An organic mental disorder and comorbid affective spectrum disturbances: a forensic-psychiatric assessment

Abstract

To identify the influence of combined pathology, an organic personality disorder and affective disturbances, on the regulation of subjects' legally significant behavior in forensic-psychiatric examination in criminal and civil proceedings. Two groups of patients with the diagnosis of organic personality disorder (ICD-10 F07) established in the course of forensic-psychiatric examination were studied. The first group included 82 criminally prosecuted men (mean age 40.7±15.8); the second group comprised 50 women (mean age 65.1±15.4) and 28 men (mean age 60.2±14.4), who underwent forensic-psychiatric examination in civil litigation over declaring their contracts null and void. All patients had affective disorders. Standard expertise procedure and data analysis were used. The modifying influence of a set of psychogenic factors is of great significance in the course of forensic-psychiatric examination of individuals diagnosed with organic personality disorder: in criminal proceedings these are determined by the fact of being prosecuted, and in civil proceedings by the problems of adaptation, deterioration of one's social status, and the somatic ill-being. The unfavorable dynamics of organic mental disorder in these cases manifested itself in decompensation of personality, cognitive disturbances or addition of comorbid depressive disorders (68.3 and 31.7%, respectively). In 48.7% of patients, the addition of affective pathology to organic disorders significantly increased the extent of disturbance of cognitive functions, insight and prognostic capacity, volitional control of activity, which determined the incapacity of patients to understand the significance of their own actions and control them at the time of entering into contract.