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Lecture notes, cheat sheets
Forensic medicine and psychiatry. Cheat sheet: briefly, the most important
Directory / Lecture notes, cheat sheets Table of contents
1. THE CONCEPT OF FORENSIC MEDICINE Forensic medicine is a medical science that studies and resolves issues of medicine, biology and natural science that arise in forensic and investigative practice. Forensic medical practice consists in the study of objects of forensic medical examination, which are: living persons, corpses, physical evidence of biological origin, materials of criminal and civil cases. Sections of forensic medicine: 1) Introduction to forensic medicine. 2) Health disorders and death from the action of mechanical factors. 3) Health disorders and death from acute oxygen starvation. 4) Health disorders and death from the action of chemicals. 5) Health disorders and death from the action of physical factors. 6) Forensic medical examination of living persons. 7) Forensic medical examination of corpses. 8) Forensic medical examination of physical evidence of biological origin. 9) Forensic medical examination based on materials of criminal and civil cases. Research methods in forensic medicine. In forensic medicine, general research methods are widely used, which are also used in other branches of medicine. So, in the examination of living persons, a survey, examination, laboratory and instrumental methods of research, which are widespread in various clinical specialties, are widely used. In addition, special research methods are being developed in forensic medicine. So, for example, methods have been developed for determining the species, group, gender and regional origin of blood, as well as examining objects in ultraviolet rays to detect traces of sperm, microscopic examination of various morphological features of hair, cytological studies of isolated cells, particles of organs and tissues, and many other methods. . 2. SURVEY AND EXPERTISE Certification. Article 179 of the Criminal Procedure Code of the Russian Federation provides for an examination, which is a procedural action, which is a type of forensic investigation. The investigator has the right to examine the suspect, the accused, the victim, as well as the witness with his consent, except in cases where the examination is necessary to assess the reliability of his testimony. The survey is carried out by the investigator himself for various reasons, for example, to establish special signs on the human body (tattoos of a certain content, scars, birthmarks), traces of a crime, bodily injuries, to identify a state of intoxication or other properties and signs that are important for a criminal case, if this is not a forensic medical examination is required. The survey is carried out in the presence of witnesses, and in some cases with the participation of a doctor. If the examination is accompanied by the exposure of the testified person, then the investigator and witnesses must be of the same sex. Examination. Evidence in a criminal case is any information on the basis of which the court, prosecutor, investigator, inquirer, in the manner prescribed by the Code of Criminal Procedure of the Russian Federation, establishes the presence or absence of circumstances subject to proof in the proceedings on a criminal case, as well as other circumstances relevant to the criminal case. The following shall be admitted as evidence: testimonies of the suspect, the accused; testimonies of the victim, witness; conclusion and testimony of an expert; evidence; protocols of investigative and judicial actions; other documents (Article 74 of the Code of Criminal Procedure of the Russian Federation). An expert examination is appointed in cases where special knowledge in science, technology, art or craft is required during the inquiry, preliminary investigation and trial. Expertise produced by experts relevant institutions or other professionals. Any person who has the necessary knowledge to give an opinion can be called as an expert (Article 57 of the Code of Criminal Procedure of the Russian Federation). The application of medical knowledge to resolve issues that arise in the practice of bodies of inquiry, investigation, prosecutor's office and court is called forensic medical examination. 3. ORDER OF APPOINTMENT AND PRODUCTION OF A FORENSIC MEDICAL EXAMINATION Appointment of expertise. If there is a need to conduct an examination, the investigator issues a decision, which indicates: the grounds for appointing a forensic examination; surname, name and patronymic of the expert or the name of the expert institution in which the forensic examination is to be carried out; questions put to the expert; materials placed at the disposal of the expert. Before appointing an expert, the investigator finds out data on his specialty and competence (Article 195 of the Code of Criminal Procedure of the Russian Federation). In accordance with Art. 198 Code of Criminal Procedure of the Russian Federation in the appointment and production of a forensic examination the suspect, the accused, his/her counsel shall have the right to: get acquainted with the decision on the appointment of a forensic examination; challenge an expert or apply for a forensic examination in another expert institution; apply for the involvement as experts of the persons indicated by them or for the production of a forensic examination in a specific expert institution; to petition for the introduction of additional questions to the expert in the decision on the appointment of a forensic examination; to be present with the permission of the investigator during the forensic examination, to give explanations to the expert; get acquainted with the expert's opinion or the report on the impossibility of giving an opinion, as well as with the protocol of the expert's interrogation. Mandatory examination. According to Art. 196 of the Code of Criminal Procedure of the Russian Federation, the appointment and production of a forensic examination is mandatory if it is necessary to establish: 1) causes of death; 2) the nature and extent of the harm to health; 3) the mental or physical state of the suspect, the accused, when there is doubt about his sanity or ability to independently defend his rights and legitimate interests in criminal proceedings; 4) the mental or physical state of the victim, when there is doubt about his ability to correctly perceive the circumstances that are important for the criminal case and give evidence; 5) the age of the suspect, the accused, the victim, when it matters for the criminal case, and documents confirming his age are absent or in doubt. Expertise production. Forensic medical examination is carried out by experts of the Bureau of Forensic Medical Examination of the Ministry of Health and Social Development of Russia. A doctor who graduated from the medical faculty of a higher medical educational institution is appointed to this position. 4. DUTIES AND RIGHTS OF THE EXPERT The doctor appointed by the expert is obliged to appear on the call of the person conducting the inquiry, the investigator of the prosecutor and the court and give an objective opinion on the questions put to him. The expert has the right: get acquainted with the materials of the criminal case related to the subject of forensic examination; to petition for the provision of additional materials necessary for giving an opinion, or for the involvement of other experts in the forensic examination; participate with the permission of the inquirer, investigator, prosecutor and court in procedural actions and ask questions related to the subject of forensic examination: give an opinion within its competence, including on issues, although not specified in the decision on the appointment of a forensic examination, but related to the subject of expert research; file complaints against actions (inaction) and decisions of the inquirer, investigator, prosecutor and court that restrict his rights; refuse to give an opinion on issues that go beyond the limits of special knowledge, as well as in cases where the materials submitted to him are insufficient for giving an opinion. An expert may not: without the knowledge of the investigator and the court, negotiate with participants in criminal proceedings on issues related to the production of an expert examination; independently collect materials for expert research; to carry out, without the permission of the interrogator, investigator, court, research that could lead to the complete or partial destruction of objects or a change in their appearance or basic properties; give a deliberately false conclusion; disclose the data of the preliminary investigation, which became known to him in connection with his participation in the criminal case as an expert, if he was warned about this in advance. The expert can receive materials only from the investigator. The investigator must tell the accused what materials he provides to the expert for the examination, and ask the accused if he has any additional materials to provide them to the expert. The accused has the right to file a motion to demand additional materials necessary for submission to the expert examination. The expert may preview the materials necessary for the examination with the investigator and determine whether they are sufficient to give an opinion. Head of the expert institution after receiving the investigator's decision on the appointment of a forensic examination, entrusts its production to a specific expert or several experts from among the employees of this institution and notifies the investigator about this. At the same time, the head of the expert institution, with the exception of the head of the state forensic expert institution, explains to the expert his rights and responsibilities. During the examination outside the expert institution the investigator issues a decision to appoint an expert examination, summons the person to whom the expert examination is entrusted, ascertains his identity, specialty and competence, establishes the attitude of the expert to the accused, suspect, victim and checks whether there are grounds for challenging the expert. 5. EXPERT CONCLUSION The forensic medical expert gives an opinion on his own behalf on the basis of the research carried out in accordance with his special knowledge and bears personal responsibility for the conclusion given by him. Expert opinion (SE) - the content of the study and conclusions presented in writing on the issues posed to the expert by the person conducting the proceedings on the criminal case, or by the parties. When several experts are appointed for examination, they consult among themselves before giving an opinion. If experts of one specialty come to a common conclusion, then it is signed by all experts. In case of disagreement between the experts, each gives his opinion separately. Since the expert is personally responsible for the conclusion, no one can demand from the expert that he give a different opinion or change the one he previously gave. The examination document containing the SE and appearing in the case is a source of evidence. Therefore, the expert should carefully consider its compilation. It must be exhaustively complete in content and impeccable in legal terms. The SE is accompanied by the results of additional studies, diagrams, drawings, photographs, supplementing and clarifying the description of the study. The SE specifies: date, time and place of the forensic examination; the basis for its production; the official who appointed the examination: information about the expert institution, as well as the surname, name and patronymic of the expert, his education, specialty, work experience, academic degree and (or) academic title, position held; information about the expert's warning about responsibility for giving a deliberately false conclusion; questions put to the expert; objects of research and materials submitted for the production of the examination: data on the persons who were present during the production of the examination; the content and results of research with an indication of the methods used; conclusions on the questions put to the expert and their justification. If, during the performance of the expert examination, the expert establishes circumstances that are important for the criminal case, but about which he was not asked questions, then he has the right to indicate them in his opinion. Materials illustrating the SE (photographs, graphs, etc.) are attached to the conclusion and are its integral part. The SE is given in writing and signed by the medical examiner. The EP is transferred to the body that appointed the examination no later than three days after the examination. The second copy of the SE remains with the Bureau of Forensic Medical Examination that conducted this study. Limits of expert competence. During the examination of living persons, the expert is asked a variety of questions. The expert can, must and must answer some questions - these are questions related to his specialty. Questions that are not related to his specialty, the expert must reject. The expert should not, in his conclusions, touch on the issues of intent, negligence, wrongfulness, qualification of the action. 6. TYPES OF FORENSIC MEDICAL EXAMINATION Primary examination called the first study of the object. Appointed when special knowledge is needed for the production of a forensic examination and giving an opinion. It can be carried out with a study of the person himself or according to documents, case materials. Primary examination in most cases is final. Additional expertise may be appointed in case of insufficient clarity or completeness of the expert's opinion, as well as in the event of new questions regarding the previously investigated circumstances of the criminal case. It can be entrusted to the same or another expert and is a sequential, milestone study with a final conclusion after one or more additional studies of the object of expertise. An additional study, upon receipt of sufficient data, provides the basis for the final conclusion of the expert. Re-examination appointed in cases of doubt in the validity of the expert's opinion or the existence of contradictions in the conclusions of the expert or experts; on the same issues, a repeated examination may be appointed, the production of which is entrusted to another expert. The re-examination is carried out after the primary examination; it is usually, but not always, carried out by a panel of experts. This examination can be carried out solely by an expert, with the participation of specialist consultants and a commission of experts. Commission expertise produced by at least two experts of the same specialty. The similar nature of the examination is determined by the investigator or the head of the expert institution entrusted with the production of a forensic examination. If, according to the results of the conducted research, the opinions of experts on the issues raised coincide, then they draw up a single conclusion. In case of disagreement, each of the experts participating in the forensic examination shall give a separate opinion on the issues that caused the disagreement. Comprehensive expertise - forensic examination, which involves experts from different specialties (for example, a forensic medical expert, a forensic chemist, an expert in automotive technology, etc.). Conducting comprehensive examinations became possible due to the expansion of the possibilities of scientific and technical research. In a comprehensive examination, medical, forensic, chemical, physical, technical and other research methods are used. The conclusion of the experts participating in the production of a comprehensive forensic examination indicates what research and to what extent each expert conducted, what facts he established and what conclusions he came to. Each expert who participated in the production of a comprehensive forensic examination signs that part of the conclusion that contains a description of the research he conducted, and is responsible for it. 7. FORENSIC SERVICE INSTITUTIONS In accordance with the Federal Law "On State Forensic Activities in the Russian Federation", there are state institutions of forensic examination. These institutions are independent of the investigating authorities, the prosecutor's office and the court, which provides broad procedural guarantees to the accused. The need for a forensic medical examination in the investigation of crimes and in court proceedings arises especially often when considering cases of crimes against life and health, crimes against sexual integrity and sexual freedom of the individual. The constant interest of the bodies of inquiry, investigation, prosecutor's office and court in the production of forensic medical examination has led to the need to organize institutions in our country that would specifically deal only with forensic medical examination. These special institutions are in the Ministry of Health of the Russian Federation. They're called the Medical Examiner's Bureau. In the constituent entities of the Russian Federation, forensic medical institutions are republican, regional, regional, in the cities of Moscow and St. Petersburg - city bureaus of forensic medical examination, which are under the jurisdiction of the relevant ministries, departments, departments, committees and health departments. The functions of the Bureau of Forensic Medical Examination of the Ministry of Health of the Russian Federation are performed by the Russian Center for Forensic Medical Examination, which consists of two structural divisions: the Bureau of Forensic Medical Examination and the Research Institute of Forensic Medicine. In addition to the Russian Center for Forensic Medical Examination, there are 86 territorial bureaus of forensic medical examination in the Russian Federation, which include 190 city and 964 district and interdistrict forensic medical examination departments. Bureaus of Forensic Medical Examination are health care institutions. These include the following structural units: - department of forensic medical examination of victims, accused and other persons (department of forensic medical examination of living persons); - department of forensic examination of corpses with a histological department; - organizational and methodological department - department of forensic medical examination of physical evidence with the following departments: - forensic biological; - forensic chemical; - forensic biochemical; - forensic bacteriological (virological) - medico-criminalistic. District, interdistrict and city branches of the bureau of forensic medical examination are organized on the basis of hospitals, outside the cities where the bureau is located, taking into account the actual volume of forensic work, the remoteness of the department from the bureau, as well as other conditions. The heads of district, interdistrict and city departments of the Bureau of Forensic Medical Examination in practical, organizational, methodological and administrative terms are subordinate to the head of the Bureau of Forensic Medical Examination, which includes these departments. The merger of the Bureau of Forensic Medical Examination as a whole or its separate structural subdivisions with institutions of other medical specialties is prohibited. 8. DEFINITION OF INJURY AND INJURY Damage (injury) is a violation of the anatomical integrity or physiological function of tissues and organs of the body under the influence of environmental factors (mechanical, physical, chemical, etc.). Mechanical damages are singled out into a separate, most extensive group and are combined according to the nature of their occurrence. In such cases, the injury is caused by an object moving towards a person who is at rest or relatively little movement, or when the person's moving body hits a stationary object (e.g., in a fall) As a result of mechanical trauma, abrasions, bruises, wounds, dislocations, bone fractures, and ruptures of internal organs can occur. The repetition of homogeneous injuries in persons who are in similar working and living conditions is called traumatism. There are the following types of injuries: - production; - transport; - household; - street - military - sports Each type of injury has its own characteristics, associated not only with the circumstances of the incident, but also with the nature of the damage caused. For example, in industrial injuries, wounds predominate, and in sports injuries, bruises and sprains Most often in the practice of forensic medical examination there are cases of domestic and transport injuries, when there is intentional or accidental damage; cases of industrial and sports traumatism are less often observed. Military injuries are within the competence of military doctors. 9. TYPES OF MECHANICAL DAMAGE: ABRUSION, BRUISING, WOUND Abrasion is a violation of the integrity of the surface layer of the skin with damage to the lymphatic and blood vessels. An abrasion does not penetrate the entire thickness of the skin, being a superficial injury. Great protective value in the formation of abrasions at the site of injury is clothing. The surface of the abrasion, initially wet, after a while becomes covered with a crust of coagulated plasma and blood. The crust disappears as the abrasion epithelializes. At the site of the abrasion, skin pigmentation persists for some time. The forensic medical significance of abrasions lies in the fact that they: firstly, always indicate the place of application of force and are sometimes the only outward sign of violence; secondly, the features of the healing of abrasions described above make it possible to establish the duration of the injury; thirdly, the detection of any particles (grains of sand, fine coal, slag) on the surface of abrasions is important for establishing the scene of the incident (for example, the detection of coal particles under fragments of the epidermis along the edge of the abrasion when a corpse is found on sandy or clay soil indicates the fact that the injury occurred elsewhere, and the corpse was then moved); fourthly, the localization of abrasions is important in determining the nature of the incident. A bruise is formed due to rupture of blood vessels at the site of impact or compression, followed by hemorrhage into the subcutaneous tissue or deeper tissues. The spilled blood shines through the skin and stains it in a blue-purple or blue color. Over time, the color of the bruise due to the reaction of the blood pigment (hemoglobin) changes from blue-purple, blue, brown, greenish to yellow. The forensic significance of bruises lies in the fact that in most cases they indicate the place of application of a traumatic object. A wound is an injury that violates the integrity of the entire thickness of the skin or mucous membranes and usually penetrates into deeper tissues. Wounds are associated with three main dangers for humans: bleeding, the possibility of infection through damaged integuments, violation of the anatomical and functional integrity of organs and tissues. The forensic significance of wounds lies in the fact that, as a rule, they indicate the place of application of the traumatic force and make it possible to establish the type of the injuring object. In addition to the type of weapon, the nature and characteristics of the wounds can in some cases be used to judge the direction of movement of the traumatic object, the position of the victim at the time of injury, the possibility or impossibility of inflicting injury with one's own hand, and other features of the injury mechanism. 10. TYPES OF MECHANICAL DAMAGE: DISTRUCTIONS, FRACTURES, RUPTURES OF INTERNAL ORGANS Dislocations - complete and persistent displacement of the bones in the joints. Dislocations occur when a force is applied to the distal end of a limb, for example. when falling, less often with direct pressure on the joint. Most often, dislocations occur in the joints of the upper extremities, less often in the lower ones. The forensic medical significance of dislocations lies in the fact that in some cases they make it possible to judge the nature and mechanism of violence. When assessing them, the possibility of habitual and congenital dislocations should be taken into account. Bone fractures - a violation of the integrity of the entire thickness of the bones of the skeleton, usually accompanied by extensive damage to nearby tissues, hemorrhages, ruptures of muscles and blood vessels. They are very diverse both in nature and mechanism of occurrence. There are closed and open fractures of bones. In cases where a bone fracture occurs inside the soft tissues without violating the integrity of the skin, they speak of a closed fracture. If a bone fracture is accompanied by a rupture of the skin and the fracture area communicates with the external environment, they speak of an open fracture. The greatest forensic significance are fractures of the bones of the skull, which are divided into direct and indirect. The former occur at the site of application of force, the latter, which are not formed at the site of impact, occur when the skull is squeezed between two blunt solid objects. The forensic medical significance of bone fractures lies primarily in the ability to identify the fracture mechanism by its nature and features. Ruptures of internal organs occur either as a result of a direct blow or squeezing of the body (for example, rupture of the liver when hit in the stomach), or when it concussions (for example, ruptures of the liver, spleen when a person falls from a height). In both direct and indirect applications of force, some internal organs are damaged more often, others less frequently. Usually, parenchymal organs rupture more often than abdominal ones. Of the former, the liver is most frequently damaged. The forensic medical significance of ruptures of internal organs is that sometimes they can be used to judge the mechanism of injury, its danger to life, causal relationship with death, etc. Traumatic ruptures of internal organs are often not accompanied by any external injuries at the site of impact. 