Exam 3 Flashcards
(276 cards)
1
Q
personality disorders
A
- enduring problems with forming a stable positive identity and sustaining close and constructive relationships
- broad range of symptoms involving problems in thinking, affect, impulse control, and interpersonal functioning
2
Q
3 clusters of personality disorders
A
- Cluster A: odd/eccentric
- Cluster B: dramatic/erratic
- Cluster C: anxious/fearful
3
Q
general personality disorder
A
- inflexible pattern of inner experience and behavior distinct from cultural expectations, and influences at least 2 of the following: cognition about the self and others, affect, interpersonal functioning, impulse control
- the pattern is inflexible, pervasive across situations, causes significant distress or impairment
4
Q
onset of general personality disorder
A
early adulthood and persistence for a long duration
5
Q
prevalence of personality disorders
A
about 1 out of 10 people meet diagnostic criteria for a personality disorder
6
Q
problems with DSM-5 approach to personality disorders
A
- personality disorders are not stable over time
- personality disorders are highly comorbid with each other
- thresholds for diagnosing personality disorders are arbitrary
7
Q
alternative DSM-5 model for personality disorders
A
- includes 6 of the 10 DSM-5 personality disorders
- hybrid dimensional + categorical model
- two types of dimensional personality scores
8
Q
the personality disorders excluded in the alternative DSM-5
A
schizoid, histrionic, dependent, and paranoid
9
Q
five personality trait domains in the alternative DSM-5 model of personality disorders
A
- negative affectivity (vs. emotional stability)
- detachment (vs. extraversion)
- antagonism (vs. agreeableness)
- disinhibition (vs. conscientiousness)
- psychoticism
10
Q
facets of negative affectivity
A
- anxiousness
- emotional lability
- hostility
- perseveration
- separation insecurity
- submissiveness
11
Q
detachment
A
- anhedonia
- depressivity
- intimacy avoidance
- suspiciousness
- withdrawal
- restricted affectivity
12
Q
facets of antagonism
A
- attention seeking
- callousness
- deceitfulness
- grandiosity
- manipulativeness
13
Q
facets of disinhibition
A
- distractibility
- impulsivity
- irresponsiblity
- (lack of) rigid perfectionism
- risk taking
14
Q
facets of psychoticism
A
- eccentricity
- cognitive perceptual dysregulation
- unusual beliefs and experiences
15
Q
strength of the alternative model
A
- personality trait ratings are more stable over time than diagnostic categories
- 25 dimensional scores provide richer detail than categorical diagnoses
- clinicians find it easier to discuss with clients and more helpful for treatment planning
16
Q
common risk factors of personality disorders
A
- personality disorders share genetic vulnerability
- environmental factors –> early adversity, childhood abuse or neglect –> aversive of unaffectionate parental style
17
Q
odd/eccentric cluster (cluster A)
A
paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder
18
Q
DSM-5 criteria of paranoid personality disorder
A
presence of 4 or more of the following signs of distrust and suspiciousness from early adulthood across many contexts:
- unjustified suspiciousness of being harmed, deceived, or exploited
- unwarranted doubts about the loyalty or trustworthiness of friends or associates
- reluctance to confide in others because of suspiciousness
- the tendency to read hidden meanings into the benign actions of others
- bearing grudges for perceived wrongs
- angry reactions to perceived attacks on character or reputation
- unwarranted suspiciousness of the partner’s fidelity
19
Q
DSM-5 criteria of schizotypal personality disorder
A
presence of 5 or more of the following signs of unsual thinking, eccentric behavior, and interpersonal deficits from early adulthood across many contexts:
-ideas of reference
- odd beliefs or magical thinking
- unusual perceptions
- odd thought and speech
- suspiciousness or paranoia
- inappropriate or restricted affect
- odd or eccentric behavior or appearance
- lack of close friends
- social anxiety and interpersonal fears that do not diminish with familiarity
20
Q
schizotypal personality disorder
A
characterized by eccentric thoughts and behavior, interpersonal detachment, and suspiciosness
21
Q
similarities between schizotypal personality disorder and schizophrenia
A
- overlap in genetic vulnerability
