1996; 36: 122–34.

4. Yeo S. Clarifying automatism. International Journal ofLaw and Psychiatry. 2002; 25: 445–58.

5. Schopp RF. Automatism, Insanity, and the Psychology ofCriminal Responsibility: A Philosophical Inquiry. NewYork: Cambridge University Press, 1991.

6. F enwick. P. Automatism, medicine and the law.Psychological Medicine Monograph. 1990 Suppl. 17: 1–27.

7. Beaumont G. Automatism and hypoglycaemia. Journal ofForensic and Legal Medicine. 2007; 14: 103–107.

8. G overnment, Crimes Bill 1989, introduced in May 1989,xxvii, 156 p. See on Clause 19, “Involuntary acts” pp.iv–v and 14.

9. R v. Kemp (1957), 1 QB 399: 407.

10. McCall Smith A, Shapiro CM, eds. Forensic Aspects ofSleep. New York: John Wiley and Sons, 1997.

11. Bourget D, Whitehurst L. Amnesia and crime. Journal ofthe American Academy of Psychiatry and the Law. 2007; 35:469–80.

12. Glancy GD, Bradford JM, Fedak L. A comparison of R v.Stone with R v. Parks: Two cases of automatism. Journal ofthe American Academy of Psychiatry and the Law. 2002; 30:541–47.

FURTHER READING

Bratty v. A-G for NI (1963), AC 386, House of Lords.

R v. Charlson (1955), 1 AII E.R. 859.

R v. Kemp (1956), 3 AII E.R. 249, 249–51.

R v. Sullivan (1983), 2 AII E.R. 673, 675–676, AC 156 Houseof Lords (1984).

R v. Quick (1973), 3 WLR 26, Court of Appeal.

People v. Higgins (1959), 5 N.Y. 2d 607, 186 N.Y.S. 2d 623,159 N.E. 2d 179.

75 Chapter 75 Amnesia

10. Schacter DL. Amnesia and crime: How much do we reallyknow? American Psychologist. 1986; 41: 286–95.

11. F enwick P. Murdering while asleep. British MedicalJournal (Clinical Research Edition). 1986; 288(6435):1938–9.

12. Fenwick P. Somnambulism and the law: A review.Behavioural Sciences and the Law. 1987; 5: 343–57.

13. Hindler CG. Epilepsy and violence. British Journal ofPsychiatry. 1989; 155: 246–49.

14. K opelman MD. Disorders of memory. Brain. 2002a; 125:2152–190.

15. Kopelman MD. Psychogenic Amnesia. In: Handbook ofMemory Disorders. 2nd ed. Eds. Baddeley MD, Kopelman MD,Wilson BA. Chichester: John Wiley & Co., 2002.

16. F ebbo S, Hardy F, Finlay-Jones R. Dissociation andpsychological blow automatism in Australia. InternationalJournal of Mental Health. 1993–94; 22: 39–59.

17. Porter S, Birt AR, Yuille JC, Herve HF. Memory formurder: A psychological perspective on dissociativeamnesia in legal contexts. International Journal of Lawand Psychiatry. 2001; 24: 23–42.

18. McSherry B. Getting away with murder? Dissociativestates and criminal responsibility. International Journalof Law and Psychiatry. 1998; 21(2): 163–76.

19. T anay E. Psychiatric study of homicide. AmericanJournal of Psychiatry. 1969; 125(9): 1252–58.

20. P yszora N. Amnesia for Criminal Offences in a Cohortof Life Sentence Prisoners. PhD Thesis, University ofLondon, 2006.

21. W iggins EC, Brandt J. The detection of simulatedamnesia. Law and Human Behaviour. 1988; 12(1): 57–78.

22. Cercy SP, Schretlen DJ, Brandt J. Simulated Amnesiaand the Pseudo-Memory Phenomena. In: Clinical Assessmentof Malingering and Deception. 2nd ed. Ed. Rogers R, NewYork: Guilford Press, 1997: 85–107.

23. Stein A. Murder and Memory. New York: WAW Institute,2001: 443–51.

24. Van der Hart O, Brown P, Graafland M. Traumainduceddissociative amnesia in World War 1 combat soldiers.Australian and New Zealand Journal of Psychiatry. 1999;33: 37–46.

25. Leitch A. Notes on amnesia in crime for the generalpractitioner. Medical Press. 1948; 219: 459–63.

26. Guttmacher MS. Psychiatry and the Law. New York: Gruneand Stratton, 1955.

27. O’Connell BA. Amnesia and homicide: A study of50 murderers. British Journal of Delinquency. 1960; 10:262–76.

28. B radford J, Smith SM. Amnesia and homicide: ThePodola case and a study of thirty cases. Bulletin of theAmerican Academy of Psychiatry and the Law. 1979; 7:219–31.

29. Parwatiker SD, Holcomb WR, Menninger KA. The detectionof malingered amnesia in accused murderers. Bulletin ofthe American Academy of Psychiatry and Law. 1985; 13(1):97–103. 30. Guöjónsson GH, Pétursson H, Skúlason S,Siguröardóttir H. Psychiatric evidence: a study ofpsychological issues. Acta Psychiatrica Scandinavica.1989; 80: 165–69. 31. G uöjónsson GH, Hannesdottir K,Pétursson H. The relationship between amnesia and crime:The role of personality. Personality and IndividualDifferences. 1999; 26: 505–10. 32. Cima M, Merckelbach H,Hollnack S, Knauer E. Characteristics of psychiatricprison inmates who claim amnesia. Personality andIndividual Differences. 2003; 35: 373–80. 33. K opelmanMD. Crime and amnesia: A review. Behavioural Sciences andthe Law. 1987b; 5: 323–42. 34. Hopwood JS, Snell HK.Amnesia in relation to crime. Journal of Mental Science.1993; 79: 27–41. 35. K opelman MD Amnesia: Organic andpsychogenic. British Journal of Psychiatry. 1987a; 150:428–42. 36. H amilton J, Kopelman MD, Maden A, Taylor PJ,Strang J, Johns A, Gunn, J. Addictions and Dependencies:Their Associations with Offending. In: ForensicPsychiatry: Clinical, Legal and Ethical Issues. Eds. GunnJ, Taylor PJ. Oxford: ButterworthHeinemann Ltd., 1993:435–89. 37. P étursson H, Guöjónsson GH. Psychiatricaspects of homicide. Acta Psychiatrica Scandinavica. 1981;64: 363–72. 38. L eong GB, Silva JA. Psychiatric–legalanalysis of criminal defendants charged with murder: A

sample without major mental disorder. Journal of ForensicSciences. 1995; 40(5): 858–61. 39. G oodwin DW. Twospecies of alcoholic ‘blackout.’ American Journal ofPsychiatry. 1971; 127(12 June): 1665–70. 40. G oodwin DW,Crane JB, Guze SB. Phenomenological aspects of thealcoholic ‘blackout.’ British Journal of Psychiatry. 1969;115: 1033–38. 41. Mechanic MD, Resick PA, Griffin MG. Acomparison of normal forgetting, psychopathology, andinformation-processing models of reported amnesia forrecent sexual trauma. Journal of Consulting and ClinicalPsychology. 1998; 66(6): 948–57. 42. Spiegal D, CardenaE. Disintegrated experience: The dissociative disordersrevisited. Journal of Abnormal Psychology. 1991; 100(3):366–78. 43. Evans C, Mezey G. The Nature of Memories ofViolent Crime among Young Offenders. In: Offenders’Memories of Violent Crimes. Ed. Christianson S.Chichester: Wiley, 2007: 3–35. 44. R v. Podola (1959), 43Cr, App R. 220. 45. R v. Tandy (1989), 1 All ER 267. 46.DPP v. Majewski (1976), 2 All ER 142. 47. R v. Kingston(1994), 3 All ER 353. 48. R v. Issitt (1978), RTR 211.

76 Chapter 76 Mutism

1. Moore DP, Puri BK. Textbook of Clinical Neuropsychia tryand Behavioral Neuroscience. 3rd ed. London: HodderArnold, 2012.

2. H aw CM, Cordess CC. Mutism and the problem of the mutedefendant. Medicine, Science, and the Law. 1988; 28:157–64.

3. Daniel AE, Resnick PJ. Mutism, malingering, andcompetency to stand trial. The Bulletin of the AmericanAcademy of Psychiatry and the Law. 1987; 15: 301–8.

4. T reasaden IH. Forensic Psychiatry. In: Psychiatry: AnEvidence-Based Text. Eds. Puri BK, Treasaden IH. London:Hodder Arnold, 2010.

77 Chapter 77 False Confessions andSuggestibility

1. Garrett LG. Convicting the Innocent: Where CriminalProsecutions Go Wrong. Cambridge, MA: Harvard UniversityPress, 2011.

2. Kassin SM, Gudjonsson GH. The psychology ofconfessions: A review of the literature and issues.Psychological Science in the Public Interest. 2004;5: 33–67.

3. Gudjonsson GH, Pearse J. Suspect interviews and falseconfessions. Current Directions in Psychological Science.2011; 20: 33–37.

4. Gudjonsson GH. Psychological vulnerabilities duringpolice interviews. Why are they important? Legal andCriminological Psychology. 2010; 15: 161–75.

5. Gudjonsson GH. The Psychology of False Confessions: AReview of the Current Evidence. In: Police Interrogationsand False Confessions. Eds. Lassiter D, Meissner CA. NewYork: American Psychological Association, 2010: 31–47.

