A recent, well-publicized case in which murder during sleepwalking was offered as a defense, underscores the fact that sleep medicine specialists are asked to render opinions or judgements regarding culpability in legal cases regarding violence claimed to have arisen from sleepwalking episodes. This review addresses this difficult issue from scientific, clinical and legal aspects, with emphasis upon the need for further research, calling for close collaboration between the legal and medical (both clinical and basic science) professions.
[Show abstract][Hide abstract] ABSTRACT: Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors. Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences--not guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.
Medicine, science, and the law 05/2008; 48(2):124-36. DOI:10.1258/rsmmsl.48.2.124 · 0.53 Impact Factor
"Recent studies have indicated that bizarre behavioral syndromes can, and do, occur as a result of the incomplete declaration or rapid oscillation of these states (Mahowald et al., 1990; Mahowald and Schenck, 1992). Sleep inertia may also play a role in state admixture-related complex behaviors (Mahowald and Schenck, 2000; Wertz et al., 2006). Although the automatic behaviors of some " mixed states " are relatively benign (e.g., shoplifting in narcolepsy ) (Zorick et al., 1979), others may be associated with very violent or injurious behaviors. "
"Fortunately, polysomnography (PSG) is able to distinguish RBD from nocturnal seizures. There is not, however, a specific PSG pattern for any of the disorders of arousal at present (Mahowald & Schenck, 2000). Although each of these parasomnias begins in a state of sleep and several are associated with dream imagery and violence, none of them address the close relationship we have observed among psychosis, dream imagery, and violence in select patients, a phenomenon we call ''psychotic dream-related aggression.'' "
[Show abstract][Hide abstract] ABSTRACT: The relationship among parasomnias, sleep-related violence (SRV), and psychosis has neither been reported nor studied. The authors introduce the phenomenon of psychotic dream-related aggression (PDRA) and, through a review of the research on manifest dreams, the continuity of thinking across the sleep–wake cycle, and SRV, argue for its inclusion alongside the parasomnias of DSM-IV. Five cases are presented that illustrate this phenomenon, usually a male diagnosed with paranoid schizophrenia whose violent act toward another was closely associated with the manifest content of his nocturnal dreams and his inability to test reality. Differential diagnostic criteria are proposed to separate PDRA from other parasomnias that may be related to violence. Treatment and forensic implications are discussed.
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