PMPs - Forensic Psychiatry

FOR 013

You are asked to write a court report on a 55-year-old man charged with indecent exposure. He has no previous convictions for this.

How would you approach the consultation and what psychiatric diagnosis would you have in mind?

Suggested probes

1. Are there any clinical features which would increase your level of concern?
2. What advice are you going to give the court with regard to the risk of re-offending?
3. What information would you require to complete your report?

Guide to Marking

The following areas are relevant to this vignette but are not necessarily all-inclusive. This list is not exhaustive.
1. Need to gather information from a range of legal and medical sources prior to completing the assessment.
2. Be aware of the particular implications of a man in this age group presenting for the first time.
3. Possible psychiatric diagnoses include organic brain syndrome, e.g. frontal lobe dementia, hypomania, depression, and substance abuse.
4. Possible association of indecent exposure with other more serious sexual offending (e.g. if p***s is erect during exposure, if there is escalating behaviour).
5. The low actuarial risk of an individual re-offending (low risk of re-offending if no previous offences of this nature).

FOR dc1

You are asked to do a court report on a 27-year-old man who has been charged with stalking and attacking a female work colleague. You hear from another psychiatrist by chance that the woman has developed a severe stress reaction, and is afraid for her safety if your patient is not given a custodial sentence.

How will you go about taking a history and assessing risk?

Suggested Probes

1. What factors in the history would cause you concern about future offending?
2. What duties do you have towards the female concerned?
3. What recommendations will you make to the court?
4. What is the most likely diagnosis?

Guidelines for Marking

Factors increasing the risk of re-offending:
a) History:
i) one or more previous episodes of violence
ii) repeated impulsive behaviour
iii) evidence of difficulty in coping with stress
iv) previous unwillingness to delay gratification
v) sadistic or paranoid traits
b) The offence:
i) bizarre violence
ii) lack of provocation
iii) lack of remorse
iv) continuing major denial
v) severity of violence
c) Mental State:
i) morbid jealousy
ii) paranoid beliefs plus a wish to harm others
iii) sadistic fantasy life
iv) deceptiveness
v) lack of self control
vi) threats to repeat violence
vii) attitude to treatment/ lack of insight or willingness to comply
d) Circumstances:
i) provocation or precipitant is likely to reoccur
ii) alcohol or drug abuse
iii) social difficulties and lack of support