11. CAUSES OF DEATH DUE TO MECHANICAL INJURIES Causes of death due to mechanical damage can be divided into two groups: 1. The primary causes of death immediately after the injury lead to the cessation of the vital functions of the body. These include: 1) gross anatomical violations of the integrity of the body (dismemberment of the body, crushing of the liver, rupture of the heart, etc.); 2) bleeding. With rapid and relatively less blood loss, especially from vessels close to the heart, death occurs from a drop in intracardiac pressure or acute anemia of the brain. The rapid loss of 1,5-2 liters of blood is usually fatal; 3) compression of important organs by outflowing blood or sucked in air. The main role here is played by the sensitivity of the organ to compression, the size of the cavity in which the vital organ is located, and the possibility of stretching this cavity. So. death from brain compression occurs with intracranial hemorrhage with a volume of 100-150 ml, as well as with cardiac tamponade of 400-600 ml of blood that has poured into the heart shirt; while with almost complete compression of one lung with pneumothorax, a person can remain alive; 4) concussion (of the brain, heart). Severe concussions of the brain are often accompanied by other head injuries and, in particular, skull fractures, hemorrhages in the substance of the brain and under the meninges; 5) asphyxia with aspirated blood. Occurs when bleeding is accompanied by blood entering the respiratory tract. It is observed with extensive incised wounds of the neck, with fractures of the base of the skull. Aspiration of blood is often found in fractures of the ethmoid bone of the skull, when blood flows freely into the nasopharynx, and from there into the respiratory tract, especially in unconscious persons; 6) embolism. Air embolism is observed with injuries of large veins of the neck, criminal abortions, especially with the introduction of soap solutions into the uterine cavity. The outcome of embolism depends on the amount and speed of air penetration into the vessels. With the introduction of 5-10 cm of air, it can dissolve in the blood. Fat embolism occurs when droplets of fat enter the veins, sometimes absorbed from the bone marrow in case of fractures of long tubular bones or mashing of fatty tissue; 7) shock is characterized by overexcitation of the central nervous system with subsequent disorder of nervous regulation. 2. Secondary causes of death cause the death of the victims after a certain period of time after the injury. Most often it is about complications. These include: 1) infections (purulent peritonitis, meningitis, pleurisy, sepsis) as complications of trauma are common; 2) intoxications develop as a result of poisoning of the body with tissue decay products (for example, with the syndrome of prolonged tissue compression). Most of the victims of disasters, earthquakes die precisely for this reason; 3) other non-infectious diseases. These include acute renal and hepatic failure, intestinal obstruction, post-traumatic aneurysms of large vessels. 12. CLASSIFICATION OF MECHANICAL DAMAGE BY ORIGIN. AVIATION AND WATER TRANSPORT INJURIES Depending on the tools (weapons) and mechanisms occurrence are distinguished: 1. Blunt injury from impact: - blunt objects; - about blunt objects when falling; - damage caused by vehicles. 2. Damage from sharp weapons: - cutting (weapons, objects); - stabbing (weapons, items) - piercing and cutting (weapons, objects): - chopping (weapons, objects); - sawing (objects). 3. Damage from firearms: - damage from firearms; - damage from explosions. Aviation injury - these are damages that occur to crew members, passengers and other persons during the operation and maintenance of aircraft. Most often, such damage is caused to persons inside the aircraft when it falls to the ground. Aircraft injury is divided into the following types: injury inside the aircraft during flight; injury when leaving a flying aircraft; injury inside the aircraft when it falls to the ground; injury inside an aircraft on the ground; injury to persons on the ground outside the aircraft; combined injuries. The nature of an aviation injury depends on the type of aircraft, flight speed and altitude, angle of incidence, etc. Aviation injuries on the ground are much less common and are associated with people falling under the running propellers of the aircraft engine or the air streams accompanying them. In this case, extensive gross injuries of the body are observed. With the advent of jet aircraft, cases of being sucked into the engines of a person who came too close to the aircraft were noted. Water transport injury - damage to ship engines by propellers, as well as cables and anchor chain. The greatest difficulties during the examination arise in the study of damage caused by propellers. The latter can injure both a living person, when he is sucked in by a jet of water and falls on rotating propellers, and a corpse in the water. Injuries from the action of propellers are more often localized on the head and upper limbs and often have the form of large cuts and cuts (with massive metal blades with sharp ribs), characterized by an oblique direction, patchwork wounds, significant gaping, skin abrasions. With several injuries, the same direction of the wounds with the deviation of the flaps in one direction attracts attention, i.e. as if their fan-shaped arrangement; from the action of the blunt edges of the screw on the trunk, buttocks and hips, only significant bruises can form, accompanied by closed bone fractures. Damage to the cables and anchor chain is formed when they break or fall into the loops formed during mooring or pushing off. In such cases, extensive injuries can be observed, up to amputations of limbs, crushing of internal organs, and even dismemberment of the body. 13. DAMAGE BY BLUNT OBJECTS Blunt force injuries are the most common in forensic medicine. The main difference between blunt objects is that they do not have sharp edges or ends. The mechanism of injury is usually twofold: either damage is caused by a moving object to a person at rest or relatively little movement, or a moving body of a person hits an immovable object (for example, when falling). The extent and features of damage by blunt objects depend on the mass and density of the damaging object, the speed of movement, the shape of the striking surface of the blunt object, and the anatomical structure of the damaged area of the body. Damage caused by a fall from a height. The nature and severity of injuries from a fall from a height depends on many reasons, and above all on the height of the fall, the characteristics of the soil and objects on which the fall occurred, and the posture of the victim. At the same time, the area of \uXNUMXb\uXNUMXbthe body that it hit at the time of the fall, the presence or absence of protruding objects that the victim’s body could hit during the fall, and, of course, the state of health and individual characteristics of the victim, matter. In a direct fall, the main damage to the human body occurs from a single impact on the surface. In an indirect fall, the body encounters during its movement any protruding objects with a limited traumatic surface (balconies, cornices, satellite dishes, etc.). One of the common signs of a fall from a height is the predominance of internal injuries arising from the concussion of the body over the external ones, formed at the moment of impact on the surface. External injuries are in the nature of abrasions and bruises (bruised wounds are very rare). They display the relief of the surface on which the fall occurred. During internal examination, as a rule, multiple fractures of the bones of the skeleton, as well as tears and ruptures of internal organs (roots of the lungs, large vessels at the base of the heart, ligaments and liver capsule, etc.) are noted. When falling on a plane (from the height of one's own height), fractures of the bones of the skull often occur in the occipital or temporal region, accompanied by intracranial hemorrhages and compression of the brain. Signs of concussion of the body (tears of the roots of the lungs, ligaments of the liver, etc.) are usually absent. 14. VEHICLE DAMAGE. ROAD INJURY Transport injury - damage resulting from the action on the human body of a moving vehicle or when falling out of it. At present, the following classification traffic injury: 1) road: automotive (trucks and cars); tractor (caterpillar and wheeled tractors); motorcycle (motorcycles with a sidecar, motorcycles without a sidecar); 2) railway (electric locomotive, diesel locomotive, railway car, tram); 3) aviation (plane, helicopter) 4) water transport (river and sea vessels, boats, yachts). Injuries from other modes of transport are rare and of less medico-legal significance. Road injury. There are automobile (trucks and cars), tractor (caterpillar and wheeled tractors) and motorcycle (motorcycles with sidecars, motorcycles without sidecars) injuries. Automobile injury. Motor vehicle injuries are the most common type of traffic injury. Due to their specific features (massiveness of vehicles, their movement at high speed), they are often found in forensic practice. In the study of automobile injuries, many different problems arise, among which the most important is the study of the mechanism of damage. According to the mechanism of occurrence, motor vehicle injuries are divided into the following kinds: hit by parts of a moving car, pressing the body with a car wheel to the ground, completely moving the body with a car wheel, falling from a moving car, injury inside the car cabin, pressing a person’s body by a car against a stationary object, car collision with other modes of transport, combined types of car injury. Tractor injury. The classification of a tractor injury can be represented by the following list: hit by parts of a moving tractor; moving with caterpillars or tractor wheels; falling out of a moving tractor; overturning of the tractor and the occurrence of injury inside the cab; pressing the human body with a tractor against an immovable object; hit by a tractor followed by a run over; falling from a moving tractor followed by a run over; hit by a trailer or towed implements. Motorcycle injury. Unlike a car injury, motorcycle injuries are less pronounced. There are the following main types of motorcycle injuries: from a collision of a person with a moving motorcycle, from moving the wheel of a moving motorcycle, from falling from a moving motorcycle, from hitting a motorcycle against stationary objects. The main difference between a motorcycle injury and a car injury is the predominance of injuries (abrasions, wounds, bruises), located, as a rule, on the front surface of the victim's body. 15. RAILWAY INJURY Forensic railway injury classification can be presented in the following form: - damage caused mainly by the wheels of railway vehicles when they roll over a body located on the rails: - pressure bands; - wiping strips; - separation of the head from the body (complete, incomplete) - division of the body into two halves (complete, incomplete); - separation of limbs (complete, incomplete) - damage arising from impacts and friction on the railway track and caused mainly by parts of locomotives, wagons located below their frames (excluding wheels): limb tears; - traces of drawing; - open and closed bone fractures: - varying degrees of damage to internal organs: from minor to moving them and falling out through open abdominal wounds - damage caused primarily by being thrown by parts of a moving railway vehicle: impact marks by parts of a moving railway vehicle - extensive abrasions on the skin, bruises, bone fractures; - traces of a fall on the body: - damages that are formed mainly in connection with the presence of the victim near the track within the limits of the dimensions of the rolling stock at the time of its passage; damage characteristic of inflicted by hard blunt objects; in cases of compression between the platform and the moving transport - stretching of the body; damage associated mainly with a fall from a rolling stock: when falling under a rolling stock - damage characteristic of wheels, parts located below the frames of a locomotive, wagons, body dragging; when falling from a moving railway transport without subsequent falling under it - characteristic of falling from a height; damages associated mainly with electric shock while being on the roofs of cars moving along the tracks of an electrified railway: electrical marks, signs of asphyxia; characteristic of falling from a height if, after an electric shock, the victim falls from the roof of the car; injuries mainly associated with squeezing buffers and in the automatic coupling mechanism: closed fractures of the ribs, spine, shoulder blades: diaphragmatic ruptures, tears and ruptures of internal organs, their displacement; extrusion of the lungs through the mouth, ruptures of the perineum with prolapse of intestinal loops; the formation of traumatic hernias with the filling of hernial sacs with internal organs, up to the heart and stomach; impressions of the contours of the buffers on the skin of the chest and back. 16. DAMAGE BY SHARP OBJECTS Sharp objects are objects whose edge or end is pointed. All variety of sharp tools can be divided into the following groups: cutting, stabbing, piercing-cutting, chopping, sawing. The damage caused by each of the listed types of guns has its own characteristics, which make it possible to determine the type of gun that caused the injury. Damage from cutting tools. Cutting objects include objects that have a flat blade with a sharply sharpened blade (table knife, razor) without a point. Wounds from their action are characterized by a rectilinear direction, smooth non-serrated edges, pointed ends, a significant predominance of length over other sizes, a wedge-shaped cross-sectional profile, gaping. The size and depth of the wound depend on the sharpness of the blade, the pressure force, the localization of the wound (for example, incised wounds on the head are shallow, since the bone is close under the skin, while on the neck they are deep and can reach the spine). Damage from piercing weapons. Stab objects include objects that have a cylindrical or polyhedral rod (needle, awl, nail) ending in a point. The inlet of a stab wound is often small and therefore hardly noticeable. The shape of a stab wound on the skin often does not correspond to the shape of the tool with which it was inflicted, since the features of a stab wound are affected not only by the shape of the tool itself, but also by the properties of the skin, in particular its elasticity. Damage by piercing-cutting tools. Stab-cutting objects (dagger, Finnish, hunting, pocket knives, scissors) have a sharp piercing end and one or two blades. By the nature of sharpening the blade, all piercing and cutting objects are divided into double-edged, having two blades (for example, a dagger) and one-sided sharpened, having a blade and a butt (for example, Finnish, penknives), and the butt can be rounded or rectangular. Damage from slashing weapons. Chopping tools (axes, scythes, checkers, choppers, etc.) usually cause extensive damage, which is associated with a large force of wounding. It depends on the weight of the tool itself and the large kinetic energy that develops during the movement of such a tool. The nature of the wound depends on the sharpness of the chopping tool, its mass and the force with which the damage is inflicted. Damage from saw blades. Injuries with sawing tools (saw, hacksaw, circular saw) are rare in forensic practice. Research is carried out when dismembered corpses are found in order to hide the body of the victim. Saws inflict rectilinear wounds with somewhat jagged and raw edges, tissue bridges at the bottom, scratches and notches at the ends of the wound. 17. GUNSHOOT INJURIES Gunshot damage - this is a type of mechanical injury that is formed as a result of hitting the body with a firearm when fired from a firearm or when a projectile or some kind of explosive explodes. The nature of gunshot wounds depends primarily on the characteristics of weapons and ammunition. A forensic medical examination of gunshot injuries, taking into account the data from the inspection of the scene and all the circumstances of the case, can be of great help in investigating crimes involving the use of firearms. Penetrating gunshot wounds are characterized by the presence of all the components of a gunshot injury: the inlet gunshot hole, the wound channel, the outlet gunshot hole. One of the main signs of the inlet gunshot hole is a tissue defect. It is formed with sufficient kinetic energy of the bullet (its penetrating action). In this case, when examining the wound and trying to bring its opposite edges closer together, the latter do not coincide with each other, and folds form along the edges of the wound when the skin is pulled. The shape of the inlet gunshot hole usually round or oval, depending on the angle at which the bullet enters the tissue of the person's body. With a right angle of entry of the bullet, the wound will be rounded. The shape of the exit gunshot hole is often linear arcuate, less often star-shaped. When penetrating into the body, the bullet wipes the particles that are on it along the edges of the inlet (traces of grease, soot, powder deposits, rust, etc.), forming a so-called wiping belt in the circumference of the hole. At the point of entry, the bullet first draws in and then pierces the skin; at the same time, with its lateral surface, it rubs against the skin that fits it and peels off the surface layers, as a result of which a belt of sedimentation 1-2 mm wide is formed. Under shot distance refers to the distance between the muzzle of the weapon barrel and the surface of the damaged body. In forensic medicine, there are three distances: 1) point-blank shot. The main signs are: the location of additional factors inside the wound channel or on a small part of the skin around the gunshot wound, skin ruptures and a "stamp mark" - an imprint (abrasion) of the muzzle of the weapon barrel, as well as scarlet-red staining of the tissues in the area of the inlet (carboxyhemoglobin) 2) close shot distance - such a distance between the muzzle of the weapon barrel and the surface of the damaged body, when additional factors of the shot act - flame, gases, soot, powders. 3) close range shot - a shot from such a distance when only the bullet acts on the body, and additional factors of the shot are not detected. Injuries from the explosion of grenades, fuses, mines, shells. Depending on the nature of the ammunition and the distance from them to the damaged area, the picture of damage during explosions of grenades, mines and shells may be different. A feature of injuries in the explosions of shells, grenades, mines is their multiplicity. Often fragments hit almost the entire surface of the body facing the site of the explosion; at the same time numerous injuries of the head, torso and extremities take place. 18. Oxygen starvation In forensic practice, much attention is paid to the diagnosis and study of health disorders, as well as death and changes that occur as a result of oxygen starvation. Oxygen starvation (hypoxia) is a consequence of insufficient intake or insufficient use of oxygen by tissues. The following types of hypoxia are distinguished in connection with the causes of oxygen deficiency. Respiratory hypoxia occurs due to insufficient saturation of the blood with oxygen in the lungs and, consequently, insufficient oxygen tension in the arterial blood. It is caused by: a decrease in the oxygen content in the inhaled air, a disorder in the regulation of breathing, damage to the lung tissue (for example, with inflammatory processes in the lungs and other pathological processes). congestive hypoxia due to a slowdown in blood flow or insufficiency of its inflow to individual organs. It is observed in circulatory disorders, chronic heart failure, and also in shock. With normal blood oxygen saturation, the total amount of oxygen supplied to the tissues per unit time decreases due to the causes of oxygen deficiency. Anemic hypoxia due to an insufficient amount of hemoglobin in the blood, resulting in a decrease in the total amount of oxygen. With this form of hypoxia, the oxygen capacity of the blood is reduced due to a decrease in hemoglobin (eg. with acute and chronic anemia, changes in the state of the blood as a result of exposure to blood poisons). tissue hypoxia occurs when the ability of tissues to use the oxygen delivered to them decreases. So, in case of cyanide poisoning, the oxidizing ability of tissues is reduced. 19. MECHANICAL ASPHIXIA. strangulation asphyxia Oxygen starvation, which developed as a result of mechanical effects that prevent breathing, and was accompanied by an acute disorder of the functions of the central nervous system and blood circulation, is called mechanical asphyxia. The following types of it are distinguished: strangulation (hanging, strangulation with a loop, strangulation with hands): obstructive (closing the respiratory openings of the nose and mouth, closing the respiratory tract with foreign bodies, drowning); compression (from compression of the chest and abdomen with loose or massive objects). Hanging - the noose put on the neck is tightened under the weight of the body itself. In order to correctly diagnose and assess death by hanging, it is important to carefully study the circumstances of the incident, inspect the scene of the incident, physical evidence, and examine the human corpse. The position of the loop and its knot on the neck may be different. The most typical location of the loop on the neck is such that its knot is located in the back of the head. With an atypical location of the loop, the knot is located on the lateral surfaces of the neck or in the chin area. The main feature hanging is a strangulation furrow. The latter is an imprint of a noose on the neck and often repeats the structure of the material from which the noose is made. On examination, pay attention to the direction, nature, appearance, texture, color and other features of the strangulation furrow. According to the direction, the strangulation furrow is distinguished: typical or atypical, and the typical and atypical loops corresponding to it. When hanging, the strangulation furrow is, as a rule, open. Between its ends there is a gap of skin free from pressure due to the fact that the ends of the loop rise towards the node. A knot resting on the skin at some distance from the strangulation groove and above it, sometimes also leaves a mark on the skin, which can be taken as a sign of violence. Loop choke - squeezing the neck with a noose tightened by an outside or one's own hand, or by some kind of weight, as well as by a moving part of the machine, differing from hanging, in which the noose around the neck is tightened by the weight of the body itself, descending in the loop. The actual sign of strangulation is the strangulation furrow. It is located according to the existing loop, repeats its moves and revolutions in terms of structure and number of revolutions. The strangulation furrow, when strangulated with a loop, is located horizontally with respect to the longitudinal axis of the body, which is different from the location of the strangulation furrow during hanging. Strangulation by hands. It leads to a rapid loss of consciousness due to compression of the neurovascular bundles. When examining a corpse shortly after the onset of death, the skin of the face is usually sharply cyanotic. In the conjunctiva there are small and large ecchymosis. But after some time, she turns pale due to post-mortem bleeding. Also found are signs, characteristic of strangulation by hands, namely: the presence of multiple abrasions of various sizes and shapes, located on the lateral surfaces of the neck, sometimes on its front surface. in the area of the chin, the angles of the lower jaw, the circumference of the openings of the nose and mouth, when hand pressure is accompanied by the closing of the respiratory openings. 20. OBTURATIONAL AND COMPRESSION ASPHYXIA Closure of the openings of the nose and mouth. There is the usual development of acute oxygen starvation, which is why death occurs. The openings of the nose and mouth can be closed with hands. In these cases, on the skin around the nose and mouth, there are traces of pressure from the fingers in the form of abrasions, scratches, bruises. It is often possible to detect minor damage to the mucous membrane of the lips, especially on their inner surface. They can also depend on pressing the lips to the teeth, as a result of which bruises, abrasions and even small wounds of the mucosa are formed. Closure of the airways with foreign bodies. Foreign bodies enter the respiratory tract, which in some cases block the entrance to the respiratory tract, in others they penetrate the respiratory tract and completely or partially close their lumen, and thirdly, due to their small volume, without closing the respiratory tract, they irritate the respiratory tract - larynx, vocal cords, which causes reflex cardiac arrest. Consequently. in such cases we may deal with both immediate death by strangulation and death by shock due to respiratory irritation and reflex cardiac arrest. Diagnosis of this type of strangulation is not difficult. At the entrance to the larynx, in the lumen of the trachea or bronchi, a foreign body is found. Heating - closure of the respiratory openings and pathways with fluid. Drowning can also occur without the complete immersion of a person's body and even his head in a liquid (for example, cases of drowning in a pool of drunks). If death occurred from drowning, then external and internal examination of the corpse reveals a complex of various signs that are not observed in all cases and the diagnostic value of which is not the same. Among the external signs of drowning, the most characteristic is the presence of fine bubble foam in the openings of the mouth and nose, in the respiratory tract, which is formed from the mixing of air, water and mucus during bronchial spasms in the convulsive period of drowning. If there is no foam on a corpse removed from the water, then after a chest massage it may reappear due to squeezing it out of the respiratory tract. Other signs are only evidence of the presence of the corpse in the water. An internal examination of the corpses of drowned people reveals: acute emphysema of the lungs, blurry pale red hemorrhages under the pleura of the lungs, the presence of fluid in the stomach and small intestine, foreign bodies (silt, algae, sand, clay) in the deep sections of the respiratory tract. One of the most reliable signs of drowning is the detection in the internal organs and bone marrow of plankton tubular bones (diatoms), which coincide in composition with the plankton of the reservoir from which the corpse was removed. Compression of the chest and abdomen (compression asphyxia). When examining a corpse at the scene, the localization and posture of the corpse are noted, the part of the body that was pressed down, the squeezing object, its dimensions and approximate mass are indicated. With this type of asphyxia, very characteristic changes are found. The skin of the corpse, especially its upper half, with the exception of areas subjected to pressure, appears to be sharply cyanotic, dark, blue-purple in color. The face of a corpse often appears puffy ("ecchymotic mask"). 