-
Question 1
Incorrect
-
You have been asked to prepare a psychiatric report by the Court regarding one of your Child and Adolescent Mental Health Team patients who has been charged with a sexual offence, having exposed himself to a group of younger children in a local park. You have been asked to comment specifically on his fitness to plead. He has a diagnosis of treatment-resistant schizophrenia and has been on clozapine for several years. In spite of this he continues to suffer from intermittent, distressing auditory hallucinations several times a day. He is also frequently thought disordered.
You discuss the alleged offence with the patient. He acknowledges that his behaviour was wrong, stating that he was hearing voices he attributed to the children telling him to remove his clothes. With careful explanation he is able to understand the roles of the various parties in Court (his legal team, prosecution, judge, jury etc). He has an understanding legal team and has developed a good relationship with them, having been accused of similar offences in the past. However he is frequently distracted during the conversation by hearing voices and his concentration is impaired due to the level of thought disorder.
Which of the following Pritchard Criteria is he likely to fail?:Your Answer: Believing his actions were morally justified
Correct Answer: Being able to follow proceedings in Court
Explanation:It is likely that the patient’s ongoing psychiatric symptoms will make it difficult for him to follow court proceedings, such as witness statements and cross-examination. The legal test for determining fitness to plead remains the case of R vs. Pritchard from 1836, which includes criteria such as the ability to enter a plea, understand the evidence against them, instruct their solicitor, follow court proceedings, and challenge a juror. While it may be possible to argue that the patient cannot give legal instruction, the question asks for the most likely criteria he would fail, and given his good relationship with his legal team and understanding of relevant issues, this may not be the case. It is important to note that believing actions are morally justified is not part of fitness to plead, but may be relevant to a plea of not guilty by reason of insanity. The patient acknowledges his actions and understands the difference between guilty and not guilty. While challenging a juror is an outdated aspect of the fitness to plead test, the patient appears to understand the roles of everyone present in court and would be able to request the removal of a juror with whom he had a prior acquaintance. There have been calls from psychiatrists to update the criteria for fitness to plead due to inconsistencies in their application, but this has not yet occurred.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 2
Incorrect
-
Which option is not included in the Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)?
Your Answer: Gender of victim
Correct Answer: PCL-R
Explanation:Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)
The Rapid Risk Assessment for Sex Offence Recidivism (RRASOR) is a well-known actuarial tool that is used to predict the likelihood of sex offence recidivism. It comprises of four items that have been proven to have predictive accuracy for sex offence recidivism. These items include the number of past sex offence convictions of charges, the age of the offender being less than 25, the offender being unrelated to the victim, and the gender of the victim.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 3
Incorrect
-
Which statement is false regarding an individual's ability to plead fitness?
Your Answer: Fitness to plead is judged by the Pritchard criteria
Correct Answer: Someone is unfit to plead if they cannot recall the alleged crime
Explanation:Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 4
Correct
-
What is a risk management factor included in the HCR-20?
Your Answer: Exposure to destabilizers
Explanation:The HCR-20 is a comprehensive tool used to assess the risk of violence in adults. It takes into account various factors from the past, present, and future to provide a holistic view of the individual’s risk. The tool consists of 20 items, which are divided into three domains: historical, clinical, and risk management.
The historical domain includes factors such as previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, major mental illness, psychopathy, early maladjustment, personality disorder, and prior supervision failure. These factors are important to consider as they provide insight into the individual’s past behavior and potential risk for future violence.
The clinical domain includes factors such as lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment. These factors are important to consider as they provide insight into the individual’s current mental state and potential risk for future violence.
The risk management domain includes factors such as plans lack feasibility, exposure to destabilizers, lack of personal support, noncompliance with remediation attempts, and stress. These factors are important to consider as they provide insight into the individual’s ability to manage their risk and potential for future violence.
