Although we do take into account the psychic status ofthe forensic examinee and his co-relation with his environment, especially regarding an injured person (and possible victimization action), his family and material status, possible earlier criminal acts committed, in each and every psychiatric forensic examination, no matter if it is mental competence, testatory capability, ability to stand trial or working capability, we are most certainly obliged to establish a psychiatric diagnosis, or, if there isn't one, i.e. when an examinee is mentally healthy, we are to state Sine morbo psychico (i.e. without a mental disorder). It is of utmost importance to underline that although the diagnosis is important, it is not the only determining component for the judgment of mental competence.
The official classification of mental disorders in the Republic of Croatia is the World Health Organization's ICD-10 (1), and there is another, American classification – the DSM-IV (2). It is quite justified to ask why there are two official classifications of mental disorders that are used all over the world, and which one of the two is better. It is important to stress that the ICD-10 was from the very beginning constructed by medical doctors who, in that same medical fashion and tradition were working for physicians-therapists. It was primarily constructed on medical criteria and it is better adjusted for the implementation in practical medicine. On the other hand, the DSM-IV was primarily done by statisticians. The first incentive for drafting a classification was population census in 1840 in which a category “idiocy/insanity” was included. Already 40 years afterwards, i.e. in 1880 during the population census there existed 7 diagnostic categories from the field of neuropsychiatry. The primary goal of that classification was motivated statistically, whilst the motivation of the classification of the World Health Organization was primarily medical. According with different aims of these classifications, there are some very important differences between them. ICD-10 has far better structural validity, while DSM-IV has better predictive validity. For forensic sciences in psychiatry as a medical-forensic discipline ICD-10 is more appropriate, but, as DSM-IV is in some chapters more detailed than ICD-10, it is those very fields where DSM-IV should be used. As neither of the two classifications was not maked primarily for forensic use, one recommends usage of psychiatric and forensic textbooks so that each and every forensic examination could be founded on reviewed sources which are compatible with recent classifications.
In somatic medicine as a rule we use the term disease, while in psychiatry we use the term psychiatric diagnosis or psychiatric disorder. The reason for that is that psychiatric disorders do not fulfill criteria for them to be named diseases for in most instances we are unaware of etiology and pathophysiology, and often not even prognosis or specific therapy.
Luckily, in forensic examination it is not the diagnosis that is crucial, but there are other important factors. Only in cases of severe mental retardation or highly advanced dementia and acute psychotic state (schizophrenic or schizoaffective or manic), a person is considered without mental competence and without ability to stand a trial.
As one finds high comorbidity with other psychiatric disorders and/or somatic diseases, forensic examination becomes even more complicated. Comorbidity of psychosis, dementia and posttrau-matic stress disorder with alcoholism and drug dependence is very frequent, and personality disorders complicate the situation even worse.
Those are all factors that make a forensic expert work difficult in finding the right decision. It is important to keep by the rules, the conclusion is to be founded on medical record and in cases where one can't examine an examinee or if there are no enough relevant date, conclusion “non-liquet” is the most appropriate one.