21. THE CONCEPT OF POISONS AND POISONINGS Toxicology - the science of poisons and poisonings. Toxicology is divided into general and particular. The first studies the general patterns of the toxic effect of various substances on the body, the second - the features of the action of individual poisons and seeks means of treating the poisoning they cause. Historically, the earliest branch of toxicology is forensic toxicology. A health disorder or death caused by the action of toxic or potent substances that enter the body from outside is called poisoning. Poison A substance is called a substance that, when it enters the body from the outside, even in small quantities, under certain conditions, causes a health disorder and death of a person. By origin all poisoning can be divided into accidental and intentional. Accidental poisoning are home, "medical" and professional. Accidental household poisonings include most poisonings. They occur due to the careless storage of toxic substances and their consumption by children, in a hurry, drunk people. "Medical" poisoning called poisoning by substances administered by medical personnel for therapeutic purposes. Such poisonings, as a rule, end with the prosecution of medical workers. Usually occupational poisoning occur as a result of accidents at work or in case of non-compliance with safety regulations. Intentional poisoning could be suicide or murder. In suicides, available poisons are more often used (acetic essence, mineral acids, caustic soda). Medicines (sleeping pills, drugs) are used less frequently. 22. ACID POISONING Sulfuric acid is an oily liquid. Purified sulfuric acid is a colorless transparent liquid, not purified - yellowish or brown-yellow. Sulfuric acid has a strong destructive effect. Lethal dose - 5 ml. Immediately after taking the acid, there are sharp pains in the mouth and the entire digestive tract, severe vomiting mixed first with red blood, and then with brown masses (due to the fact that the blood under the action of acid takes on a brown color). Simultaneously with vomiting, a strong cough rises due to inhalation of vapors or acid droplets entering the respiratory tract. From the action of vapors or the acid itself on the epiglottis and respiratory tract, a sharp edema of the larynx, vocal cords develops, causing severe breathing difficulties, and therefore even a tracheotomy is sometimes required. The face of the poisoned person becomes cyanotic, the pupils dilate. There is a fall and weakening of cardiac activity. death comes in the first 1-2 hours and sometimes very quickly. With prolonged poisoning, bloody diarrhea, convulsions, hiccups, cessation of urine output, deep fainting and death develop. When taking less concentrated acid solutions, death may not occur. Esophageal burn heals. There is scarring and subsequent narrowing, and even complete obstruction of the esophagus, which later leads to death from exhaustion. Hydrochloric acid is an aqueous solution of hydrogen chloride. Diluted hydrochloric acid is used in medical practice. Lethal dose undiluted hydrochloric acid - 15-20 ml. The clinical picture is similar to the clinical picture of sulfuric acid poisoning, differing only in the lesser severity of symptoms. Death usually comes from shock in the first hours or even minutes. During the survival of the organism, severe cicatricial changes occur in it along the esophagus and in the stomach. Hydrochloric acid poisoning is mostly accidental, when acid is taken or given instead of another liquid, but there are cases of suicide. Acetic acid more common in everyday life in the form of vinegar essence. It contains 50-80% acetic acid. Table vinegar contains up to 6% acetic acid. Lethal dose - 15 ml of vinegar essence or a glass of table vinegar. After taking acid, there is a strong vomiting of brown masses, emitting a characteristic smell of vinegar. There are severe pains along the digestive tract, swelling of the mucous membrane of the upper respiratory tract, sometimes a sharp cough in case of poisoning with concentrated acid. death comes fast. When experiencing a poisoned person, jaundice develops due to hemolysis of red blood cells, diarrhea with brown masses mixed with red blood joins, the temperature rises, blood is found in the urine, and women may also experience spotting from the vagina. Death can occur in the first hours from shock, during experience - from various complications, and sometimes after a long period of time after poisoning. The outcome may be the same as when a person is poisoned with inorganic acids. 23. POISONING WITH ARSENIC, MERCURY, CARBON OXIDE Arsenic poisoning. Arsenic anhydride is the most important of the arsenic preparations. Lethal dose when taken, it is 0,1-0,2 g. When arsenic anhydride is ingested, the gastrointestinal form of poisoning is more often observed. The victim has a metallic taste in the mouth, vomiting, severe pain in the abdomen. The vomit is greenish in color. Loose stools resembling rice water. Severe dehydration of the body, accompanied by convulsions. Further, as a result of the destruction of red blood cells, jaundice, hemolytic anemia, acute renal and liver failure develop. Death may come in the next few hours after poisoning. Mercury poisoning. Poisoning can be caused by inorganic mercury preparations (mercuric chloride, calomel, mercury cyanide) and organic preparations (granosan, diethylmercury, and others). Of the toxic compounds of mercury, sublimate is of practical importance. Her lethal dose 0,3-0,5 When taking sublimate inside, symptoms of acute poisoning develop, the clinical picture of which also depends on the form in which the sublimate is taken - in the form of a solution or tablets. There is a metallic taste in the mouth, followed by nausea and vomiting. If pills were taken, sometimes vomiting is bloody. Abdominal pains appear, then diarrhea with blood. The mucous membranes of the mouth and pharynx acquire a copper-red color. Anuria develops and death occurs from uremic coma more often after 6-8 days. In addition, there is loosening and ulceration of the gums, accompanied by bad breath. In some cases death comes even in the first day from the weakening of cardiac activity. Carbon monoxide poisoning. Carbon monoxide is a colorless, odorless gas and is found in its pure form only under laboratory conditions. It is most often formed during the incomplete combustion of organic substances. Typically, carbon monoxide is found in mixtures with various gases in the form of carbon monoxide, which is formed during the burning of faulty furnaces, or the exhaust gases of internal combustion engines of cars. Carbon monoxide has an increased selective effect on blood hemoglobin. It displaces oxygen from oxyhemoglobin, forming carboxyhemoglobin. By replacing oxygen, carbon monoxide causes hypoxia. In turn, carbon monoxide has a toxic effect directly on tissues, inhibiting tissue respiration due to its combination with an iron-containing respiratory enzyme. Carbon monoxide also has a specific effect on the central nervous system, causing severe changes in the nervous tissue. When a corpse is opened, the blood in the heart, vessels, sinuses of the hard shell has a bright red color, which is transmitted to all organs and tissues that have the same color. Muscle tissue is especially brightly stained. 24. THE EFFECT OF HIGH TEMPERATURE ON THE HUMAN BODY The effect of high temperature on the human body can be general and local. Heatstroke occurs with the general action of high temperature, which causes overheating of the body. It is observed in conditions conducive to overheating of the body: at high temperature, high humidity, increased muscle work. These conditions impede heat transfer, increase the production of heat in the body. When conducting a forensic medical examination of the corpses of persons who died from overheating of the body, no specific phenomena are revealed either during autopsy or during microscopic examination of organs. They state only the pathomorphological picture characteristic of rapid death: edema and plethora of the brain and its membranes, overflow of blood in the veins, small hemorrhages in the brain tissue and under the membranes of the heart, pleura of the lungs, liquid dark blood and plethora of internal organs. Painful changes in tissues and organs arising from local exposure to high temperatures are called thermal burns. Burns are caused by the short-term action of a flame, hot liquids, resins, gases, vapors, heated objects, molten metal, napalm, etc. From the action of acids and alkalis arise chemical burns, by changes in tissues sometimes resembling thermal ones. The degree of tissue damage depends on the temperature of the damaging substance and the duration of its action. First degree burn characterized by redness, swelling, burning sensation of the skin. The consequences of a burn are limited only to peeling of the surface layer of the skin. Second degree burn occurs with prolonged exposure to high temperature with the formation of blisters in the affected area as a result of acute inflammation of the skin. The skin surrounding the blisters is sharply swollen, red. third degree burn diagnosed with prolonged exposure to high temperature, it is characterized by necrosis of the skin. The skin in the place of necrosis is yellowish, edematous, covered with blisters. With dry necrosis, the skin is dry, dense, brown or black. The result of the healing of such a burn is a scar. Fourth degree burn occurs under the action of a flame, it causes irreversible changes in the skin, underlying tissues, up to the bones (charring). 25. THE EFFECT OF LOW TEMPERATURE ON THE HUMAN BODY The occurrence and severity of general and local reactions during cooling depend not only on the ambient temperature, but also on humidity, air velocity, the nature of clothing, and the state of the body. Alcohol intoxication, exhaustion, overwork contribute to the rapid cooling of the body. Low temperature has a local and general effect on the human body. The local effect of cold leads to frostbite. First degree frostbite characterized by purplish skin color and edema. Such lesions heal in a few days, accompanied by slight peeling. Frostbite second degree accompanied by the formation of blisters with bloody contents, swelling and redness around. Third degree frostbite characterized by the formation of necrosis (death) of soft tissues with the development of reactive inflammation. The skin takes on a pale bluish color, and blisters appear on it, filled with bloody contents. Over time, the diseased tissue is rejected, slow healing occurs with the formation of a scar after 1-2 months. Frostbite fourth degree characterized by the development of deep necrosis with necrosis of not only the skin, soft tissues, but also bones. General cooling is accompanied by increased heat transfer from the body. A decrease in body temperature to +35 "C is dangerous for human health, and below +25" C causes irreversible phenomena. The clinical picture during cooling is characterized at first by an excessive feeling of cold, trembling, "goose bumps" appear, then weakness, drowsiness, numbness of certain parts of the body join, unconsciousness sets in, and with further cooling - death. When examining the corpse, at the place of its discovery, they note the “pose of a chilling person”, who, trying to keep warm, presses his arms and legs to the body, bending them, he seems to “curl up”. In the immediate vicinity of the corpse and under it, signs of the effect of the heat of the human body on the snow are found, which melts with the subsequent formation of a crust of ice. Icicles can be seen at the openings of the nose and mouth of the corpse, frost on the eyelashes. Skin, cadaveric spots have a pinkish tint due to oversaturation of blood with oxygen. When examining a corpse, specific signs for cooling are not found. However, signs of rapid death are expressed. At autopsy, it is possible to detect hemorrhages in the gastric mucosa - "Vishnevsky's spots". There is an overflow of the bladder due to a violation of its innervation. In connection with increased heat production, the loss of carbohydrates increases, which is expressed in the disappearance of glycogen from the liver, pancreas, and brain, which is determined by histochemical examination. Microscopically, it is possible to detect areas of necrosis in the adrenal glands, testicles. When examining brain tissues, an increase in its volume is sometimes noted, followed by cracking of the skull bones and divergence of the sutures. Post-mortem skin breaks may be mistaken for trauma. 26. ACTION OF ELECTRICITY electrical injury - this is the result of the action on a living organism of technical (from the power and lighting network) and atmospheric (lightning) electricity. A forensic medical examination is carried out in the case of determining the degree of disability in persons affected by electric current. Electric current renders thermal action - from local burns to charring, mechanical - tissue damage from convulsive muscle contractions, when the body is thrown away from the conductor, and electrical - electrolysis of tissue fluids. For non-fatal injuries disorders of the nervous system (paralysis), organs of vision and hearing can be observed. specific sign electric shocks are electrotags. A typical electromark is a damage in the form of formations of a round or oval shape, grayish-white, pale yellowish in color with roller-shaped edges and a sinking center, usually without signs of inflammation, sometimes with swelling of the tissues around and plaque of metal particles, peeling of the epidermis. The sizes of electrical tags are usually up to 1 cm. Burns from the action of high voltage current can occupy a large area. Metallization of the electrotag, depending on the type of metals that make up the conductor, gives it the appropriate color. The shape of the conductor can be reflected in the electrotag. Electrotags can have different localization, but more often on the palms and plantar surfaces of the feet. Atmospheric electricity damage is observed during periods of increased thunderstorm activity. Lightning - a powerful charge of atmospheric electricity (with a voltage of millions of volts and a force of up to 1 A), striking both outdoors and indoors, transport. More often it affects people who are near high objects, electrical equipment and other conductive objects. Both fatal and non-fatal injuries are possible. Lightning damage occurs due to its mechanical and thermal effects. At the same time, tears in the fabric of clothing and holes in it, its burning, and melting of metal objects are revealed. Sometimes clothes are torn to shreds and scattered. Lightning damage is characterized by singed hair, burns of the body of various sizes and depths, as well as "lightning figures" on the skin in the form of tree-like branches of a reddish color. "Lightning figures" usually disappear by the end of the first day. Of great importance for the forensic medical diagnosis of cases of lightning strikes is a detailed examination of the scene and the corpse. Split and burnt trees, damaged buildings, caked clods of earth and sand, traces of destruction and fire in the room, deformed and melted metal objects can be found at the scene of the incident. When examining a corpse, attention is drawn to the presence of ruptures in clothing, its burning, melting of metal objects, as well as damage to the body characteristic of lightning. 27. ACTION OF RADIANT ENERGY In contrast to injuries of other origin in humans at the time of exposure to radiant energy there are no pain, heat and other sensations, characteristic of the impact on the body of most physical factors. Before the onset of signs of radiation injury, hidden period, the duration of which is mainly determined by the dose of absorbed energy. The severity of the lesion depends on the dose of absorbed energy and the time of the lesion. Depending on the magnitude of the absorbed dose and the duration of exposure, acute and chronic forms of radiation sickness are distinguished. Acute radiation sickness is an independent disease that develops as a result of short-term irradiation of significant areas of the body with ionizing radiation or the intake of radioactive isotopes into the body, creating a total single dose of 200 x-rays of external gamma radiation. With a single irradiation of more than 400 roentgens as a result of circulatory disorders and secondary infectious complications, death occurs on the 3-4th week after irradiation with large doses. chronic radiation sickness occurs as a result of prolonged exposure to low doses of ionizing radiation. It is characterized by gradual development, long and undulating course. The mechanism of chronic radiation sickness is the selective absorption of radioactive substances by the tissues of internal organs in accordance with their radiosensitivity. Clinical differentiation into separate periods in chronic radiation sickness is not detected. Diagnose total lesions of the body with a general severe reaction of the body and damage to one degree or another of the hematopoietic organs; local lesions with the formation of radiant ulcers (edema, blisters, necrosis, scarring), malignant tumors, but also with a general reaction of the body and the addition of an infection (sepsis) and heavy bleeding. Death mainly occurs from the addition of various complications and exacerbation of existing diseases. Local radiation injury most often found in forensic medical examinations. The term "local lesion" is rather arbitrary, since it indicates the reaction of the whole organism to the effects of radiation. For local radiation injuries, the same periods are characteristic as for acute radiation sickness: latent, period of hyperemia, period of blistering, necrosis and healing period. Forensic medical examination of living persons is most often carried out in order to determine the degree of loss of general and professional ability to work from exposure to radiant energy. At the same time, the forensic medical expert must examine the circumstances preceding the illness (death), the source of radiation, the testimony of witnesses, medical documents, and the measures taken to protect against radiation. 28. REASONS FOR FORENSIC EXAMINATION OF LIVING PERSONS Issues arising in legal practice relating to human life and health are very diverse and relate to many medical specialties. Forensic medical practice shows that the examination of living persons is carried out for the following reasons that arise in criminal and civil cases: 1. When causing harm to health - to determine the severity of harm to health and solve a number of other problems associated with it; to determine the size of the loss of general ability to work: to determine the size of the loss of professional ability to work; to establish infection with a venereal disease; to establish HIV infection; to determine the state of health, physical condition of the suspect, the accused, the victim and the witness; to determine artificial and feigned diseases (simulation, aggravation, dissimulation, as well as self-harm). 2. When determining sexual status - to determine the controversial sexual condition (hermaphroditism); to determine sexual inviolability; to determine puberty; to determine the productive ability (the ability to have sexual intercourse, fertilization, conception, childbearing); to determine pregnancy (existing, existing), former childbirth, abortion. 3. For sexual crimes - to determine rape; to determine indecent acts; to determine sodomy; to define lesbianism. 4. Other occasions - to determine the age; for personal identification. 29. FORENSIC HAIR EXAMINATION Hair appears as physical evidence in cases of murder, rape, bodily harm, theft, animal theft, etc. Depending on the nature and characteristics of the crime, hair can be discovered on the clothes and body of the victim and the suspect, on the instruments of crime and other objects. The objects on which to look for hair are determined in each case by the circumstances of the incident. Thus, hair (hair) can be found on the weapon of crime (eg, inflicting bodily harm, murder), on the clothes and body of the suspect and the victim (eg, in rape). Finding hair is sometimes very difficult, because it is not easy to notice, especially if they do not differ in color from the general background of the object on which they are located. On various objects, hair is detected by examining them with the naked eye, using a magnifying glass. Hair can be found in a tuft or singly. The color of single hair is defined as black, brown, yellow, etc., in a bundle or strands - as black, dark blond, light blond and red. 30. HAZARD TO HEALTH, SEVERE, MODERATE AND MINOR Under harm to health understand either bodily injury, i.e. violation of the anatomical integrity of organs and tissues or their physiological functions, or diseases or pathological conditions resulting from the impact of various environmental factors: mechanical, physical, chemical, biological, mental. guide to determining the severity of harm to health is the Criminal Code of the Russian Federation. At the same time, it should be borne in mind that if there is a written order from the prosecutor's office, the Ministry of Internal Affairs or the court, a forensic medical examination can be carried out. The Criminal Code distinguishes: severe bodily harm, moderate bodily harm and slight bodily harm. In addition, the Criminal Code of the Russian Federation provides for special methods of causing damage: beatings, torment, torture, the establishment of which is not within the competence of a forensic medical expert. The solution of this issue belongs to the competence of the bodies of inquiry of the preliminary investigation, the prosecutor's office and the court. Qualifying signs of the severity of harm health are: danger of harm to health for human life; duration of health disorder persistent loss of general ability to work; loss of any organ or loss of its functions by the organ; loss of vision, speech, hearing; complete loss of professional ability to work; abortion; indelible disfigurement of the face; mental disorder; drug addiction or substance abuse. To establish the severity of harm to health, the presence of one of the qualifying signs is sufficient. If there are several qualifying signs, the severity of harm to health is determined by the one that corresponds to the greater severity of harm to health. sign of serious harm health is a life-threatening harm to health, and in the absence of this sign - the consequences of causing harm to health: loss of vision, speech, hearing; loss of any organ or loss of its functions by the organ; indelible disfigurement of the face; health disorder associated with a permanent loss of general ability to work by at least one third; complete loss of professional ability to work; abortion; mental disorder; drug addiction or substance abuse. Signs of harm to health of moderate severity are: no danger to life; the absence of the consequences specified in Art. 111 of the Criminal Code of the Russian Federation; long-term health disorder; Significant permanent loss of general ability to work by less than one third. Signs of mild harm to health are a short-term health disorder; slight permanent loss of general ability to work. Establishing a permanent disfigurement of a face is not within the competence of a forensic medical expert, because this concept is not medical. A mental disorder, its diagnosis and a causal relationship with the impact received, is carried out by a forensic psychiatric examination. This examination can also be carried out by a commission of experts with the participation of a psychiatrist, a neuropathologist, chaired by a forensic medical expert. 31. HARM TO HEALTH - DANGEROUS AND NOT DANGEROUS TO LIFE life-threatening is a health hazard that causes a life-threatening condition that can result in death. Prevention of death as a result of medical care does not change the assessment of harm to health as life-threatening. Life-threatening harm to health can be both bodily injuries and diseases and pathological conditions. Life-threatening injuries are: injuries that, by their nature, threaten the life of the victim at the time of their application and can lead to his death; damage that caused the development of a life-threatening condition, the occurrence of which is not accidental. К life-threatening conditions include shock of severe (III-IV) degree of various etiologies: coma of various etiologies; massive blood loss acute cardiac or vascular insufficiency, collapse, severe cerebrovascular accident; acute renal or acute liver failure; severe acute respiratory failure; purulent-septic conditions; disorders of regional and organ circulation, leading to a heart attack of internal organs, gangrene of the extremities, embolism (gas and fat) of cerebral vessels, thromboembolism; a combination of life-threatening conditions. Non-life-threatening bodily harm, which is serious in consequences. Damage to health, leading to loss of vision - this is understood as complete permanent blindness in both eyes or such a condition when there is a decrease in vision to visual acuity of 0,04 and below (finger count at a distance of 2 m and to light perception). When determining the severity of harm to health on the basis of loss of vision, the possibility of improving vision with the help of medical and technical means (corrective glasses) is not taken into account. Damage to health, leading to loss of speech, - this is understood as the loss of the ability to express one's thoughts in articulate sounds understandable to others, or as a result of loss of voice. From this point of view, stuttering in a pronounced form should also be classified as serious harm to health. Health damage resulting in hearing loss - this is understood as complete deafness or such an irreversible condition when the victim does not hear spoken language at a distance of 3-5 cm from the auricle. Hearing loss in one ear, as the loss of its functions by an organ, refers to serious harm to health. Harm to health, leading to the loss of any organ or the loss of its functions by an organ, - this should be understood as: 1. Lose arms, legs those. their separation from the body or the loss of their functions (paralysis or other condition that excludes their activity) The loss of the most functionally important part of the limb (hand, foot) is equated to the loss of an arm or leg. In addition, the loss of a hand or foot entails a permanent disability of more than one third and, on this basis, also refers to serious harm to health. 