- deficits in cognitive and neuropsychological functioning
- enlarged ventricles
- less temporal lobe gray matter
- neurotransmitter dysregulation
22
Q
dramatic/erratic cluster (cluster B)
A
antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder
characterized by symptoms that range from:
- rule-breaking behavior
- exaggerated emotional displays
- highly inconsistent behavior
-inflated self-esteem
23
Q
antisocial personality disorder
A
- pervasive disregard for the rights of others (aggressive, impulsive, and callous traits)
- pattern of irresponsible behavior
- little regard for truth and little remorse for misdeeds
24
Q
prevalence of antisocial personality disorder
A
- 5x more common in men
- 75% also meet criteria for another disorder
- substance use is very common
25
clinical description of psychopathy
- clinical/personality concept that predates DSM diagnosis of antisocial personality disorder
- not a DSM disorder
- compared to antisocial personality disorder... does not require symptoms before age 15, includes more affective symptoms
- focuses on internal thoughts and feelings --> poverty of emotion
- three core traits
26
poverty of emotion
- negative emotions --> lack shame, remorse, and anxiety; does not learn from mistakes
- positive emotions --> merely an act used to manipulate others; superficially charming
27
three core traits of psychopathy
- boldness --> social poise and calm demeanor
- meanness --> lack of empathy for others
- impulsivity --> behave irresponsibly for thrills
28
DSM-5 criteria of antisocial personality disorder
pervasive pattern of disregard for the rights of others since the age of 15 as shown by at least three of the following:
- repeated law breaking
- deceitfulness, lying
- impulsivity
- irritability and aggressiveness
- reckless disregard for own safety and that of others
- irresponsibility, as seen in unreliable employment of financial history
- lack of remorse
29
etiology of antisocial personality disorder - interactions of genes and the social environment
- overlap with genetic risk for substance use disorders
- social environment --> poverty, exposure to violence
- family environment interacts with genetics
30
etiology of antisocial personality disorder - psychological risk
- insensitivity to fear and threat: difficulty learning from experience to avoid trouble; lack of fear or anxiety, behaviorally and physiologically; poor attention to threat when pursuing rewards/goals
- deficits in empathy
31
borderline personality disorder (BPD)
- impulsivity and instability in relationships and mood
- difficulty being alone, fears of abandonment, chronic feelings of depression and emptiness
- high degree of emotional sensitivity
- high levels of stress
- suicidal behavior and non-suicidal self-injury is common
32
DSM-5 criteria of borderline personality disorder
presence of 5 or more of the following signs of instability in relationships, self-image and impulsivity from early adulthood across many contexts:
- frantic efforts to avoid abandonment
- unstable interpersonal relationships in which others are either idealized or devalued
- unstable sense of self
- self-damaging, impulsive behaviors in at least two areas
- recurrent suicidal behavior or gestures, or self-injurious behavior
- marked mood reactivity
- chronic feelings of emptiness
- recurrent bouts of intense or poorly controlled anger
- during stress, a tendency to experience transient paranoid thoughts and dissociative symptoms
33
etiology of borderline personality disorder - neurobiological influences
diminished connectivity of brain regions involved in emotion experience; prefrontal cortex, anterior cingulate cortex, amygdala; could help explain poor control over emotions and impulsivity when emotions are present
34
etiology of borderline personality disorder - parenting interacts with child vulnerability
- Linehan's biosocial theory of BPD
- person's feelings are discounted and disrespected
35
Linehan's biosocial theory of BPD
biological (possibly genetic) vulnerability interacts with a family environment that is invalidating; biological vulnerability --> emotional dysregulation in the child --> great demands on the family --> invalidation by parents through punishing or ignoring the demands --> emotional outbursts by child to which parents attend --> emotional dysregulation in the child --> etc.