6. Williamson T. Psychology and Criminal Investigation.In: Handbook of Criminal Investigation. Eds. Newburn T,Williamson T, Wright A. Devon, UK: Willan Publishing,2007: 68–91. 7. Gudjonsson GH. The Psychology ofInterrogations and Confessions. A Handbook. Chichester:John Wiley & Sons, 2003. 8. Elks L. Righting Miscarriagesof Justice? Ten Years of the Criminal Cases ReviewCommission. London: Justice, 2008. 9. K assin SM, DrizinSA, Grisso T, et al. Police-induced confessions: Riskfactors and recommendations. Law and Human Behavior. 2010;34: 3–38. 10. Gudjonsson GH, Sigurdsson JF. FalseConfessions in the Nordic Countries: Background andCurrent Landscape. In: Forensic Psychology in Context:Nordic and International Approaches. Ed. Granhag PA.Devon, UK: Willan Publishing, 2010: 94–116. 11. Pearse J,Gudjonsson GH. Measuring influential police interviewingtactics: A factor analytic approach. Legal andCriminological Psychology. 1999; 4: 221–38. 12. Leo RA,Drizin SA. The Three Errors: Pathways to False Confessionand Wrongful Conviction. In: Police Interrogations andFalse Confessions. Eds. Lassiter GD, Meissner CA. NewYork: American Psychological Association, 9–30. 13. HomeOffice. Police and Criminal Evidence Act 1984, Codes ofPractice—Code C Detention, Treatment and Questioning ofPersons by Police. London: The Home Office, 2008. 14.

Gudjonsson GH, Clark NK. Suggestibility in policeinterrogation: A social psychological model. SocialBehaviour. 1986; 1: 83–104. 15. Gudjonsson GH.Suggestibility, intelligence, memory recall andpersonality: An experimental study. British Journal ofPsychiatry. 1983; 142: 35–7. 16. Gudjonsson GH. TheGudjonsson Suggestibility Scales Manual. Hove, UK:Psychology Press, 1997. 17. Grisso T. EvaluatingCompetencies: Forensic Assessments and Instruments. NewYork: Plenum Press, 1986. 18. Janoson M, Frumkin B.Review of the Gudjonsson Suggestibility Scales. In: TheSeventeenth Mental Measurements Yearbook [Internet]. 2010.Available from: http://www.unl.edu/buros, 2007. 19.Frumkin IB. Psychological Evaluation in Miranda Waiver andConfession Cases. In: Clinical Neuropsychology in theCriminal Forensic Setting. New York: Guilford Press, 2008:135–75. 20. Gudjonsson GH, Sigurdsson JF, Einarsson E,Bragason OO, Newton AK. Interrogative suggestibility,compliance and false confessions among prisoners and theirrelationship with attention deficit hyperactivity disorder(ADHD) symptoms. Psychological Medicine. 2008; 38:1037–44.

78 Chapter 78 Psychiatric Aspects ofMiscarriages of Justice

1. Nobles R, Schiff D. Understanding Miscarriages ofJustice: Law, the Media and the Inevitability of a Crisis.Oxford: Oxford University Press, 2000.

2. Zander M, Henderson P. Crown Court Study. The RoyalCommission on Criminal Justice Research Study No. 19.London: HMSO, 1993.

3. Zalman N. Qualitatively estimating the incidence ofwrongful convictions. Criminal Law Bulletin. 2012; 48:221–79.

4. Gross SR. How Many False Convictions Are There? HowMany Exonerations Are There? In: Miscarriages of Justice:Causes and Remedies in North American and EuropeanCriminal Justice Systems. Eds. Huff CR, Killias M. NewYork: Routledge, 2013: 45–60.

5. Court of Appeal (Criminal Division). 2014–15 AnnualReport. London: Court of Appeal, 2015. Available from:https://www.judiciary.gov.uk/wp-content/

6. Ministry of Justice. Criminal Court Statistics Bulletin:July to September 2015 (main tables). London: NationalStatistics, 2015. Available from: https://

79 Chapter 79 Mental Capacity Act 2005

1. Brown RA, Barber P, Martin M. The Mental Capacity Act2005: A Guide for Professionals. 3rd ed. London: Sage,2015.

2. Letts P, ed. Assessment of Mental Capacity: A PracticalGuide for Doctors and Lawyers. 3rd ed. London: The LawSociety, 2010.

3. C ouncil of Europe. The European Convention on HumanRights. Rome: European Court of Human Rights, 1950.

80 Chapter 80 Mental Health Act 1983

3. Hale B. Mental Health Law. 5th ed. London: Sweet andMaxwell, 2011.

4. J ones R. Mental Health Act Manual. 19th ed. London:Sweet and Maxwell, 2016.

5. Winterwerp v. Netherlands (1979), 2EHRR387.

6. HL v. UK (2004), 40EHHR761.

7. Council of Europe. The European Convention on HumanRights. Rome: The European Court of Human Rights, 1950. 8.M ental Health Act 1959. London: Parliament of the UnitedKingdom, 1959. 9. Department of Health and SocialSecurity. Reforming Mental Health Legislation. Cmnd 8405.London: HMSO, 1981. 10. UK Department of Health. MentalHealth Act 1983, Code of Practice. London: The StationeryOffice, 2015.

81 Chapter 81 Mental Health Tribunals

● Section 3 patients whose cases have not previously beenconsidered by the MHT (other than following anapplication/reference made while detained under Section 2or Section 4 MHA 1983) will have their cases referred tothe MHT by the hospital managers of the detaining hospitalat 6 months from the date on which the patient was firstdetained (i.e., not from when the patient was firstdetained under Section 3). Hospital managers are obligedto refer Section 37 hospital order patients (and Section 3patients) when the MHT has not considered the patient’scase for 3 years (1 year when the patient is under 18 yearsof age), the time running from the date of detention orthe date of the last MHT hearing.

● There is no duty on the relevant social servicesauthority to refer guardianship patients to the MHT.

● What about CTO patients? There must be a referral by thehospital managers to the MHT at the end of the first 6months since the day on which the patient was detained fortreatment (or for assessment if there was a precedingSection 2), but only if the “hovering” treatment order isa Section 3, and then every 3 years— presuming there hasbeen no prior consideration of the patient’s case by theMHT. In addition, if the CTO is revoked, the hospitalmanagers must refer the patient’s case to the MHT “as soonas possible” after revocation. ● The secretary of statefor health is empowered to refer the case of anunrestricted patient at any time; the secretary of statefor justice has a similar power in respect of restrictedpatients. ● The secretary of state for justice is obligedto refer the case of a restricted patient detained in ahospital (excluding conditionally discharged patients)whose case has not been considered by the MHT within thepreceding 3 years. ● The secretary of state is also undera statutory duty to refer to the MHT the case of theconditionally discharged patient who has been recalled tohospital. The reference must be made within 1 month of therecall. RULES AND PROCEDURE As previously indicated, theTribunal Procedure (First-tier Tribunal) (Health,Education and Social Care Chamber) Rules 2008 (the Rules),govern how the MHT goes about its task. From time to timethese Rules have been (and will continue to be) amended,most recently on August 21, 2015. The Practice Direction:First-tier Tribunal Health Education and Social CareChamber: Statements and Reports in Mental Health Cases(PD), made by the senior president of tribunals (SPT) setsout the statements and reports (and their content) which

must be sent to the MHT prior to the hearing. The mostrecent version of the PD is dated October 28, 2013. Inaddition, from time to time the SPT introduces and/oramends supplementary provisions of relevance includingPractice Statements. There is insufficient space withinthis chapter to consider the Rules and the PD and othersupplementary provisions in great detail. What follows isan attempt to highlight some significant proceduralissues. Tribunal composition The Practice Statement:Composition of Tribunals in relation to matters that fallto be decided by the Health, Education and Social CareChamber, made by the SPT in the exercise of powers grantedto the SPT by the First-tier Tribunal and Upper Tribunal(Composition of Tribunals) Order 2008 dated December 16,2015 recognizes that MHT decisions made at or following ahearing must be made by: ● A tribunal judge; and ● Atribunal member who is a registered medical practitioner;and ● A tribunal member who has substantial experience inhealth or social care matters Most MHT judges and othermembers (often called

“medical members” and “specialist members” respec

tively) are part-time. In recent years 21 full time sala

ried judges have been appointed. Not only do they sit on

MHT hearings, but they also are responsible for decisions

in respect of interlocutory matters and applications for

leave to appeal against MHT decisions (revisited later in

this chapter). There is also a salaried medical member,

whose primary task is to provide support and guidance

to medical members. MHTs considering applications or

sided over by judges designated to hear such cases, such

as Crown Court judges or their equivalent, or certain

salaried judges “ticketed” to hear such cases. Indetermining whether a conf lict of interest might

prevent them from sitting, MHT members must ask

themselves the well-established question formulated in

2002 by the House of Lords in Porter v. Magill: 8 “Would

the fair-minded and informed observer, having consid

ered the facts, conclude that there was a real possibility

that the tribunal was biased.” The ministry of justice hasrecently undertaken a

review, initiated a consultation and proposed changes

over panel composition in tribunals generally, calling

for the system to be streamlined. 9 If its recommendations

for greater f lexibility are realized, the MHT panel may,

in the future, consist of a single member (a judge) with

medical and specialist members deployed only in cases

where their expertise is deemed necessary by the SPT

(whose functions include ensuring tribunals are acces

sible, fair and speedy pursuant to Section 2(3) TCEA).

Change of this sort will only be possible by the introduc

tion of amending legislation.