Overall, the HCR-20 is a valuable tool for assessing the risk of violence in adults. It provides a comprehensive view of the individual’s risk and can be used to inform treatment and risk management strategies.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 5
Incorrect
-
Which of the following characteristics is not associated with antisocial personality disorder?
Your Answer: History of repeated physical fights
Correct Answer: Rapidly shifting and shallow set of emotions
Explanation:Histrionic personality disorder is characterized by quick changes in emotions.
Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 6
Correct
-
What is the approximate occurrence rate of functional psychosis among male remand prisoners in England and Wales?
Your Answer: 10%
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 7
Incorrect
-
What is a partial defence to murder?
Your Answer: Insanity
Correct Answer: Loss of control
Explanation:Some partial defences to murder are available, such as diminished responsibility, loss of control, and killing in accordance with a suicide pact.
Murder and Manslaughter: Understanding the Difference
Homicide is the act of killing another person, but it’s important to distinguish between murder and manslaughter. Murder is committed when a person of sound mind and discretion unlawfully kills another human being who is born alive and breathing through their own lungs, with the intent to kill of cause grievous bodily harm. Manslaughter, on the other hand, can occur in three ways: killing with the intent for murder but where a partial defense applies, conduct that was grossly negligent given the risk of death, and conduct taking the form of an unlawful act involving a danger of some harm that resulted in death. Infanticide is a specific type of manslaughter that applies to women who cause the death of their child under 12 months old by a wilful act of omission, but at the time of the act of omission, the balance of their mind was disturbed by the effects of giving birth of lactation. It’s important to understand these distinctions to properly classify and prosecute these crimes.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 8
Correct
-
Which cluster B personality disorder is most prevalent among prisoners aged 50 and above in prisons located in England and Wales?
Your Answer: Antisocial
Explanation:Prisoner Mental Health: Focus on Older Adults
Limited research exists on the mental health of older adults (60 years and above) in prison. However, a study conducted in 2001 in England and Wales revealed high rates of depressive disorder and personality disorder among this population. More than half (53%) of the sample had a psychiatric diagnosis, with approximately 30% diagnosed with depression and another 30% with personality disorder (including 8% with antisocial personality disorder). Only 1% of the sample had dementia. Further research is needed to better understand and address the mental health needs of older adults in prison.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 9
Incorrect
-
Which statement accurately describes mentally disordered offenders?
Your Answer: The prevalence of epilepsy among prisoners is higher than in the general population
Correct Answer:
Explanation:There are several possible reasons why the prevalence of epilepsy is higher among prisoners compared to the general population. One explanation is that an underlying organic mental disorder may be responsible for both epilepsy and offending. Another possibility is that the development of epilepsy can negatively impact an individual’s self-esteem and lead to social rejection, which may then result in antisocial behavior. Additionally, adverse social circumstances may contribute to both epilepsy and antisocial behavior. Finally, a tendency towards impulsivity and antisocial behavior may lead to brain injuries and subsequent post-traumatic epilepsy.
Offending by the Mentally Disordered
The prevalence of epilepsy is higher among prisoners than in the general population, but this does not necessarily mean that they are more likely to be serving a custodial sentence for violence. Matricide, the killing of one’s mother, is often associated with schizophrenia, although not always. Othello’s syndrome, a delusional jealousy that usually affects men in their 40s after about 10 years of marriage, can be difficult to treat with antipsychotic medication and may require separation from the spouse. Depressive disorder is more commonly associated with suicide, but in some cases, it can lead to homicide, particularly in the morning and involving family members.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 10
Incorrect
-
You are providing oral testimony in Court in the case of a 30-year-old patient with a mixed personality disorder (with emotionally unstable and dissocial features) and co-occurring substance misuse (opiate dependence). The patient has been found guilty of Grievous Bodily Harm following a violent assault during a burglary, presumably to fund drug use.