2. Damage to the genital organs, accompanied by a loss of productive capacity, i.e. the ability to copulate, fertilize, conceive, bear, bear children and feed. 3. Loss of one testicle, resulting in organ loss. 32. DETERMINATION OF THE VALUE OF THE PERSISTENT LOSS OF GENERAL WORK CAPABILITY The duration of a health disorder is determined by the duration of temporary disability (temporary disability). When assessing the severity of harm to health, both temporary and permanent disability are taken into account. From a forensic point of view pillar should be considered the loss of general ability to work either with a definite outcome, or with a duration of health disorder over 120 days. Under pillar disability not less than one third should be understood as a permanent disability of more than 30%. Under significant permanent loss general working capacity less than one third should be understood as permanent disability from 10 to 30% inclusive. Under slight permanent loss ability to work should be understood as a permanent loss of total ability to work up to 5%. The degree of loss of professional ability to work is determined by the "Rules for establishing the degree of loss of professional ability to work as a result of accidents at work and occupational diseases" (2000). Duration of temporary disability determined taking into account the data contained in the submitted medical documents. The forensic medical expert, assessing the nature and duration of the disease or dysfunction associated with the harm caused to health, must proceed from objective medical data, including those established during the examination. The forensic medical expert should critically evaluate the data of medical documents, since the duration of the treatment of the victim may not be justified by the nature of the injury. On the other hand, there may be a refusal of the injured person from a disability certificate and a premature exit to work at his own request. In all cases, the medical examiner must assess the duration of the disease and its severity based on objective data. Under long-term health disorder should be understood as temporary disability lasting more than 3 weeks (more than 21 days). When examining injuries that caused a long-term health disorder, it is necessary to carefully analyze medical documents, since in some cases a patient’s long stay in treatment is not due to the injury itself, but to the need for a clinical examination or other factors. Under short-term health problems should be understood as temporary disability lasting no more than 3 weeks (21 days). К serious bodily harm also include injuries, diseases, pathological conditions that entailed a complete loss of professional ability to work. Under professional ability to work understand the ability of a person to perform a certain amount and quality of work in a particular profession. If the sub-expert has several professions, then the main profession is considered to be the one in which the damage was received or in which there is the longest work experience, or the one obtained through special training, or the one in which the highest qualification has been achieved. 33. BEATING, TORTURE AND TORTURE beating are actions characterized by repeated blows, as a result of which bodily injury may occur. However, beatings may not leave behind any objectively detectable damage. If, as a result of repeated blows, harm to health occurs (serious, moderate or light), then such actions are not considered as beatings, but are assessed as causing harm to health of the appropriate severity. If, after striking, damage is found in the subject under examination (abrasions, bruises, small wounds that do not entail temporary disability or a slight permanent loss of general ability to work), they are described, noting the nature of the damage, localization, signs indicating the properties of the object that caused them, prescription and the mechanism of education. At the same time, these injuries are not regarded as harm to health and their severity is not determined. Torment and torture are actions that may result in harm to health. The forensic medical expert does not establish the fact of torment and torture. However, the expert must determine: the severity of the harm to health caused by the torment, i.e. actions that cause suffering (disease) by prolonged deprivation of food, drink, air, heat or light; or placing (or leaving) the injured person in unhealthy conditions, or other similar actions; the presence, nature of injuries, their localization, the instrument and mechanisms for the occurrence of injuries, the prescription and non-simultaneity of their infliction, the severity of harm to health in cases of causing it in a way that is in the nature of torture. Under torture understand the infliction of physical or mental suffering by systematic infliction of beatings or other violent actions (prolonged infliction of pain by pinching, cutting, inflicting multiple, including small, injuries with blunt or sharp piercing objects, exposure to thermal factors and other similar actions). 34. FORENSIC-MEDICAL EXAMINATION OF DETERMINATION OF THE STATE OF HEALTH AND THE AMOUNT OF DISABILITY TO WORK Conducted by expert commissions in connection with transport and domestic injuries; about causing harm to health at work and in a number of other cases. Determination of the physical state of health may be required for suspects, accused, when there are doubts about their ability to independently protect their rights and legitimate interests in criminal proceedings. Conducting a forensic medical examination is mandatory to determine the physical condition of the victim, when there is doubt about his ability to correctly perceive the circumstances relevant to the criminal case and give evidence (Article 196 of the Code of Criminal Procedure of the Russian Federation). In some cases, it is necessary to determine the state the health of the witness summoned to the court session, if he refuses to appear, referring to illness. The court may have doubts about the correctness of the medical documents submitted by such a person, therefore a forensic medical examination is appointed. May require health assessment street, sentenced to corrective labor and declaring his illness, in connection with which he cannot serve his sentence. Article 398 of the Criminal Procedure Code of the Russian Federation provides for the postponement of the execution of a sentence on condemning a person to compulsory labor, corrective labor, restriction of freedom, arrest or deprivation of liberty on the following grounds: illness of the convict that prevents the serving of the sentence - until his recovery, the convict's pregnancy or the presence of her young children - until she reaches youngest child aged 14. In civil cases, this examination is carried out in connection with various claims, determining the need for enhanced nutrition, spa treatment, motorized transport, etc. 35. FORENSIC EXAMINATION OF ARTIFICIAL AND MAKE DISEASES The forensic medical examiner has to conduct research on suspicion of an artificial or feigned disease in cases where such diseases are the basis for criminal liability. In some cases, self-harm, feigned or feigned illness are detected in the course of the study of the subject, in others, the study is carried out on suspicion of self-harm, feigned or feigned illness. self harm - this is an intentional, unlawful infliction of harm to one's health in the form of damage caused by various means and methods independently or with the help of other persons. We have to deal with self-damage caused by mechanical effects on organs and tissues, as well as chemical, physical and other agents. Artificial disease. With an artificial disease, the subject also harms his health in various ways. Only the appearance of this harm does not have the character of a mechanical or chemical injury, but proceeds in the form of a disease that can be mistaken not for self-harm, but for an ordinary disease. In these cases, the subject goes to the doctor not with an injury, a burn, but with a disease, the artificial nature of which must be recognized. Simulation. During simulation, a healthy subject only pretends, depicts a disease, sometimes using for this some means that do not cause harm to health. For example, he paints a part of the skin, wishing to depict a bruise, adds blood to the urine, depicts an epileptic seizure, etc., i.e. a healthy person portrays himself as sick, pretends to be sick. Aggravation. In medical practice, aggravation refers to the exaggeration of the symptoms of an actual disease. Aggravation is said to be when a patient suffering from a disease exaggerates some of its symptoms. For example, he complains of a severe headache, when it is much weaker than the witness tries to show, or a rheumatic complains of severe pain in the joints, when he does not really experience such pain. The difference between simulation and aggravation lies in the fact that the simulator is actually healthy and only depicts the disease or symptoms of the disease, while the aggravant is a sick person who exaggerates the severity of the symptoms of his disease. Dissimulation. In practice it is necessary to meet sometimes with deliberate concealment of really existing disease. This state is called dissimulation. Dissimulation is the opposite concept of simulation. During simulation, a healthy person pretends to be sick; during dissimulation, a sick person pretends to be healthy, hides his disease for various motives and reasons. For example, life and health insurance. The conditions of insurance provide for the refusal to pay the insurance premium if it turns out that the insured person concealed his illness during insurance. 36. FORENSIC EXAMINATION OF THE ESTABLISHMENT OF GENDER AND IN THE INVESTIGATION OF SEX CRIMES Forensic medical examination of the establishment of gender and sexual conditions. In criminal and civil cases, a forensic examination of the determination of sexual status may be associated with the need to establish: true sex: puberty; the ability to have sexual intercourse, fertilization, conception; sexual inviolability; the presence of pregnancy, its absence, former childbirth, abortion. Forensic medical examination in the investigation of sexual crimes. When investigating these crimes, it is necessary to conduct a forensic medical examination, which may be subjected to victims, suspects, defendants and material evidence. Before the forensic medical examination, a number of special issues are put up for resolution. The Criminal Code of the Russian Federation provides for the following types of crimes for which a forensic medical examination may be ordered: rape; violent acts of a sexual nature. Sexual intercourse with a person under the age of 16; indecent acts against a person under the age of 14; sodomy with the use of physical violence or against a minor; lesbianism with the use of physical violence or against a minor. Forensic medical examination of infection with a venereal disease. Infection with a venereal disease is a crime against human health. The punishment for this crime is provided by Art. 121 of the Criminal Code of the Russian Federation. It does not matter which way the infection occurred: sexual or non-sexual, if the necessary personal hygiene measures are not observed, the so-called household infection. If the patient was treated, and he had reason to believe that he was cured, or there was an erroneous medical conclusion about the cure, but in fact there was no cure and as a result of this infection occurred, then liability under Art. 121 of the Criminal Code of the Russian Federation is excluded. Venereal diseases are: syphilis, gonorrhea, soft chancre, inguinal lymphogranulomatosis. Infection with only these infectious sexual diseases can be discussed when bringing to criminal responsibility. Forensic medical examination of HIV infection. Art. 122 was first introduced into the new Criminal Code of the Russian Federation. She views HIV infection as a crime against human health. A person guilty of contracting HIV infection is brought to criminal responsibility only if he knew that he had this disease. It does not matter which way the infection occurred: sexual (more often with homosexual contacts) or non-sexual (more often by injection through the blood of drug addicts), or if hygiene standards and rules are not observed. The HIV virus is contained in the blood, saliva and seminal fluid of a patient or carrier of the infection. Withdrawal, packaging and shipment of material to be tested for HIV infection is carried out in accordance with special instructions from the Ministry of Health and Social Development of the Russian Federation. 37. DEATH AND BODY CHANGES Dying and death. Persons who are the first to examine the corpse at the scene of the incident have to solve a number of complex problems: to state the onset of death, to determine the nature and lifetime of the injuries found on the corpse and the time of death. To solve them, it is necessary to know well how a person dies, and what changes occur in the corpse at various times after the onset of death. The onset of death is manifested in the irreversible violation of the basic vital functions of the body, followed by the cessation of the vital activity of individual tissues and organs. Death from old age (physiological) is rare. More often, the cause of death is diseases or the impact on the body of various adverse factors (trauma, extreme temperatures, etc.). Death is preceded agony. It is characterized by a profound disruption of all vital processes in the body and can last up to several hours or even days. During this period, cardiac and respiratory functions are weakened, confusion often sets in, the skin of the dying person becomes pale, the nose sharpens, sticky sweat appears, and the body temperature drops. Consciousness is confused. Sometimes a person dying in agony is agitated, tosses about in bed and can inflict various injuries on himself (inflicting abrasions on his face, neck, chest and other parts of the body with his fingernails). The agonal period passes into a state of clinical death. Clinical death - a condition in which the cessation of breathing and cardiac arrest, increasing oxygen starvation of all organs and tissues are recorded. With the timely provision of medical care, it is sometimes possible to return a dying person from a state of clinical death to life. This possibility is due to the fact that during this period, in the absence of external signs of life, metabolic processes remain at a minimum level in the tissues. Thanks to the great successes of resuscitation, many patients who were in a state of clinical death have been brought back to life. Clinical death lasts about 5-6 minutes, but low body temperature (hypothermia) can prolong it somewhat. biological death - the next stage of dying, which is characterized by a transition to a state when irreversible changes occur in tissues and organs. First of all, they occur in the higher parts of the central nervous system as the most sensitive to oxygen starvation, in particular in the cerebral cortex. A number of tissues and organs retain their vital activity for a longer time, which is used in medical practice when transplanting them from one person to another (from a corpse to a living person). To establish the fact of death a number of orienting signs indicating the onset of death are used. These include: lack of sensitivity (reaction) to various stimuli (thermal, pain), reflexes from the cornea and pupils, respiration, blood circulation, and a number of others. To ascertain death, the forensic medical expert uses both the orienting signs described above and reliable signs associated with the appearance of early cadaveric changes. 38. DEATH, ITS CLASSIFICATION BY CATEGORY, TYPE AND GENUS In forensic medicine, death itself is distinguished by category, type and genus. There are two categories of death: violent and non-violent. Violent death is associated with the impact on the human body of various environmental factors - mechanical, chemical, thermal, etc. Non-violent death occurs from various diseases (cardiovascular system, respiratory system, cancer, etc.). Type of death - its definition is associated with the establishment of factors similar in origin or effect on the human body. For example, during a violent death, there are injuries resulting from the action of sharp and blunt tools, parts of a moving vehicle, caused by firearms, etc. All this distinguishes the type of death from mechanical damage. Kind of violent death. Depending on the conditions of occurrence, violent death can be the result of murder, suicide, or an accident. The type of non-violent death includes sudden and sudden death. The first comes from a disease, but among apparent health, unexpectedly for others; the second is ascertained against the background of the disease at the time of diagnosis, and although no life-threatening signs were seen during this period, a complication that arose or an unexpected rapid development of the disease suddenly caused death. The first and main issue to be resolved during a forensic medical examination of a corpse is establishing the cause of death. The cause of death is considered to be diseases, conditions, processes that caused cardiac arrest. Wherein distinguish between: ■ Immediate causes of death: cardiac arrest, respiratory arrest, "brain death" (cessation of the functions of the central nervous system); • immediate causes of death: reflex cardiac arrest, shock, acute blood loss, hypoxia of various origins, embolism (fat, air, gas), intoxication, diseases, collapse, coma, acute cardiovascular failure, acute renal failure, acute liver failure, etc. 39. EARLY CARDIAC CHANGES Reliable signs of death are divided into early (appearing shortly after death) and late (observed some time after death). Corpse cooling. The temperature of the corpse due to the cessation of metabolic processes in the body gradually decreases to the ambient temperature (air, water, etc.). The degree of cooling depends on a number of factors: the ambient temperature (the lower it is, the faster the cooling occurs, and vice versa), the nature of the clothing on the corpse (the warmer it is, the slower the cooling occurs), fatness (in obese people, cooling occurs more slowly than in malnourished), causes of death, etc. Parts of the body that are not covered with clothes cool faster than those that are covered. The degree of cooling of the corpse is one of the reliable signs of death (body temperature below +25 "C usually indicates death). Dead spots. They arise as a result of the post-mortem redistribution of blood in the corpse. After cardiac arrest, the movement of blood through the vessels stops, and, due to its gravity, it begins to gradually descend into the relatively lower parts of the corpse, overflowing and expanding the capillaries and small venous vessels. The latter are translucent through the skin in the form of bluish-purple spots, which are called cadaveric. Higher parts of the body do not have cadaveric spots. They appear approximately 2 hours (sometimes 20-30 minutes) after death. When examining a corpse at the scene and in the morgue, attention is paid to the presence and severity of cadaveric spots, their color and the area they occupy (prevalence), disappearance or color change when pressed. Rigor mortis. After the onset of death, biological processes occur in the muscles of the corpse, leading first to relaxation, and then (3-4 hours after death) to contraction and hardening, their stiffness. In this state, the muscles of the corpse create an obstacle to passive movements in the joints, therefore, to straighten the limbs, which are in a state of pronounced rigor mortis, it is necessary to use physical force. The full development of rigor mortis in all muscle groups is achieved on average by the end of the day. After 1,5-3 days. stiffness disappears (resolved), which is expressed in muscle relaxation. Corpse desiccation. After the onset of death, the body begins to lose fluid and partially dry out. Drying of the skin and visible mucous membranes becomes noticeable a few hours after death. First of all, the areas covered with the stratum corneum of the skin or moistened during life dry up. Relatively quickly (5-6 hours after the onset of death), the corneas of open or half-open eyes dry out (they become cloudy, acquire a whitish-yellowish color), the mucous membrane and the border of the lips. Signs of cadaveric drying are used during an external examination of a corpse to ascertain death, to resolve the issue of the time of its onset. Corpse digestion. With the onset of death, the tissues of a corpse undergo self-digestion under the influence of enzymes, especially tissues and organs rich in enzymes: the pancreas, adrenal glands, liver, etc. 40. LATE cadaveric changes. ROT AND MUMMIFICATION The corpse, depending on the nature of the processes developing in it, is subjected to destruction (rotting) or conservation (mummification, peat tanning, transformation into fat wax). Such changes complete their formation a month or even years after death. They are called late cadaveric changes (phenomena). Their character largely depends on the conditions in which the corpse is located. Putrefaction - this is a complex process of decomposition of organic compounds, primarily proteins, under the influence of microbes, usually begins on the second or third day after death. Its development is accompanied by the formation of a number of gases (hydrogen sulfide, methane, ammonia, etc.), which have an unpleasant odor specific to decay. The intensity of the decay process depends on many factors. The most significant are ambient temperature and humidity. Decay occurs quickly at an ambient temperature above 30 "C. In air, it develops faster than in water or soil. The degree of development of putrefactive decomposition of a corpse is used for an approximate judgment about the prescription of death. Sharp putrefactive changes in a corpse make it difficult, and sometimes impossible, to determine the lifetime or posthumous origin of the injuries present on the corpse, as well as the causes of death due to diseases. Mummification. Under certain conditions, the decay that has begun can be stopped due to the rapid drying of the corpse. This phenomenon is called mummification. Under favorable conditions for mummification (dry air and sufficient ventilation), complete drying occurs, while the weight of the mummified corpse is about 710 neP "initial. Mummification usually occurs when corpses are found in attics, when they are buried in dry coarse-grained and sandy soils, in well-ventilated crypts, etc. Complete mummification of an adult corpse requires 6-12 months after death. In a state of natural mummified corpses persist for a long time.The skin of a mummified corpse takes the form of a dense brownish-brown parchment, sometimes becomes very brittle, the internal organs also completely dry out, lose their appearance, sharply decrease in size and are dry, shapeless formations in the form of films. In some cases, only certain parts of the corpse, more often the limbs, are mummified. The rapid drying and preservation of corpses during mummification make it possible to use them to describe and identify a person (in some cases, for these purposes, it is necessary to resort to the restoration of a corpse). On the skin of such corpses, injuries that occurred during life (strangulation furrow, injuries from sharp tools, firearms, etc.) are well preserved, the nature and origin of which can be determined during the study. It is possible to establish previously transferred diseases of the skeletal system, group specificity of proteins in tissues and organs, which corresponds to the blood group. 41. LATE cadaveric changes. LADYWAX AND PEAT TANNING Zhirovovsk. When corpses are buried in moist, clayey or swampy soil, as well as when they stay in stagnant water bodies, the decay that has begun due to the lack of oxygen stops, the tissues and organs of the corpse gradually turn into a state of fat wax (saponification of the corpse). Zhirovovsk is a greyish-white granular mass with a greasy sheen and a characteristic smell of rancid cheese. As a result, tissues acquire a whitish-yellowish color, coarse-grained appearance, gradually harden and become crumbly. The development of the adipose tissue is promoted by the increased content of fat in the tissues of the corpse. The formation of a fat wax becomes noticeable after 3-5 weeks. The corpse of a newborn usually turns completely into a state of fat wax after 5-6 months, and the corpse of an adult - not earlier than after 10-12 months. But corpses in this state are also suitable for identification, they may retain traces of damage, a strangulation furrow and other changes that are of great importance for the investigation and examination. In the study of internal organs, it is sometimes possible to establish even various painful changes. Peat tanning. The corpse, when it enters marshy soil or peat bogs, under the influence of the humic acids and tannin contained in them, undergoes the so-called peat tanning. At the same time, the skin of the corpse is tanned, becomes dense, dark brown in color, the internal organs decrease in size, the mineral salts in the bones dissolve and are washed out of the corpse, the bones become soft and are easily cut with a knife, resembling cartilage in their consistency. In this state, the corpses are preserved for a long time. Peat tanning fixes the damage on the corpse and allows the identification of the deceased. The natural preservation of a corpse can also occur under certain other conditions that contribute to the cessation of the process of decay at the very beginning of its development (stay of the corpse in water with a high concentration of salts, in oil, at low ambient temperatures, etc.). In such cases, corpses can be preserved for a long time, which allows the expert to solve a number of important questions for the investigation (cause of death, nature of injuries, etc.) during their examination. 