“The overriding objective”

Rule 2 states that the overriding objective of the Rules isto

enable the MHT to deal with cases “fairly and justly.” Itthen

expands on this laudable aim, by identifying that this will

include:

1. Dealing with cases in a manner that is proportionate tothe importance of the case, the complexity of the issues,the anticipated costs and the resources of the parties

2. Avoiding unnecessary formality and seeking flexibilityin the proceedings

3. Ensuring, so far as practicable, that the parties areable to participate fully in the proceedings

4. Using any special expertise of the tribunal effectively

5. Avoiding delay, as far as compatible with properconsideration of the issues There is an obligation on theparties (see the following

section) to help the tribunal further the overridingobjective

and to cooperate with the tribunal generally. Parties A“party” in a MHT case is defined in Rule 1(3) as being thefollowing: ● The patient ● The responsible authority ●The secretary of state (if the patient is a restrictedpatient) ● The nearest relative but only if he or she hasmade the MHT application. Party status offers certainentitlements, most obviously the right to see anysubmitted reports (subject to Rule 14[2]; see thefollowing discussion). Notification of the proceedings toothers, including “victims” Rule 33 outlines who isentitled to receive notification of the MHT proceedings,including (1) the patient’s nearest relative (unless thepatient with capacity requests otherwise), and (2) “anyother person who, in the opinion of the Tribunal, shouldhave an opportunity of being heard.” This latter categorycould clearly include victims of offenses committed by thepatient. In any event, certain “victims” have certainentitlements in respect of a forthcoming MHT hearing. Fulldetails appear in the, Practice Guidance on ProceduresConcerning Handling Representations from Victims in theFirst-Tier Tribunal (Mental Health). 10 In summary, victimsof offenders who have committed specified sexual orviolent offenses have the right (1) to be informed if thepatient is to be discharged, (2) to be informed about anyconditions attached to that discharge that relate tocontact with them or their families, and (3) to makerepresentations about the conditions to which the patientshould be subject if conditionally discharged ordischarged onto a community treatment order. These rightshave been in force since July 1, 2005, in respect ofrestricted patients, the arrangements being applied mainlyby the probation service and the mental health unit of theministry of justice. Beginning on November 3, 2008, theserights were extended to unrestricted patients, resultingin new duties being placed on hospital managers,responsible clinicians, approved mental healthprofessionals, and national health service (NHS) bodiesresponsible for NHS patients in independent hospitals.

Information and reports Rule 32 lists various obligations(including time limits) of the responsible authority andthe secretary of state to supply information anddocuments; the nature of those obligations depends on thestatus of the patient. Failure to comply with theobligations can result in the issuing of a noncompliancedirection (akin to a court order) from the MHTadministrative center in Leicester. Rule 32 also refers tothe PD concerning the state

ments and reports to be delivered to the MHT (see Rules

and Procedure section above) and sets out the time frame

for compliance. As far as clinicians, nurses, and care

coordinators are concerned, the PD specifies what must

be included within their reports. The clinical report must

be countersigned by the responsible clinician if not the

author. In response to the frequent lack of timeliness

in the delivery of statements and reports to the MHT,

a new procedure was introduced in 2015 by the deputy

president of tribunals to encourage compliance with

the time limits in Rule 32. The warning that persistent

defaulters are likely to find themselves referred to the

Upper Tribunal for the imposition of a financial penalty

has secured far greater compliance. In recognition of thepotential sensitivity of some of the

information contained within reports, provision is made

within the Rules for the MHT to direct that certain infor

mation not be disclosed to a party (most obviously, the

patient). The test in Rule 14(2) that the report author must

satisfy is a demanding one. The MHT must be satisfied that

(1) disclosure is likely to cause the party or some other

per

son serious harm, and that (2) with regard to the interestsof

justice, it is proportionate to give a nondisclosuredirection. 11

The MHT may direct that disclosure of the document be

granted to the patient’s representative, provided it issatisfied

that disclosure to the representative would be in the inter

ests of the party and the representative would not be likely

to disclose it either directly or indirectly to any otherperson

without the consent of the MHT. So a solicitor representa

tive would receive the nondisclosed document but would be

under a strict obligation not to share it with the clientunless

given permission to do so by the MHT.

Representatives

Rule 11 acknowledges that a party may appoint a repre

sentative (whether a legal representative or not) to provide

representation in the hearing. In practice the patient isusu

ally represented by a specialist Law Society accredited men

tal health solicitor and with the benefit of non meanstested

public funding, with no other parties being represented

other than in high-profile restricted patient cases (inwhich

case it is probable that both the responsible authority and

the secretary of state will be legally represented). If thepatient has not appointed a representative, the

MHT may appoint a legal representative for the patient if(1)

the patient has stated they do not wish to conduct their own

case or that they wish to be represented, or (2) the patient

lacks capacity to appoint a representative, but the MHT

believes it to be in the patient’s best interests for thepatient

to be represented.

Medical examination

Rule 34 establishes the circumstances in which the MHT

medical member must, so far as is practicable, examine thepatient before the MHT hearing in order to form an opinionof the patient’s mental condition. Rule 34 states that“Pre- hearing examinations” of this type occur: ● Whenthe MHT is considering the case of a Section 2 patientunless the MHT is satisfied that the patient does not wantan examination ● When the patient or his or herrepresentative requests such an examination take place ●When the MHT directs it to occur. In practice the MHTmedical member should visit the patient a few days beforethe hearing and report back to the other two members ofthe MHT panel shortly before the hearing starts. To ensurecompliance with various court rulings on this practicethat have been delivered since the Human Rights Act 1998,12 a summary of what the medical member has reportedshould be given at the commencement of the hearing.Listing of hearings Section 2 cases must be heard by theMHT within 7 days after the date on which the MHT receivedthe application. 13 Recalled conditional dischargepatients must have their cases referred to the MHT by thesecretary of state and must be heard within 5–8 weeksafter the date on which the MHT received the reference. 14For all other cases coming before the MHT there is noprescribed time limit for the MHT hearing. That said,because of the courts’ recognition of the requirement inArticle 5(4) ECHR that reviews of detentions should bedecided “speedily,” considerable effort is now made by thetribunal service to list unrestricted cases (other thanSection 2) within 8 weeks and restricted cases within 16

weeks. 15 Three working days’ notice must be given ofSection 2 hearings, and 21 days’ notice of other hearingsunless parties consent to a shorter notice period or “inurgent or exceptional circumstances” (Rule 37(4)). Publicor private hearing? All hearings must be held in privateunless the MHT considers that it is in the interests ofjustice for the hearing to be held in public (Rule 38).The Upper Tribunal grappled with this rule in the case ofAH v. West London MHT and SSJ, 16 and concluded that therelevant questions in deciding whether a public hearingshould be permitted are the following: ● Is it consistentwith the subjective and informed wishes of the applicant(assuming he is competent to make an informed choice)? ●Will it have an adverse effect on his mental health in theshort or long term, taking into account the views of thosetreating him and any other expert views?

● Are there any other special factors for or against apublic hearing?

● Can practical arrangements be made for an open hearingwithout a disproportionate burden on the authority? UnderRule 38 the MHT may give a direction excluding

the following from any hearing or part of it:

● Any person whose conduct the MHT considers disrupting orlikely to disrupt the hearing

● Any person whose presence the MHT considers likely toprevent another person from giving evidence or makingsubmissions freely

● Any person the MHT considers should be excluded in orderto give effect to a non disclosure direction under Rule14(2) (withholding information likely to cause harm)

● Any person whose attendance would defeat the purpose ofthe hearing

Hearing procedure

The procedure to be adopted at each MHT hearing is a

matter for the individual MHT panel, which must keep

the provisions of Rule 2 in mind. Practice regarding who

“goes first” in respect to giving evidence (the patient orthe

responsible authority?) varies across the country. The panel

must ensure that all parties have the opportunity to pre

sent their evidence and ask questions of others’ evidence.

The MHT panel itself, in an inquisitorial role, will fully

participate by asking questions of all. If a party fails toattend a hearing, the MHT may proceed

with the hearing if it is satisfied that (Rule 39):

● The party has been notified of the hearing or thatreasonable steps have been taken to notify the party of thehearing and

● It is in the interests of justice to proceed with thehearing. Where the missing party is the patient, the MHTmay

proceed where satisfied that:

● The Rule 34 requirements in relation to the pre-hearingmedical examination have been satisfied and

● The patient has decided not to attend the hearing or isunable to attend the hearing for reasons of ill health.Generally in order to make a decision which disposes of

the proceedings the MHT must hold a hearing (Rule 35).

Where the case is that of a CTO patient aged over 18 years,

whose case is referred to the MHT, the MHT can dispose of

the case without a formal hearing taking place. The circum

stances in which a so called “paper hearing” can occur are

set out in Rule 35(3):

● Where the patient’s representative has stated in writingthat the patient does not wish to be represented at theMHT hearing or to attend; ● Where the patient has statedin writing that he or she does not wish to attend or berepresented at the MHT hearing and the MHT is satisfiedthat the patient has the capacity to make that decision.Withdrawals A patient or the nearest relative (when he or

she is the applicant) may apply to the MHT, either inwriting or orally at the hearing, to withdraw the MHTapplication (Rule 17). The MHT must consent to thewithdrawal request for it to be effective. In decidingwhether to agree, the MHT will make up its own mind,should refuse consent if in doubt and should question whomade the withdrawal request and why, following theapproach set out in AMA v Greater Manchester West MentalHealth NHS Foundation Trust. 17 After a MHT application hasbeen successfully withdrawn, an application for the caseto be reinstated can be made within 28 days. Withdrawal isa useful option for the patient because it preserves hisor her right to apply again during that period ofdetention. No application can be made to withdraw amandatory (as opposed to a discretionary) reference to theMHT. Adjournments The MHT has the power to adjourn a caseat any time (Rule 5(3)(h)). In reaching a decision whetherto adjourn, the MHT must have Rule 2 (“the overridingobjective”) firmly in mind. The MHT must balance the needto avoid delay against the requirement to act justly andfairly. When adjourning a case, the MHT will invariablyissue “directions” (for example, in respect of updatedreports and witness attendance at the adjourned hearing)to seek to ensure that the hearing can proceed on itsnext scheduled date. Such directions are similar to courtorders and should be complied with, although it is possibleto apply for any direction to be amended, suspended, orset aside. The MHT has the power to summons witnesses toattend a hearing as a witness, to answer questions or toproduce documents (Rule 16). Decisions Where a decisionfalls to be decided by the MHT panel, the MHT makes thatdecision unanimously or by majority. Subject to Rule14(2) (the nondisclosure provisions), Rule 41 ensures thatthe MHT must provide the following to each party as soonas reasonably practicable (within 7 days—or, in the caseof Section 2 patients, within 3 working days) after makinga decision that finally disposes of all issues in the case(except a reviewed or appealed decision): ● A decisionnotice stating the MHT decision ● Written reasons for thedecision

