Forensics

Question 1

Assault in ward (history)

Answer 1

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

Question 2

Assault in ward (d/w CCN)

Answer 2

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

Question 3

Fire-setting (history)

Answer 3

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

Question 4

Morbid jealousy (history)

Answer 4

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

Question 5

Morbid jealousy (explanation)

Answer 5

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

Question 6

Erotomania and stalking (history)

Answer 6

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

Question 7

Erotomania and stalking (d/w victim)

Answer 7

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

Question 8

Violence risk assessment (history)

Answer 8

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

Question 9

Violence risk assessment (d/w consultant)

Answer 9

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

Question 10

Sexual offence (history)

Answer 10

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

Question 11

Fitness to plead (assessment)

Answer 11

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

Question 12

Exhibitionism (history)

Answer 12

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

Question 13

Exhibitionism (collateral history/management)

Answer 13

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