36
etiology of BPD - genetic vulnerability and abuse
genetically driven impulsivity, emotionality, or risk-seeking in the parents could increase the risk that both abuse and BPD will occur
37
histrionic personality disorder
- overly dramatic and attention-seeking behavior
- often use their physical appearance to draw attention to themselves
- self- centered, overly concerned with physical attractiveness, and uncomfortable when not the center of attention
- inappropriately sexually provocative and seductive
- easily influenced by others
38
DSM-5 criteria of histrionic personality disorder
presence of 5 or more of the following signs of excessive emotionality and attention seeking from early adulthood across many contexts:
- strong need to be the center of attention
- inappropriate sexually seductive behavior
- rapidly shifting and shallow expression of emotions
- use of physical appearance to draw attention to self
- speech that is excessively impressionistic and lacking in detail
- exaggerated, theatrical emotional expression
- being overly suggestible
- misreading relationships as more intimate than they are
39
narcissistic personality disorder
- grandiose view of self
- self-centered
- demands constant attention
- lacks empathy
- feelings of arrogance, envy, entitlement
- view themselves as superior to others
- primary goal of interaction with others is to bolster their own self-esteem
- value being admired more than gaining closeness
- may be vindictive and aggressive when faced with a competitive threat or a put-down
40
DSM-5 criteria of narcissistic personality disorder
presence of 5 or more of the following signs of grandiosity, need for admiration, and lack of empathy from early adulthood across many contexts:
- grandiose view of one's importance
- preoccupation with one's success, brilliance, beauty
- belief that one is special and can be understood only be other high-status people
- extreme need for admiration
- strong sense of entitlement
- tendency to exploit others
- lack of empathy
- envy of others
- arrogant behavior or attitudes
41
etiology of narcissistic personality disorder - parenting
- overly indulgent parents foster children's belief that they are special
- parental tendencies to see their children as highly superior to others predicts children's narcissistic traits
42
etiology of narcissistic personality disorder - fragile self-esteem
- inflated self-worth and denigration of others defend against feelings of shame
- sensitivity to negative social interactions
- associated with higher levels of neuroticism and depression
43
anxious/fearful cluster (cluster C)
avoidant personality disorder, dependent personality disorder, obsessive compulsive personality disorder
- prone to worry and distress
44
avoidant personality disorder
- fearful of criticism, rejection, and disapproval
- avoids social situations due to fear of negative feedback
- restrained and inhibited in social situations
- beliefs of incompetence and inferiority
- high comorbidity with social anxiety disorder
45
DSM-5 criteria of avoidant personality disorder
a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism as shown by 4 or more of the following from early adulthood across many contexts:
- avoidance of occupational activities that involve significant interpersonal contact, because of fears of criticism or disapproval
- unwilling to get involved with people unless certain of being liked
- restrained in intimate relationships because of the fear of being shamed or ridiculed
- preoccupation with being criticized or rejected
- inhibited in new interpersonal situations because of feelings of inadequacy
- views self as socially inept, unappealing or inferior
- unusually reluctant to try new activities because they may prove embarrassing
46
dependent personality disorder
- excessive reliance on others
- intense need to be taken care of
- subordinate needs to ensure protective relationships are not threatened
- urgently seek new relationship when one ends
- view themselves as weak
- likely to develop depression after interpersonal losses
47
DSM-5 criteria of dependent personality disorder
an excessive need to be taken care of, as shown by the presence of at least 5 of the following from early adulthood across many contexts:
- difficulty making decisions without excessive advice and reassurance from others
- need for others to take responsibility for most major areas of life
- difficulty disagreeing with others for fear of losing their support
- difficulty doing things on own or starting projects because of lack of self-confidence
- doing unpleasant things as a way to obtain the approval and support of others
- feelings of helplessness when alone because of fears of being unable to care for self
- urgently seeking new relationship when one ends
