Questions and lessons can't be printed or saved as a PDF.
What caused the defendant's state of mind at the time of the act, so which defence applies?
More, if you want it
How was the patient's mind affected during the act?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: an act without awareness caused by something outside the body.
You can: Tell sane automatism from insane automatism by a cause from outside the body.
Definition: an act without awareness caused by something inside the body.
You can: Tell insane automatism from sane automatism by a cause from inside the body, such as epilepsy.
Definition: a mother's killing of her baby under 12 months while her mind is disturbed by childbirth.
You can: Tell infanticide from diminished responsibility by a child under 12 months and a mind disturbed by childbirth.
Definition: a partial defence to murder that reduces the conviction to manslaughter.
You can: Tell diminished responsibility from insane automatism by a murder charge in a person with mental illness.
Definition: sudden extreme violence after a small drink, with steady movement and later amnesia.
You can: Tell pathological intoxication from ordinary drunkenness by a small drink, steady movement and later amnesia.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
Automatism is an involuntary act done without conscious control or awareness.
Automatism is an involuntary act done without conscious control or awareness. A crime committed while unconscious is a matter for the automatism defence. Sane automatism, also called non-insane automatism, has an external factor, such as concussion, insulin or a spiked drink. Insane automatism has an internal factor such as epilepsy or a brain tumour. Both pleas are rare.
Automatism argues that the defendant lacked intention altogether. The guilty mind, called mens rea, is then absent. Acts committed while sleepwalking are the standard example. A sleepwalker gets up and moves about without fully waking. A sleepwalker can carry out complex behaviours while unconscious. Automatism is hard to establish after the event. The defence is now rarely used, though automatism shaped nineteenth-century psychiatry.
Daniel takes insulin for diabetes and arrives in the emergency department with a very low blood sugar. Daniel hits a nurse and later says, "I don't remember hitting anyone."
Insane automatism looks like sane automatism at first, because the patient has no awareness in both. Daniel's low sugar came from insulin, an outside cause. An outside cause makes the automatism sane, and an inside cause makes the automatism insane.
Automatisms occur during complex partial and absence seizures. Amnesia for the episode is usual. Absence attacks bring simple automatisms such as eyelid fluttering. Complex partial seizures last longer, with more complex automatisms and slower recovery. Sleepwalking is the paradigm example of an act with no intention.
Mnemonic
Outside burglar: sane. Inside fire: insane. Cue: without conscious control or awareness
Picture the brain as a house. A burglar breaking in from outside is concussion, insulin or a spiked drink, which gives sane automatism. A fire starting inside the house is epilepsy or a brain tumour, which gives insane automatism.
Analogy
The cause of the state of mind is the address on a parcel. The court is the sorting office. An outside address goes into the sane automatism box. An inside address goes into the insane automatism box.
Where the analogy breaks: a parcel carries one fixed address, while a court weighs evidence to decide the cause.
5 more sections on Automatism, diminished responsibility, infanticide and pathological intoxication
Log in free to read the rest: the full mental model, exam recognition, and the look-alikes that trip people up. Your daily session is free, always.
mrcpsych.co.uk · An independent study tool · not affiliated with the Royal College of Psychiatrists