Friday, 1 July 2022

Infanticide and its Legal Status

Infanticide

Infanticide is child murder in the first year of life. We define maternal filicide as a child murder by the mother.  Neonaticide is the murder of an infant within the first 24 hours of life. Almost all neonaticides are committed by mothers. Neonaticidal mothers are often young, unmarried women with unwanted pregnancies who receive no prenatal care.

Infanticide laws often reduce the penalty for mothers who kill their children up to one year of age, based on the principle that a woman who commits infanticide does so because "the balance of her mind is disturbed because of her not having fully recovered from the effect of giving birth to the child". The infanticide law allows mothers to be charged with manslaughter rather than murder if they are suffering from a mental disturbance.

However, women convicted of infanticide sometimes do not have significant mental illness as technically required by the law (so e.g. as per the definition of mental disorder under Punjab Mental Health Act).

The British 1922 Infanticide Act, which legally differentiates infanticides from manslaughter or murder, was introduced in recognition of the socioeconomic “stressors” that could lead unmarried women to kill their illegitimate newborn children out of the shame of being pregnant out of wedlock and to offer leniency in such cases.

Previous studies into the mental condition of women who kill their newborn children have reported that such women respond not callously and purposefully to self-preservation, but out of fear associated with shame and guilt of being pregnant and concern about the reaction of parents, partners, and others if the pregnancy is discovered.

Conclusion 

In order to engage in the defense of infanticide for a mother who has killed our child; mental illness (e.g. postnatal depression or postnatal psychosis) can be used ...... also if no mental illness; then psychosocial circumstances can be used as a mitigating factor such as unwanted child, maltreatment or abuse by the husband and killing of the child by a woman to take revenge on her husband by emotionally torturing him.


Friday, 10 June 2022

ICD-11 Criteria for Disorders due to the Use of Non-psychoactive Substances (6C4H)

ICD-11 Criteria for Disorders due to the Use of Non-Psychoactive Substances (6C4H)

Disorders due to use of non-psychoactive substances are characterised by the pattern and consequences of non-medical use of non-psychoactive substances. Non-psychoactive substances include laxatives, growth hormone, erythropoietin, and non-steroidal anti-inflammatory drugs. They may also include proprietary or over-the-counter medicines and folk remedies. Non-medical use of these substances may be associated with harm to the individual because of the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration (e.g., infections due to intravenous self-administration). They are not associated with intoxication or with a dependence or withdrawal syndrome and are not recognized causes of substance-induced mental disorders.

6C4H.0          Episode of harmful use of non-psychoactive substances

An episode of use of a non-psychoactive substance that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to direct or secondary toxic effects on body organs and systems or a harmful route of administration. This diagnosis should not be made if the harm is attributed to a known pattern of non-psychoactive substance use.

Exclusions:             

  • Harmful pattern of use of non-psychoactive substances (6C4H.1)

 

6C4H.1           Harmful pattern of use of non-psychoactive substances

A pattern of use of non-psychoactive substances that has caused clinically significant harm to a person’s physical or mental health. The pattern of use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (i.e., daily or almost daily). Harm may be caused by the direct or secondary toxic effects of the substance on body organs and systems, or a harmful route of administration.

Exclusions:             

  • Harmful pattern of use of other specified psychoactive substance (6C4E.1)
  • Episode of harmful use of non-psychoactive substances (6C4H.0)

6C4H.10               Harmful pattern of use of non-psychoactive substances, episodic

A pattern of episodic or intermittent use of a non-psychoactive substance that has caused damage to a person’s physical or mental health. The pattern of episodic or intermittent use of the non-psychoactive substance is evident over a period of at least 12 months. Harm may be caused by the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

6C4H.11               Harmful pattern of use of non-psychoactive substances, continuous

A pattern of continuous use of a non-psychoactive substance (daily or almost daily) that has caused damage to a person’s physical or mental health. The pattern of continuous use of the non-psychoactive substance is evident over a period of at least one month. Harm may be caused by the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

6C4H.1Z          Harmful pattern of use of non-psychoactive substances, unspecified
6C4H.Y            Other specified disorders due to use of non-psychoactive substances
6C4H.Z            Disorders due to use of non-psychoactive substances, unspecified
 6C4Y                   Other specified disorders due to substance use
  6C4Z                   Disorders due to substance use, unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


Thursday, 9 June 2022

ICD-11 Criteria for Generalised Anxiety Disorder (GAD)

ICD-11 Criteria for Generalised Anxiety Disorder (GAD)

Foundation URI:  http://id.who.int/icd/entity/1712535455

Description

Generalised anxiety disorder is characterised by marked symptoms of anxiety that persist for at least several months, for more days than not, manifested by either general apprehension (i.e. ‘free-floating anxiety’) or excessive worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The symptoms are not a manifestation of another health condition and are not due to the effects of a substance or medication on the central nervous system.