- preoccupation with fears of having to take care of self
48
obsessive-compulsive personality disorder (OCPD)
- perfectionistic
- preoccupied with rules, details, schedules, and organization
- overly focused on work
- reluctant to delegate or to let others make decisions
49
obsessive-compulsive personality disorder compared to OCD
- does not have the obsessions/compulsions of OCD
- symptoms often co-occur and share genetic vulnerability
50
DSM-5 criteria of OCPD
intense need for order, perfection, and control, as shown by the presence of at least 4 of the following from early adulthood across many contexts:
- preoccupation with rules, details, and organization to the extent that the point of an activity is lost
- extreme perfectionism interferes with task completion
- excessive devotion to work to the exclusion of leisure and friendships
- inflexibility about morals and values
- difficulty discarding worthless items
- reluctance to delegate unless others conform to one's standards
- miserliness
- rigidity and stubbornness
51
treatment of personality disorders
- often enter treatment for a condition other than personality disorder
- presence of personality disorder predicts slower improvement in psychotherapy
- psychotherapy
- often supplemented with medications
52
psychodynamic theory of personality disorders
childhood problems are at the root of personality disorders
53
cognitive theory of personality disorders
- negative cognitive beliefs are at the root of personality disorders
- treat person by helping them become more aware of beliefs and challenge maladaptive cognitions
54
treatment of schizotypal personality disorder
antipsychotic and antidepressant medications
55
treatment of avoidant personality disorder
- same treatments as social anxiety disorder
- antidepressant medications
- CBT: challenge negative beliefs, social skills training, exposure to feared situations
56
treatment of borderline personality disorder
- difficult to treat
- goals of treatment: reduce symptoms, suicidality, and risk of self-harm
- psychodynamic therapy: transference focused therapy, mentalization based therapy
- dialectical behavior therapy
- group and individual therapy sessions
- DBT skills
57
transference focused therapy for BPD
helps client consider parallels between response to therapist and experiences in other relationships
58
mentalization based therapy (MBT) for BPD
helps client to be more reflective about feelings, and those of other people, so as not to automatically act without thinking when emotions or interpersonal stressors occur
59
dialectical behavior therapy (DBT) for BPD
combines client-centered empathy and acceptance and cognitive behavioral problem solving, emotion-regulation techniques, and social skills training
60
four stages to treating BPD
1) addressing dangerously impulsive behaviors (e.g., suicidal actions)
2) modulating extreme emotionality and coaching the client to tolerate emotional distress
3) improving relationships and self-esteem
4) promoting connectedness and happiness
61
sexual revolution of 1970s
availability of birth control led to shifts in attitudes towards premarital sex
62
research methods in the study of sexuality
- 1940s: research focused on interviewing people about their sexuality
- 1950s: use of direct observations and physiological assessments during masturbation or sexual intercourse
- use penile or vaginal plethysmographs to assess physiological responses to sexual stimuli
- stigma may interfere with sexuality research
63
men are more likely to...
- meet diagnostic criteria for paraphilic disorder
- endorse engaging in masturbation and using pornography
64
women are more likely to...
report sexual dysfunction
65
gender differences in sexuality have...
decreased over time
66
female sexual interest/arousal disorder
persistent deficits in sexual interest (fantasies or urges), biological arousal, or subjective arousal
67
male hypoactive sexual desire disorder
deficient or absent of sexual fantasies and urges
68
male erectile disorder
failure to attain or maintain an erection
69
DSM-5 criteria of female sexual interest/arousal disorder
diminished, absent, or reduced frequency of at least three of the following:
- interest in sexual activity
- erotic thoughts or fantasies
- initiation of sexual activity and responsiveness to partner's attempts to initiate
- sexual excitement/pleasure during 75% of sexual encounters
- sexual interest/arousal elicited by any internal or external erotic cues
- genital or nongenital sensations during 75% of sexual encounters
70
DSM-5 criteria of male hypoactive sexual desire disorder
sexual fantasies and desires, as judged by the clinician, are deficient or absent
71
DSM-5 criteria of erectile disorder
on at least 75% of sexual occasions, one of the following occurs:
