The history of forensic neuropsychiatry.

Significant advances in various disciplines of neurosciences, such as neurology, neuropsychiatry, neuroimaging, and neurogenetics, have caused an exciting field to emerge in the field of forensic neuropsychiatry called neurolaw. The resurgence of interest in this field has paralleled the renaissance of neuropsychiatry in the last few decades. This historical review of the practice of forensic neuropsychiatry provides an insight into the past with the hope that it will guide the future development of this field.

Forensic neuropsychiatric aspects of epilepsy.

Epilepsy may be associated with automatisms that are classed as 'insane 'as they are deemed to have originated within the mind. 'Sane automatism' is said to occur from external factors, such as physical trauma, while 'insane automatism' is said to be innate to the individual experiencing them. To claim automatism within the context of a criminal matter requires a detailed evaluation of the behavior demonstrated and a questioning of the volitional and purposeful nature of this behavior. It is insufficient to rely upon past behavior in association with these seizures to justify the defense of automatism within a specific event. Epilepsy is often considered to be associated with an increase in violence. Proper epidemiological research, both in long-term, large population control studies and hospital-based studies, has suggested that epilepsy, per se, is not associated with an increase in violence when compared to the population at large and controlled for other familial and environmental factors.

Late-Onset Sex Offending and the Assessment of Behavioral Variant Frontotemporal Dementia (bvFTD).

Behavioral variant frontotemporal dementia (bvFTD) is a common neuropsychiatric disorder, which is often missed or misdiagnosed by both neurologists and psychiatrists as a cause of emotional and behavioral problems. Inappropriate emotional responses and maladaptive behavior, including criminal behaviors, may be the first obvious expression of bvFTD caused by altered moral feelings, loss of empathy, disinhibition, and compulsive behavior. New onset sex offenses, including indecent exposure, sexually inappropriate comments, and unwanted sexual advances have been documented in early bvFTD. These behaviors may escalate with progressive disease and lead to harsh penalties. The presence of inappropriate sexual behaviors in older individuals with no prior history should raise concern about the presence of bvFTD in forensic examinations. In addition to the forensic examination, diagnostic evaluation requires psychological testing (including tests of social and affective cognition) and imaging studies. In sex offenders, a diagnosis of bvFTD has significant implications for risk assessments, requirements regarding supervision and management, and as evidence for mitigation. In this article, we review the neuropsychiatry of bvFTD, how the pathophysiology may contribute to sex offenses, and important psycholegal considerations for the forensic psychiatrist when evaluating bvFTD.