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Handbook of Forensic Psychiatric Practice in Capital Cases


Tis handbook is not a textbook of psychiatry and it is assumed that the reader will have access to a general psychiatry text.9


Te following summary of different mental disorders includes a description


of ways in which they can enhance the risk of criminal offending. Tis is not an exhaustive exploration of the field and individual factors must be considered in every assessment.


Te relationship between specific diagnoses and criminal behaviour is susceptible to epidemiological investigation, and in respect of this the reader is referred to Chapter 7, which deals with risk assessment based upon population statistics. However, in general there is little robust evidence of clear statistically significant association between many types of mental disorder, or specific mental symptoms, and violence in particular. Rather, in some individuals with particular types of mental disorder, particular symptoms can be observed to be associated with violent behaviour in the past, and are therefore relevant to the genesis of their violence, in terms of their own particular ‘biography of violence’. What follows are therefore descriptions of known associations between disorder and offending as they can occur in individuals. Where there is epidemiological evidence of association an attempt has been made to make this clear.


Functional psychosis including paranoid schizophrenia


Psychotic disorders are associated with a somewhat higher risk of violent offending at a population level, although much of this enhanced risk is mediated through concurrent drug abuse. Symptoms particularly capable of enhancing risk in the individual include:


• Altered perceptions of external reality, including false perceptions of threat • Delusional misinterpretation of other people’s identities, and of any threat they might pose • Delusions of jealousy • Delusions of love and subsequent experience of rejection • Distorted cognitions of a wide range of types • Disordered mood • High levels of fear and anxiety secondary to psychosis • Reduction in inhibition, arising from intrinsic mental illness, or drug or alcohol ingestion


Alcohol and drug misuse and dependence


Drug and alcohol misuse is commonly seen in violent offenders and is predictive of violence in the aggregate. Of all mental disorders, this group is most strongly linked to offending and violence. Mechanisms of enhanced risk of violence in the individual include:


• Disinhibition associated with intoxication • Disorganised behaviour associated with intoxication


We recommend Semple D and Smyth R (2009) Oxford Handbook of Psychiatry, Oxford University Press, Oxford, UK as being particularly useful in that is the ‘sister’ handbook to the Oxford Specialist Handbook of Forensic Psychiatry and is written in the same ‘handbook’, rather than ‘textbook’ style as the latter.


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