● Notification of any right of appeal against the decisionand the time within which, and the manner in which, theright of appeal may be exercised Over the years there havebeen many successful challenges

to MHRT, and now MHT, decisions on the grounds of inad

equacy of the reasons for the tribunal’s decision. Tribunal

panels need to ensure that their reasons (1) set out theirrea

sons with reference to the relevant detention criteria, (2)iden

tify areas of dispute over law and evidence and explain how

the MHT resolved such disputes, (3) give clear unambiguous

reasons for the decision reached, (4) explain the factsthat the

MHT found as a result of the evidence and the conclusions

reached by the MHT on those facts. 18 They must also ensure

that any orders they make are within their powers. Inpractice, in most instances the parties are told of the

decision, if not the full reasons, immediately after thehear

ing. When a violent reaction is anticipated, the MHT willlimit

communication of the decision to written notification only.

Appeals, reviews, and “re-sectioning”

Prior to the creation of the First-tier and Upper Tribunal

structure, the primary means of challenging MHRT deci

sions was by seeking judicial review within the High

Court. Part 5 of the Rules outlines a variety of newly

devised means for challenging MHT decisions, which are

cheaper and speedier than the previous High Court judi

cial review route. The position is complex, and clearlylegal

advice should be sought by both patients and professionals

if dissatisfied with a MHT decision. In summary:

● Rule 44 enables the MHT to correct clerical or accidental

errors in a decision

● Rule 45 empowers the MHT to set aside a decisionfollowing a procedural irregularity coming to light and inthe interests of justice.

● Rules 46–49 detail the process for seeking permissionto appeal to the Upper Tribunal and set out the basis uponwhich the MHT might review the decision (in practice, byone of the salaried judges) where satisfied of an error oflaw.

● If the MHT refuses permission to appeal to the UpperTribunal then the applicant can renew the request forpermission to appeal by petitioning the Upper Tribunalitself.

● Section 9(2)(a) TCEA gives the MHT the power to review adecision of its own initiative. Assuming the case proceedsto the Upper Tribunal

as an appeal against the MHT decision, the parties to the

appeal will be the patient, the nearest relative (if theorigi

nal applicant), the responsible authority, and (in the caseof

restricted patients) the secretary of state. In practice,when

the patient is the appellant, the responsible authority and

the secretary of state often do not participate in theappeal

hearing. Judicial review proceedings are still apossibility, with the Upper Tribunal empowered to conductand rule on such proceedings. If there is cogent evidencethat danger and risk are likely to result from an MHTdecision to discharge a section, thus enabling the patientto leave the hospital, the MHT (in the form of a salariedjudge) may be persuaded to suspend the effect of thedischarge decision pending the determination of anyapplication for leave to appeal against, and any appeal orreview of, that decision (Rule 5(3)(l)). It is now wellestablished that a “re-sectioning” of the patientfollowing an MHT decision to discharge the section isunlawful, except in certain circumstances. The appropriate

way to challenge an MHT decision with which there isdisagreement is the same as for challenging any courtdecision, namely, by seeking to successfully appeal thedecision. The circumstances in which “re-sectioning” mightbe considered lawful were addressed in 2003 by the Houseof Lords in the case of R v. East London and the CityMental Health NHS Trust and another ex parte VonBrandenburg. 19 In this case the former senior Law Lord,Lord Bingham, referring to the approved social worker(ASW) whose role is now carried out by the approved mentalhealth professional, stated that: [A]n ASW may not lawfullyapply for the admission of a patient whose discharge hasbeen ordered by the decision of a mental health reviewtribunal of which the ASW is aware unless the ASW hasformed the reasonable and bona fide opinion that he hasinformation not known to the tribunal which puts asignificantly different complexion on the case as comparedwith that which was before the tribunal. He continued, “Itis impossible and undesirable to attempt to describe inadvance the information which might justify such anopinion,” but he did give three hypothetical examples: ●That the patient had on an earlier date attempted to killhimself, and the approved mental health professionalconcludes that this fact would have significantly affectedthe MHT’s risk assessment ● Clear evidence that thepatient has no intention of complying with medicationdespite giving an assurance at the hearing that he wouldbe compliant ● That the patient’s mental condition hassignificantly deteriorated. CRITERIA, DISCRETION, DUTIESAND POWERS Criteria, discretion and duties Whenconsidering an application or reference, the MHT mustapply the criteria in Part V MHA 1983. 20 The criteriavary depending on the section applicable to the individualpatient whose case is under consideration. Thus, whenconsidering the case of an unrestricted

patient such as the patient subject to Section 3 orSection 37,

the MHT has a discretion to discharge the section (which

is rarely exercised) and must discharge it if not satisfiedin

regard to any of the following criteria:

● That the patient is then suffering from mental disorderor from mental disorder of a nature or degree which makesit appropriate for him or her to be liable to be detainedin a hospital for medical treatment.

● That it is necessary for the health or safety of thepatient or for the protection of other persons that thepatient should receive such treatment.

● That appropriate medical treatment is available for thepatient In the case of a Section 3 patient, the MHT mustalso dis

charge the section (when the case has come before the tribu

nal as a consequence of an application by the nearestrelative

whose direction for discharge of the section has been barred

by the responsible clinician) if not satisfied that thepatient,

if released, would be likely to act in a manner dangerous to

self or other persons. In the case of a restricted patientsubject to Section

37/41, the MHT has no discretionary power to discharge.

The MHT must discharge a Section 37/41 restricted patient

conditionally if it is not satisfied that the criteriaabove are

made out. Such a patient will only be granted an absolute

discharge if, in addition to not being satisfied as to oneor

more of the aforementioned criteria, the MHT is also satis

fied that it is not appropriate for the patient to remainliable

to be recalled to the hospital for further treatment. Thesecriteria are also relevant when the MHT considers

the case of a transferred prisoner subject to Sections47/49 and

48/49 or a patient subject to Section 45A (a hospital andlimita

tion direction) (considered further later in this chapter).The criteria to be applied when considering the cases of

patients subject to Section 2, to guardianship, or to a CTO

are similarly outlined in Part V MHA 1983.

STATUTORY TERMS

Over the years the courts, and now the Upper Tribunal,

have grappled with the meaning of expressions and phrases

in the criteria, such as mental disorder, 21 nature ordegree, 22

in a hospital, 23 medical treatment, 24 and appropriatemedical

treatment is available. 25 As far as discharge is concerned:

● In the case of unrestricted patients, it means dischargefrom being liable to be detained (rather than dischargefrom hospital) or from being subject to guardianship or aCTO.

● In the case of restricted patients, the term has been thesubject of much judicial consideration in recent years.This issue in particular can arise with restrictedpatients in the context of conditions that may beassociated with their conditional discharge. The Court ofAppeal has recently confirmed that the MHT has no power“to impose conditions on a conditional discharge thatextend to the imposition of an objective deprivation ofliberty”. 26 BURDEN AND STANDARD OF PROOF It is not thepatient’s responsibility to prove that he or she shouldnot be liable to be detained or subject to compulsion inthe community. In the case of R (on the application of AN)v. MHRT and Interested parties, 27 the Court of Appealconcluded that all the criteria outlined earlier aresusceptible to proof on the balance of probabilities andthat the burden of satisfying the MHT that the grounds forthe patient’s continued detention are made out, rests onthe detaining authority. Powers The full extent of MHTpowers varies depending on the section that the patient issubject to. 28 In respect of unrestricted patients, theoptions are the following: ● No discharge ● Immediatedischarge ● Discharge on a specified date and time in thefuture There is no power to impose conditions on anydischarge. In a case where the MHT does not discharge the

patient, there is a power to recommend the following: ●Leave or transfer to another hospital or into guardianshipwith a view to facilitating discharge on a future date ●In the case of Section 3 and Section 37 patients, that theresponsible clinician consider whether to make a CTO TheMHT has the power to reconsider the patient’s case furtherif any such recommendation is not acted upon. As far asguardianship patients and CTO patients are concerned, theoptions are solely the following: ● No discharge ●Discharge There is no power to vary the terms of theguardianship or the conditions of a CTO. In the case ofSection 37/41 patients, the options are the following: ●No discharge ● Absolute discharge ● Conditional discharge● Deferred conditional discharge A deferred conditionaldischarge is a provisional MHT decision. Its aim is togive those responsible the opportunity to put in place thearrangements as required in order that the patient canmeet the conditions specified by the MHT.

The MHT has no power to direct the necessary arrange

ments are made, such as specific aftercare or the alloca

tion of a supervising clinician. Ever since the case of R

(on the application of IH) v. Secretary of State for theHome

Department (1) Secretary of State for Health (2), 29 aftera

period fixed by the MHT, the case will come back before

the MHT and the decision will be reviewed with all options

being available to the MHT.

There is no power to delay the discharge of a Section

37/41 patient to a fixed time and date. There is nolegislative

provision for formal recommendations in respect of leave or

transfer to another hospital.

