FORENSIC ASPECT OF

MENTAL STATUS
Ida Bagus Putu Alit
Department of Forensic Medicine,
Medical Faculty, University of
Udayana

Content
1. Psycho-organic aspect of drugs
abuse
2. Mental status in concept of the Law
3. Medico legal aspect of the mental
status

SUBSTANCE INDUCED ORGANIC

DISORDER -1
(FAULK)
1. INTOXICATION

EXCESSIVE
ALTERED PSYCHOLOGICAL FUNCTIONING

2. IDIOSYNCRATIC INTOXICATION

MANIA A POITU
DELIRIUM
AUTONOMIC CHANGES

3. WTHDRAWAL EFFECT

STOPPING THE SUBSTANCE

SUBSTANCE INDUCED ORGANIC

DISORDER -2 (FAULK)
4. MENTAL ILNESS
a) Direct (Amphetamine, Cocaine, LSD)
b) An effect of sudden withdrawal

Paranoid psychosis

c) Chronic effects of drugs

Alcoholic dementia

d) Precipitating relaps in patient with

Schizophrenia

canabis

Psycho-organic aspect of
DoA
WHO definitions
A drug is any substance other than
those required for the maintenance
of normal health, that when taken
into living organism may modify one
or more of its functions

SUBSTANCES MISUSE
DRUG MISUSE (Royal College of Psychiatrists)
Harm and threatens physical and mental or social
well-being

TOLERANCES
DEPENDENCE
Psychic and physical sate, behavioural compulsion
to take on continous basis in order psychic effects
and disconfort of it absence

ADICTION:
PHYSICAL , PSYCHOLOGICAL, LIFE STYLE

SUBSTANCES MISUSE

Experimental use
Social use
Situational use
Abuse
Pathologic
Social and occupational impairment

Dependence
Tolerance
Withdrawal

YURIDICAL ASPECTS

REGULATION :

UU PSIKOTROPIKA (UU No.5 TH 1997)

UU NARKOTIKA ( UU No. 22 TH 1997)

NARCOTICS :

1.
2.
3.

OPIAT
CANNABIS
COCAINE

ADDITIVE SUBSTANCES :

1.
2.
3.
4.
5.
6.
7.
8.

ALCOHOL
AMPHETAMINE
HALUSINOGEN
SEDATIVE-HIPNOTIC
SOLVEN
PCP
NICOTINE
CAFEINE

FORENSIK FK UNUD

MEDICO LEGAL ASPECT

CRIME WITHOUT VICTIM
VICTIMLESS CRIME
ORGANIZED- CRIME
impunity

PARTICIPATED-VICTIM CRIME
CRIMINALS CONTRIBUTION
HOT SHOT
SWALLOWER
BODY PACKER SYNDROME
MULLES

NARCOTICS
CNS DEPRESSANT
OPIATE

CNS STIMULANT
COCAINE

MIND EXPANDING PSYCHODELICT

CANNABIS, MARIHUANA

FORENSIK FK UNUD

MORFINE AND HEROINE

Heroine 6 Mono Acetyl Morfine
(MAM)
Exitation phase euphoria
Narcose phase :
Somnolens
Coma
Pin head size

Mechanism of death
Direct mechanism
Depression of respiration center
Swelling of the lungs (Narcotics Lung)
Anaphylactic Shock (COLLOIDOCLASTIC
CRISIS)

Indirect mechanism of death

Unsteril

FORENSIK FK UNUD

Forensic medicine examination

Needle Mark
Intravenous Mainline Tracks
Granuloma, Abses (Skin-Popper)
Nasal Perforation
Enlargement of lymph node
Skin Blister
Achute pulmonal oedema
FORENSIK FK UNUD

Cannabis (marihuana)
Psychosa marihuana
Instability of emosion
Delusion
Panic
Anorexia
Weakness
Loss of libido

Precipitate mental disorder

COCCAINE-1
The most potent of the CNS stimulants
Potent addictive compound
Increasing of Catecholamine
Stimulate the release of NE
Blocking reuptake of NE

Mechanism of death
1) Cardiac arrhytmia

Direct action on myocardium

2) Cardiopulmonary arrest

Central action on CNS

COCCAINE-2
A CHEMICAL PARANOID PSYCHOSIS
EXTREMELY VIOLENT AND ASSAULTIVE
AGGRESIVE
PARANOID

The three curse of mankind :