Diagnostic Requirements

Essential (Required) Features:

  • Marked symptoms of anxiety manifested by either:
    • General apprehensiveness that is not restricted to any particular environmental circumstance (i.e., ‘free-floating anxiety’); or
    • Excessive worry (apprehensive expectation) about negative events occurring in several different aspects of everyday life (e.g., work, finances, health, family).
  • Anxiety and general apprehensiveness or worry are accompanied by additional characteristic symptoms, such as:
    • Muscle tension or motor restlessness.
    • Sympathetic autonomic overactivity as evidenced by frequent gastrointestinal symptoms such as nausea and/or abdominal distress, heart palpitations, sweating, trembling, shaking, and/or dry mouth.
    • Subjective experience of nervousness, restlessness, or being ‘on edge’.
    • Difficulty concentrating.
    • Irritability.
    • Sleep disturbances (difficulty falling or staying asleep, or restless, unsatisfying sleep).
  • The symptoms are not transient and persist for at least several months, for more days than not.
  • The symptoms are not better accounted for by another mental disorder (e.g., a Depressive Disorder).
  • The symptoms are not a manifestation of another medical condition (e.g., hyperthyroidism) and are not due to the effects of a substance or medication on the central nervous system (e.g., caffeine, cocaine), including withdrawal effects (e.g., alcohol, benzodiazepines).
  • The symptoms result in significant distress about experiencing persistent anxiety symptoms or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Additional Clinical Features:

  • Some individuals with Generalized Anxiety Disorder may only report general apprehensiveness accompanied by chronic somatic symptoms without being able to articulate specific worry content.
  • Behavioural changes such as avoidance, frequent need for reassurance (especially in children), and procrastination may be seen. These behaviours typically represent an effort to reduce apprehension or prevent untoward events from occurring.

Boundary with Normality (Threshold):

  • Anxiety and worry are normal emotional/cognitive states that commonly occur when people are under stress. At optimal levels, anxiety and worry may help to direct problem-solving efforts, focus attention adaptively, and increase alertness. Normal anxiety and worry are usually sufficiently self-regulated that they do not interfere with functioning or cause marked distress. In Generalized Anxiety Disorder, the anxiety or worry is excessive, persistent, and intense, and may have a significant negative impact on functioning. Individuals under extremely stressful circumstances (e.g., living in a war zone) may experience intense and impairing anxiety and worry that is appropriate to their environmental circumstances. These experiences should not be regarded as symptomatic of Generalized Anxiety Disorder if they occur only under such circumstances.

Course Features:

  • Onset of Generalized Anxiety Disorder may occur at any age. However, the typical age of onset is during the early-to-mid 30s.
  • Earlier onset of symptoms is associated with greater impairment of functioning and presence of co-occurring mental disorders.
  • Severity of Generalized Anxiety Disorder symptoms often fluctuates between threshold and subthreshold forms of the disorder and full remission of symptoms is uncommon.
  • Although the clinical features of Generalized Anxiety Disorder generally remain consistent across the lifespan, the content of the individual’s worry may vary over time and there are differences in worry content among different age groups. Children and adolescents tend to worry about the quality of academic and sports-related performance, whereas adults tend to worry more about their own well-being or that of their loved ones.