In the case of patients subject to restriction direc

tions (i.e., transferred prisoners under Section 47 or

48, subject under Section 49) or limitation directions

(i.e., under Section 45A), the powers are very limited. They

have been drafted in recognition of the fact that prior to

the authority to detain the patient in the hospital, there

was an authority to detain in prison. The prison deten

tion authority is in effect in abeyance during the hospital

admission. The MHT approaches such cases initially as if

the patient were subject to the provisions of Section 37/41.

If it is satisfied that the criteria for an absolute or acondi

tional discharge are met, the MHT is then guided by the

provisions of Section 74 MHA 1983.

In regard to Section 48 patients (i.e., most commonly,

patients transferred while awaiting trial):

● If the absolute discharge criteria have been met, thesecretary of state must direct a return to prison

● If the conditional discharge criteria have been met, thesecretary of state must direct a return to prison, unlessthe MHT has recommended that the patient remain in thehospital. Such a recommendation would be made if the MHTfeared relapse on return to prison In regard to Section 47patients (i.e., patients transferred

after conviction) and Section 45A patients:

● If the absolute discharge criteria have been met, theMHT can then go on to direct such a discharge provided thesecretary of state serves notice of his or her agreementwithin the following 90 days. In the absence of suchnotice, the hospital must return the patient back toprison at the end of the 90-day period. The secretary ofstate is most likely to agree if the patient is nearinghis earliest date of release from the prison sentence thatwas imposed.

12. For example, R (on the application of S) v. MHRT and

Department of Health (Interested party) [2002] EWHC Admin2522 and R (on the application of H) v. Ashworth HospitalAuthority and others [2002], EWCA Civ 923.

13. Rule 37(1).

14. Rule 37(2).

15. https://www.gov.uk/mental-health-tribunal/after-you-send-your-appeal.

16. [ 2010] UKUT 264 (AAC).

17. [ 2015] UKUT 36 (AAC).

18. Judge Knowles in HK v Llanarth Court Hospital [2014]UKUT 410 (AAC).

19. [2003] UKHL 58.

20. Specifically sections 72, 73, and 74 MHA 1983.

21. D L-H v. Devon P’ship NHS Trust v. Sos for Justice[2010], UKUT 102 (AAC).

22. R v. MHRT for the South Thames Region ex. p. Smith(1999), 47 B.M.L.R. 104. 23. R (on the application of DR)v. Mersey Care NHS Trust [2002], EWHC 1810 (Admin); R (onthe application of CS) v. MHRT [2004], EWHC 2958 (Admin);SL v Ludlow Street Healthcare [2015], UKUT 398 (ACC). 24.B v . Croydon Health Authority (1995), W.L.R. 294; Section145(4) MHA. 25. MD v. Nottinghamshire Health Care NHSTrust [2010], UKUT 59 (AAC); DL-H v. Devon P’ship NHSTrust v. Sos for Justice [2010], UKUT 102 (AAC); H-L vPartnerships in Care & SSJ [2013], UKUT 500 (AAC); WH vLlanarth Court Hospital [2015], UKUT 695 (AAC). 26. Secretary of State for Justice v MM; Welsh Ministers v PJ[2017] EWCA Civ 194 [18]. 27. [2005] EWCA Civ 1605. 28.Sections 72–75 MHA 1983. 29. [2003] UKHL 59. 30. Manythanks to John Horne, former Northumbria UniversityTeaching Fellow for his input into the drafting of thisChapter.

82 Chapter 82 Care Quality Commission

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85 Chapter 85 Malingering

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9. The Psychology Testing Centre. Statement on the Conductof Psychologists Providing Expert Psychometric Evidence toCourts and Lawyers. Leicester, UK: The British PsychologySociety, 2007.

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Table 86.1 Characteristics of some common drugs

Drug Half-life (h) a Typical blood concentration (mg/L)Major metabolites (pharmacologically active or inactive)

Amphetamine 7–34 0.02–0.20 Benzoic acid, hippuric acid(both inactive)

Cannabis (THC) 20–57 (infr equent users) 3–13 days(frequent users) 0.001–0.010 (THC) 0.001–0.050(carboxy-THC) Hydroxy-THC (active) Carboxy-THC (inactive)

Cocaine 0.7–1.5 0.05–0.30 (cocaine) 0.1–1.0(benzoylecgonine) Benzoylecgonine, methylecgonine (bothinactive)

Diamorphine (heroin) 0.03–0.1 (diamorphine) 0.1–0.4 (6-MAM)2–3 (morphine) Diamorphine ND 0.01–0.10 (6-MAM) 0.01–0.10(morphine) 0.1–0.5 (morphine-3-glucuronide)6-Monoacetylmorphine (6-MAM), morphine (both active),morphine-3glucuronide (inactive), morphine-6-glucuronide(active)

Methadone 15–55 0.03–0.30 EDDP, EMDP (both inactive)

Diazepam 21–37 0.05–2.00 (diazepam) 0.1–3.0(desmethyldiazepam) Desmethyldiazepam, temazepam, oxazepam(all active)

Methylenedioxymetamphetamine (MDMA) 5–9 0.10–0.35Methylenedioxyamphetamine (MDA, active)

γ-Hydroxybutyrate (GHB) 0.3–1 80–250 Succinic acid(inactive)

Half-life – t ½ : the time taken for a concentration of adrug to decrease to half of the initial concentration.

a From Baselt RC. Disposition of Toxic Drugs and Chemicalsin Man, 9th edn. Seal Beach, CA: Biomedical Publications,2011.

Typical blood concentration: the range of whole bloodconcentrations likely from a therapeutic or typical abusedose.

EDDP, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine;EMDP is 2-ethyl-5-methyl-3,3-diphenylpyrrolidine; THC,tetrahydrocannabinol.

ND, not detected.

87 Chapter 87 Electroencephalography

1. Kiloh LG, Osselton JW. Clinical Electroencephalography.2nd ed. London: Butterworth, 1966.

2. Fenton GW. The straightforward EEG in psychiatricpractice. Proceedings of the Royal Society of Medicine.1974; 67: 911–19.

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Figure 88.2 Middle cerebral artery infarct. Non-dominant

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104 Chapter 104 DSPD Units In The Hospital

Table 104.6 Future placement needs of the high-securityDSPD population, n = 51

Placement needs Prison n (%) High-security DSPD n (%)High-security PD n (%) Medium security n (%) Community n(%)

After 1 year 2 (4) 34 (67) 9 (18) 6 (12) 0 (0)

3 years’ time 5 (10) 12 (24) 5 (10) 24 (47) 5 (10)

5 years’ time 10 (20) 0 (0) 2 (4) 18 (35) 21 (41)

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24. R iordan S, Wix S, Humphreys M. Forensic communitymental health nurses’ perceptions of statutory communityaftercare: Implications for practice. Journal of ForensicNursing. Winter 2005; 1(4): 172–8.

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G. Interface between forensic and general psychiatry inthe community. Criminal Behaviour and Mental Health. 2002;12(1): S73–S79. 29. Bonta M, Law M, Hanson K. Theprediction of criminal and violent recidivism amongmentally disordered offenders: A meta-analysis.Psychological Bulletin. 1998; 123(2): 123–42. 30.Weisman RL, Lamberti JS, Price N. Integrating criminaljustice, community healthcare, and support services foradults with severe mental disorders. Psychiatric Quarterly.Spring 2004; 75(1): 71–85.

109 Chapter 109 Managing PersonalityDisorder in the Community

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110 Chapter 110 Psychopharmacology: SomeMedicolegal Aspects

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Alcohol is often involved. Amnesia is usually present forthe relevant period. The defendant may typically wake upin the BOX 110.1 A 57-year-old CEO developed insomniabecause of business worries. He was treated withnitrazepam. He went for a boozy lunch at an exclusive golfcourse. Following the lunch he drove erratically, causingdamage to parked cars totalling £100,000. The generalpractitioner could not prove that he had warned hispatient. The driver was found not guilty. The civil casewas settled out of court by the medical defenseorganisation. BOX 110.2 A musician took lorazepam forflight phobia. He was not warned about its interactionwith alcohol. On boarding the flight, he drank three largeglasses of whiskey. He became truculent, then aggressive,and assaulted a crew member. Nevertheless, the jury foundhim not guilty. police cell with no recollection ofevents. A benzodiazepine alone can be a defense if thepatient was not warned.

3. Attempts have been made to include such episodes underthe rubric of “drug-induced automatism” in parallel withthe epilepsy literature (see Box 110.3). 4. Date rape.These alleged cases usually involve flunitrazepam orγ-hydroxybutyric acid (GHB) (see Box 110.4). Many claimsare probably exaggerated. In most cases alcohol isinvolved, which in sufficient concentration can induce thesame state of passivity and amnesia as the drugs. Thealcohol is usually in sufficient concentration to explainthe complainant’s state of mind and amnesia, partial orcomplete. 5. Lithium toxicity. The author has collectedapproximately 25 cases of irreversible neurotoxicityascribed to lithium poisoning. Various mechanisms areimplicated in the causation. The most common are: ●Co-prescription of diuretics. ● Dehydration in hotclimates. ● Confusion about dose. ● Misdispensing (seeBox 110.5). The central nervous system damage isconcentrated in the cortical and cerebellar regions of thebrain. It can be life-threatening or leave devastatingsequelae. Measurable cognitive impairment can usually bedetected on formal neuropsychological examination.Sometimes cognitive deterioration or personality changescan be subtle and deterioration can be insidious. 6. Thechemoprophylaxis of malaria or its treatment may involvedrugs with severe adverse effects in the susceptible. Theyshould be avoided for prophylaxis if the patient has ahistory of psychiatric disorders (including depression) orconvulsions (see Box 110.6).