- inability to attain an erection
- inability to maintain an erection for completion of sexual activity
- marked decrease in erectile rigidity interferes with penetration or pleasure
72
orgasmic disorders
female orgasmic disorder, early ejaculation disorder, delayed ejaculation disorder
73
DSM-5 criteria of female orgasmic disorder
- persistent absence or reduced intensity of orgasm after sexual arousal
- on at least 75% of sexual occasions
- marked delay infrequency or absence of orgasm or markedly reduced intensity of orgasmic sensation
74
DSM-5 criteria of early ejaculation disorder
- ejaculation that occurs too quickly
- tendency to ejaculate during partnered sexual activity within 1 minute of penile insertion on at least 75% of sexual occasions
75
DSM-5 criteria of delayed ejaculation disorder
- persistent difficulty in ejaculating
- least common, reported by less than 1% of men
- marked delay, infrequency, or absence of orgasm on at least 75% of sexual occasions
76
sexual pain disorders
genito-pelvic pain/penetration disorder
77
DSM-5 criteria of genito-pelvic pain/penetration disorder
persistent or recurrent difficulties with at least one of the following:
- marked vulvar, vaginal, or pelvic pain during vaginal penetration or intercourse attempts
- inability to have vaginal penetration during intercourse
- marked fear or anxiety about pain or penetration
- marked tensing of the pelvic floor muscles during attempted vaginal penetration
78
etiology of sexual dysfunctions - biological influences
- biological influences include diabetes, multiple sclerosis, spinal cord injury, heavy alcohol use before sex, chronic alcohol use, heavy cigarette smoking
- excessive activation of sympathetic nervous system, inhibits blood flow to genitals
- deactivation of parasympathetic nervous system
- hormone levels --> low levels of testosterone or high levels of anabolic steroids or testosterone supplements
- side effect of some medications --> SSRIs
79
biological influences particularly important for...
erectile dysfunction and premature ejaculation
80
etiology of sexual dysfunctions - social and psychological influences
- history of rape, sexual abuse, absence of positive sexual experiences
- social and cultural learning
- relationship problems
- stress and exhaustion
- depression and anxiety
- negative cognitions --> self-blame
81
treatments of sexual dysfunctions
- psychoeducation
- couples therapy
- cognitive interventions
- sensate focus
- limited success in identifying medical treatments for sexual dysfunction disorders among women
82
psychoeducation as treatment for sexual dysfunction
normalize symptoms, reduce anxiety, model effective communication, eliminate blame
83
couples therapy as treatment for sexual dysfunction
- training in nonsexual communication skills
- focus on nonsexual issues
- focus on communication and restoration of intimacy
84
cognitive interventions as treatment for sexual dysfunctions
challenge self-demanding, perfectionistic thoughts
85
sensate focus as treatment for sexual dysfunctions
re-establish intimacy by engaging in contact through touch
86
treatments for female sexual interest/arousal disorder
- medication called Addyi for premenopausal women with low sexual desire
- efficacy is limited with significant side effects
87
treatment for female orgasmic disorder
- directed masturbation
- 60-90% of that subgroup achieving orgasm post-treatment
88
treatment for genito-pelvic pain/penetration disorder
- trained in relaxation
- practice inserting smaller and then larger dilators into vagina
89
treatment for premature ejaculation
- SSRI taken one hour before sex
- squeeze technique --> partner is trained to squeeze the penis in the area where the head and shaft meet to rapidly reduce arousal
- withdraw penis as needed during intercourse to reduce arousal
- psychotherapy to regain confidence after experiences of these symptoms
90
treatment for erectile disorder
- medication (e.g., Viagra)
- 83% able to successfully have intercourse
91
paraphilic disorders
- recurrent sexual attraction to unusual objects or sexual activities
- lasting at least 6 months
- should only be diagnosed when: there is marked distress or impairment, behaviors are done with nonconsenting partner
92
categories of paraphilic disorders based on source of arousal
- sexual attractions based on inanimate objects
- sexual attractions based on children
93
types of paraphilic disorders
fetishistic disorder, pedophilic disorder, voyeauristic disorder, exhibitionistic disorder, frotteuristic disorder
94
fetishistic disorder
- reliance on an inanimate object or a nongenital part of the body for sexual arousal
- recurrent and intense sexual urges toward these fetishes
- compulsive attraction to the object
95
DSM-5 criteria of fetishistic disorder