Developmental Presentations:

  • Anxiety or Fear-Related Disorders are the most prevalent mental disorders of childhood and adolescence. Among these disorders, Generalized Anxiety Disorder is one of the most common in late childhood and adolescence.
  • Occurrence of Generalized Anxiety Disorder increases across late childhood and adolescence with development of cognitive abilities that support the capacity for worry, which is a core feature of the disorder. As a result of their less developed cognitive abilities, Generalized Anxiety Disorder is uncommon in children younger than 5. Girls tend to have an earlier symptom onset than their same age male peers.
  • While the essential features of Generalized Anxiety Disorder still apply to children and adolescents, specific manifestations of worry in children may include being overly concerned and compliant with rules as well as a strong desire to please others. Affected children may become upset when they perceive peers as acting out or being disobedient. Consequently, children and adolescents with Generalized Anxiety Disorder may be more likely to report excessively on their peers’ misbehaviour or to act as an authority figure around peers, condemning misbehaviour. This may have a negative effect on affected individuals’ interpersonal relationships.
  • Children and adolescents with Generalized Anxiety Disorder may engage in excessive reassurance seeking from others, repeatedly asking questions, and may exhibit distress when faced with uncertainty. They may be overly perfectionistic, taking additional time to complete tasks, such as homework or classwork. Sensitivity to perceived criticism is common.
  • When Generalized Anxiety Disorder does occur in children, somatic symptoms, particularly those related to sympathetic autonomic overactivity, may be prominent aspects of the clinical presentation. Common somatic symptoms in children with Generalized Anxiety Disorder include frequent headaches, abdominal pain, and gastrointestinal distress. Similar to adults, children and adolescents also experience sleep disturbances, including delayed sleep onset and night-time wakefulness.
  • The number and content of worries typically manifests differently across childhood and adolescence. Younger children may endorse more concerns about their safety or their health or the health of others. Adolescents typically report a greater number of worries with content shifting to performance, perfectionism, and whether they will be able to meet the expectations of others.
  • Adolescents with Generalized Anxiety Disorder may demonstrate excessive irritability and have an increased risk of co-occurring depressive symptoms.

Culture-Related Features:

  • For many cultural groups, somatic complaints rather than excessive worry may predominate in the clinical presentation. These symptoms may involve a range of physical complaints not typically associated with Generalized Anxiety Disorder such as dizziness and heat in the head.
  • Realistic worries may be misjudged as excessive without appropriate contextual information. For example, migrant workers may worry greatly about being deported, but this may be related to actual deportation threats by their employer. On the other hand, evidence of worries across several different aspects of everyday life may be difficult to establish when an individual places emphasis on a single overwhelming source of worry (e.g., financial concerns).
  • Worry content may vary by cultural group, related to topics that are salient in the milieu. For example, in societies where relationships with deceased relatives are important, worry may focus on their spiritual status in the afterlife. Worry in more individualistic cultures may emphasize personal achievement, fulfilment of expectations, or self-confidence.

Sex- and/or Gender-Related Features:

  • Lifetime prevalence of Generalized Anxiety Disorder is approximately twice as high among women.
  • Although symptom presentation does not vary by gender including the common co-occurrence of Generalized Anxiety Disorder and Depressive Disorders, men are more likely to experience co-occurring Disorders due to Substance Use.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