BOX 110.3

A 35-year-old man had an unfaithful wife. One day

she met her lover in a hotel room at 7 a.m. She

returned home at 10 a.m and was confronted by her

angry husband. He rushed into the kitchen, seized a

knife, and stabbed her to death. His defense was that hewas taking 5 mg of

zolpidem every night at 10 p.m. for insomnia. But the

time since his last dose was 12 hours, his actions were

deliberate, and he could remember every detail. The

defense of drug-induced automatism was dropped.

BOX 110.4

A 40-year-old gynecologist in private practice was

accused of “spiking” his nurse assistant’s glass of wine

with an unidentified benzodiazepine and then raping

her. No drug was found in her blood 72 hours later,

but other complainants came forward. He was con

victed and removed from the medical register.

BOX 110.5

A 67-year-old woman with bipolar I disorder had

been maintained for many years on Priadel (200 mg

tablets). Her serum lithium concentrations were stable

in the therapeutic range. She began to develop

Parkinsonism with slow progression. The local com

munity pharmacist misdispensed double-strength

(400 mg) tablets, which she took for 2 weeks. She

went into a coma with a serum lithium concentration

of 3.4 mmol/L. She was dialyzed and recovered, but

her Parkinsonism is much worse. She now has moder

ate cognitive impairment, especially for short-term

memory. She received substantial damages. BOX 110.6 A48-year-old film producer visited Mombasa, Kenya, onbusiness. He had suffered from a severe episode of majordepressive disorder (MDD) 5 years before, which eventuallywas treated with electroconvulsive therapy. He tookmefloquine as prescribed by his general practitioner(250 mg once weekly). After 4 weeks he became increasinglymoody and depressed. On the flight home from Mombasa, hebecame confused and paranoid, and tried to open the doorson the airplane. After he returned home, it took 4 weeksto for him to regain his normal mood. He has sufferedadditional affective episodes and now seems to be moresusceptible to further episodes of MDD or mania. Hereceived substantial damages.

111 Chapter 111 Cognitive Behavior Therapy

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118 Chapter 118 Reasoning andRehabilitation and Enhanced ThinkingSkills

Table 118.2 Cognitive skills programs: R&R and ETS—past andpresent versions

Components of relevance in promoting forensic mental health:

• Challenge egocentric thinking through perspective-takingexercises and by delivery in a group format, whileappealing to egocentric thinking by highlighting thebenefits of developing cognitive skills for theparticipants themselves.

• Recognize and label “problems” well, generate solutions,and think about likely outcomes.

• Avoid the content of antisocial thinking: focus on theprocess of thinking (i.e., how to think, not what to think18 ); bolster participant’s existing cognitive skills andchannel these prosocially rather than directly challengingantisocial thinking.

• Offer a coaching/teaching style of delivery; fitscomfortably within a recovery-oriented timetable ofresources for users of forensic mental health services 39and empowers the participant as a “personal scientist”testing out new skills. 40

• Are perceived as worthwhile by the majority of men whograduate. 33

• Can improve self-confidence, literacy, and interpersonalskills, and provide a foundation for onward learning. 36,37

• Generally useful in preparing “high-risk” groups forother offending behavior interventions and are consistentwith recommendations to emphasize and target cognitiveskills, rather than the affective deficits of such apopulation. 40,41

• Possibly less relevant for lower risk groups in communitysettings.

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119 Chapter 119 Aggression Management

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Table 121.3 Prevalence of PTSD in prisoners and samplecharacteristics in four studies Powell et al. (1997)Simpson et al. (1999) Brink et al. (2001) Butler et al.(2003)

Country USA New Zealand Canada Australia

Sample size 213 802 202 566

Gender Male Mixed Male Mixed

Definition of ‘current’ PTSD 6 months 1 month 1 month 12months

Assessor’s training Basic training Basic training QualifiedBasic training

Assessment tool DIS III R CIDI-A SCID CIDI-A

Diagnostic tool DSM III R DSM IV DSM IV ICD 10

PTSD rate 21% 10.20% 4% 21.40%

Source: From Goff, Rose, Rose and Purves. 8

122 Chapter 122 Suicide in Prisons

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126 Chapter 126 HMP Grendon

1. Pinel

2. P olicy paper etc

3. Bion W

4. Harrison

5. B lom Cooper

6. Fallon

7. M cGuire What works book

8. G roup analytic reference

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17. M oJ consultation 2011

127 Chapter 127 TBS in the Netherlands

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130 Chapter 130 Victims of Torture

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2. Amnesty International. http://amnesty.org/report2006/index-eng.

3. Convention Against Torture and Other Cruel, Inhuman orDegrading Treatment or Punishment. Adopted by the UnitedNations General Assembly, 1984.

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5. Wenzel T, Kastrup M, Eisenman D. Survivors of Torture.A Hidden Population. In: Immigrant Medicine. Eds. WalkerP, Barnett E. Philadelphia: Saunders Elsevier, 2007.

6. Jaranson J, Quiroga J. Evaluating the services oftorture rehabilitation programmes. Torture. 2011;21: 98–140. 7. Kastrup M, Jaranson J. Management ofVictims of Torture. In: Psychiatry. 3rd ed. Eds. Tasman A,Kay J, Lieberman JA, First MB, Maj M. Chichester: JohnWiley, 2008. 8. Genefke I, Kastrup M. Psychological andPhysical Abuses, Torture: A Man-Made Disaster. In:Handbook of Disaster Me d icine. Eds. Boer JD, Dubouloz M.Amsterdam: International Society of Disaster Medicine,2000. 9. Skylv G. Physical Sequelae of Torture. In:Torture and Its Consequences. Ed. Basoglu M. Cambridge:Cambridge University Press, 1992. 10. Dahl S, Dahl CI,Sandvik L, Hauff E. Chronic pain in traumatized refugees.Tidsskr Norsk Lægeforening. 2006; 126: 608–10. 11. OlsenDR, Montgomery E, Bøjholm S, Foldspang A. Prevalence ofpain in the head, back and feet in refugees previouslyexposed to torture: A ten-year follow-up study. Disabilityand Rehabilitation. 2007; 29(2): 163–71. 12. Gavagan T,Martinez A. Presentation of recent torture survivors to afamily practice center. Journal of Family Practice. 1997;44: 209–12. 13. Somnier F, Genefke I. Psychotherapy forvictims of torture. British Journal of Psychiatry. 1986;149: 323–29. 14. Basoglu M, Paker M, Paker O, Ozmen E,Marks I, Incesu C, et al. Psychological effects oftorture: A comparison of tortured and non-torturedpolitical activists in Turkey. American Journal ofPsychiatry. 1994; 151: 76–81. 15. Jaranson J, Butcher JN,

Halcon L, Johnson DR, Robertson C, Savik K, et al. Somaliand Oromo refugees: Correlates of torture and traumahistory. American Journal of Public Health. 2003;94: 591–98. 16. Saraceno B, Saxena S, Maulik PK. MentalHealth Problems in Refugees. In: Psychiatry in Society.Eds. Sartorius N, Gaebel W, Lopez-Ibor JJ, Maj M.New York: John Wiley & Sons, Ltd., 2002. 17. Holtz TH.Refugee trauma versus torture trauma: A retrospectivecontrolled cohort study of Tibetan refugees. Journal ofNervous and Mental Disease. 1998; 186: 24–34. 18.American Psychiatric Association. Diagnostic andStatistical Manual (DSM-III). Washington, DC: AmericanPsychiatric Association, 1980. 19. A merican PsychiatricAssociation. Posttraumatic Stress Disorder (DSM-5).[Internet.] 2013. Available from:http://www.dsm5.org/Documents/PTSD%20 Fact%20Sheet.pdf.20. World Health Organization. International Classificationof Diseases. 10th revision. Geneva: WHO, 1994. 21. UnitedNations High Commissioner for Human Rights. IstanbulProtocol. Geneva: UNHCR, 2004. 22. Ortiz D. The Survivors’Perspective. In: The Mental Health Consequences ofTorture. Eds. Gerrity E, Keene TM, Tuma F. New York:Springer, 2001.

131 Chapter 131 Civil Aspects of ForensicPsychiatry

1. Banks v. Goodfellow (1870) LR5 QB 549

2. Dew v. Clark and Clark (1826) 162 ER 410

3. RV Adomako (1995) 1 AC 171

4. Montgomery v. Lanarkshire Health Board (2015) UKSC 11

132 Chapter 132 Termination of Pregnancy

1. American Psychological Association Task Force on MentalHealth and Abortion. Report of the American PsychologicalAssociation Task Force on Mental Health and Abortion.Washington, DC: American Psychological Association, 2008.

2. Charles VE, Polis CB, Sridhara SK, Blum RW. Abortionand long-term mental health outcomes: A systematic reviewof the evidence. Contraception. 2009; 78: 436–50.