42. EXAMINATION OF THE CORSE AT THE SITE OF DETECTION External examination of the corpse at the place of its discovery investigator with the participation of attesting witnesses, a forensic medical expert, and if it is impossible to participate - a doctor. If necessary, other specialists may be involved in the examination of the corpse. Unidentified corpses are subject to mandatory photography and fingerprinting. Cremation of unidentified corpses is not allowed. If it is necessary to remove the corpse from the burial place, the investigator takes out exhumation order and notifies close relatives or relatives of the deceased. The decision is binding on the administration of the respective burial place. In the event that close relatives or relatives of the deceased object to the exhumation, permission to conduct it is issued by the court (Article 178 of the Code of Criminal Procedure of the Russian Federation). At the site where the body was found forensic doctor reveals signs that make it possible to judge the time of death, the nature and mechanism of the occurrence of injuries, and other data that are important for investigative actions; advises the investigator on issues related to the external examination of the corpse at the place of its discovery and the subsequent conduct of a forensic medical examination; assists the investigator in detecting traces similar to blood, semen or other biological secretions of a person, hair, various substances, objects, tools and other objects, and assists in their removal; draws the attention of the investigator to all the features that are important for this case; gives explanations to the investigator about the actions performed by him. The results of the examination of the scene and the corpse, as well as the start and end time of the inspection of the corpse are recorded in the protocol of the inspection of the scene, drawn up by the investigator (Article 180 of the Code of Criminal Procedure of the Russian Federation). The protocol describes all the actions of the investigator, as well as everything discovered during the inspection in the order in which the inspection was carried out, and in the form in which the discovered was observed at the time of the inspection. The protocol lists and describes all items seized during the inspection. The protocol should also indicate at what time, in what weather and what kind of lighting the inspection was carried out, what technical means were used and what results were obtained, what items were seized and sealed and with what seal, where the corpse or items of importance to the body were sent after the inspection. criminal case. The formulation of records relating to the description of the corpse, traces similar to blood, on behalf of the investigator, can be made by a forensic physician who has the right to make comments and additions to be included in the protocol. After reading the protocol, the participants in the examination of the scene of the incident, including the doctor - a specialist in the field of forensic medicine, sign (Article 166 of the Code of Criminal Procedure of the Russian Federation). 43. FORENSIC EXAMINATION OF A CORSE In accordance with the Order of the Ministry of Health No. 161 of April 24, 2003 "On the approval of the Instructions for the organization and production of expert studies in the bureau of forensic medical examination" expert examination of the corpse can be started only after the appearance of early cadaveric changes (cadaveric cooling, cadaveric spots, rigor mortis). Before the appearance of these changes, the examination of the corpse can be carried out only after the fact of death has been ascertained in the prescribed manner. An expert study of a corpse is carried out in the relevant departments of the bureau of forensic medical examination or on the basis of the pathoanatomical departments of state and municipal healthcare institutions. The incoming corpse, clothes and various items delivered with the corpse are registered in the prescribed manner. The clothes of the corpse and other items delivered with it are kept until the start of the expert examination in the condition in which they arrived. If necessary, the forensic doctor instructs the orderly to carry out specific measures aimed at preventing damage to the delivered items (dry clothes, hang them on mannequins, etc.). Expert examination of the corpse includes the following actions of a doctor - a forensic medical expert: familiarization with the submitted documentation; cadaver study planning; external examination of the corpse; internal examination of the corpse: taking biological material; registration of the protocol (research) part; drawing up a forensic medical diagnosis; registration of "Medical certificate of death"; processing requests for the provision of materials; laboratory studies of the taken biological material: a comprehensive assessment of the results of the autopsy, laboratory studies and data from the submitted materials; preparation of expert opinions. The outlined general scheme of the sequence of actions of a doctor - a forensic medical expert in each specific case may be changed, specified or supplemented. Formulation of "Expert's opinion" is carried out in accordance with the Federal Law "On State Forensic Activities in the Russian Federation" dated May 31, 2001 No. 73-FZ. "Medical certificate of death" is filled in on the day of completion of the study of the corpse. If laboratory tests are necessary to establish or clarify the cause of death, then a preliminary certificate is issued. The impossibility of establishing the type of death or the circumstances and place of injury by the time the death certificate is issued is not grounds for issuing a provisional death certificate; in this case, the form is underlined - "the type of death is not established." After receiving the results of laboratory tests and other necessary information, immediately instead of the preliminary death certificate, the doctor - forensic expert draws up a new "final death certificate". 44. FORENSIC BLOOD EXAMINATION Blood traces play an important role in investigative practice, since they are often traces of an incident or a crime committed. The questions resolved during the examination of blood traces are determined both by the circumstances of the case and by expert capabilities. Identification of traces similar to blood is carried out visually in natural light, bright sunlight or artificial light with or without a magnifying glass; inspection in ultraviolet rays; careful scraping with a sharp object on the surface of the trace (especially if it has a dark color); microscopic examination of clippings from suspicious areas, which are pre-treated with concentrated sulfuric acid. Determination of the species of blood. After identifying traces of blood on material evidence, it is necessary to determine the species specificity of its proteins, i.e. determine whether the blood belongs to a person or some animal. Determination of blood grouping. The classical ABO blood group system is of paramount importance for the forensic differentiation of blood traces. This is due to the high polymorphism of this system, the favorable frequency of distribution of groups among the population of the entire globe, and, most importantly, the exceptional resistance of the antigens of this blood system to external environmental influences. Within this system, all people can be divided into four main groups: 00 (I), AO (II), BO (III) and AB (IV). Determining the gender of the blood. The solution of this issue is often of great importance for the investigation, especially in cases where the group characteristics of the blood of persons of different sexes involved in the case coincide. It is known that women have two identical sex chromosomes (XX), and men have two different (XY). The male chromosome "Y" is characterized by a specific glow (luminescence) that occurs when a blood smear, and, consequently, the nuclei of its cellular elements are processed with a special dye (fluorochrome). The diagnosis of male blood is based on this glow of the Y-chromosome, detected by fluorescence microscopy of blood smears. Traces of blood. Finding traces of blood is often a known difficulty, especially when examining a suspected crime scene. In most cases, the perpetrator is trying to wash or destroy them. Therefore, subtle traces can only be detected upon careful examination (they may have a yellowish or yellowish-pink color). Depending on the characteristics of the formation of traces of blood, several of their forms are distinguished. When bleeding from a damaged vessel (vein, artery), drops, splashes, jets appear, which form spots, streaks, puddles. The nature of the spots from drops, splashes of a jet of blood is different. If drops of blood fall vertically from a small height onto a horizontal surface, rounded spots form. As the fall height increases, the spots first acquire jagged edges, then rays begin to depart from them, and secondary small spots appear around the main spot (from blood splashing). The greater the fall height, the greater the circumference occupied by the secondary spots. When drops of blood fall from a sufficiently high height, they lose their rounded shape. 45. FORENSIC EXAMINATION ON THE CASE MATERIALS The materials of a criminal or civil case are one of the objects of a forensic medical examination. The procedure for the production of these examinations is regulated by the Order of the Ministry of Health "On approval of the Instructions for the organization and production of expert examinations in the bureau of forensic medical examination". The production of forensic medical examinations based on the materials of the case may be entrusted experts of the Bureau of Forensic Medical Examination (republics, regions, territories), researchers and forensic experts of the Russian Center for Forensic Medical Examination of the Ministry of Health of the Russian Federation. The personal composition of experts is determined by the person who appointed the expertise, or the head of the institution whose specialists are entrusted with its production. If in the process of conducting a forensic medical examination based on the materials of the case, it becomes necessary to conduct laboratory tests, the forensic medical experts who performed them are also included in the expert commission. Together with the decision to conduct an expert examination, a criminal or civil case and, if necessary, material evidence or other objects subject to examination are sent to the Bureau of Forensic Medical Examination. The head of the Bureau of Forensic Medical Examination examines the received resolution and case materials and decides on the sufficiency of materials for the examination, the required volume and nature of forensic medical examinations, the composition of the expert commission and the time period for the examination. Having determined, taking into account the requirements of the Code of Criminal Procedure (CPC) of the Russian Federation composition of the committee of experts, the head of the forensic medical examination bureau, on behalf of the investigator, explains to the experts their rights and obligations under the relevant articles of the Code of Criminal Procedure (CPC) of the Russian Federation, and warns of responsibility for giving a knowingly false conclusion and for disclosing the data of the preliminary investigation. Deciding on the order of production forensic medical examination on the basis of the case file is within the competence of forensic medical experts. In "Expert opinion" based on the materials of the criminal (civil) case" mandatory reflections require: data from the examination of the corpse at the place of its discovery and examination of the scene; "Conclusions" of all previous forensic examinations: protocols of post-mortem examinations: data borrowed from medical records of an outpatient or inpatient; protocols of clinical conferences; results of departmental investigations; production characteristics of persons called to account from among the medical personnel; information from the protocols of interrogations, certificates, etc., necessary for a comprehensive and objective expert analysis; other investigative data, including the results of investigative experiments, examinations that are important for substantiating the conclusions. The “expert opinion on the case materials” is registered at the forensic medical examination bureau in accordance with the form established by the Ministry of Health and Social Development of the Russian Federation and is sent no later than three days along with the packed materials of the criminal (civil) case and the objects of study to the body that ordered the examination. 46. FORENSIC EXAMINATION IN CASES OF BREACH OF PROFESSIONAL DUTIES BY MEDICAL WORKERS medical activity, in which moral, ethical and legal norms are very closely intertwined, has significant differences from other professions in relation to both the rights and obligations of a medical worker. These features found their reflection in the "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" of July 22, 1993. Speaking about the protection of the health of citizens, art. 1 of the Fundamentals of Legislation emphasizes that "Protection of the health of citizens is a set of measures of a political, economic, legal, social, cultural, scientific, medical, sanitary-hygienic and anti-epidemic nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of loss of health. The state guarantees the protection of the health of every person in accordance with the Constitution of the Russian Federation. Medical errors. An unfavorable outcome of treatment associated with a conscientious delusion of a doctor is usually referred to as medical errors. Medical errors are divided into three groups: 1) diagnostic errors, which include non-recognition or erroneous recognition of the disease; 2) tactical errors, which include the incorrect definition of indications for the operation, the erroneous choice of the time of the operation, its volume, etc.; 3) technical errors, including the misuse of medical equipment, the use of inappropriate medicines and diagnostic tools, etc. Accidents in medical practice. Sometimes the unfavorable outcome of an operation or other medical intervention is accidental, and the doctor was not able to foresee the misfortune. Such outcomes have received the name of accidents in medical practice in the medical literature. These include all deaths that were unexpected for the doctor. Examples of such outcomes include: 1) activation of a chronic infection after surgery; 2) postoperative complications - cases of peritonitis and bleeding after simple appendectomies, rupture of the surgical scar or thrombosis many days after the operation, air embolism of the heart, and many others; 3) suffocation with vomit during anesthesia; 4) death after encephalography, esophagoscopy, etc. 47. CRIMES OF MEDICAL WORKERS To resolve the issue of criminal liability of medical workers for professional crimes to the investigator and the court necessary identify the presence of the following circumstances: 1) incorrect or untimely provision of medical care, and in cases of failure to provide it, the presence or absence of good reasons for this and the patient's life-threatening condition at the time of failure to provide assistance; 2) the occurrence of death or serious harm to the health of the victim; 3) a causal relationship between the listed actions (inaction) of medical workers and the indicated adverse outcomes; 4) the presence of guilt of a medical worker; 5) establishing the causes and conditions conducive to the commission of a crime. Before deciding on a causal relationship between the action (inaction) of a medical worker and an unfavorable outcome, it is necessary to establish direct cause of death or injury the victim. Guilt of a medical worker in an unfavorable outcome follows from the essence of the facts listed above, testifying to the objective side of the offense. These data should be supplemented with information about the identity of the medical worker (his professional qualifications, attitude to work, patients, assessment of previous activities, etc.). Naturally, the legal assessment of an unfavorable outcome also depends on the conditions that could contribute to the onset of such an event. These include various shortcomings in the work of medical institutions, in particular, the lack of a qualified assistant during an emergency operation, a shortage or low qualification of nursing staff, and a lack of necessary equipment etc. Medical workers are subject to criminal liability for the following professional crimes: failure to provide assistance to the patient, leaving in danger, illegal abortion, illegal private medical practice or private pharmaceutical activity, violation of sanitary and epidemiological rules, forgery, illegal manufacture, acquisition, storage, transportation, transfer or sale of narcotic drugs or psychotropic substances, theft or extortion of narcotic drugs or psychotropic substances, illegal issuance or forgery of prescriptions or other documents giving the right to receive narcotic drugs or psychotropic substances, illegal circulation of potent or toxic substances for the purpose of sale, negligence. Professional crimes of medical workers include also sterilization of women and men without medical indications, unacceptable experiments on humans, although these categories of criminal actions of medical workers are not specifically provided for by the Criminal Code of the Russian Federation. These actions are usually considered by the investigating authorities and the court, by analogy, as infliction of grievous bodily harm on the basis of the loss of its function by the body in the event of sterilization, or as abuse of official authority in cases of inadmissible human experiments. 48. SUBJECT, METHODS AND CONTENT OF FORENSIC PSYCHIATRY Forensic psychiatry is a special branch of general psychiatry. She is inseparable from her. but has its own characteristics. If general psychiatry studies mainly the causes and nature of mental illnesses, their diagnosis, treatment, rehabilitation of mentally ill people and other issues (including the prevention of mental disorders in healthy individuals), then forensic psychiatry, to one degree or another, retains the solution of these issues for itself. , also studies mental illness in relation to the requirements of the special tasks of the criminal and civil process. The object of study of forensic psychiatry there may be a mentally ill and healthy person in everyday life, a suspect, an accused, a defendant, a victim, a witness, a plaintiff, a defendant, and the subject of her research is the state of the psyche, painful disorders and their mental activity, both during a tort and a forensic psychiatric examination, and the establishment of psychopathological changes retrospectively according to the testimony of eyewitnesses, the materials of the criminal and civil cases, the data of medical, official and personal documents (handed over by the investigation and the court for examination by a forensic psychiatric expert). Purpose of forensic psychiatry comes down to establishing the mental state of the subject and helping justice to solve the main problem that arises in the course of judicial and investigative actions - a criminal or a mentally ill person has committed certain unlawful acts. After all, from the point of view of legislation and law, a mentally ill person who has committed a socially dangerous act is not considered a criminal and no punitive and educational influence is applied to him. However, such a person needs coercive measures of a medical nature. This is what determined the practical task of forensic psychiatry: to identify mental disorders in the subject of the study before and during the act (retrospectively) and during the examination (during the examination), to study and evaluate them in relation to the legal norms of domestic justice and healthcare. Such a formulation of the problems of forensic psychiatry determined its main sections: forensic psychiatric examination, coercive measures of a medical nature, penitentiary psychiatry. Based on the fact that generally accepted guiding principle domestic forensic psychiatry and its main section - forensic psychiatric examination is objectivity, evidence and independence, the entire system of forensic psychiatric examination in the Russian Federation has been built. It is under the control of the health authorities. The operational management of expert activities is carried out by the Ministry of Health of the Russian Federation through the local health authorities, and the methodological and scientific management is carried out by the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian. The direct legislative act, which considers the main provisions of mental health care in our country, was the Law "On Psychiatric Care and Guarantees of Citizens' Rights in its Provision" (1992). 49. FORENSIC PSYCHIATRIC EXAMINATION Forensic psychiatric examination is the main section and priority area of forensic psychiatry. Based on the urgent needs of justice, it pursues goal: evaluate and give an expert opinion on the mental state of the persons under expert (subjects of criminal or civil proceedings) during the commission of certain actions, the conduct of an expert examination and the exacerbation of a mental illness. Forensic psychiatric examination subscription is required then, when during the judicial and investigative process, special medical knowledge in the field of psychiatry was required. It is appointed by the bodies of preliminary inquiry, the investigator, the prosecutor and the court. Mandatory execution of such an order is a special procedural document called "Resolution on the production of a forensic psychiatric examination" issued by the person conducting the investigation, or "Determination (decree) on the conduct of a forensic psychiatric examination" issued by a judge in a private prosecution case or in the course of pre-trial preparation of a civil case. The obligatory grounds for the above officials to appoint a forensic psychiatric examination in a criminal process are doubts about the normal state of mental health suspect, accused, defendant, victim, witness; oddities in their behavior and statements; references to existing chronic mental illness or dementia: consequences of traumatic brain injury or brain diseases; examination and treatment in psychiatric hospitals; stay on the register (outpatient treatment) in neuropsychiatric institutions (dispensaries); past forensic psychiatric or labor (military, professional) examinations; lack of visible motives and goals of the committed act; special cruelty in violence and abuse of the victim: incomprehensible mockery of the corpse; constant conflicts (in the family, team, society); gross opposition to everything and everyone. 50. TYPES OF FORENSIC PSYCHIATRIC EXAMINATION In case of insufficient clarity or completeness of the expert’s opinion, as well as in the event of new questions regarding the previously investigated circumstances of the criminal case, a additional forensic examination, the production of which is entrusted to the same or another expert. In cases where there is doubt about the validity of the expert’s opinion or there are contradictions in the conclusions of the expert or experts on the same issues, a re-examination, the production of which is entrusted to another expert, and in especially difficult cases - to the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian. Correspondence examination is carried out only in exceptional cases, when the person under expert cannot be delivered for personal participation, in particular, when he is outside the Russian Federation. Posthumous examination. As a rule, it is carried out in civil proceedings and its difficulty lies primarily in the fact that there is no preliminary investigation in civil proceedings and therefore the quality and quantity of materials that would characterize the actions and personality of the deceased are very limited. Therefore, forensic psychiatric experts, in order to retrospectively establish the mental state of the deceased during the period when he committed certain actions (for example, concluding transactions), it is necessary to familiarize himself with the materials of the civil case submitted to him by the court, medical and non-medical documents, personal correspondence, characteristics of the deceased, presented from the spot work and residence. It is very helpful for forensic psychiatric experts to substantiate the conclusions about the mental state of persons under expertise in this type of examination by examining testimonies. At the same time, their inconsistency, as a rule, entails the need for the participation of an expert in the court session. This is due to the fact that his purposeful questioning of witnesses about the behavior during the period of the act of such a person (for example, the testator during the period of paperwork), relationships with representatives of the parties, certain information about mental disorders that they voluntarily or involuntarily can give at the same time, contribute to identifying the nature of the disease, establishing the depth and severity of pathological mental disorders (if any) and even compiling a retrospective diagnosis. The post-mortem examination is designed to eliminate the consequences of the patient's painful actions, which makes it necessary to assess the mental state of the person under expert retrospectively (after his death). This causes the great complexity of these examinations, because. the expert opinion is based only on the study of the case materials, medical documentation (if any) and the testimony of witnesses. The reason for the appointment of a post-mortem examination, for example, are lawsuits for the invalidation of a will (deed, transactions) drawn up by a person whose mental usefulness is in doubt. 