  • Boundary with Panic Disorder: Panic Disorder is characterized by recurrent, unexpected, self-limited episodes of intense fear or anxiety. Generalized Anxiety Disorder is differentiated by a more persistent and less circumscribed chronic feeling of apprehensiveness usually associated with worry about a variety of different everyday life events. Individuals with Generalized Anxiety Disorder may experience panic attacks that are triggered by specific worries. If an individual with Generalized Anxiety Disorder experiences panic attacks exclusively in the context of the worry about a variety of everyday life events or general apprehensiveness without the presence of unexpected panic attacks, an additional diagnosis of Panic Disorder is not warranted and the presence of panic attacks may be indicated using the ‘with panic attacks’ specifier. However, if unexpected panic attacks also occur, an additional diagnosis of Panic Disorder may be assigned.
  • Boundary with Social Anxiety Disorder: In Social Anxiety Disorder, symptoms occur in response to feared social situations (e.g., speaking in public, initiating a conversation) and the primary focus of apprehension is being negatively evaluated by others. Individuals with Generalized Anxiety Disorder may worry about the implications of performing poorly or failing an examination but are not exclusively concerned about being negatively evaluated by others.
  • Boundary with Separation Anxiety Disorder: Individuals with Generalized Anxiety Disorder may worry about the health and safety of attachment figures, as in Separation Anxiety Disorder, but their worry also extends to other aspects of everyday life.
  • Boundary with Depressive Disorders: Generalized Anxiety Disorder and Depressive Disorders can share several features such as somatic symptoms of anxiety, difficulty with concentration, sleep disruption, and feelings of dread associated with pessimistic thoughts. Depressive Disorders are differentiated by the presence of low mood or loss of pleasure in previously enjoyable activities and other characteristic symptoms of Depressive Disorders (e.g., appetite changes, feelings of worthlessness, suicidal ideation). Generalized Anxiety Disorder may co-occur with Depressive Disorders, but should only be diagnosed if the diagnostic requirements for Generalized Anxiety Disorder were met prior to the onset of or following complete remission of a Depressive Episode.
  • Boundary with Adjustment Disorder: Adjustment Disorder involves maladaptive reactions to an identifiable psychosocial stressor or multiple stressors characterized by preoccupation with the stressor or its consequences. Reactions may include excessive worry, recurrent and distressing thoughts about the stressor, or constant rumination about its implications. Adjustment Disorder centres on the identifiable stressor or its consequences, whereas in Generalized Anxiety Disorder, worry typically encompasses multiple areas of daily life and may include hypothetical concerns (e.g., that a negative life event may occur). Unlike individuals with Generalized Anxiety Disorder, those with Adjustment Disorder typically have normal functioning prior to the onset of the stressor(s). Symptoms of Adjustment Disorder generally resolve within 6 months.
  • Boundary with Obsessive-Compulsive Disorder: In Obsessive-Compulsive Disorder, the focus of apprehension is on intrusive and unwanted thoughts, urges, or images (obsessions), whereas in Generalized Anxiety Disorder the focus is on everyday life events. In contrast to obsessions in Obsessive-Compulsive Disorder, which are usually experienced as unwanted and intrusive, individuals with Generalized Anxiety Disorder may experience their worry as a helpful strategy in averting negative outcomes.
  • Boundary with Hypochondriasis (Health Anxiety Disorder) and Bodily Distress Disorder: In Hypochondriasis and Bodily Distress Disorder, individuals worry about real or perceived physical symptoms and their potential significance to their health status. Individuals with Generalized Anxiety Disorder experience somatic symptoms associated with anxiety and may worry about their health but their worry extends to other aspects of everyday life.
  • Boundary with Post-Traumatic Stress Disorder: Individuals with Post-Traumatic Stress Disorder develop hypervigilance as a consequence of exposure to the traumatic stressor and may become apprehensive that they or others close to them may be under immediate threat either in specific situations or more generally. Individuals with Post-Traumatic Stress Disorder may also experience anxiety triggered by reminders of the traumatic event (e.g., fear and avoidance of a place where an individual was assaulted). In contrast, the anxiety and worry in individuals with Generalized Anxiety Disorder is directed toward the possibility of untoward events in a variety of life domains (e.g., health, finances, work).

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


Saturday, 28 May 2022

ICD-11 Criteria for Secondary Impulse Control Syndrome (6E66)

ICD-11 Criteria for Secondary Impulse Control Syndrome (6E66)

A syndrome characterised by the presence of prominent symptoms that are characteristic of Impulse Control Disorders or Disorders Due to Addictive Behaviours (e.g., stealing, fire-setting, aggressive outbursts, compulsive sexual behaviour, excessive gambling) that are judged to be a direct pathophysiological consequence of a health condition not classified under mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., as part of an adjustment disorder in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the impulse control symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code aslo the causing condition

Exclusions:  

  • Delirium (6D70)


REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


ICD-11 Criteria for Secondary Neurocognitive Syndrome (6E67)

ICD-11 Criteria for Secondary Neurocognitive Syndrome (6E67)

A syndrome that involves significant cognitive features that do not fulfill the diagnostic requirements of any of the specific neurocognitive disorders and are judged to be a direct pathophysiological consequence of a health condition or injury not classified under mental and behavioural disorders (e.g., cognitive changes due to a brain tumour), based on evidence from the history, physical examination, or laboratory findings. This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the cognitive symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code also the causing condition

Exclusions:

  • Disorders with neurocognitive impairment as a major feature (BlockL1‑8A2)

Coded Elsewhere:  

  • Delirium (6D70)


REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


ICD-11 Criteria for Secondary Dissociative Syndrome

ICD-11 Criteria for Secondary Dissociative Syndrome

Description

A syndrome characterised by the presence of prominent dissociative symptoms (e.g., depersonalization, derealization) that is judged to be the direct pathophysiological consequence of a health condition not classified under mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., as part of an acute stress reaction in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the dissociative symptoms are sufficiently severe to warrant specific clinical attention.