3. National Collaborating Centre for Mental Health.Induced Abortion and Mental Health. A Systematic Review ofOutcomes of Induced Abortion, Including Prevalence andAssociated Factors. London: Academy of Medical RoyalColleges, 2011. 4. C oleman PK. Abortion and mentalhealth: A quantitative synthesis and analysis of researchpublished from 1995–2009. British Journal of Psychiatry.2011; 199(3): 180–86. 5. Fergusson DM, Horwood LJ, BodenJM. Does abortion reduce mental health risks of unwanted orunintended pregnancy? A reappraisal of the evidence.Australian and New Zealand Journal of Psychiatry. 2013;47(9): 819–27. 6. Munk-Olsen T, Larsen TM, Pedersen CB, etal. Induced first trimester abortion and risk of mentaldisorder. New England Journal of Medicine. 2011; 364(4):332–39. 7. Taft AJ, Watson LF. Depression and terminationof pregnancy (induced abortion) in a national cohort ofyoung Australian women: The confounding effect of women’sexperience of violence. BMC Public Health. 2008; 8: 75.8. Major B, Cozzarelli C, Cooper ML, Zubek J, Richards C,Wilhite M, Gramzow RH. Psychological responses of womenafter first trimester abortion. Archives of GeneralPsychiatry. 2000; 57: 777–84. 9. Gilchrist A, Hannaford P,Frank P, Kay C. Termination of pregnancy and psychiatricmorbidity. British Journal of Psychiatry. 1995; 167:243–48. 10. Hill, AB. The environment and disease:Association or causation? Proceeding of the Royal Societyof Medicine. 1965; 58: 293–300. 11. C ougle JR, ReardonDC, Coleman PK. Generalised anxiety following unintendedpregnancy resolved through childbirth and abortion:A cohort study of the 1995 National Survey of FamilyGrowth. Journal of Anxiety Disorders. 2005; 19: 137–42.12. Steinberg JR, Russo NF. Abortion and anxiety: What’sthe relationship? Social Science and Medicine. 2008; 67:238–52. 13. Fergusson DM, Horwood LJ, Boden JM. Abortionand mental health disorders: evidence from a 30-yearlongitudinal study. British Journal of Psychiatry. 2008;193: 444–51. 14. Kersting A, Kroker K, Steinhard J, et al.Complicated grief after traumatic loss: A 14-monthfollow-up study. European Archives Psychiatry and Clinical

Neuroscience. 2007; 257(8): 437–43. 15. Schmiege S, RussoNF. Depression and unwanted first pregnancy: Longitudinalcohort study. British Medical Journal. 2005; 331(72):1303–8. 16. Goodwin P, Ogden J. Women’s reflections upontheir past abortions: An exploration of how and whyemotional reactions change over time. Psychology andHealth. 2007; 22(2): 231–48. 17. Mota NP, Burnett M,Sareen J. Associations between abortion, mental disorders,and suicidal behaviour in a nationally representativesample. Canadian Journal of Psychiatry. 2010; 55(4):239–47.

18. Coleman PK, Coyle CT, Shuping M, et al. Inducedabortion and anxiety, mood and substance abuse disorders:Isolating the effects of abortion. Journal of PsychiatricResearch. 2009; 43(8): 770–76.

19. Pedersen W. Childbirth, abortion and subsequentsubstance use in young women: A population basedlongitudinal study. Addiction. 2007; 102(12): 1971–78.

20. D ingle K, Alati R, Clavarino A, et al. Pregnancy lossand psychiatric disorders in young women: An Australianbirth cohort study. British Journal of Psychiatry. 2008;193: 455–60.

21. Gissler M, Hemminki E, Lonnqvist J. Suicides afterpregnancy in Finland, 1987–94: Register linkage study.British Medical Journal. 1996; 313: 1431–34.

22. Reardon DC, Rue PG, Scheuren F, et al. Deathsassociated with pregnancy outcome: A record linkage studyof low income women. Southern Medical Journal. 2002;95(8): 834–41.

23. P edersen W. Abortion and depression: A populationbased longitudinal study of young women. ScandinavianJournal of Public Health. 2008; 36: 424–28.

24. R eardon DC, Cougle JR. Depression and u nintendedpregnancy in the National Longitudinal Survey of Youth: Acohort study. British Medical Journal. 2002; 324(7330):151–52.

25. G iannandrea SIAM, Cerulli C, Anson E, et al.Increased risk for post-partum disorders among women withpost-partum pregnancy loss. Journal of Women’s Health.2013; 22(9): 2013.

26. Bradshaw Z, Slade P. The effects of induced abortion

on emotional experiences and relationships: A criticalreview of the literature. Clinical Psychological Review.2003; 23(7): 929–58.

27. Coleman P, Rue VM, Coyle CT. Induced abortion andintimate relationship quality in the Chicago Health andSocial Life Survey. Public Health. 2009; 123(4): 331–38.

28. Fertl KL, Beyer R, Geissner E, et al. Women with ahistory of pregnancy loss or abortion. In a behaviouralmedicine hospital. Psychotherapy and PsychosomaticMedicine and Psychology. 2010; 60(8): 298–306. 29. DavidHP, Rasmussen NK, Holst E. Post-partum and post-abortionpsychotic reactions. Family Planning Perspectives. 1981;13(2): 91–92. 30. R eardon DC, Cougle JR, Rue VM, et al.Psychiatric admissions of low-income women followingabortion and childbirth. Canadian Medical AssociationJournal. 2003; 168(10): 1253–56, 31. Coleman PK, ReardonC, Rue VM, et al. State funded abortions versusdeliveries: A comparison of outpatient mental health claimsover 4 years. American Journal Orthopsychiatry. 2002;72(1): 141–52. 32. Fergusson DM, Horwood LJ, Boden JM.Reactions to abortion and subsequent mental health.British Journal of Psychiatry. 2009; 190: 420–26. 33.Burke T. Forbidden Grief: The Unspoken Pain of Abortion.Springfield, IL: Acorn Books, 2002. 34. D u Puy C, DovitchD. The Healing Choice. Your Guide to Emotional RecoveryAfter Abortion. New York: Simon and Schuster, 1997. 35.Layer SC, Roberts C, Wild K, et al. Post-abortion grief:Evaluating the possible efficacy of a spiritual groupintervention. Research on Social Work Practice. 2004;14(5): 344–50. 36. Kumar R, Robson K. Psychologicalmedicine: Previous induced abortion and ante-natal diagnosis. Primiparae: Preliminary Report of a Survey ofMental Health in Pregnancy. 1987; 8: 711–15. 37. Kitamura T, Shima S, Sugawara M, et al. Psychological andsocial correlates of the onset of affective disordersamong pregnant women. Psychological Medicine. 1993; 23(4):967–75. 38. Silverman JG, Decker MR, McCauley HL, et al.Male perpetration of intimate partner violence andinvolvement in abortions and abortion-related conflict.American Journal of Public Health. 2010; 100(8): 1415–17.39. Biggs MA, Upadhay UD, McCulloch CE et al. Women’smental health and well-being 5 years after receiving orbeing denied an abortion: A prospective longitudinal cohortstudy. JAMA Psychiatry. [Epub ahead of print, December2016.] 40. Gissler M, Karsalis E and Ulander VM. Decreasedsuicide rate after induced abortion after the Current CareGuidelines in Finland 1987–2012. Scandinavian Journal ofPublic Health. 2015; 43. 99–101.

133 Chapter 133 Negligence

9. Mulheron R. Trumping Bolam: A critical legal analysisof Bolitho’s “gloss.” Cambridge Law Journal. 2010; 69:609–38.

10.

11. Savage v. South Essex NHS Trust (2011).

12. Kumaralingam A. Judging doctors and diagnosing the law:Bolam rules in Singapore and Malaysia. Singapore Journalof Legal Studies. 2003; 125–46. 13.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4010641.Accessed May 13, 2012. 14. http://www.bma.org.uk/employmentandcontracts/2_ expert_witnesses/Mediation.Accessed May 13, 2012. 1 5.

134 Chapter 134 Coroner’s Court andInquests

1. The High Court refused an application for judicialreview by the Avon coroner who had been removed fromoffice by the then Lord Chancellor Kenneth Clarke; Forrestv (1) The Lord Chancellor (2) The Lord Chief Justice, 2011EWHC 142 (Admin).

2. R v North Humberside and Scunthorpe Coroner ex parteJamieson [1993] 3 All ER 972.

3. R(Middleton) v West Somerset Coroner [2004] 2 All ER465 HL.

4. Schedule 5 of the Coroners and Justice Act 2009 andRegulation 28 of the Coroners (investigations)Regulations 2013, No 1616.

135 Chapter 135 The General MedicalCouncil: Fitness to Practice Proceduresand Panels

1. Consultation 2011: Reform of the fitness to practiseprocedures-consultation on changes to the way we deal withcases at the end of an investigation: www.gmc-uk.org

2. Consultation 2011: The future of adjudication and theestablishment of the Medical Practitioners TribunalService. www.gmc-org.uk

3. Council Board meeting : A report on responses to theconsultation paper on “Reform of the Fitness to PractiseProcedures at the GMC; the future of adjudication and theestablishment of the Medical Practitioners TribunalService.” July 2011.

4. Council Board meeting: A report on responses to theconsultation paper on “Reform of the Fitness to PractiseProcedures at the GMC; changes to the way we deal withcases at the end of an investigation.” June 2011.

5. Shipman inquiry 5th report Dame Janet Smith“Safeguarding patients: Lessons from the past; proposalsfor the Future’’ 09/12/04.The shipman Inquiry;www.shipman-inquiry.org.uk/reports

6. The Medical Act 1983 www.legislation.gov.uk

7. G eneral Medical Council (Fitness to Practice) RulesOrder of Council 2006 www.gmc-org.uk

8. GMC Thresholds July 2016. www.gmc-org.uk

9. G ood Medical Practise www.gmc-org.uk check date

10. Annual Statistics for investigations into doctorsFitness to practise 2013 gmc-org.uk

11. Review of doctors who commit suicide while under FtPinvestigations December 14 and with GMC action plan June15. www.gmc-org.uk

136 Chapter 136 Euthanasia

1200

1000 800 600 400 200 0 2005 2006 2007 2008 Year

N

o .

o

f c

a s

e s 2009 2010 2011 Physical Mental and physical Mental

Figure 136.1 Reported cases of euthanasia in Belgium

(2005–2011).

