Sexsomnia – a forensic psychiatric challenge – a case report

In rare penal cases, a defendant makes a claim that he or she was asleep at the time of an alleged crime. This article discusses a case of alleged sexsomnia where a man claimed that he had been asleep during a sexual encounter (rape) with a woman. The question that often arises during an investigation and in court is how complex a behaviour is someone able to perform and still be asleep? To assist the court in answering this question, forensic psychiatric experts may be appointed. But the experts were not present during the act and must therefore consider each case on the basis of the available information and existing research. This paper provides a brief overview of the research regarding sexsomnia. It will also discuss what kind of information is important to elaborate in these cases in order to clarify the premises for the experts’ conclusions to the court.     

Finding a voice – the feasibility and impact of setting up a community choir in a forensic secure setting

This study reports on the feasibility and impact of running a choir for forensic psychiatric inpatients, staff and members of the local community, within the confines of a medium secure psychiatric unit. The choir ran between October and December 2013. Eight weekly workshops and a final concert performance were evaluated through participant observation and focus groups held with the participants. Between 12 and 16 male and female patients attended each workshop and the final concert. All participating patients had received a diagnosis of schizophrenia, schizo-affective disorder or personality disorder, all had committed serious violent or sexual offences and all were legally detained and receiving treatment in a forensic medium or low secure ward, under the Mental Health Act (England and Wales). Considerable benefits were reported by patients, as well as by the participating community choir members and staff. Primary benefits reported by patients included the following: improved happiness and well-being; increased confidence and self-esteem; greater emotional connectedness and reduced sense of stigma. Participating staff also reported increased feelings of well-being and happiness, greater tolerance and more positive perceptions of the functioning and capabilities of forensic psychiatric patients. The longer term benefits of music participation on the mental health and social functioning of forensic psychiatric patients require further investigation.     

Market-based mechanism and ‘climate justice’: reframing the debate for a way forward

International Environmental Agreements: Politics, Law and Economics - The Paris Agreement on climate change recognizes, reluctantly albeit, the importance of ‘climate justice’ in its...     

The de-medicalisation of assisted dying: is a less medicalised model the way forward?

Although assisted dying has been most commonly presented within a medicalised framework, the notion of de-medicalisation is employed in this paper to suggest that there are emerging models of assisted dying in which some medical aspects assumed to be an integral part of the phenomenon are both challenged and diminished. The paper considers cases where relatives have facilitated a loved one's assisted suicide abroad, cases of assisted death in which the assistor in the actual suicide act is a non-medic, and the growing debate surrounding non-medical grounds for desiring death. In evaluating the potential impact of partial de-medicalisation on the assisted dying debate, the argument presented is that whilst a de-medicalised model could well contribute to a richer understanding of assisted dying and a better death for the person who is assisted, there are cogent reasons to retain some aspects of the medicalised model and that a completely de-medicalised model of assisted dying is unrealistic.     

Axonal injury – a diagnostic tool in forensic neuropathology?: A review

We used β-amyloid precursor protein (β-APP) to investigate our own forensic neuropathological case material (n=252) in light of the current literature on the phenomenon “axonal injury” (AI) to determine the incidence, specificity and biomechanical significance of AI and its significance for determining vitality and survival time. The case material consisted of cases of fatal nonmissile closed-head injury (n=119), gunshot injury (n=30), fatal cerebral ischemia/hypoxia (n=51), brain death caused by mechanical trauma (n=14) or nonmechanical injury (n=18), and acute hemorrhagic shock (n=20). AI was observed in 65% to 100% of cases of closed-head injury, fatal cerebral ischemia/hypoxia, and brain death with a survival time of more than 3 h; AI could not be detected in the cases of acute hemorrhagic shock. A statistically significant difference between traumatically and nontraumatically induced (nondisruptive) AI was not found. There was no statistical evidence of a correlation between AI and the different types of external force, since AI could be demonstrated after both acceleration/deceleration injuries and traumatic impact. Therefore, biomechanical inferences for reconstruction purposes are not possible. On the other hand, β-APP was found to be a definite marker of vitality. In our material, cases with a posttraumatic interval of under 180 min did not express β-APP. Moreover, the literature shows that the posttraumatic interval can be determined by other methods for demonstration of AI such as by ubiquitin immunostaining (360 min), silver staining (15–18 h), hematoxylin and eosin staining (about 24 h), or by demonstration of a microglial reaction (about 4 to 10 days) or of a few remaining isolated bulbs, without accompanying fibers, which can be detected after a survival time of up to 17 months.     

The use of telepsychiatry within forensic practice: a literature review on the use of videolink – a ten-year follow-up

In the last decade, telepsychiatry – the use of telecommunications technologies to deliver psychiatric services from a distance – has been increasingly utilised in many areas of mental health care. Since the review by Khalifa and colleagues in 2007 the body of literature relevant to the forensic applications of telepsychiatry has grown substantially, albeit not by much in the United Kingdom. In the current review, we aim to provide an update summary of the literature published since 2007 to determine the effectiveness and feasibility of increasing telepsychiatry utilisation in forensic practice. The literature reviewed provides some encouraging evidence that telepsychiatry is a reliable, effective and highly acceptable method for delivering mental health care in forensic settings. There are also a number of papers that indicate the use of telepsychiatry may be cost effective for health providers in the longer term. Further research is required to consider the potential legal and ethical implications of using telepsychiatry in forensic settings.     

Background survey of polyethylene in the Australian Capital Territory – A demonstration of variability in isotopic abundance values and their application to forensic casework

Plastics including adhesive tapes, cable ties, and packaging are common evidence types encountered in forensic investigations and casework. Traditional examination techniques such as Fourier Transform Infrared (FTIR) spectroscopy lack specificity and are unable to discern differences within the same polymer structures leaving the analyst with a generic identification. High quality manufacturing methods further amplify the limitations in detecting variability between samples. Isotope Ratio Mass Spectrometry (IRMS) has been shown to be a valuable technique in further discriminating plastics. Discrimination is achieved by analysing the relative abundances of stable isotopes within a sample, with differences detected in isotope ratios possibly attributed to the source of raw materials and fractionation during the manufacturing process. A survey of cling wraps and re-sealable zipper storage bags collected in the Australian Capital Territory was undertaken to assess the variability in carbon and hydrogen isotope ratios of different brands and samples. The results of this research are discussed, particularly with respect to within and between brand trends, and a case study is presented as an example of the value of including IRMS in a casework context.