The patient is well-known to local psychiatric services and has had multiple brief admissions in the past after parasuicidal behavior. The patient has been detained in the local Medium Secure Unit for 12 months under section 38 of the Mental Health Act for assessment of his treatability in hospital. The patient has engaged with treatment, although there are concerns among the clinical team that this engagement is superficial and the patient may be using the hospital system to avoid receiving a custodial sentence.
Based on this information, what would be the most appropriate medical recommendation for sentencing?Your Answer: Section 37/41 of the Mental Health Act
Correct Answer: Section 45a of the Mental Health Act
Explanation:Section 45a of the Mental Health Act allows for a Hybrid Order, which combines both a Mental Health and Criminal Justice component to a sentence. This means that the offender would receive treatment in a hospital initially, but would also be given a prison sentence. Once the treatment is complete, the offender would return to prison to serve the remaining time.
Extending the offender’s section 38 assessment in hospital post-conviction is not possible as it can only last for a maximum of one year.
The most appropriate sentencing option could be Section 37/41, which is a Hospital Order with Restrictions. However, it is uncertain if the offender is treatable as there seems to be little connection between his mental disorder and offending behavior.
Section 47/49 is for the transfer of sentenced prisoners and is not applicable in this case.
No hospital disposal is also an option, but the offender has responded well to treatment and has a mental disorder, which makes him suitable for disposal under the Mental Health Act, even if he does not have a mental illness.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 11
Correct
-
Which of the following is an Indictable offence?
Your Answer: Rape
Explanation:The most severe crimes are classified as indictable offences and are heard in the Crown Court. These crimes include heinous acts such as rape of aggravated sexual assault, murder of attempted murder, piracy, and treason.
Court Structure in England and Wales
The legal system in England and Wales is divided into two main categories: criminal and civil law. Criminal law governs the rules set by the state for citizens, while civil law regulates the relationships and transactions between citizens.
All criminal cases begin in the Magistrates’ Court. Criminal offenses are classified into three main categories: summary offenses, triable either way offenses, and indictable offenses. Summary offenses are the least serious and are tried in the Magistrates’ Court, with a maximum penalty of six months imprisonment and/of a fine of up to £5,000. Triable either way offenses are the middle range of crimes and can be tried in either the Magistrates’ Court of Crown Court. Indictable offenses are the most serious crimes, including murder, manslaughter, and rape, and must be tried in the Crown Court, with the first hearing at the Magistrates’ Court.
Magistrates’ courts handle 95% of cases, including many civil cases such as family matters, liquor licensing, and betting and gaming. Magistrates cannot typically order sentences of imprisonment exceeding six months (of 12 months for consecutive sentences) of fines exceeding £5,000. In cases triable either way, the offender may be committed by the magistrates to the Crown Court for sentencing if a more severe sentence is deemed necessary.
The Crown Court deals with serious criminal cases, some of which are on appeal of referred from Magistrates’ courts. Trials are heard by a Judge and a 12-person jury. The Crown Court is located at 77 centers across England and Wales and handles cases transferred from the Magistrates’ Courts. It also hears appeals against decisions of Magistrate’s Courts and deals with cases sent for sentence from Magistrates’ Courts.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 12
Correct
-
Which statement accurately describes arson?
Your Answer: Approximately 40% of all serious fires are started deliberately
Explanation:Arson Epidemiology
Arson is a serious issue, as approximately 40% of all serious fires are started deliberately. In the UK, arson is responsible for 1% of all serious crimes, with the incidence for both homicide and rape being three times higher. The peak age for arson is 17 for men and 45 for women, and 80% of those convicted are men. Interestingly, there is an increased incidence of arson among those with learning disabilities and those who suffer from alcohol dependence syndrome.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 13
Incorrect
-
NICE has made a recommendation for the treatment of antisocial personality disorder, but the specific recommendation is not provided in the given information.