137 Chapter 137 Consent

1. Tay C. Recent developments in informed consent: Thebasis of modern medical ethics. Journal of Rheumatology.2005; 8: 165–70.

2. Kirby M. Patients Rights—Why the Australian courts haverejected “Bolam.” Journal of Medical Ethics. 1995; 21:5–8.

3. Rogers v. Whitaker (1992).

4. Schloendorff v. Society New York Hospital (1914).

138 Chapter 138 Confidentiality

3. Gillick v. West Norfolk and Wisbech Area HealthAuthority (1986), AC 112.

4. A nthony S. Child Care Matters: The GMC’s new guidanceon roles and responsibilities towards treating youngpeople is relevant to all doctors. Medical ProtectionSociety Casebook. 2006; 16(1): 7.

5. Department of Health. Confidentiality NHS Code ofPractice. London: Author, 2003: 4.

6. Z v . Finland (1998), 25 EHRR 371; MS v. Sweden (1998),45 BMLR 1.

7. Campbell v. MGN (2004), UKHL 22.

8. R v. Department of Health ex p. Source Informatics(2000), 1 All ER 786.

9. Sayers v. Smithkline Beecham PLC (2007), EWHC 1346 (QB).

10. General Medical Council. Confidentiality. London:Author, 2009.

11. Royal College of Psychiatrists. Good PsychiatricPractice: Confidentiality and Information Sharing. London:Author, 2010.

12. B ritish Medical Association. Medical Ethics Today.London: Author, 2004: 190; British Psychological Society.Guidelines on Confidentiality and Record Keeping. London:Author, 2002: 4; Department of Health. NHS Code ofPractice. London: Author, 2003: para 33.

13. W v . Edgell (1990), 1 All ER 835.

14. P almer v. Tees Health Authority (2000), PIQR 1. 15.See, e.g., Royal College of Paediatrics and Child Health.Responsibilities of Doctors in Child Protection Cases withRegard to Confidentiality. London: Author, 2004: passim,for a useful, clear synthesis of the legal and ethicalobligations with respect to child protection. 16. RoyalCollege of Paediatrics and Child Health. The PhysicalSigns of Child Sexual Abuse: An EvidenceBased Review andGuidance for Best Practice. London: Author, 2008; Rose D.Doctors “must be alert to signs of child abuse.” London:The Times, 19 March 2008; Williams C. Bearing goodwitness: The reluctant experts. Family Law. 2002; 153–58,

for a useful perspective on the controversy surroundingchild abuse cases where it was alleged expert opinion ledto miscarriages of justice. 17. R ice v. Connelly (1966),2 All ER 649. 18. See Department of Health.Confidentiality NHS Code of Practice. London: Author,2003, for details concerning appropriate use of medicalrecords to support direct patient care. 19. Ss. 14 and10, respectively. 20. See R v. Mid-Glamorgan FHSA ex p.Martin (1995), 1 All ER 356, which notes that medicalrecords were owned by health authorities and doctors butthat this is not absolute; and MG v. UK (2002), 3 FCR413, where third-party rights was the concern of theauthorities refusing to allow access and also confirmedthat such rights are part of Art. 8(1).

139 Chapter 139 Duty to Warn

1. “French psychiatrist convicted of manslaughter forfailing to recognise danger of patient.” Daily Telegraph,20 Dec 2012.

2. W v. Egdell (1990), 1 All ER 835; R v. Crozier (1990),12 Cr App Rep (S) 206.

3 . G eneral Medical Council. Confidentiality. [Internet.]October 2009, paragraph 8. Available from: http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp.

4. Royal College of Psychiatrists. Good psychiatricpractice: Confidentiality and information sharing 2nd ed.[Internet.] September 2010, p. 29. Available from:http://www.rcpsych.ac.uk/publications/collegereports/cr/cr160.aspx.

5. Rabone and another v. Pennine Care NHS Foundation Trust(2012), UKSC 2.

6. Alexandrou v. Oxford (1993), 4 All E.R. 328.

7. Capital and Counties PLC v. Hampshire County Council(1997), Q.B. 1004.

8. Brazier M, Cave E. Medicine, Patients and the Law. 4thed. London: Penguin Books, 2007: 156.

9. Tarasoff v. The Regents of the University ofCalifornia, et al., 17 Cal.3d 430.

10. Some US states recognized duties even broader thanthose in Tarasoff; for example, Peck v. Counseling Serviceof Addison County, 499 A.2d. 422 (Vt. 1985), extended theduty to encompass damage to property, and Lipari v. Sears,Roebuck and Co., 497 F.Supp. 185 (D.Neb. 1980), imposedliability in a situation where the eventual victims werenot identifiable. 11. For the Canadian approach, seeWenden v. Trikha (1991), 8 C.C.L.T. (2d) 138 (Q.B.) (firstinstance), and (1991), 14 C.C.L.T. (2d) 225 (Court ofAppeal). 12. G avaghan C. A Tarasoff for Europe? AEuropean Human Rights perspective on the duty to protect.International Journal of Law and Psychiatry. 2007; 30:255–67; Gavaghan C. Dangerous patients and duties to warn:A European Human Rights perspective. European Journal ofHealth Law. 2007; 14: 113–30. 13. Osman and Another v.Ferguson and Another (1993), 4 All E.R. 344. 14. Hill v.

Chief Constable of West Yorkshire (1989), A.C. 53. 15.General Medical Council. Confidentiality. [Internet.]October 2009. Available from: http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp. 16.“[I]n general, disclosure should only be considered ifthere is a significant risk of death or serious harm,including abuse.” Royal College of Psychiatrists. GoodPsychiatric Practice: Confidentiality and informationsharing 2nd ed. [Internet.] September 2010, p. 31.Available from: http://www.rcpsych.ac.uk/publications/ collegereports/cr/cr160.aspx. 17. It should be rememberedthat pedophilic urges per se do not necessarily constituteany type of threat to the public. 18. A. v. UnitedKingdom (1999), 27 E.H.R.R. 611. 19. Even the CaliforniaSupreme Court seems to have had a change of heart aboutthis; see Reisner v. Regents of the University ofCalifornia, 31 Cal. App.4th 1195 (1995). 20. Smith v.Jones (1998), 62 BCLR (3d) 198. 21. Ibid, per Cody, J. atparagraph 80. 22. Palmer v. Tees AHA (2000), P.I.Q.R. P1.23. “[I]t is at least necessary for the victim to beidentifiable (though as I have indicated it may not besufficient) to establish proximity.” Per Stuart-Smith,LJ at p.12. 24. “[I]n circumstances such as the present,the identity of the victim is an important factor indeciding whether the foreseeability test is passed.” PerPill, LJ at p.19. 25. Tarasoff, per Tobriner J, at p.439; emphasis added. 26. Anfang SA, Applebaum PS. Twentyyears after Tarasoff: Reviewing the duty to protect.Harvard Review of Psychiatry. 1996; 4(2): 67–76. 27.McBride J. Protecting life: A positive obligation to help.European Law Review. 1999; 24: 43–54, at 48. 28. M itchelland another v. Glasgow City Council (2009), UKHL 11, at[33].

140 Chapter 140 Human Rights Act of 1998

1. The term exhaustively covers any “judgment, decision,declaration or advisory opinion of the Court,” any“opinion of the Commission given in a report adopted underArticle 31,” any “decision of the Commission in connectionwith Article 26 or 27(2),” or any “decision of theCommittee of Ministers taken under Article 46.” The words“in connection with” appear to mean that all findings thatmay be said to be linked to the admissibility procedure,including reports prepared during the preliminaryexamination of a case, could be taken into account.

2. [ 2004] UKHL 26; [2004] 2 AC 323; [2004] 3 WLR 23;[2004] 3 All ER 785.

3. He relied on R (Alconbury Developments Ltd) v.Secretary of State for the Environment, Transport and theRegions [2001] UKHL 23, [2003] 2 AC 295, at para 26. 4.At [20]. 5. [ 2008] UKHL 38; [2009] 1 AC 173 at [33-4].6. [2009] UKHL 28; [2009] 3 WLR 74. 7. [2008] AC 440. 8.At para 108. 9. [2010] 1 WLR 2601. See in particular[33], [40], [41], [47]. 10. [2001] 2 Cr App R 21; [2002]1 AC 45. 11. [2002] 2 AC 291. 12. [2004] 3 All ER 411.13. See Straw, HC Official Report Cols 409–10 (1998). 14.[2006] EWHC 1133 QB. 15. See HL Deb, Vol. 583; col. 811,24 November 1997. 16. HL Deb, Vol. 583; col. 811, 24November 1997. See also Clayton R, Tomlinson H. The Law ofHuman Rights. Oxford: Oxford University Press, 2000:paras 5–03. 17. [2001] 4 All ER 604. 18. [2002] EWHC 529.19. R (on the Application of Ward) v. Leonard CheshireFoundation [2002], 2 All ER 936. 20. [2007] All ER 271.21. Oliver D. Functions of a public nature under the HumanRights Act, Public Law. 2004; 329–51. 22. [2003] UKHL 37;[2004] 1 AC 546; [2003] 3 WLR 283; [2003] 3 All ER. 23.At [160]. 24. At [12]. 25. At [44]. 26. [2007] UKHL 27;[2008] 1 AC 95; [2007] 3 WLR 112; [2007] 3 All ER 957.27. At [31]. 28. See also Quane H. The Strasbourgjurisprudence and the meaning of “public authority” underthe HRA. Public Law. 2006; 106; Oliver D. The frontiers ofthe State: Public authorities and public functions underthe HRA. Public Law. 2000; 476 at 477. 29. H ealth andSocial Care Act 2008, Section 145. 30. [2009] EWCA Civ587. 31. At [41].