Mahowald Mark W, Schenck Carlos H, Cramer Bornemann Michel A
Minnesota Regional Sleep Disorders Center, Hennepin County -Medical Center, 701 Park Avenue, Minneapolis, MN 55415, USA.
Curr Neurol Neurosci Rep. 2005 Mar;5(2):153-8. doi: 10.1007/s11910-005-0014-3.
Most violent behaviors arise from wakefulness. It is important to realize that violent behaviors that may have forensic science implications can arise from the sleep period. By virtue of the fact that these behaviors arise from sleep, they are executed without conscious awareness, and, therefore, without culpability. The most common underlying conditions arising from sleep are disorders of arousal (sleepwalking and sleep terrors), the rapid eye movement sleep behavior disorder, and nocturnal seizures. In addition, there are a number of psychiatric conditions (dissociative disorders, malingering, and Munchausen syndrome by proxy) that actually arise from periods of wakefulness occurring during the sleep period. The clinical and medico-legal evaluation of such cases is outlined, and should be performed by a multidisciplinary team of experienced sleep medicine practitioners.
大多数暴力行为源于清醒状态。必须认识到，可能具有法医学意义的暴力行为也可能源于睡眠阶段。由于这些行为源于睡眠，它们是在无意识状态下实施的，因此不存在罪责。睡眠中最常见的潜在情况是觉醒障碍（梦游和夜惊）、快速眼动睡眠行为障碍以及夜间癫痫发作。此外，还有一些精神疾病（分离性障碍、诈病和代理型孟乔森综合征）实际上源于睡眠期间出现的清醒时段。本文概述了此类病例的临床和法医学评估，应由经验丰富的睡眠医学从业者组成的多学科团队进行评估。
