Parasomnias: Sleepwalking and the law

ArticleinSleep Medicine Reviews 4(4):321-339 · September 2000with20 Reads
DOI: 10.1053/smrv.1999.0078 · Source: PubMed
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.
    • "A similar EEG/brain activity dissociation supports confusional arousals both in children and, more rarely, in adults in the form of sleep inertia or sleep drunkenness [30]. Basic drives may complicate these episodes with the occurrence of sleep-related eating disorder (SRED) or complex auto or hetero sex behaviors (sexsomnia) [31], which are performed by the subject while still partially asleep and in an altered state of consciousness, which is not morally and legally prosecutable [32]. During night terrors there is, instead, an intense autonomic activation including mydriasis, diaphoresis, tachycardia and tachypnea. "
    [Show abstract] [Hide abstract] ABSTRACT: The last few years have been characterized by a growing interest of the medical and scientific world for the field of consciousness and its related disorders. Medically speaking, consciousness can be defined as the state of awareness of self and environment and the alertness to external stimulation, besides responsiveness to inner need.Transient loss of consciousness can be due to alterations in cerebral blood flow leading to fainting or syncope, migraine, metabolic dysfunctions, unexpected intracranial pressure increases, epileptic seizures, and sleep disorders. Chronic disorders of consciousness are a tragic success of high-technology treatment, in an attempt to maintain or reestablish brain function, which is to be considered as the main goal of therapeutics. Management of vegetative or a minimally conscious state individuals involves charily getting the right diagnosis with an evidence-based prognosis, also taking into account the medical, ethical, and legal key factors of the ideal treatment. This paper is aimed at exploring the wide spectrum of consciousness disorders and their clinical differential diagnosis, with particular regards to those with a negative impact on patient and their caregiver quality of life, including epilepsy, sleep disorders, and vegetative/minimally conscious state.
    Full-text · Article · Jan 2016
    • "rında olduğu bildiril- miștir.[3] Uyanma bozuklukları, REM uykusu davranıș bozukluğu, noktürnal nöbetler, psikojenik dissosiyatif bozukluklar, temaruz ve bakım verenin yapay bozukluğu bu davranıșların eșlik ettiği hastalıklardandır. Bu davranıșlar ve nadir olarak uykuda ortaya çıkan cinsel davranıșlar, ciddi yasal sorunlara neden olabilmektedir.[3,4] Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı- Yeniden Gözden Geçirilmiș Dördüncü Baskısı (The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-DSM-IV-TR) [5] parasomnileri dört ayrı grupta incelerken, Uluslararası Uyku Bozuklukları Sınıflaması (The International Classification of Sleep Disorders:"
    [Show abstract] [Hide abstract] ABSTRACT: Parasomnias, as described in the recent second edition of the International Classification of Sleep Disorders, are “undesirable physical events or experiences” occurring during sleep transition, during arousal from sleep, or within the sleep period. These events encompass abnormal sleep related movements, behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. Parasomnias are classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM (rapid eye movement) sleep; and 3) other parasomnias. This sleep disorders in childhood are common, and often more frequent than in adults. Clinicians should be aware that many pediatric parasomnias have benign and self-limited nature. Most of the parasomnias may not persist into late childhood or adolescence. Parasomnias in adults often differ in type from childhood parasomnias and may portend significant psychiatric disturbances or neurodegenerative disorders. A reliable diagnosis can often be made from a detailed history from the patient and, if possible, the parents or bed partner. Detailed overnight investigations of parasomnias are usually not required. The non-REM parasomnias are more common in community although REM parasomnias are more likely to be seen in general neurological practice. Sleep related eating disorder, sleep related dissociative disorders and sleep related sexual behavior and sleep related violence are novel and rarely reported sleep disorders. REM sleep behavior disorder is common and should be sought in all neurodegenerative diseases. They are included among clinical disorders due to the resulting injuries, and adverse health and psychosocial effects, which may affect the bed partner as well as the patient. Finally, parasomnias are common disturbances of sleep that may significantly affect the patient’s quality of life and that of the bed partner. Therefore, appropriate diagnostic and therapeutic strategies are warranted.
    Full-text · Article · Oct 2009
    • "This need for accurate and reliable answers is all the more important if, as is often the case, the defendant does not fulfil all the generally accepted criteria for the medical diagnosis of somnambulism, confusional arousal, or other parasomnia or where other factors, such as alcohol, complicate the clinical and diagnostic findings. Advances in diagnostic techniques, coupled with a greater debate and discussion amongst sleep medicine specialists, are providing an impetus toward a more reliable set of scientific criteria for the diagnosis of these disorders (Broughton et al., 1994; Cartwright, 2004; Guilleminault et al., 1995; Moldofsky et al., 1995; Ohayon et al., 1997, Mahowald and Schenck, 2000; Pressman, 2007; Ebrahim and Fenwick, 2007; Cartwright, 2007). In this article, we provide an overview of the classification, physiology and diagnosis of the most common of the sleep disorders that may be implicated in sleep-related automatism – the disorders of arousal (DOA). "
    [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.
    Full-text · Article · May 2008
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