51. TYPES OF FORENSIC PSYCHIATRIC EXAMINATION DEPENDING ON THE PLACE OF ITS PRODUCTION Outpatient examination is carried out by forensic psychiatric outpatient commissions, which consist of at least three psychiatrists: the chairman, a member of the commission and a speaker. The personal composition of the outpatient expert commission is approved by the local health authorities on the proposal of the republican, regional, regional or city psychiatrist. If the outpatient examination cannot answer the questions posed for its resolution, it gives a conclusion on the need to place the subject for an inpatient examination. Stationary expertise is carried out only in psychiatric hospitals, where stationary forensic psychiatric expert commissions are organized, consisting of at least three psychiatrists: the chairman, a member of the commission, and a speaker who monitors the subject. The personal composition of the commission is approved by the local health authorities. For examination, the subjects are placed in forensic psychiatric departments, and in the absence of such - in specially designated wards of the general departments of psychiatric (psycho-neurological) institutions. During the examination, the necessary methods of medical research are used, and, in appropriate cases, treatment. The term of the stationary test shall not exceed 30 days. If it is impossible to make a final conclusion on the mental state and sanity within the specified period, the stationary expert commission makes a decision on the need to extend the test period, a copy of which is sent to the body that appointed the examination. In those cases when a competent judgment of doctors of other specialties is necessary to resolve the issue of the mental state of the subject, the bodies that appointed the examination can create complex expert commissions. Examination at the court session is carried out by a forensic psychiatric expert alone or by a commission of several psychiatrists of the health authorities called by the court. After getting acquainted with the circumstances of the case and the personality of the subject during the judicial investigation, the forensic psychiatric expert gives a written opinion. He announces it at the court session and gives explanations on the questions asked in connection with his conclusion. An expert opinion may also be given in relation to the accused, persons acting in the process as plaintiffs, defendants, witnesses, victims, as well as persons regarding whom the issue of their legal capacity is being decided. If it is impossible to give answers to the questions posed by the court, the forensic psychiatric expert shall issue a conclusion on the need to send the person under expert for a hospital examination. Examination in the investigator's office can be performed solely by a psychiatrist or a commission of experts. After examining the accused or suspect, an expert or a commission of experts gives its final opinion or indicates the need for an additional outpatient or inpatient forensic psychiatric examination. 52. FORENSIC PSYCHIATRIC EXAMINATION OF MINORS When considering this section, it is necessary to take into account the rapid development of the body of a teenager (boys and girls) from 12 to 18 years old. Restructuring covers all organs and systems as a whole and leads them to mental and sexual maturation, changes in physiological and biochemical processes, and often to a pubertal crisis. Although the latter is of decisive importance in the formation of the character, behavior and actions of minors, at the same time it can contribute to the transformation of individual mental deviations into persistent pathological personality traits that cause antisocial behavior. Violations of the tempo of puberty can become a source of pathological formation of the psyche with all the ensuing social consequences. It is necessary to point out such a feature as sharp dynamism of the psychopathological state of adolescents with an emerging psychopathy. Therefore, non-identical expert opinions of psychiatrists on the state of health of mentally ill adolescents are quite frequent. It is also necessary to recognize that the forensic psychiatric examination of particular forms of mental illness in adolescents is a significant difficulties. Adolescents are much more likely than adults to undergo complex forensic psychological and psychiatric examinations, since it is psychologists who provide the most objective data on the level of mental development of a teenager, the features and structure of cognitive processes, the emotional and motivational sphere, volitional stability, mental performance, etc. It should also be pointed out that the issue of using psychological research as a paraclinical method in the process of forensic psychiatric examination is decided not by the court and investigating authorities, but by a forensic psychiatric expert. Considering the forensic psychiatric examination, it is necessary to specifically highlight the provision that during these examinations, due to the complexity of assessing their results, forensic psychiatric experts allow a certain subjectivity. This is influenced by the attitudes and views of various psychiatric schools, unequal knowledge and personal experience. That is why in forensic psychiatry a collegial expert study of sub-experts is adopted in order to achieve a more objective and correct conclusion. This achieves greater authority and credibility of forensic psychiatric expert opinions. The legislator in Art. 195 Code of Criminal Procedure determined procedure for appointment of examinations. At the same time, practice shows some difficulties for legal workers in issuing a decision (determination) on the production of a forensic psychiatric examination and raising specific questions that forensic psychiatric experts need to answer. 53. Sanity-Insanity The ability to be accountable for the actions taken, to control and manage them by willpower, in other words, to be sane for a specific act, perhaps in the case when nothing prevents the individual from making such a choice, i.e. when the shutter speed is not violated. The loss of understanding of the social danger of one's actions (inaction), unawareness of this and the inability to critically evaluate and manage them are not so rare when ascertaining mental disorders of various etiologies (origins). Sanity и insanity are determined precisely by the normal or painful course of mental processes and well-being in the state of mental health of a person, i.e. data from psychology and psychiatry. However, in judicial and investigative practice there are cases when a sane person at the time of the commission of a crime, nevertheless, due to a mental disorder diagnosed in him, although he could not fully realize the nature and social danger of his actions (inaction) or manage them, but is recognized subject to criminal liability due to the fact that illegal actions (according to the conclusion of expert psychiatrists) did not rule out sanity. At the same time, the legislator indicated that a person who was in a state of insanity at the time of committing a socially dangerous act was not subject to criminal liability. Sanity is a condition for the prerequisite of guilt, i.e. the ability of a person to correctly understand the essence of the action being performed, to realize its consequences for themselves, others, society as a whole and the ability to control their actions. A person who, at the time of committing a socially dangerous act, was in a state of insanity, i.е. could not realize the actual nature and social danger of their actions (inaction) or manage them due to a chronic mental disorder, temporary mental disorder, dementia or other morbid condition. In part 2 of Art. 21 of the Criminal Code of the Russian Federation also states that such a person, by a court decision, may be assigned coercive medical measures, provided for in Art. 97 of the Criminal Code of the Russian Federation. In judicial and investigative practice, lawyers meet with prosecution persons with mental disorders that do not exclude sanity (Article 22 of the Criminal Code of the Russian Federation). In this case, forensic psychiatric experts, although they recognize them as sane for the crimes committed, indicate in their expert opinions that such persons, due to the mental disorders diagnosed in them, could not fully realize the actual nature and social danger of their actions or inaction, or lead them. These mental disorders (disorders, diseases), which do not exclude sanity, in accordance with Part 2 of Art. 22 of the Criminal Code of the Russian Federation are taken into account by the court when passing a sentence on their punishment and can serve as the basis for appointing them in accordance with Part 1 of Art. 97 of the Criminal Code of the Russian Federation on compulsory medical measures. 54. CRITERIA OF INSANE The insanity formula contains two criteria - medical (biological) и legal (psychological), which act in unity and determine the insanity of a person who has committed a socially dangerous act. Medical criterion (can be ascertained only in a mentally ill person) consists of four signs of mental disorders ' chronic mental disorder (eg schizophrenia, epilepsy, manic-depressive psychosis, progressive paralysis, senile psychosis and other mental illnesses with a tendency to progression), leaving after acute clinical manifestations a growing mental defect in the form of irreversible intellectual dysfunctions of an acquired nature up to dementia and insanity: ' temporary mental disorder (eg exceptional and reactive states, alcoholic psychosis) - a reversible disease that can last from several minutes to several hours and even days and, in rare cases, weeks. It ends with recovery, leaving no visible changes in mental activity. - dementia (for example, oligophrenia, involutionary processes), in which the leading is the irreversibility of intellectual function disorders, both congenital and acquired: - other disease state (eg, psychopathy) as a persistent disorder or anomaly in the development of the psyche, resulting from various somatic, neurological, infectious and other diseases, or as a defect in pathological education. Legal criterion is formulated as the impossibility of the insane to realize the actual nature and social danger of their actions (inaction) or to control them. This criterion is a generalizing characteristic of a mental state, in particular, the severity (depth) of painful mental disorders, and consists of two features: - intellectual (the inability to realize the actual nature and social danger of their actions-inaction, for example, with oligophrenia in the degree of debility); - strong-willed (inability to control one's actions, for example, with psychopathy). The presence of these features in the legal criterion makes it possible to analyze various aspects of the mental activity of the person under expert (thinking, emotional, volitional, intellectual, etc.). If the first part of the criterion (intellectual) requires an analysis of mental and critical abilities, makes it possible to adequately assess the situation and the subject’s own behavior, then if its second part (volitional criterion) is defective, control over one’s statements, actions and deeds, the ability to understand their essence and manage them. With the loss of criticality, the intellectual criterion (that is, with its insufficiency in the pathological sense) seems to override the volitional one. The presence of this sign violates the ability to control one's actions and entails the decision of insanity. 55. CAPABILITY-INcapacity Civil capacity occurs with the onset of 18 years of age and only in exceptional cases earlier (from the time of marriage). Legal capacity as a prerequisite implies such a mental state of the subject, which provides him with the ability to understand the meaning of his actions or manage them. Incapacity is determined by a combination of two criteria: medical (mental disorder) and legal (lack of understanding of the meaning of their actions or inability to manage them). Insolvency set when both criteria match. Those mentally ill are recognized as incompetent who, due to a mental disorder, are not able to reasonably conduct their affairs, cannot correctly understand the environment and the life situation and give an account of their actions or manage them. The mentally ill, even if they suffer from a severe and incurable mental illness, but understand the significance of their actions and are able to regulate their behavior and actions, remain capable. The ability to judiciously conduct their affairs is determined by the presence of such qualities of mind that ensure the correct behavior of patients in their practical activities. Incapacity can relate to both a separately committed legal act (signing a will, concluding an agreement and a transaction), and the ability of a person to conduct his affairs critically enough for a more or less long period of time in the future. When examining in civil proceedings in other cases, it is important to establish from what time a mentally ill person became incapacitated, since in some cases incapacity occurs after the signing of such an act, and in this case the document does not lose its legal force. If it is established that the transaction (signing of the contract, marriage) were executed in a state where the person who entered into the transaction could not understand the meaning of his actions, then such a legal act may be declared invalid. Recognition of the subject as incapacitated carried out only court. Members of his family, public and trade union organizations, the prosecutor, guardianship and guardianship authorities, psychiatric medical institutions can petition the court to recognize a mentally ill person as incompetent. Appointment for a forensic psychiatric examination to determine the mental state of the subject is made by the court in the presence of sufficient reasoning and data on his mental illness or dementia. In exceptional cases, if such a person clearly evades the examination, the court (with the participation of an expert psychiatrist) may issue a ruling on forced referral of a patient to a forensic psychiatric examination. Although the law does not recognize limited capacity of mentally ill persons, but allows the possibility of its restriction for persons who abuse alcohol or drugs and put their family in a difficult financial situation. In this case, the court appoints a trustee, without whose consent such persons cannot make transactions, receive a salary (pension) or other types of income and dispose of them. 56. CORRECTIVE MEASURES OF A MEDICAL NATURE APPLIED TO THE MENTALLY Ill Persons who have committed offenses in a state of insanity due to chronic or temporary mental disorders are not criminals and are not subject to punishment and educational influence in correctional institutions of the penitentiary system. To them, as well as to the mentally ill, as well as to persons who abuse alcohol or drugs and their surrogates who have committed crimes and are recognized as sane for them, by court order, various medical measures can be assigned. Measures against the mentally ill are of an exclusively medical nature, are aimed at treating mental illness and are carried out in order to prevent society from repeating socially dangerous actions (deeds) committed by morbid motives by patients. Organizationally, the procedure for considering compulsory treatment by the court is carried out after the trial of a criminal case, but also in a court session in the presence of the person in respect of whom it is being decided (if his mental state allows), with the participation of a prosecutor and a lawyer, and, if necessary, witnesses, victims and judicial psychiatric expert. The court, on the basis of the conclusion of the forensic psychiatric expert commission, after discussion, decides on the application of compulsory medical measures to such a person. This form of medical measures can be assigned to the following categories of persons: 1) who committed the acts provided for by the articles of the Criminal Code of the Russian Federation, in a state of insanity: 2) who, after the commission of a crime, developed a mental disorder that makes it impossible to impose or execute a sentence (i.e. during the investigation and trial, or while serving a sentence and being in a correctional institution); 3) who have committed a crime and are suffering from mental disorders that do not exclude sanity (i.e., convicted of a crime and suffering from a mental illness, but recognized as sane for the committed act). Compulsory medical measures are prescribed only in cases where mental disorders in this category of persons are associated with the possibility of them causing other significant harm in the future or with a danger to themselves or others (i.e. in this case we are talking about the degree of social danger to society). Types of compulsory medical measures: 1) outpatient compulsory observation and treatment by a psychiatrist; 2) in a general psychiatric hospital; 3) in a psychiatric hospital of a specialized type; 4) in a psychiatric hospital of a specialized type with intensive supervision. All psychiatric institutions that organize compulsory medical treatment and observation in accordance with the order of the Ministry of Health of the Russian Federation are under the jurisdiction of health authorities. The exceptions are those in which convicts undergo compulsory treatment (these are outpatient clinics of medical units or psychiatric hospitals of the penitentiary system). 57. GENERAL CONCEPTS ABOUT MENTAL ILLNESS Mental illness It is the result of complex and diverse disorders of the activity of human organs and systems with a predominant functional or organic lesion of the brain. At the same time, the mental health of people should always be assessed taking into account not only biological, but also social patterns that have an indirect impact on the state of the psyche. Psychiatrists in the process of studying human development have long noticed that there is a certain dependence of his mental state on a number of biological and social factors (environment, heredity, intelligence level, personality type, individual character traits, bad habits). Distinguish with the flow acute and chronic mental illness. Acute diseases include diseases (disorders, disorders, psychoses) that develop quickly, transiently and usually end in recovery (eg, alcoholic psychoses, exceptional conditions); chronic - mental illnesses (disorders, disorders) with a long course, which are distinguished by a gradual increase in clinical manifestations (progression), and then a decrease in the severity of psychopathological symptoms and syndromes and the appearance of a more or less long and stable remission, i.e. they are characterized by a certain dynamics (staging) of the disease process. In this case, the following stages of the course of mental illness are distinguished: harbingers (pre-manifest) - characterized by the appearance of a number of symptoms (common to a variety of diseases): anxiety, irritability, headache, sleep disturbance, malaise, causeless weakness, etc. debut (manifest) - this is an acute phase of the actual disease or relapse (exacerbation of a mental illness), which develops gradually or, conversely, quickly and acutely. The debut of the disease is characterized by symptoms such as delusions, hallucinations, speech and motor excitation or inhibition. In the future, at this stage, a detailed clinical picture of the disease is observed with certain patterns of the course and the rate of increase of painful symptoms, which can be fast, malignant or slow, long-term, chronic with a gradual expansion of pathological manifestations, usually leading to a mental defect in the form of dementia (for example, this is typical for schizophrenia, epilepsy, etc.). išhod (post-manifest) - at this stage, the following are possible: recovery (for example, this is typical for acute psychoses, exceptional conditions); remission (improvement of the clinical condition in the form of varying in time and degree of compensation of the disease); a defective state (when the sluggish course of the disease prevails, it seems to stop, but persistent irreversible changes in personality and character, the phenomena of increasing dementia remain); lethal outcome (the death of the patient occurs from the associated somatic complications). 58. CLASSIFICATION OF MENTAL ILLNESS Modern classification of mental illness established by the World Health Organization. It takes into account the causes of mental disorders, the nature of clinical manifestations, the course of mental illness. To determine the form and type of the disease, i.e. when making a diagnosis, they take into account: etiology (origin), symptoms, clinical course, phase of the process, prognosis and outcome of the disease act, determine the capacity, prognosis, employment opportunities and disability of the patient. When considering the classification of mental diseases, it is necessary to understand that there are several groups of mental illnesses, in the occurrence of which internal and external factors and their clinical manifestations play a certain role (the dynamics of symptoms and syndromes during the course of the disease, complications - a mental defect in the form of sharpening character traits and dementia etc.) are different. Group of endogenous diseases, originating from internal causes (more often with pathological inheritance), while the progredient of mental disorders increases, the mental defect (accompanying these diseases) in most cases progresses. This group includes: schizophrenia, epilepsy, manic-depressive psychosis. A group of exogenous diseases, due to external causes, while (as in the first group) the progression of mental disorders increases, the mental defect in most cases progresses. This group includes: the consequences of craniocerebral injuries, oncological, infectious and somatic diseases, intoxication, as well as mental disorders resulting from mental trauma (the so-called psychogenic disorders). In the latter case, due to their short duration, noticeable progression in mental pathology, after these conditions there is no mental defect in the form of dementia; such persons practically recover. A group of mental disorders caused by developmental disorders of the psyche; with them, due to the peculiarities of their course, there is no visible progression of clinical symptoms, and the mental defect remains stable. This group includes: mental retardation (oligophrenia), character disorders (psychopathy). In forensic psychiatry, a slightly different classification of mental illness is adopted, which proceeds from the medical criterion of insanity. According to this classification, mental disorders are divided into chronic and temporary mental disorders, dementia and other mental illnesses. 59. SCHIZOPHRENIA Schizophrenia - a mental illness with a progressive course and a variety of psychopathological symptoms up to the appearance of a mental defect - schizophrenic dementia. Its most characteristic clinical signs are expressed in the disorder of thought processes (disruption of speech, inadequacy), the emotional sphere (emotional tension, dullness and coldness). In addition, auditory hallucinations and delusions are quite frequent in patients with schizophrenia, which they can and often try to hide (dissimulate). At the same time, the patient's memory, his intellect, previously acquired knowledge remain for a long time without significant changes. But despite this, the patient's performance is gradually falling. Clinical symptoms patients with schizophrenia are characterized by a gradual decrease in mental activity, an increase in personal changes, withdrawal into their inner life, vulnerability, narrowing of the circle of interests, quarrelsomeness, conflict, opposition to everything, the disappearance of former attachments, indifference to loved ones and their suffering, callousness, loss of curiosity and interest, progressive lethargy and passivity, impaired adaptation, mannerisms, originality, absurdity, eccentricity. At the same time, they note irritability, malice, rudeness, aggressiveness, exaggerated pedantry, litigation. Inseparably with the progression of schizophrenia, one should consider the features of specific clinical psychopathological symptoms and syndromes, as well as the degree of their severity, which is more pronounced during the period of relapse of the disease. - Illegal actions are committed by patients mainly at the initial stage of the disease; more often they are in the form of hooliganism or acts associated with a disorder of drives or impulsive actions; - in the acute period of the disease, with psychosis, a continuously ongoing process or a pronounced schizophrenic defect (even during remission), the diagnosis is not in doubt, and patients are recognized as insane; - upon detection of a schizophrenic defect and persistent positive disorders (in the form of asthenia, depression, mania, paranoid ™, hallucinations, delirium, clouding of consciousness), even during the period of remission, patients are recognized as insane: - as psychopathic disorders in patients with schizophrenia, one can consider the presence of such a state as the denial of a mental illness, and the peculiarities of the morbid state should also include the fact that they prefer to bear criminal responsibility than to be recognized as mentally ill; - in case of offenses committed during a period of long-term remission or recovery with satisfactory social adaptation, such persons are recognized as sane; - Persons under investigation and trial to evade criminal responsibility now tend to simulate schizophrenia more often than other mental illnesses. 