Explore chapters and articles related to this topic
Disorders of brain structure and function and crime
Published in John C. Gunn, Pamela J. Taylor, Forensic Psychiatry, 2014
Pamela J Taylor, John Gunnm, Michael D Kopelman, Veena Kumari, Pamela J Taylor, Birgit Völlm, Mairead Dolan, Paul d‘Orban, John Gunn, Anthony Holland, Michael D Kopelman, Graham Robertson, Pamela J Taylor
People who become patients in psychiatric services commonly have sleep problems, most of which are attributable to their primary mental disorder, sometimes compounded by histories of substance misuse. It may be that, in the interests of parsimony in diagnosis, dyssomnias are not often enough recognized; often the late sleeper/late riser poses a real challenge to nursing management, not readily helped by conventional medication and routine sleep hygiene practices. At worst, patients show complete sleep reversal. The focus of most interest for specialist forensic mental health clinicians, however, lies in the parasomnias, because, occasionally, it is alleged that a serious crime has taken place during sleep. This brings the attendant implication that the individual is not responsible for his or her act and therefore not culpable so that, if the relevance of the sleep disorder can be established in relation to a criminal charge, the person might be acquitted and walk free from the court. In England and Wales, courts have made a distinction between insane and ‘none-insane’ automatism since Kemp. Sleepwalking, a parasomnia, was, then, included alongside concussion, involuntary intoxication and insulin-induced hypoglycaemia as a non-insane automatism. Changes followed; in Quick, a distinction was introduced between external and internal factors causing the abnormality of mind. Since then, abnormalities due to external factors have been regarded as non-insane automatisms, whereas those due to internal factors are regarded in law as insane automatisms due to ‘disease of the mind’. In March 1991, the English Court of Appeal ruled that sleepwalking was ‘an abnormality or disorder, albeit transitory, due to an internal factor’ and that it should, therefore, be regarded as an insane automatism (Burgess). There remains the possibility, however, that an external factor, such as change in medication, might be sufficient to be accepted as an ‘external trigger’. Elsewhere, legal responses vary within and between jurisdictions. Cartwright (2004), for example, described two similar cases for which she gave evidence to the Court as a sleep expert. In neither case was the fact of the homicide disputed. In one case, under Canadian law, the man was acquitted as having been suffering a noninsane automatism, while the other, under US law, was convicted of first degree murder. She sets out clearly how both cases nevertheless fitted well with the criteria proposed by Bonkalo (1974), with EEG evidence of exceptional frequency of arousals from early non-REM (non-rapid eye movement) sleep. In brief, Bonkalo’s criteria are: an established history of sleep disorder, but absence of history of violence; timing (soon after sleep onset, following a period of goal directed behaviour that was initially non-violent); affection for the victim and absence of motivation for the attack; cognitive features (confusion after the attack, amnesia for it, no attempt to conceal it); presence of some potential trigger factors like stress and/or a period of poor sleep; and absence of others, like taking alcohol or illicit substances.
A primer on sleeping, dreaming, and psychoactive agents
Published in Journal of Social Work Practice in the Addictions, 2023
Dyssomnias are disorders wherein a person experiences changes to sleep duration and sleeps too much or too little. Of the numerous sleep disorders, which fall under the dyssomnia category, insomnia, the difficulty of initiating or staying asleep, is the most common and has been classified as a North American public health crisis. Over 95% of the studied population have claimed to have experienced at least one period of insomnia during their lifetime (Sateia, 2014). With the exception of Fatal Familial Insomnia,1A rare genetic condition that causes progressively worsening insomnia there exists no consensus on any other intrinsic or primary insomnia. Secondary insomnia, often referred to as chronic insomnia disorder, does not involve intrinsic sleep-wake neurological systems that regulate transitions into and out of sleep, rather, it is typically linked to medical conditions, psychological issues, or everyday anxiety and work-related stress. Parasomnias are disruptions of behavior and consciousness during sleep, typically occurring between states, including sleep to waking, or REM to nREM sleep. Table 1 provides a summary of the ICDS-3 Major Diagnostic Sections and the affiliated sleep disorders.
Subacute sleep disturbance in moderate to severe traumatic brain injury: a systematic review
Published in Brain Injury, 2020
Bianca Fedele, Gavin Williams, Dean McKenzie, Edwina Sutherland, John Olver
There is limited research available which focuses on early-onset sleep disturbance in adults with moderate to severe TBI. Following TBI, sleep disturbance is commonly not assessed during treatment and rehabilitation (60). Whilst there is some variability between studies (in terms of samples, measurement, and quality), the evidence appears to collectively indicate subacute disruptions to sleep and sleep architecture. Disturbances to sleep may be associated with level of consciousness, affecting 78.7% of the patients during the PTA phase, compared with 35.7% after PTA has cleared (53). Symptoms of dyssomnias were common, with studies collectively reporting disruptions to the duration, continuity, and timing of sleep. Overall, sleep periods were fragmented and difficult to initiate and can be characterized as increases in 1) sleep onset latency (time taken to fall asleep), 2) sleep duration, 3) quantity of awakenings and 4) wake duration after sleep onset. Such disruptions may account for the decreased sleep efficiency reported within studies (16,23,49,54). An increased sleep duration may reflect an increased sleep need (54), which can occur as a response to recovery and to compensate for sleep deficiencies (61). The architecture of sleep appeared to be affected, with marked reductions in REM sleep (51).