FM>Chap 21: Forensic Psychiatry>Long Essay 1

1. Classify insanity? What is a delusion? Describe the various types of delusion.
[RS Mar 05, Nov 01]


Classification of insanity (WHO 1965)

1) Idiocy
2) Imbecility
3) Feeblemindedness

1) Dementia
(a)Presenile dementia
(b)Senile dementia

2) Alcoholic psychosis:
(a)Alcoholic blackouts
(b)Delirium tremens
(c)Alcoholic hallucinosis
(d) Korsakov’s psychosis
(e)Delusions of jealousy

3) Psychoses associated with intracranial infections:
a. Epidemic encephalitis
b. Abscess
c. Meningitis
d. TB
e. General Paralysis of insane (GPI)
i) Meningovascular syphilis
ii) Tabes dorsalis

4) Psychosis associated with CNS diseases:
a. Psychosis associated with epilepsy:
i) Pre epileptic insanity
ii) Epileptic psychosis
iii) Post epileptic insanity
iv) Twilight state
v) Psychomotor epilepsy: temporal lobe epilepsy, masked epilepsy, psychic

b. Intracranial/Intracerebral tumors of:
i) Prefrontal lobe
ii) Frontal lobe
iii) Temporal lobe
iv) Parietal lobe

c. Degenerative diseases

d. Brain anomalies

e. Cerebral arteriosclerosis

f. Cerebral trauma: post traumatic psychosis/ post concussion syndrome

5) Psychosis associated with physical conditions:
a. Nutritional disorders:
i) Pernicious anemia
ii) Pellagra
iii) Phenyl ketonuria (PKU)
iv) Primary hypoglycemia

b. Endocrine disorders:
i) Secondary hypoglycemia to DM

c. Metabolic disorders

d. Systemic infections

e. Drug induced psychosis/drug dependence:
i) Drug addiction: Morphine type dependence, Barbiturates type dependence
ii) Drug habituation:
Cocaine type
Cannabis type
Amphetamine type
iii) Psychedelics:
f. Toxic psychosis:
Heavy metals- arsenic and mercury.
g. child birth.

1) Schizophrenia:
a) Simple schizophrenia
b) Hebephrenia
c) Catatonia
d) Paranoid schizophrenia/ paranoia/paraphrenia
e) Schizo-affective psychosis
f) Pseudo neurotic schizophrenia

2) Affective psychosis:
a. Involutional melancholia
b. Manic-depressive psychosis
c. Paranoid states
d. Atypical types:
i) Endogenous
ii) Reactive and neurotic
iii) Puerperal

1) Anxiety neurosis
2) Hysterical neurosis
3) Phobic neurosis
4) Obsessive compulsive neurosis
5) Depressive neurosis
6) Depersonalization syndrome
7) Hypochondriacal neurosis
8) Unspecified neurosis.


A. Unnatural offences:
1) Sodomy/anal intercourse:
2) Tribadism
3) Bestiality
4) Buccal coitus

B. Sexual perversions:
1. Sadism:
a. Algolagnia- mild degree
b. Lust murder- extreme degree
c. Necrophagia- extreme degree
2. Masochism
3. Necrophilia
4. Fetishism
5. Transvestism
6. Exhibitionism
7. Masturbation
8. Voyeurism:
a. Scoptophilia- mild form
b. Troilism-extreme form
9. Frotteurism
10. Undinism
11. Uranism
12. Paraphilias
13. Pyromania
14. Sexual oralism:
a.Fellatio (blow job)
b.Cunnilingus (mouth job)

It is a false belief in something that is not a fact and which persists even after its falsity has been clearly demonstrated. It is seen in epileptic, affective and schizophrenic psychosis. The person suffering from delusions is not legally responsible for his acts.
1) Delusion of grandeur/exaltation:
The person imagines himself to be very rich, while in fact he may be quite poor.
It is seen in delirium tremens.
2) Delusion of persecution/ Paranoid delusion:
The person imagines that people around him are attempting to kill him.
It is seen in paranoid schizophrenia, dementia and depression.
Usually delusion of grandeur and persecution are found together.
3) Delusion of influence:
The person believes that his/her thought process, feelings and actions are being influenced and controlled by some external power, like radio, hypnotism, telepathy etc.
It is seen in schizophrenia.
4) Delusion of reference:
The person believes that people, things, events refer to him in a special way.
5) Delusion of infidelity:
It is usually seen in married men. The person believes that his wife is unfaithful, even though she may be devoted to him.
6) Delusion of self-reproach/self-criticism:
The person blames himself for past failures and misdeeds of no actual importance, or for some imaginary offence committed by him.
7) Nihilistic delusion:
The person believes that either himself or the world around him dint exist by matter.
8) Hypochondriacal delusion:
The person believes that there is some pathology or something radically wrong with his body, even though he may be healthy.
9) Erotomania:
It is a delusion in which the person believes that someone is deeply in love with him/her, which in fact may not be the case. The erotomanic is obsessed with the particular person and starts believing that other person is reciprocating. the person of interest may be famous or a complete stranger. Erotomanic tries to get close by phone calls, letters, gifts, visits etc. He is otherwise normal.
10) Delusion of other types:
a. delusion of jealousy
b. delusion of religion



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