Alcohol
Morphine
coccaine

METHAMPHETAMINE AND
AMPHETAMINE-1
EFFECT :
Increasing release of DOPAMINE and
blocking reuptake of DOPAMINE
hyperstimulation of receptor neurons

Increasing release of NE and blocking

reuptake of NE

THE EUPHORIC EFFECTS TEN TIME

THAN OF COCCAINE
ENTACTOGENIC EFFECTS

METHAMPHETAMINE AND
AMPHETAMINE-2
Over dosis :

Restlessness
Confulsion
Hallucination
Coma, convulsion
Cardiac arrhytmia

Chronics use
a chemical paranoid psychoses

Death generally not dose related

ALCOHOL (ETHYL-ALCOHOL)
The most misuse
Related to accident, homicide,
suicide and assault (physical or
sexual)
Burning, drowning
Both as victim or perpetrator

Banay reaserch at Sing Sing jail

HOW MANY ALCOHOLICS ARE
CRIMINALS AND HOW MANY
CRIMINALS ARE ALCOHOLICS

DELIRIUMTREMENS ( VIOLENT
INSANITY)
Narcoses phase : over than 300 mg
Delirium
Halusinasi
Neuro-muscular control disturbance
hypothermia

Deformity on chronic alcoholism

Encefalitishemoragic superior (Wernicke)
Necroses of hypothalamus, corpus
mammilaria, cortex athrophy

Marchiava Bignami Syndrome

Thinning of corpus callosum anterior

Korsakoffs syndrome
Accumulation of lipochrome at cortex,
neuroglia and microglia
ALCOHOLIC DEMENTIA

Mental status in concept of

Law
Actus Rheus- Mens Rhea Concept
Wrong doer :
Actus Rheus : Evil Doing
Mens Rhea : Evil Mind

The focus is mental status when the

criminal act occur

Mental status when criminal

act
Intentional
Random or specific victim
Specific motive or spontaneous
Planned or not

To protect him/herself
Negligence
Under pressure

Strafuitsluitingground
Excusable homicide :
Overmach
Noodtoestand
Not have responsibility ( suffer mental
illness)
Mental Retardation
Organic mental disorder
Altered of mental status (psychosis etc)
ARTICLE 44 INDONESIAN PENAL CODE

Law point of view

Infanticide (article 341 Indonesian
penal code )

Specific murder
Murderer is the mother
Victim is her baby
at or soon after delivery
Because afraid someone know

British Law : the time under the baby 1 years

old
Because pain when delivery and lactation

Law point of view

Parricide
Specific murder
Murderer is the son/daughter
Victim is one of the parent or both parent
(double parricide )
The murderer under mental illness :
Abuse when childhood
Murder is reflection of overprotection

Law point of view

Somatoform disorder not a legal reason
Munchausen Syndrome by Proxy (MSBP) :
Child abuse
Factitious illness
Illness induction
Damages to the child :Diagnostic
procedures, Illness induction
Long impact : Invalidism chronic

Medico legal aspect of mental

status
Delict
Material delict
Responsibility by sequence
Murder

Formal delict
Responsibility by act
Sexual harassment

Criminal act can make mental defect

Qualification of wound

Qualification of the wound

Slight : there is no illness
Moderate : there is illness and need
medical care
Severe : regulated by act 90
Indonesian Penal Code

Qualification of the wound (art 90

Indonesian Penal Code)
1. Medatangkan bahaya maut (high risk to
death)
2. Tidak bisa diharapkan sembuh
3. Kehilangan panca indera
4. Verminking
5. Verlamming
6. Kehilangan pekerjaan secara permanen
7. Kematian bayi dalam kandungan
8. Gangguan mental lebih dari 4 minggu

Qualification of the wound (art 90

Indonesian Penal Code)
Not the diagnosis but the duration of
mental disorder
Post Traumatic Stress Disorder
(PTSD)
Child Protection and Domestic
Violence Law
Repeated mental disorder ( acute
psychosis)
Dysfunction of reproduction organs

Mental evidence in Child

Abuse
Behavioral analysis
Three phase :
1. Hyperaurosal
Altered behavior

2. Intrusion
Night mare
Flash back

3. Numbing
Isolation
Invalidism chronic

Be careful The Perfect

Murder
1.
2.
3.
4.

Dont repeat the act if failure

Kill base on the victims habit
Kill by unstable or endogen poison
Eternity silent

THANK YOU
Alit