Criteria for fitness to stand criminal trial.

OBJECTIVE: To identify criteria whereby triability can be determined. DESIGN: Questionnaire survey. The final rating was decided on the basis of a structured psychiatric interview. SETTING: Oranje Hospital, Bloemfonteln. PARTICIPANTS: A total of 736 questionnaires was sent to 176 judges of the Supreme Court, 480 magistrates and 32 attorneys-general and state advocates in South Africa and Namibia, and 33 psychiatrists and 15 clinical psychologists working in forensic psychiatric units in South Africa. With the information from the completed questionnaires, rating criteria were compiled. The rating criteria were applied by means of a structured interview to 100 persons referred in terms of section 77(1) of the Criminal Procedure Act 51 of 1977. A multiprofessional psychiatric team was requested to evaluate the same 100 observandi independently. RESULTS: A total of 298 (40.5%) of the questionnaires were returned. From the data of the completed questionnaires, 19 legal items, 17 psychiatric items, 2 special laboratory tests and 2 psychosocial items were identified as the most important and clear diagnostic indications for the evaluation of triability. The similarity between the findings of the researchers and those of the multiprofessional psychiatric team was meaningful to 1% of significance. For the proper application of the criteria a cut-off point of 31 was determined. A score of 31 or higher therefore indicates that a patient is unfit to stand trial, while a score of less than 31 indicates triability. CONCLUSIONS: The application of the proposed final rating criteria as a single method of rating is at the very least just as reliable as the multiprofessional team in evaluating fitness to stand trial. The proposed criteria, used as a single rating instrument, are cost-effective in terms of time and staff, avoid unnecessary hospitalisation and ensure that mentally ill accused will have a fair trial.

Identification of depression in a rural general practice.

Major depression is underdiagnosed by general practitioners, but the reasons for this are not clear. This study aimed to establish the prevalence of major depression and coexisting generalised anxiety disorder in a rural general practice in the Orange Free State. It also assessed the predictive value of a screening questionnaire for use by general practitioners. The two practitioners evaluated 858 patients over a 4-week period. Those who met the screening criteria, together with a random sample of 60 patients who did not, were re-evaluated by a registrar in psychiatry who was unaware of the findings of his colleagues. Of the patients studied, 134 (15.6%) had major depression; 59 of these (44.0%) also had coexisting generalised anxiety disorder. The general practitioners had correctly diagnosed major depression in 32 patients (3.7%) before the study started. The screening questionnaire had a 42% chance of correctly identifying a patient with depression and a 97% chance of correctly identifying a patient who did not have major depression. Both practitioners were equally capable at identifying major depression. The study confirmed both the high prevalence of depression in a rural general practice and its low identification rate. It also showed the advantage of using a screening questionnaire to alert practitioners to the possibility of depression in their patients.

Possible reasons why certain epileptics commit unlawful acts during or directly after seizures.

Courts have accepted that epileptics sometimes commit unlawful acts as a result of an epileptic seizure. Reasons for this unlawful behaviour may be found in the interictal, ictal and post-ictal phases of the seizure. Interictal aspects which are relevant to the form of epileptic automatism may be the person's natural tendencies, the same psychodynamic factors which determine the contents of dreams, the person's social background of violence and the contents of a person's thoughts immediately before a seizure. Ictal aspects include the specific part of the brain from which the seizure originates, the loss of integration of incoming sensorial stimuli with motor-emotional output, the loss of higher control associated with a reversion to primitive automatic behaviour and the emergence of repressed feelings and aggressive instincts. Post-ictal violent behaviour may stem from the epileptic's misinterpretation of well-meant attempts by bystanders to protect him or her against the consequences of his or her confused conduct--and is usually characterized by a clouded consciousness, paranoid ideas and hallucinations.