60. EPILEPSY Epilepsy - a chronic mental illness, in the clinic of which convulsive and non-convulsive seizures (paroxysms), psychoses and specific personality changes up to epileptic dementia are noted. Epilepsy is quite common among young offenders. The manifestations of epilepsy are quite diverse. Group I - convulsive (paroxysmal) condition. They are divided into major and minor epileptic seizures (a group of paroxysmal convulsive conditions) and epileptic equivalents. Grand mal seizures characterized by short-term convulsive seizures, accompanied by loss of consciousness. It lasts 1-3 minutes and is manifested by a successive change of the following phases: aura (usually occurring a few seconds or minutes before an attack, mainly in the form of a variety of autonomic mental, sensory and motor disorders); tonic and clonic convulsions against the background of impaired consciousness (possibly with biting the tongue, involuntary urination); stupor of consciousness or short-term sleep. Minor epileptic seizure usually diagnosed against the background of a short-term loss of consciousness. It may also be preceded by an aura. At the same time, it is noteworthy that the patients either "freeze" in one position, or they have stereotyped movements, the pronunciation of the same phrases, or a wandering look appears, or, conversely, a look directed at one point. With this type of paroxysm, individual convulsive twitches of various muscle groups can be noticeable. Epileptic equivalents - short-term mental disorders that develop as if instead of a seizure. They are of the same type and more often manifest in the form of dysphoria (mood disorders, melancholy, fear, irritability, anger, tension, suspicion, readiness for aggression) and twilight obscurations of consciousness (loss of orientation, delusional perception of reality, affect of fear, anger, aggression). Variants of twilight stupefaction with equivalents - fugue and trance are quite frequent in the practice of forensic psychiatry. At the same time, patients in a state of altered consciousness perform outwardly expedient, sometimes quite complex actions in the form of salvation, averting danger, wandering, traveling. Outwardly, such persons do not pay any attention to themselves, except that they are, as it were, beyond the necessary distance from reality, immersed in their thoughts. The duration of each such episode is from several minutes to several days. They also record subsequent amnesia. Group II - epileptic psychoses. They are acute, prolonged and chronic. In patients with epilepsy, unlike other diseases, psychoses occur without visible clouding of consciousness, but in the form of delusions of varying time and severity (persecution, jealousy, poisoning, hypochondria) and other mental changes. Group III - specific epileptic personality changes. With them, personality and intellectual disorders are typical, constantly accompanying patients and increasing with the duration of the course of epilepsy. 61. MANIC-DEPRESSIVE PSYCHOSIS Manic-depressive psychosis (MDP) is a mental illness with a chronic course. It proceeds in the form of periodically alternating attacks of manic (elevated mood, accelerated thinking, motor arousal) and depressive (low mood, slow thinking, motor inhibition) states. The duration of these phases is from 2 to 6 months. and they are most often separated by intermissions (i.e., such conditions in which mental disorders disappear and normal mental activity is restored with the psychological characteristics inherent in a given person, which is how they differ from other mental illnesses, such as schizophrenia). However, depressive phases are still longer. During a manic episode for patients, increased mental activity, overestimation of their capabilities and abilities, unjustified optimism and altruism, boasting, sometimes turning into delusions of grandeur, reformism, and an idea of their high social origin are typical. In this state, they are characterized by unproductive employment. They find a lot of cases for themselves, which are accompanied by disorganization at home and at work. The resulting irritability pushes patients to ill-conceived and even hooligan actions. In this phase, they have increased various drives, there is a tendency to alcoholic and sexual excesses, wastefulness, the desire to communicate with antisocial personalities. This phase usually occurs in the evening. During the depressive phase they state depressed mood, unreasonable anxiety, poor sleep, lethargy, weakness, vague fears, uncertainty, painful forebodings, decreased mental activity, inability to concentrate, absent-mindedness, forgetfulness, somatic disorders, asthenia, weight loss, constipation. The aggravation of mental symptoms usually occurs in the wee hours and early in the morning. TIR flow forms different from the classic version. This psychosis can proceed in the form of only an attack of manias or only depressions. In other cases, phases doubled in clinical manifestations are noted (depressive, suddenly without a visible transition is replaced by manic or vice versa), and only after that does intermission occur. Forensic psychiatric practice indicates that patients with TIR are characterized by: • в manic phase - a special tendency to excite, violate public morality and social behavior (waste, illegal transactions, sexual excesses, exacerbation of desires, altruism); - at depressive phase - inhibition prevails, an increased painful possibility of self-incrimination and slander, a tendency to aggression, harm to one's health, self-harm and suicide, committing serious, socially significant criminal acts. Patients with TIR are recognized as insane (incompetent) when committing acts in a state of psychosis (acute period of the disease), and sane when committing an act during the period of intermission. 62. TRAUMATIC INJURIES OF THE BRAIN In forensic psychiatric practice, the consequences of a traumatic brain injury (in the form of a formed psycho-organic syndrome) are more common than other mental illnesses, mainly due to the increased aggressive behavior of a part of the population (often under the influence of alcohol abuse), a noticeable increase in the number of young people participating in hostilities engaged in regular boxing, karate, and generally rising crime in the country. The consequences of a traumatic brain disease is one of the most complex and unresolved problems in medicine, and in particular psychiatry. After all, the symptoms of a traumatic brain injury are differently presented in the same brain injury by emotional-volitional and intellectual-mnestic disorders caused by irreversible changes in the areas of the brain equally affected by trauma and intracranial hemorrhages, and impaired circulation of the cerebrospinal fluid. It should be noted that the symptomatology in the post-traumatic period is determined by a large polymorphism and consists of general cerebral and local neurological, as well as mental disorders. But despite the various types of craniocerebral injuries, the dynamics of mental disorders is known to be uniform and tend to gradually regress, which made it possible to identify three major stages in the post-traumatic period • initial, following immediately after the injury and characterized by varying degrees of loss of consciousness (in mild cases - short, in severe cases - up to coma), stupor: - spicy, accompanied by the restoration of consciousness and the emergence of a variety of neuropsychiatric disorders; during this period, various forms of memory loss are observed, i.e. amnesia (retrograde, anterograde), severe asthenia with sleep disturbances, vestibular and vasovegetative disorders (dizziness, nausea, labile pulse and blood pressure, sweating); ' long-term effects with complete reduction (reverse development), neuropsychopathological symptoms that have taken place or the formation of residual psychoorganic and neurological syndromes (i.e., apraxia and other disorders are possible). Persons with a consequence of a traumatic brain injury and paranoid (psychopathological) personality development or hallucinatory-delusional psychoses, severe dysphoric disorders, as well as those suffering from epileptiform seizures, traumatic dementia, as well as decompensation of a traumatic disease, are recognized as insane for the committed act. 63. SYPHILITIC DISEASES OF THE CENTRAL NERVOUS SYSTEM Neurosyphilis - specific diseases of the central nervous system are relatively rare in the practice of general psychiatry, but often in forensic psychiatric research. In the origin of this group of diseases, forensic psychiatric experts assign the main role to past and poorly treated (or not treated) syphilis. At the same time, psychopathological manifestations are due to the place of penetration into the brain of the causative agent of the disease - pale treponema and the corresponding damage to the parenchyma, nerve cells and blood vessels of the brain, inflammation of the meninges or the appearance of a specific tumor (gumma). It is according to the degree of destructive changes in the central nervous system, somato-neurological and psychopathological complications in this group of diseases that syphilis of the brain and progressive paralysis are distinguished. Syphilis of the brain. Brain damage is focal in nature, although the statement and clinical manifestations of mental disorders largely depend on targeted and timely diagnosis, the nature of syphilitic lesions, the intensity of treatment and the age of the patient. It is necessary to clarify the forms of the disease (which are distinguished during their progression according to the leading symptoms): neurasthenic, meningeal, gummous, etc. personality traits, and later - epileptiform disorders (eg, convulsions), initial signs of mental degradation (dementia), and other violations that are noticeable to others. progressive paralysis. Usually diagnosed with untreated syphilis, 10-12 years after infection. In this case, a rather extensive damage occurs not only to the brain, but also to the body as a whole. There is a tendency to a progressive course. There are characteristic signs from the internal organs (bone fragility, etc.). nervous system (violation of the reaction of the eyes, speech, tendon reflexes), blood and cerebrospinal fluid. In the mental sphere, the above-mentioned symptoms of syphilis of the brain are accompanied by incorrect behavior, euphoria that does not correspond to the circumstances, a frivolous attitude to everything, disinhibition of drives (sexual, food), cynicism, special absurdity in statements and actions, loss of criticism, increasing dementia, unstable delusional ideas of depressive character, movement disorders. In a forensic psychiatric study, the diagnosis of "cerebral syphilis" with clinical compensation for the disease in such persons indicates their sanity in committing an offense. However, the establishment of even the initial stage of progressive paralysis leads to the recognition of the person as insane. 64. VASCULAR DISEASES OF THE BRAIN A forensic psychiatric study of mental disorders in vascular lesions of the brain is more often than others carried out in a person with cerebral atherosclerosis and quite often concomitant hypertension. Consider their clinic and behavior observed in patients with cerebral atherosclerosis of cerebral vessels and hypertension. Cerebral atherosclerosis. This is a chronically occurring general disease of the human body, but with a predominant sclerotic lesion of the arteries of the brain. Its occurrence is facilitated by unfavorable heredity, repeated craniocerebral injuries, acute and chronic traumatic effects, chronic intoxication (alcohol), infectious diseases. In the clinic of cerebral atherosclerosis with psychopathological disorders, neurasthenic syndrome prevails. There is a gradual increase in disturbances that become noticeable to others and are accompanied by a decrease in the activity of mental activity with a predominance of intellectual disorders (in the form of memory impairment, attention), sharpening of personal characteristics, a decrease in working capacity, an increase in emotional changes (irritability, weakness, etc.), selfishness, narrowing the range of interests. At the same time, in such persons, the mental ability acquires a rigid character (persistence, turning into pathological obstinacy), thinking loses its lightness and flexibility. At the same time, in persons with cerebral atherosclerosis, the basic ethical and social attitudes persist for a long time, and they are selectively more prone to the emergence of psychogenic conditioned reactive states. Basically, they are sane for the acts that they committed. Hypertonic disease. Its occurrence and course are quite often due to nervous and functional disorders of the regulation of vascular tone and the progressive atherosclerosis of the cerebral vessels, which quite often accompanies this disease. Clinical manifestations of mental changes are in a certain dependence on destructive lesions, their localization (in the brain) and the stage of the disease process. In the initial stage of hypertension, patients remain critical of their actions and they are sane. Difficulties are presented by the forensic psychiatric examination of patients with the second stage of hypertension, especially in reactive states. These patients with symptoms of dementia or vascular psychosis are recognized as insane in the incriminated acts. Patients with the third stage of hypertension and its complications require special attention in determining capacity. They are recognized as incompetent with the consequences of acute disorders of cerebral circulation (disorders of consciousness, memory, speech), chronic post-stroke conditions (with severe dementia). 65. PSYCHOSIS OF LATE AGE Borderline mental disorders determined by the clinical manifestations of neurosis-like syndrome. In addition, it is not uncommon for such people to fixate on unpleasant sensations, depressed mood, anxiety, irritability, exaggerated attention to their health, affective instability, narrowing of the range of interests, sharpening of personality traits, etc. These changes are more often noted in those older people who have them. associated with somato-neurological diseases. Basically, this group of persons is law-abiding, sane for the incriminated acts and capable. Psychotic (involutional) disorders occur with an unfavorable course of the sclerotic process in elderly and senile people. They are stated in the form of presenile (presenile) and senile (senile) disorders (incorrect assessment and perception of the environment, violation of criticism, intellectual and mnestic features), which are often associated with certain chronically flowing monotonous psychotraumatic circumstances and acute real situations that are socially significant for such persons. . Presenile psychoses occur more often in people aged 60-65 years and are accompanied by depression, anxiety, melancholy, fussiness, fear, suspicion, hypochondria, frightening hallucinations, delirium, motor and speech excitement. Due to the peculiarities of painful manifestations, psychiatrists distinguish the following forms of presenile psychosis: 1) involutionary melancholy - presenile melancholia (Kraepelin's disease). In its clinical manifestations, emotional disturbances predominate, more often in the form of anxious depression and hypochondriacal experiences, motor retardation, or vice versa, excitement with the affect of anxiety, fear and anxiety, up to delusional ideas of guilt and persecution; 2) involutional paranoid - a more severe mental state, in which delusions of jealousy, persecution, damage against the background of anxiety and longing are already episodically diagnosed; 3) involutionary hysteria characterized by affective instability and lability with a statement in patients of violent emotional reactions for minor reasons and even so-called hysterical stigmas (spasms in the throat, functional seizures, hysterical paresis) and autonomic disorders (redness, blanching, stuttering): 4) involutional dementia develops as a result of destructive atrophic processes in the brain. They are characterized by the progression of local psychopathological disorders, their gradual expansion, progressiveness. the irreversibility of the course and the growth of dementia. senile psychosis occurs against the background of pathological aging of the body and occurs already from the age of 70. At the same time, such persons have difficulty in perceiving processes, depletion of memory reserves, impaired thinking, naivety of judgments, fussiness, selfishness, insomnia, and even delusions of damage and guilt. It is not uncommon for them to have dementia. At the same time, in itself, the mental (somatic) recognition of senile decrepitude does not exclude legal capacity (if there is no dementia and productive psychopathological symptoms). 66. ALCOHOLISM Simple intoxication. It is based on certain mental and somato-neurological disorders that occur as a result of taking even a small dose of alcohol. Alcohol selectively depresses primarily the central nervous system, disrupts the normal course of the physiological processes of inhibition and excitation, thereby determining human behavior. Degree of intoxication depends not so much on the amount of alcohol taken, but on the state of the body, the functionality of the brain, addiction to alcohol-containing drinks, the method of its introduction into the body, and a number of other reasons. Simple alcohol intoxication certain mental, neurological and somatic dynamics, according to the clinical features of which forensic psychiatrists give a medical opinion. Simple intoxication is often found in forensic psychiatric expert practice and the solution to the question of sanity does not cause difficulties. This is due to the fact that such persons retain contacts with external stimuli for a long time, as well as the ability to critically perceive the situation, realize the nature and social danger of their actions and manage them. They do not develop psychotic states (in the form of twilight confusion, delirium, hallucinations) and therefore they are subject to criminal liability. pathological intoxication. It occurs only in some cases in people who, as a rule, do not drink alcohol regularly, who have suffered brain injuries or diseases in the past and are considered mentally healthy people, in conditions of emotional stress, overwork, chronic lack of sleep, insecurity, fearfulness. Quite complex psychophysiological mechanisms take part in its origin, including at the molecular level. This is a qualitatively different morbid state of the psyche than that caused by simple alcohol intoxication, and requires a different approach, in addition to a medical and legal approach. This type of intoxication is possible after just a few minutes after drinking alcohol and usually proceeds regardless of the dose taken. Forensic psychiatrists in their retrospective studies, as a rule, establish that a drunk person, after some time after drinking alcohol, unexpectedly for others, became anxious, confused, detached, inaccessible to contacts. The movements and posture had a pronounced defensive variant due to the fact that reality acquired for him the character of unaccountable horror. As a result of perverted acute alcohol intoxication, such a person develops a short-term psychotic disorder with deep twilight clouding of consciousness, delusional and hallucinatory experiences, and the resulting inappropriate behavior, which largely depends on the characterological characteristics of the individual. But motor excitation usually ends suddenly (after a few minutes), passes into a state of physical weakness, and then into sleep, followed by amnesia of the events taking place. During a forensic psychiatric examination, doctors, analyzing pathological intoxication, diagnose it as a rapidly proceeding psychotic disorder in the form of psychosis and recognize such persons under expert insane for the committed act. 67. CHRONIC ALCOHOLISM In social terms, this disease is considered as excessive consumption of alcoholic beverages, leading to violations of the norms of behavior in everyday life and society, causing significant damage to health, moral and material well-being of the family. Alcoholism in medical terms a disease that leads to pathological changes in the internal organs (liver, heart, pancreas), nervous system and selectively the brain. Alcohol has a relaxing (relaxing, relieving stress), euphoric and partly sedative (calming) effect on the mental sphere. The need for such an effect is most often in people who are poorly adapted, with neurotic and psychopathological characterological features. At the same time, the microenvironment, upbringing, traditions, mental and physical overstrain, psychotraumatic situations matter. The causes of alcoholism also include (conditionally) heredity, various metabolic (exchange) disorders of internal organs, some physiological disorders, primarily of the autonomic nervous system. In its development note three consecutive stages (compensated) - with neurasthenic symptoms and mental dependence on alcohol; average (subcompensated) - with the addition of functional changes to organic symptoms, the appearance of physical dependence on alcohol, withdrawal (hangover) syndrome (alcohol psychoses are already possible); Heavy (decompensated) - with irreversible somatoneurological disorders (dementia and personality disintegration), phenomena of mental and social degradation, the appearance of chronic hallucinations and other psychopathological disorders. When analyzing the acts of forensic psychiatric examinations of patients with alcoholism, lawyers need to pay attention to the fact that at the basis of their offenses lies the activation of instinctive mechanisms (primitivism in their implementation), increased suspicion (acquiring a painful character), sharpening of personal characteristics (straightforwardness, truth-seeking), the introduction of a number of new features that were unusual for them before alcoholism (deceit, alcoholic humor, cynicism, cruelty, etc.), which significantly affect the intent and nature of the commission of actions (often aggressive, senseless and unpredictable). Forensic psychiatric assessment of patients with chronic alcoholism is not difficult. In view of the fact that the disease itself (alcoholism) does not deprive them of the ability to realize the actual nature and social danger of their actions (inaction) and manage them, these persons are recognized as sane for offenses committed (Part 1 of Article 97 of the Criminal Code of the Russian Federation and Part 2 of Art. 99 article XNUMX of the Criminal Code of the Russian Federation). Exceptions are those cases when alcoholism is combined with severe atherosclerosis of cerebral vessels or age-related involutional changes that have taken on the character of severe dementia (dementia). 68. ALCOHOLIC PSYCHOSIS. substance abuse Alcoholic psychoses. Alcoholic psychosis is a complication of chronic alcoholism. They can be provoked by: various psychogenies (including a criminogenic situation, arrest, investigation, detention in a pre-trial detention center, etc.); forced abstinence from habitual and regular intake of alcoholic beverages; in more rare cases, massive alcohol intoxication at the "height" of hard drinking. The most common in legal practice (depending on the prevailing symptoms) are the following acute alcoholic psychoses: delirium (delirious tremens), acute hallucinosis and paranoid. In a forensic psychiatric assessment, it is necessary to take into account the behavior of such patients during psychoses, which is due to confusion and proceeds adequately to hallucinatory-delusional experiences that determine the nature of their motor activity and can cause fear for his life and the lives of others. In such a state, they have no awareness of the actual nature and social danger of their actions and the ability to direct them (i.e., criticism and will). Therefore, persons who have undergone alcoholic psychosis during the period of the incriminated acts are recognized as insane. Substance abuse. This problem is also of great social importance, since at present almost half of the city dwellers more or less systematically take medications and "folk" remedies, especially tranquilizers (seduxen, elenium, tazepam, etc.), stimulants (caffeine, pircofen, citramon etc.) and hypnotics (Nembutal, Barbamil, Berlidorm, Luminal). All these drugs are ultimately addictive, require an increase in dose approximately every four weeks, depending on the physiological and biochemical characteristics of the body, to obtain the same effect, loosen the nervous system and adversely affect the mental activity of a person. Only when these drugs are abused, when mental and physical dependence on them sets in, can we talk about substance abuse as a disease and give a forensic psychiatric assessment of the acts of such persons. As a rule, drug addicts who have committed crimes while intoxicated with intoxicating substances, in accordance with Art. 23 of the Criminal Code of the Russian Federation are sane, with the exception of those cases when they are diagnosed (which is very rare) with psychotic changes (delusions, hallucinations) that occurred during the abuse (poisoning) of medicinal and "folk" remedies. 