Forensic psychiatric statement — Anders Behring Breivik

[Psykopatologia]

Forensic psychiatric statement — Anders Behring Breivik (I - X)

CHRISTIAN SKAUG http://www.document.no/2012/03/forensic ... breivik-x/
Englanninkielinen käännös norjasta valmis!

VG (originaali faksimile) Rettspsykiatrisk erklæring http://www.vg.no/nyheter/innenriks/oslo ... vurdering/ (originaali faksimile) (norjaksi)

Norjan TV2 Sammendrag ym. (7, 8) http://pub.tv2.no/multimedia/TV2/archiv ... 27719a.pdf (norjaksi)

[Psykopatologia]

The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic criteria for research (DCR-10).
Geneva: World Health Organization (WHO), 1993. http://www.who.int/classifications/icd/en/GRNBOOK.pdf

pp. 64 - 66

F20 - 29 SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS

F20 SCHIZOPHRENIA

This overall category includes the common varieties of schizophrenia, together with some less common varieties and closely related disorders.

F20.0 - F20.3 General criteria for paranoid, hebephrenic, catatonic, and undifferentiated type of schizophrenia:

G1. Either at least one of the syndromes, symptoms and signs listed below under (1), or at least two of the
symptoms and signs listed under (2), should be present for most of the time during an episode of psychotic
illness lasting for at least one month (or at some time during most of the days).

(1) At least one of the following:

a) Thought echo, thought insertion or withdrawal, or thought broadcasting.

b) Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception.

c) Hallucinatory voices giving a running commentary on the patient's behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.

d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with aliens from another world).

(2) Or at least two of the following:

e) Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent over-valued ideas.

f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.

g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.

h) "Negative" symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).

G2. Most commonly used exclusion clauses

(1) If the patient also meets criteria for manic episode (F30) or depressive episode (F32), the criteria listed under G1.1 and G1.2 above must have been met before the disturbance of mood developed.

(2) The disorder is not attributable to organic brain disease (in the sense of F00 - F09), or to alcohol- or drug-related intoxication (F1x.0), dependence (F1x.2), or withdrawal (F1x.3 and F1x.4).

Comments

In evaluating the presence of the these abnormal subjective experiences and behaviour, special care should be taken to avoid false-positive assessments, especially where culturally or sub-culturally influenced modes of expression and behaviour, or a subnormal level of intelligence, are involved.

In view of the considerable variation of the course of schizophrenic disorders it may be desirable (especially for research) to specify the pattern of course by using a fifth character. Course should not usually be coded unless there has been a period of observation of at least one year (For remission, see note 5 on Notes for users).

Pattern of course

F20.x0 Continuous. No remission of psychotic symptoms throughout the period of observation.

F20.x1 Episodic with progressive deficit. Progressive development of "negative" symptoms in the intervals between psychotic episodes.

F20.x2 Episodic with stable deficit. Persistent but non-progressive "negative" symptoms in the intervals between psychotic episodes.

F20.x3 Episodic remittent. Complete or virtually complete remissions between psychotic episodes.

F20.x4 Incomplete remission.

F20.x5 Complete (or virtually complete) remission.

F20.x8 Other (pattern of course).

F20.x9 Course uncertain, period of observation too short.


F20.0 Paranoid schizophrenia

A. The general criteria for Schizophrenia (F20.0 - F20.3 above) must be met.

B. Delusions or hallucinations must be prominent (such as delusions of persecution, reference, exalted birth, special mission, bodily change or jealousy; threatening or commanding voices, hallucinations of smell or taste, sexual or other bodily sensations).

C. Flattening or incongruity of affect, catatonic symptoms, or incoherent speech must not dominate the clinical picture, although they may be present to a mild degree.

[Psykopatologia]

Husby & Sørheim evaluete in Breivik's case:

(1) At least one of the following (2/2):

Hold:
b) Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception. -
d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with aliens from another world). -

Don't hold:
a) Thought echo, thought insertion or withdrawal, or thought broadcasting. -
c) Hallucinatory voices giving a running commentary on the patient's behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.

(2) Or at least two of the following (2/2):

Hold:
f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech. -
h) "Negative" symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication). -

Don't hold:
e) Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent over-valued ideas. -
g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor. -

[Psykopatologia]

Randi Rosenqvist's statements
VG http://www.vg.no/nyheter/innenriks/oslo ... vurdering/ (13.1.2012)

Notat 18.10.2011 (3 s.)
Notat 01.11.2011 (4 s.)
Notat 20.12.2011 (3 s.)

In English by google ("Panu", 14.1.2012 5:21 pm).
http://murha.info/phpbb2/viewtopic.php? ... start=1305

Svenn Torgensen http://www.aftenposten.no/nyheter/Dette ... akkyndig... jo (5.12.2011)

Torgensen katsoo, että kyseessä voi olla paranoidinen skitsofrenia tai kernaammin paranoidinen psykoosi mutta että mielentilatutkimusraportissa esitetyt perustelut eivät kaikin osin tue skitsofrenian diagnostisia kriteereitä; ts. että Breivikin löydöksiä on tulkittu psykopatologian suuntaan.

An alternative could be F22.0 Delusional [paranoid] disorder, grandiose (or megalomanic] type.

[Psykopatologia]

Randi Rosenqvist's statements
VG http://www.vg.no/nyheter/innenriks/oslo ... vurdering/ (13.1.2012)

Notat 18.10.2011 (3 s.)
Notat 01.11.2011 (4 s.)
Notat 20.12.2011 (3 s.)

In English by google ("Panu", 14.1.2012 5:21 pm).
http://murha.info/phpbb2/viewtopic.php? ... start=1305

Svenn Torgensen http://www.aftenposten.no/nyheter/Dette ... akkyndig... jo (5.12.2011)

Torgensen katsoo, että kyseessä voi olla paranoidinen skitsofrenia tai kernaammin paranoidinen psykoosi mutta että mielentilatutkimusraportissa esitetyt perustelut eivät kaikin osin tue skitsofrenian diagnostisia kriteereitä; ts. että Breivikin löydöksiä on tulkittu psykopatologian suuntaan.

Questions about the true validity of the results and criticism has been raised, e.g. Svenn Torgensen (5.12.2011, Aftenposten), and Randi Rosenqvist (18.10.- 20.12. 2011 http://www.vg.no/nyheter/innenriks/oslo ... vurdering/) found no psychotic. The is no direct evidence about hallucinations (c, e). Are delusions really bizarre (d)? Are those "neologisms" real neologisms (f)? Evidence of negative symptoms (h) are partly contradictory, e.g. the rather good planning vs. an emotional flattering.

- An alternative could be F22.0 Delusional [paranoid] disorder, grandiose [or megalomanic] type.

- It must, however, be remembered, that the criteria of ICD-10 or DSM-IV-TR cannot be the ultimate criteria of a disorder in the individual case (they are criteria for research). The ultimate criteria are the resuts of individual clinical investigations.

The serious limitation in investigations has been the lack of a clinical psychologist with projective technics (Rorschach etc.).