Your Answer: Psychodynamic psychotherapy
Correct Answer: Group based cognitive interventions
Explanation:NICE suggests that individuals with antisocial personality disorder, including those who struggle with substance misuse, who are receiving care in community and mental health services, should be offered group-based cognitive and behavioural interventions. These interventions aim to tackle issues such as impulsivity, interpersonal challenges, and antisocial behaviour.
Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 14
Correct
-
What are the factors that increase the risk of suicide in prison?
Your Answer: Being married
Explanation:Suicide in Prison: High Rates and Risk Factors
Suicide rates among prisoners are significantly higher than in the general population, with an average rate of 133 per 100,000 population per year in England and Wales in 1999-2000. Remand prisoners had an even higher rate of 339 per 100,000 population per year. Early suicides were more common in drug-dependent prisoners, with 59% occurring within 7 days of reception into prison.
The most common method of suicide was hanging of self-strangulation, with bedclothes being the most common ligature used. Window bars, beds, and cell fittings such as lights, pipes, cupboards, sinks, toilets, of doors were the main ligature points. 72% of prisoners had at least one known psychiatric diagnosis, with drug dependence being the most common primary diagnosis at 27%. Schizophrenia was diagnosed in 6% of prisoners, and affective disorder in 18%.
Risk factors for suicide in prisoners include being in a single cell, being male, having a psychiatric illness, having a history of substance misuse, having a history of previous self-harm of attempted suicide, recent suicidal ideation, and being on remand. Surprisingly, being married was found to be a risk factor for suicide in prisoners, in contrast to the general population where it is a protective factor.
Overall, these findings highlight the urgent need for effective suicide prevention strategies in prisons, particularly for those at higher risk. This may include improved mental health services, better screening and assessment of risk factors, and measures to reduce access to means of suicide such as ligature points.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 15
Correct
-
What is a true statement about antisocial personality disorder?
Your Answer: Antisocial behaviours seen in conduct disorder are typically present before the age of 8
Explanation:Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 16
Correct
-
What other medication should be administered alongside IM haloperidol for rapid tranquilization?
Your Answer: IM promethazine
Explanation:Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 17
Correct
-
Which of the following factors would be the least useful in determining a diagnosis of pathological intoxication?
Your Answer: Presence of liver cirrhosis
Explanation:Pathological Intoxication: A Rare Legal Defence
Pathological intoxication, also known as mania a potu, is a legal defence that is seldom used. It refers to a sudden onset of aggressive and violent behaviour that is not typical of the individual when sober. This behaviour occurs shortly after consuming small amounts of alcohol that would not typically cause intoxication in most people. The individual may experience complete of partial amnesia following the episode. Unlike regular alcohol intoxication, there is no motor incoordination, slurred speech, of diplopia present in pathological intoxication.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 18
Incorrect
-
What is a true statement about paedophilic disorder as defined by the DSM-5?
Your Answer: The minimum age for a diagnosis is 14
Correct Answer: The individual must be at least 5 years older than the child of interest to qualify for a diagnosis
Explanation:There is a correlation between adult males with paedophilia and a history of childhood sexual abuse, but it is uncertain whether this relationship indicates that childhood sexual abuse causes adult paedophilia.
Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 19
Incorrect
-
For what purpose is the Gudjonsson Scale primarily used in assessment?
Your Answer: Malingering
Correct Answer: Suggestibility
Explanation:The Gudjonsson Suggestibility Scale
The Gudjonsson Suggestibility Scale is a tool used to measure suggestibility in individuals. It involves reading a story to participants, who are then asked to recall as much as they can remember. Afterward, participants are asked 20 questions related to the story, 15 of which are misleading. Once the questions have been answered, participants are given negative feedback on their performance and told that they made several errors. They are then asked to repeat the questions to obtain more accurate answers. Based on the participants’ responses to the misleading questions, a total suggestibility score can be calculated. This scale is useful in understanding how easily individuals can be influenced of manipulated by external factors.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 20
Correct
-
A 16-year-old male is caught spying on his neighbour whilst she is undressing. The police report that this is the fifth time he has been caught doing this in the past 6 months. He is assessed by a psychiatrist and discloses a six-month history of intense urges to watch females undressing in their homes. He denies feeling distressed by these urges.