69. DRUGS This is a group of diseases united by painful addiction (addiction), as a rule, to the non-medical use of narcotic drugs, i.e. to those substances that are classified by the Ministry of Health of the Russian Federation to the list of drugs. In the Russian Federation, morphine, codeine, poppy straw, hemp, stimulants (perventin, caffeine) are most widely used. They render specific impact (stimulant, sedative, hallucinatory, etc.) to the central nervous system. Medicinal and other chemicals not included in this list (including the so-called "folk remedies") are classified as toxic, and the diseases they cause are classified as substance abuse; despite. that they have a number of narcotic properties, the social danger of their abuse is not so high. This division is rather conditional and is mainly of a legal nature. Addiction characterized by adverse mental, somatic and social consequences. Drug addicts reveal mental and physical dependence on drugs, the desire to increase the dose (increase tolerance) to get even more euphoria, complacency, high spirits, a surge of strength, lightness, detachment from the outside world and emerging problems. Hence the painful need for repeated drug use and active actions aimed at acquiring them. Drugs cause noticeable changes in oral speech. When they are taken and acute intoxication and, accordingly, pleasant excitement and euphoria, there is a tendency to fast speech, the use of slang expressions, a manic increase in defects in pronunciation, flat humor, cynicism, buffoonery, etc. With withdrawal symptoms (during forced abstinence from the usual doses) and accordingly, depression is marked by a slowdown in the pace of speech, an angry reaction to remarks (inadequate in form and intensity), "heavy speech". The main objective method for the determination of narcotic substances and their alkaloids (as well as alcohol and other "strong" substances) is a chromatographic and spectral analysis, as well as a radioimmunochemical method. In narcological institutions of health authorities, an express method is used to determine drugs in dry form. In addition, these institutions use new imported and domestic devices, with the help of which they determine quantitatively and qualitatively the presence of narcotic drugs contained in the blood and urine of the examined. In the analysis of forensic psychiatric reports of persons who have committed crimes while intoxicated with narcotic drugs, as a rule, they recognize sane. Cases of offenses directly related to acute drug intoxication are extremely rare (due to the severe somatic and mental state of drug addicts at this time and their helplessness at the same time). And only acts committed by them in psychotic states (twilight clouding of consciousness, delirium and hallucinations) or with profound personality changes (degradation) and severe dementia make psychiatric experts recognize them. insane and send them on a mandatory basis for compulsory treatment in psychiatric hospitals. 70. OLIGOPHRENIA: IDIOT, IMBECILITY Oligophrenia - This is a group of congenital or very early acquired in childhood morbid mental states. It is characterized by such common clinical signs as impaired perception, attention, memory, thinking, motor disorders, speech, emotional-volitional sphere. With oligophrenia, as a biological pathology, mental retardation and the initial underdevelopment of the intellect come first. They are stable, and the disease itself, unlike others, does not have its own development and dynamics of the course of the pathological process. That is, a mental defect - dementia - remains the same as it was from childhood for life without changes, having neither positive nor negative dynamics. Causes of oligophrenia - pathological heredity, asocial burden of the existence of parents, malnutrition of the mother and child, intoxication of the fetus with alcohol, drugs, nicotine or their surrogates, damage (congenital or traumatic) to the brain of the fetus or child (especially with its early development - up to 2 years), severe illness of the mother or child, etc. Of particular interest is the classification of oligophrenia, based on the degree of severity of congenital dementia. At the same time, idiocy, imbecility and debility are distinguished. Idiocy - severe degree of congenital dementia. In forensic and investigative practice, persons with such a depth of dementia are not encountered because of their innate helplessness (physical and mental). Most of them have severe somato-neurological and mental disorders. These defects indicate abnormal development of the central nervous system. Idiots draw attention to themselves already with their appearance (ugly head, half-open mouth, stupid facial expression), propensity for simple stereotypical movements (clapping hands, sucking fingers), inability to meaningful independent movement, planned motor acts. Their behavior is outwardly unmotivated. Imbecility - the average degree of congenital dementia (stupidity). These faces already show elementary mental concepts, orientation in everyday situations, and a variety of reactions to familiar conditions and situations. However, imbeciles are completely lost in new situations. Their speech is primitive, tongue-tied, agrammatic, vocabulary is small, but can reach 300 words. In imbeciles, it is already possible to establish individual characterological differences, a differentiated attitude towards others, and selective attachment to loved ones. But such persons, due to their lack of initiative and increased suggestibility, are prone to blind obedience and imitation (which is what the leaders of criminal gangs use), antisocial behavior and drunkenness. Moreover, their actions are mainly due to instinctive urges (self-preservation, sexual, food, etc.), which leads to hooliganism, aggressive acts, murders, sexual excesses, theft, arson, etc. Imbeciles are led to such deeds by a lack of awareness of the nature and social danger of their deeds and an understanding of their responsibility. 71. DEFILITY debility - mild degree of congenital dementia. This is the most common form of oligophrenia. According to the severity of mental insufficiency (mental defect), such persons distinguish between deep, moderate and mild debility. They have a vocabulary of 600 or more words. The actions of morons are characterized by a combination of weakness of motives with impulsive behavior, increased suggestibility and stubbornness, passive obedience. lack of self-control and low ability to suppress their desires. Therefore, they are often the object of sexual abuse. They are not so rare excitation and aggression or lethargy and lethargy, indifference. With some integrity of comprehension of their actions, some of them may critically assess one's behavior depending on the changing conditions and dynamics of the situation and to anticipate the consequences of their actions. Persons with debility can even cope with the demands of family life, raising children. They easily adapt to work activities. At the same time, it is necessary to take into account the possibility of the influence of social and psychological conditions of life, life and work on the formation of the personality of persons suffering from debility (due to their increased suggestibility and imitation). With the same mental defect, but a benevolent attitude, they are more likely to show helpfulness, devotion, diligence, diligence, positive results of medical and social rehabilitation. Under negative conditions of life, morons have an even greater delay in mental development, increased social and pedagogical neglect, and the formation of asocial attitudes towards study, work, life, society, and compliance with generally accepted norms of behavior. It is these individuals who are easily involved in criminal groups, often commit illegal acts as perpetrators of aggressive and cruel crimes. They are prone to conflicts, fights, the use of alcoholic beverages and drugs. When interpreting the conclusions of a forensic psychiatric examination of persons suffering from oligophrenia in the degree of debility, lawyers need to be sympathetic to its causes and the lack of dynamics in the development of congenital dementia, and most importantly, to the determination by expert psychiatrists of the depth of a mental defect in comparison with their ability to assimilate moral moral norms and a socially significant stereotype of behavior in society. It should be recognized that Excerpts offenders with debility quite complicated because far from being so obvious (as it seems to non-specialists) is the depth of their mental inferiority, intellectual and volitional insufficiency, inability to realize the actual nature and social danger of their actions (inaction) and manage them. However, when establishing this, moronic personalities are recognized insane for illegal acts. But if the experts manage to trace the formation of asocial tendencies in the subjects and state that the antisocial acts committed by offenders with debility reflected real events, and their decision-making was based on an understanding of illegality and the possibility of punishment, then such persons are recognized as sane. At the same time, the same debility individuals are recognized as sane in relation to some offenses and insane in relation to others. 72. PSYCHOPATHY Psychopathy - this type of mental pathology, which has a special social significance. It lies in the fact that psychopathy is not so much a disease as persistent personality anomalies, characterized primarily by disharmony, a violation of the emotional and volitional spheres, and a peculiar, predominantly affective, thinking (i.e., a type of character and temperament that deviates from the normal version). The psychopathic features of such persons are formed in childhood and adolescence, as a rule, go through the stage of character accentuation and develop against the background of biological inferiority (abnormality), primarily of the brain (injuries and diseases), and end by the end of puberty. These features persist throughout life without noticeable changes, weakening in old age. They permeate the personality, determining its structure and character, preventing full adaptation and adaptation to the environment. About one-third of the population of our country suffers from psychopathy, but most of them remain outside the field of vision of psychiatrists. The emergence of psychopathy determined it etymological classification: nuclear (congenital constitutional), marginal (due to the pathological influence of the environment, deficiencies in education), organic (the impact of injuries and diseases of the brain). In psychiatric practice, it is accepted other classification. It is based on the clinical features of abnormal character traits, and they are subdivided as excitable, hysterical, paranoid, inhibitory, etc. When evaluating the conclusions of forensic psychiatric studies of persons suffering from psychopathy, it is necessary to remember their hypersensitivity to various kinds of external (environment) and internal (biological) influences in the process of life. These factors largely determine the clinical picture of psychopathy, its dynamics and stages of the course, exacerbation (decompensation) and remission (compensation). And socially significant and dangerous acts of such persons it is at the stage of psychopathic decompensation, when the main pathological properties of the personality are exposed (mainly in violation of social adaptation). At the same time, it is possible psychopathological reactions (short-term affective discharges) and pathological development (long-term). When interpreting the results Forensic psychiatric studies should pay attention to the assessment by experts of the clinical course and symptoms of psychopathy, since depending on this, various behaviors of such persons are possible and this determines their criminal liability. They confess insane for acts committed in a state of decompensation, with psychopathic reactions with loss of compensatory properties, total psychopathic disorders and lack of social adaptation, unusual aggression and viciousness, inadequacy and ambiguity, and in other cases when it becomes necessary to equate these states with temporary mental disorders (part 1 article 21 of the Criminal Code of the Russian Federation). 73. TYPES OF PSYCHOPATHY Excitable psychopathy. The leading clinical symptoms in individuals with this diagnosis are increased excitability, explosiveness, malice, tension, irritability, vindictiveness, selfishness, a tendency to mood swings and unpredictability. They are always dissatisfied, picky, intolerant of other people's opinions. They are characterized by brutal affect on insignificant occasions, unwillingness to reckon with anything. hysterical psychopathy. The need to be in the center of events or to attract attention, demonstrativeness, theatricality, the desire for originality, mental immaturity, infantilism. Their feelings are superficial and shallow, emotional attachments are unstable, judgments are contradictory. Quite frequent are mood swings, a quick change of likes and dislikes. For them, a combination of external benevolence with internal emotional coldness is typical. paranoid psychopathy. A special propensity for super-valuable formations, combined with low plasticity of the psyche, suspicion, increased self-esteem, straightforwardness, a tendency to leadership and self-affirmation, resentment and vindictiveness, categorical judgments. Inhibitory psychopathy. The leading place is occupied by asthenic, psychasthenic and even schizoid features with a predominance of passive (inhibitory) reactions to various psycho-traumatic factors, feelings of inferiority, expressed by fluctuations in working capacity. Often there is a tendency to obsessive doubts, a desire for constant introspection and self-control, the formation of various phobias and hypochondria. They have constant irritable weakness in the form of flashes of passion at any unbearable tension for them, depressed mood background anxiety, timidity, shyness, fatigue, indecision, insecurity, cowardly suffering, weakness of desires and even abnormal sexuality (impotence, homosexuality, pedophilia and other pathology) , somatic disorders (headaches, poor appetite, sleep disturbance, discomfort in the heart, liver, stomach), poor adaptation in the team, increased conflict. Schizoid psychopathy. Along with vulnerability, timidity, shyness, some inertia in life situations, symptoms such as introvertedness (unsociableness, isolation, constant introspection of actions and statements), a tendency to fantasize, lack of a sense of humor, daydreaming, eccentricity, difficulties in contacts, coldness and dryness, excessive seriousness and sentimentality, stiffness and pathos in behavior. However, their hobbies are not divorced from life, but they are "non-standard" and unusual (philosophical-religious and Eastern beliefs, telepathy). Unstable psychopathy. Instability of interests, attachments, decisions, inability to long-term concentration and monotonous activity, unusual suggestibility and ease of falling under the influence of others: they are easily involved in gambling, in the abuse of alcohol, drugs and their surrogates, in sexual excesses and even in non-standard public delicts. 74. REACTIVE STATES: NEUROSIS Reactive (psychogenic) states - these are temporary, reversible disorders of mental activity, usually arising as a reaction to severe mental experiences or traumas for a particular person (arrest, investigation, trial, insult, etc.). To clarify the possible actions in these conditions, it is necessary to know their main groups - neuroses and reactive psychoses, the difference and clinical manifestations. Neuroses. Their occurrence is associated with long-term psycho-traumatic conditions of life, and their development affects those personality traits that reflect the weakness of higher nervous activity, the low limit of physiological endurance to psychogenies of various strengths, etc. With hysterical neurosis ascertain vegetative, motor, sensory and mental disorders. Vegetative disorders are observed in the form of a spasm of smooth muscles (lump in the throat), a feeling of obstruction of the esophagus, a feeling of lack of air. Hysterical vomiting, loose stools and other vegetative manifestations (blanching of the skin, etc.) are also possible. Motor disorders are recorded more often as hysterical seizures (accompanied by screams and tears), but there may also be hysterical paralysis (refusal to be in a standing position with intact musculoskeletal system), hysterical aphonia (loss of voice), hysterical refusal of speech (muteness with preservation of understanding the speech of others and the absence of damage to the centers of speech in the brain). Sensory changes are usually noted in the form of disorders of skin sensitivity and disturbances in the activity of individual organs (more often it is hysterical blindness and deafness). Mental disorders are represented by mood swings, depression, depression, fears, hypochondriacal manifestations, phobias. With obsessive-compulsive disorder obsession predominates with a predominantly figurative and diverse affective content of experiences, doubts, ideas, memories, fears and actions that is painful for a particular person. Forensic psychiatric practice says that. that such patients usually do not commit criminal acts due to their remaining criticism of the manifestations of obsession. With neurasthenia isolated against the background of chronic fatigue and prolonged psychogenic traumatic conditions of life, increased morbid excitability, the development of depression, the inability to concentrate, mental and physical exhaustion, intolerance of common stimuli, headache, absent-mindedness, decreased creative activity, sleep disturbance, etc. These asthenic manifestations continue for quite a long time, are never accompanied by psychotic symptoms, and when the situation normalizes, the condition of such persons returns to the original. In forensic psychiatric practice, neuroses are quite rare, because forensic psychiatrists do not detect psychotic disorders in such subjects (psychosis, delusions, hallucinations, twilight clouding of consciousness) and always establish in them the ability to realize the actual nature and social danger of their actions (inaction) and lead them, i.e. such persons are considered sane. 75. REACTIVE STATES: REACTIVE PSYCHOSIS reactive psychoses. This group of mental disorders includes a variety of clinical manifestations and intensity of manifestations of the state, which are united by the following common features: 1) the onset of psychosis immediately after psychogeny or a short period after it (minutes, hours, less often days); 2) compliance of the content of psychotic experiences with the nature of mental trauma; 3) the reversibility of psychosis as the action of the psychotraumatic factor ceases; 4) significant severity in the clinical symptoms of various affective disorders that occur in stressful situations (when fear for one's life becomes the dominant experience). Acute shock reactive psychoses arise under the influence of a sudden and severe psychogenic trauma (threatening life) or severe shocks (unexpected news), etc. Moreover, they can last minutes or hours, in some cases taking the form of psychogenic retardation up to stupor, or in others - a sharp psychomotor agitation with sudden onset of fear, panic, chaotic motor anxiety, aimless movement, screams, senseless flight, and in severe cases - a violation consciousness up to twilight. At the same time, abundant vegetative disorders (sharp blanching, etc.) are revealed, which necessarily accompany an acute psychotic state. Many psychiatrists consider the whole variety of mental disorders in shock reactions in terms of their belonging to hysterical disorders with the involvement of others in psychosis and the possibility of panic among them ("psychic induction"). Such arousal can also turn into a deep lethargy. Subacute reactive psychoses (the most common form) - can last from 2 to 12 weeks. These include (according to the leading clinical sign) psychogenic depression, psychogenic paranoid, psychogenic hallucinosis and hysterical psychosis. According to the leading clinical syndromes, reactive psychoses are classified into: - psychogenic depression - a pronounced depressive syndrome prevails with the affect of melancholy, despondency, apathy and general psychomotor retardation; - psychogenic paranoid - proceeds with the development of delusions of relationship, persecution, external influence, etc., directly or indirectly associated with a traumatic situation (arrest, judicial-investigative actions, being in a pre-trial detention center); - psychogenic hallucinosis - quite often states with auditory, and sometimes with visual deceptions of perception associated with the subject of delirium and a psychotraumatic situation, accompanied by the affect of fear. Prolonged reactive psychoses - last 6 months. and more, keeping as the leading psychopathological syndrome puerilism, pseudodementia, delusional fantasies, etc. Giving a forensic psychiatric assessment of socially dangerous acts committed by persons in a state of reactive psychosis, one should know that they are recognized as insane in relation to the incriminated actions. 76. EXCEPTIONAL CONDITIONS: PATHOLOGICAL DRUNKNESS Exception States - a group of mental disorders stands separately in the classification of mental illness and refers to short-term mental disorders. When considering the causes of their occurrence, it should be taken into account that these mental disorders are a kind of reaction to a sudden (acute) psychogenic conditioned external influence that is personally significant for a particular person. Such transient psychoses usually occur in apparently healthy people, but still more often in those who have suffered trauma or brain disease. Exceptional conditions in the vast majority of cases occur in people with chronic asthenic conditions, with lack of sleep, overwork. These psychopathological disorders are characterized by the following common clinical features: a sudden onset, a short course (minutes), the obligatory presence of an upset, predominantly twilight clouding of consciousness (sometimes with motor agitation), the absence of any contact with others, the sudden cessation of psychosis, the reversibility of symptoms, turning into sharp mental and physical exhaustion or in a dream with the subsequent forgetting of the occurred events. Pathological intoxication develops against the background of negative external and internal conditions of life, literally a few minutes after taking alcohol or its surrogates (which is more common) or even against the background of previous simple alcoholic intoxication (which is much less common). Unlike the latter, this condition is caused by a qualitatively different psychopathological symptomatology ( but necessarily provoked by alcoholic beverages) and, above all, due to the ascertainment of twilight clouding of consciousness, which is usually accompanied by the affect of fear of death, and not by a banal total increase in the symptoms of simple intoxication. Moreover, pathological intoxication can also be with hallucinations and delusional disorders of a frightening nature, and in other cases - with a predominance of sharp motor restlessness, usually of a defensive nature. When diagnosed, the subject is declared insane. Twilight clouding of consciousness (not a symptom of any chronic mental illness), in addition to the above symptoms, more often than with other types of temporary mental disorders, they state: partial or complete detachment from the environment, varying degrees of disorientation in place, time and situation, impaired thinking with partial or the complete impossibility of correct judgments and the forgetting of past events. In more acute cases, aggravation of psychotic symptoms, the development of hallucinosis, delirium, the affect of anger, melancholy, fear, violent excitement, a tendency to aggressive actions, often extremely cruel, vandalism, or, conversely (which is much less common), outwardly ordered behavior, but necessarily with the development of amnesia for the events. When identifying twilight clouding of consciousness as an independent type of temporary mental disorder, forensic psychiatric experts always conclude that the subject is insane for the incriminated act. 77. EXCEPTIONAL CONDITIONS: PATHOLOGICAL PROSONIC CONDITION, PATHOLOGICAL AFFECT, "SHORT CIRCUIT" REACTION Pathological sleepy state (intoxication with sleep) occurs, as a rule, during the period of pathological awakening from deep physiological sleep, which was accompanied by vivid (nightmare) dreams (but it can also be during the period of falling asleep). When evaluating the results of a forensic psychiatric study, it must be borne in mind that in such a state, an awakened person perceives reality as a continuation of a dream, which, in turn, is intertwined with a wrong perception of the environment. As a result, pathological experiences and actions dangerous for others (aggression) arise. This state ends with subsequent deep sleep. When a pathological prosonic state is established, the subject is recognized as insane for the alleged offenses. Pathological affect - at the same time, the impact of a sudden and intense mental trauma with the short-term appearance of three phases is ascertained: preparatory, explosion and final. In the preparatory phase, under the influence of a psychogenically conditioned trauma (for example, insults), there is a sharp increase in affective tension with a loss of the ability to critically evaluate and realize what is happening. In the phase of the explosion, tension is noted, which develops into a deep stupefaction of consciousness, and then into an affect of anger or frenzy with sharp motor excitement, aggression and vegetative disorders (blanching or reddening of the face, a change in the rhythm of breathing). The final phase is characterized by a sharp depletion of mental and physical strength (indifference to the deed and the environment) up to sleep or prostration. There is little or no recollection of what happened. With a forensic psychiatric assessment of a pathological affect, such a person is exempted from criminal liability for a committed socially dangerous act. Reaction "short circuit" characterized by prolonged affective tension with a predominance of a melancholy mood or despair and the impact of an instantly changed situation. At the same time, consciousness is acutely disturbed for a short time (like twilight stupefaction) and the possibility of impulsive actions sharply increases. This leads to aggression, self-harm, suicidal acts, followed by prostration up to sleep with partial or even complete amnesia. Forensic psychiatric experts recognize such sub-expert persons as insane. A feature of forensic psychiatric examinations when establishing temporary mental disorders in individuals should be a clear indication of forensic psychiatric experts to a combination of signs that form the clinical picture of transient psychoses (and not their isolated statement), which will allow employees of the investigation, prosecutor's office, court and advocacy to judge the legality diagnosis. But the main thing in this case is the proof of the existence of an acute clouded consciousness (as a symptom) in the subjects at the time of the commission of the incriminated acts, which is the basis for recognizing such persons as insane.
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