FM11.1-6 | Forensic Psychiatry — Glossary

A written document under Sections 5-11 MHA 2017 in which a person specifies how they wish (and do not wish) to be treated during a mental health crisis — must be registered with the DMHA to be enforceable

Vivid auditory hallucinations (typically accusatory voices) occurring in a clear, non-delirious state during or after heavy alcohol use — distinct from DT by absence of delirium and autonomic storm

The insanity defence in the Bharatiya Nyaya Sanhita 2023 (replacing IPC Section 84 from 01 July 2024) — provides a complete criminal defence if unsoundness of mind at the time of the act rendered the accused incapable of knowing the nature of the act or that it was wrong

Clinical Institute Withdrawal Assessment for Alcohol — Revised: a validated 10-item scale for quantifying alcohol withdrawal severity; score ≥15 indicates severe withdrawal requiring pharmacotherapy

Auditory hallucinations in which voices instruct the patient to perform specific acts, including violent acts — directly relevant to criminal responsibility assessments

Unconscious fabrication of plausible but false memories to fill amnestic gaps — characteristic of Korsakoff syndrome; not deliberate deception

Severe alcohol withdrawal syndrome occurring 48-96 hours after the last drink, characterised by tremor, autonomic hyperactivity, and delirium with vivid visual hallucinations — a medical emergency

A fixed, false, unshakeable belief out of keeping with the patient's cultural and educational background, maintained despite evidence to the contrary

The district-level authority under MHA 2017 — registers MHEs, maintains Advance Directive records, conducts MHE inspections, and receives complaints

Experienced as alien to or inconsistent with one's sense of self — characterises obsessions and distinguishes them from delusions, which are ego-syntonic

Deliberate production or feigning of symptoms primarily to assume the sick role, without external gain incentive — distinct from malingering

Current mental capacity to participate meaningfully in trial proceedings — understanding the charge, following proceedings, instructing counsel, challenging witnesses — distinct from responsibility at time of act

Tactile hallucination of insects or small animals crawling on or under the skin — seen in alcohol withdrawal and cocaine use

The principal inhibitory ligand-gated ion channel in the CNS — potentiated by alcohol chronically, leading to downregulation; this downregulation is a core mechanism of DT on alcohol cessation

A genuine ICD-11 dissociative disorder characterised by approximate answers (Vorbeireden), altered consciousness, conversion symptoms, and hallucinations — commonly encountered in forensic settings

A perception that occurs in the absence of any real external stimulus, experienced by the patient with the full force of a genuine sensory experience

International Classification of Diseases, 11th revision (WHO, 2022) — the standard diagnostic classification system used in Indian forensic psychiatric reports

A misperception or misinterpretation of a real, existing external stimulus — distinct from hallucination in that a real stimulus is present

Admission of a person with mental illness who refuses treatment, requiring examination by two psychiatrists certifying necessity and Magistrate approval for sustained admission under MHA 2017

Progressive worsening of withdrawal severity with repeated cycles of alcohol dependence and cessation — each withdrawal episode sensitises the brain, leading to more severe features

Largely irreversible chronic amnestic sequela of Wernicke's encephalopathy — profound anterograde and retrograde amnesia with confabulation; caused by permanent damage to mammillary bodies and medial thalami

A period of restored mental clarity and normal cognitive capacity in a person otherwise suffering from a mental disorder — during which testamentary capacity and criminal responsibility are intact

Deliberate, conscious simulation or exaggeration of symptoms for external gain — not a mental disorder in ICD-11/DSM-5

The 1843 English legal test for criminal insanity — a two-pronged test: either the accused did not know the nature of the act, OR did not know the act was wrong

The guilty mind — the mental element required for criminal liability; severe mental illness can negate mens rea and is the legal basis for the insanity defence

Any health facility providing mental health services — must be registered with the relevant authority under MHA 2017

A quasi-judicial body in each district under MHA 2017 — reviews involuntary admissions, hears patient appeals, and adjudicates disputes about Advance Directives and treatment decisions

Indian statute that replaced the Mental Health Act 1987 — establishes a rights-based framework for mental health care, including rights of persons with mental illness, admission procedures, treatment standards, and decriminalisation of attempted suicide

Electro-convulsive therapy administered under general anaesthesia with a muscle relaxant — the only permitted form of ECT under MHA 2017 Section 94, subject to strict consent requirements

A person appointed by a person with mental illness under Sections 14-16 MHA 2017 to take treatment decisions on their behalf when they lack capacity — the NR must follow the Advance Directive if one exists

A repetitive, intrusive, unwanted thought or impulse recognised by the patient as their own, experienced as ego-dystonic and resisted — as seen in OCD

Pathological jealousy — a fixed, false delusion that one's partner is being sexually unfaithful; a major forensic risk factor for intimate-partner violence

A strongly held, abnormal belief that is understandable in the context of the person's history and is not held with the absolute conviction of a delusion — lying on a spectrum between normal belief and true delusion

The most common type of delusion — a fixed belief that one is being watched, followed, poisoned, or plotted against

Post-Traumatic Stress Disorder — a stress-related disorder (ICD-11 block) following traumatic exposure, characterised by re-experiencing, avoidance, negative cognitions, and hyperarousal lasting >1 month

A primary psychotic disorder characterised by positive symptoms (hallucinations, delusions, disorganised thinking) and negative symptoms (blunted affect, avolition), with symptom duration ≥1 month under ICD-11

The landmark provision that decriminalises attempted suicide — a person who attempts suicide shall be presumed to be under severe stress and shall not be tried and punished; creates an affirmative duty on the government to provide rehabilitation

Legal capacity to make a valid will — requires understanding the nature of the act, the extent of the property, the claims of potential beneficiaries, and freedom from delusions influencing the will

Essential coenzyme for glucose metabolism enzymes (pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase); must be given before glucose infusion in any patient at risk of thiamine deficiency

United Nations Convention on the Rights of Persons with Disabilities — ratified by India in 2007; the international framework from which the MHA 2017's rights-based philosophy derives

ECT without general anaesthesia and muscle relaxant — absolutely prohibited under MHA 2017 Section 94; historically associated with spinal fractures and respiratory complications

The characteristic approximate-answer response in Ganser syndrome — the patient gives an answer that is wrong but clearly in the correct domain, demonstrating awareness of the correct answer

Acute thiamine deficiency syndrome in chronic alcohol users — triad of confusion, ophthalmoplegia, and ataxia; requires immediate high-dose parenteral thiamine before glucose

Visual hallucinations of small moving animals (insects, rats, snakes) — characteristic of Delirium Tremens