Which of the following conclusion would be most appropriate in this case according to the DSM-5?Your Answer: A diagnosis of ‘Voyeuristic Disorder’ should not be made as the individual is under the age of 18
Explanation:Voyeuristic disorder is typically observed in adult males who develop a sexual interest in secretly observing individuals without their knowledge. While this interest may first arise during adolescence, a diagnosis of voyeuristic disorder is only made after the age of 18 due to challenges in distinguishing it from normal sexual curiosity during puberty. The DSM-5 identifies voyeuristic behavior as a disorder when it causes harm, which can manifest as either personal distress of engaging in non-consensual acts.
Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 21
Incorrect
-
Which of the following scenarios could be considered as a valid defence of insane automatism?
Your Answer: Concussion
Correct Answer: Somnambulism
Explanation:The origin of insane automatism is internal to the body, while in the case of sane automatism, it is caused by external factors.
Criminal Responsibility and Age Limits
To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.
Not Guilty by Reason of Insanity and Other Defenses
A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 22
Incorrect
-
What is the term used to describe when a parent takes the life of their own child?
Your Answer: Mariticide
Correct Answer: Filicide
Explanation:The act of a parent killing their child is known as filicide, while matricide specifically refers to the killing of one’s husband. Matricide is the act of killing one’s mother, while patricide refers to the killing of one’s father. Fratricide, on the other hand, refers to the act of killing one’s own brother.
Infant Homicide
Homicide is a significant contributor to infant mortality, with infants under 1 year of age being more likely to be victims of homicide than older children of the general population. Neonaticide, the killing of a baby within 24 hours of delivery, is different from the homicide of infants older than a day. Neonaticide is usually committed by the mother, who is often young, single, and living with her parents. The pregnancy is often unintentional and concealed, and the motivation to kill is usually because the child was unwanted. In contrast, the homicide of infants older than a day is more likely to be committed by a parent, with boys at greater risk than girls. Risk factors for the homicide of infants older than a day include younger age, family history of violence, violence in current relationships of the perpetrator, evidence of past abuse of neglect of children, and personality disorder and/of depression.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 23
Incorrect
-
In accordance with the laws of England and Wales, when does an individual become accountable for their actions?
Your Answer: 12
Correct Answer: 10
Explanation:As of December 2021, the age of criminal responsibility in Scotland is 12, while in England and Wales it remains at 10.
Criminal Responsibility and Age Limits
To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.
Not Guilty by Reason of Insanity and Other Defenses
A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 24
Correct
-
As a consultant psychiatrist, you are requested by a lawyer to provide a psychiatric evaluation for a 25-year-old woman who is presently on bail after being accused of murder. The lawyer asks you to assess whether the defence of 'diminished responsibility' is applicable. You inform the lawyer that this defence is only relevant to a specific offence. What is that offence?
Your Answer: Murder
Explanation:The defence of diminished responsibility is applicable only to cases of murder. If successfully argued, the accused may be convicted of manslaughter instead of murder, resulting in a less severe punishment. Two partial defences to murder are available, namely provocation and diminished responsibility. The insanity defence is a complete defence to murder, but it can be used in other criminal charges as well.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 25
Correct
-
What diagnosis is indicated when a man accused of a violent crime claims to only remember having one alcoholic drink on the day in question, yet witnesses observed him walking normally and displaying violent behavior at the time of the crime?
Your Answer: Pathological intoxication
Explanation:The crucial details in this scenario are the restriction of one drink and the apparent absence of motor impairment in the individual. These factors help to differentiate pathological intoxication from other potential causes such as alcohol intoxication of alcohol-induced amnesia. Blackouts, which involve the inability to remember events that occurred while drinking, can be either complete of partial and are caused by alcohol interference with memory formation.