Exclusions

  • Delirium (6D70)
  • Acute stress reaction (QE84)

Diagnostic Requirements

Essential (Required) Features:

  • The presence of prominent dissociative symptoms (e.g., depersonalization, derealization, dissociative amnesia, a marked alteration in the individual’s normal sense of personal identity).
  • The symptoms are judged to be the direct pathophysiological consequence of a medical condition, based on evidence from the history, physical examination, or laboratory findings. This judgment depends on establishing that:
    • The medical condition is known to be capable of producing the observed symptoms;
    • The course of dissociative symptoms (e.g., onset, remission, response of the dissociative symptoms to treatment of the etiological medical condition) is consistent with causation by the medical condition; and
    • The symptoms are not better accounted for by Delirium, Dementia, another mental disorder (e.g., Dissociative Disorders, Disorders Specifically Associated with Stress, Schizophrenia or Other Primary Psychotic Disorders) or the effects of a medication or substance, including withdrawal effects.
  • The symptoms are sufficiently severe to be a specific focus of clinical attention.

Boundary with other disorders and normality:

Boundary with Dissociative Disorders: 

Determining whether dissociative symptoms are due to a medical condition as opposed to manifestations of a primary mental disorder is often difficult because the clinical presentations may be similar. Establishing the presence of a potentially explanatory medical condition that can cause dissociative symptoms and the temporal relationship between the medical condition and the dissociative symptoms is critical in diagnosing Secondary Dissociative Syndrome.

Boundary with dissociative symptoms caused by substances or medications, including withdrawal effects: 

When establishing a diagnosis of Secondary Dissociative Syndrome, it is important to rule out the possibility that a medication or substance is causing the dissociative symptoms. This involves first considering whether any of the medications being used to treat the medical condition are known to cause dissociative symptoms at the dose and duration at which it has been administered. Second, a temporal relationship between the medication use and the onset of the dissociative symptoms should be established (i.e., the dissociative symptoms began after administration of the medication and/or remitted once the medication was discontinued). The same reasoning applies to individuals with a medical condition and dissociative symptoms who are also using a psychoactive substance known to cause dissociative symptoms, either in the context of intoxication or withdrawal (e.g., amnesia due to ketamine or phencyclidine intoxication, depersonalization due to dextromethorphan intoxication).

Boundary with dissociative symptoms that are precipitated by the stress of being diagnosed with a medical condition: 

The stress of a medical diagnosis can precipitate dissociative symptoms (e.g., depersonalization, derealization). Depending on the nature of the medical condition (e.g., a life-threatening type of cancer, a potentially fatal infection) or its onset (e.g., a heart attack, a stroke, a severe injury), being diagnosed and/or having to cope with a severe medical condition can be experienced as a traumatic event, which may trigger dissociative symptoms. In the absence of evidence of a physiological link between the medical condition and the dissociative symptoms, a diagnosis of Secondary Dissociative Syndrome is not warranted. Instead, the appropriate mental disorder can be diagnosed (e.g., Adjustment Disorder, Depersonalization-Derealization Disorder).

Potentially Explanatory Medical Conditions (examples):

Brain disorders and general medical conditions that have been shown to be capable of producing dissociative syndromes include:

  • Diseases of the Nervous System (e.g., encephalitis, migraine, seizures, stroke)
  • Endocrine, Nutritional or Metabolic Diseases (e.g., hyperglycaemia)
  • Injury, Poisoning or Certain Other Consequences of External Causes (e.g., intracranial injury)
  • Neoplasms (e.g., neoplasms of brain)


REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/



ICD-11 Criteria for Secondary Personality Change (6E68)

ICD-11 Criteria for Secondary Personality Change (6E68)

A syndrome characterised by a persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern that is judged to be a direct pathophysiological consequence of a health condition not classified under Mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., social withdrawal, avoidance, or dependence in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the personality symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code aslo the causing condition

Exclusions: 

  • Personality difficulty (QE50.7)
  • Personality disorder (6D10)
  • Delirium (6D70)


REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


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