Pathological Intoxication: A Rare Legal Defence
Pathological intoxication, also known as mania a potu, is a legal defence that is seldom used. It refers to a sudden onset of aggressive and violent behaviour that is not typical of the individual when sober. This behaviour occurs shortly after consuming small amounts of alcohol that would not typically cause intoxication in most people. The individual may experience complete of partial amnesia following the episode. Unlike regular alcohol intoxication, there is no motor incoordination, slurred speech, of diplopia present in pathological intoxication.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 26
Correct
-
A 25-year-old female with a diagnosis of bipolar disorder is admitted to your unit. She is convinced that her roommates are plotting against her and becomes verbally aggressive towards them. The nursing staff is concerned that this may escalate to physical aggression and calls for your advice on how to manage the situation.
Which of the following statements is true regarding the management of this situation?Your Answer: Physical restraint of an individual in the prone position carries risks
Explanation:When dealing with situations involving aggression, it is important to prioritize non-coercive management techniques such as de-escalation of time out, which require the patient’s agreement. Physical restraint may be necessary in cases of immediate danger, but should be used for the shortest possible time to avoid potential harm. Seclusion should only be considered as a last resort due to the significant loss of freedom it entails. Rapid tranquillisation is intended to address acute situations rather than the underlying illness, which may require a longer-term approach.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 27
Incorrect
-
What is a true statement about antisocial personality disorder?
Your Answer: It has an estimated prevalence of 50% in female prisoners
Correct Answer: Mortality rates are increased in antisocial personality disorder
Explanation:While the PCL-R can aid in evaluating the extent of the disorder, it should not be solely relied upon for diagnosis.
Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 28
Correct
-
What is the most prevalent personality disorder among women incarcerated in England and Wales?
Your Answer: Antisocial
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 29
Correct
-
What is a true statement about the HCR-20?
Your Answer: It can be completed individually of by a team
Explanation:One of the primary criticisms of the HCR-20 is its failure to account for protective factors. While formal training is not required to use the tool, it is recommended. Additionally, the HCR-20 only assesses the risk of violence towards people and does not consider violence towards animals of property. The value of the HCR-20 lies in the process of completing it, rather than the final score, which is considered meaningless and cannot be used to determine dangerousness. The HCR-20 can be completed by an individual of a team.
The HCR-20 is a comprehensive tool used to assess the risk of violence in adults. It takes into account various factors from the past, present, and future to provide a holistic view of the individual’s risk. The tool consists of 20 items, which are divided into three domains: historical, clinical, and risk management.
The historical domain includes factors such as previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, major mental illness, psychopathy, early maladjustment, personality disorder, and prior supervision failure. These factors are important to consider as they provide insight into the individual’s past behavior and potential risk for future violence.
The clinical domain includes factors such as lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment. These factors are important to consider as they provide insight into the individual’s current mental state and potential risk for future violence.
The risk management domain includes factors such as plans lack feasibility, exposure to destabilizers, lack of personal support, noncompliance with remediation attempts, and stress. These factors are important to consider as they provide insight into the individual’s ability to manage their risk and potential for future violence.
Overall, the HCR-20 is a valuable tool for assessing the risk of violence in adults. It provides a comprehensive view of the individual’s risk and can be used to inform treatment and risk management strategies.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 30
Correct
-
NICE recommends a specific treatment as the initial option for addressing antisocial personality disorder (ASPD).
Your Answer: Pharmacological interventions are not recommended by NICE for ASPD
Explanation:The routine use of pharmacological treatments for antisocial personality disorder of related behaviors such as aggression, anger, and impulsivity is not recommended.
Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
-
This question is part of the following fields:
- Forensic Psychiatry
-
00
Correct
00
Incorrect
00
:
00
:
0
00
Session Time
00
:
00
Average Question Time (
Secs)