- for at least 6 months, recurrent and intense sexually arousing fantasies, urges, or behaviors involving the use of nonliving objects or nongenital body parts
- causes significant distress or impairment in functioning
- sexually arousing objects are not limited to articles of clothing used in dressing as another gender, nor to devices designed to provide tactile genital stimulation
96
pedophilic disorder
- diagnosed only when adults act on their sexual urges toward children, or when the urges cause distress to the person or those close to them
- victims are usually known to pedophile
- show more arousal to sexual stimuli involving children than to stimuli involving adults
- incest subtype
97
DSM-5 criteria for pedophilic disorder
- for at least 6 months, recurrent and intense, sexually arousing fantasies, urges, or behaviors involving sexual contact with a prepubescent child
- person has acted on these urges or the urges and fantasies caused marked distress or interpersonal problems
- person is at least 16 years old and 6 years older than the child
98
age of onset of paraphilic disorders
at least 6 months
99
voyeuristic disorder
- intense and recurrent desire to obtain sexual gratification by watching
- common in men
- may not find it particularly exciting to watch someone undress for his benefit
- the element of risk, and the threat of discovery, is important
99
age of onset of erectile disorder
at least 75% of sexual occasions
100
age of onset of female orgasmic disorder
at least 75% of sexual occasions
101
age of onset of early ejaculation disorder
at least 75% of sexual occasions
102
age of onset of delayed ejaculation disorder
at least 75% of sexual occasions
103
DSM-5 criteria for voyeuristic disorder
- for at least 6 months, recurrent, intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors
- person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems
104
exhibitionistic disorder
- exposing one's genitals to an unwilling stranger
- seldom an attempt to have other contact with the stranger
- usually involves desire to shock or embarrass the observer
- many exhibitionists masturbate during the exposure
105
DSM-5 criteria for exhibitionistic disorder
- for at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving showing one's genitals to an unsuspecting person
- person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems
106
frotteuristic disorder
- sexually oriented touching of an unsuspecting person
- rubbing genitals against a person's body or fondling a person's genitals
- often occurs in crowded places
107
DSM-5 criteria for frotteuristic disorder
- for at least 6 months, recurrent and intense and sexually arousing fantasies, urges, or behaviors involving touching or rubbing against a nonconsenting person
- person has cated on these urges with a nonconsenting person, or the urges and fantasies cause clinically significant distress or problems
108
sexual sadism disorder
inflicting pain or psychological suffering (such as humiliation) on another
109
sexual masochism disorder
being subjected to pain or humiliation
110
most sadists establish relationships with...
masochists, to derive mutual sexual gratification
111
DSM-5 criteria for sexual sadism disorder
- for at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving the physical or psychological suffering of another person
- causes clinically significant distress or impairment in functioning or the person has acted on these urges with a nonconsenting person
112
DSM-5 criteria for sexual masochism disorder
- for at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving the act of being humiliated, beaten, bound, or made to suffer
- causes marked distress or impairment in functioning
113
etiology of the paraphilic disorders - neurobiological influences
- almost all individuals with paraphilias are men
- they do not have unsual levels of testosterone or other androgens
114
etiology of the paraphilic disorders - psychosocial influences
- history of childhood sexual abuse
- loss of control over behavior
- heightened impulsivity and poor emotion regulation
- poor recognition of emotional expression of others
- slightly lower IQ and higher rates of neurocognitive problems
- more minor physical anomalies related to prenatal development
115
treatment for the paraphilic disorders
- very little is known about the effectiveness of treatments
- treatments aim to enhance motivation for treatment
- bolster hope for control over urges
- focus on benefits for change and consequences of continued engagement in illegal sexual behaviors
116
treatment for paraphilic disorders - cognitive behavioral
- cognitive behavioral treatment
- aversion therapy --> pair paraphilic fantasies with aversive stimuli
- covert sensitization --> asked to imagine negative consequences of inappropriate sexual behavior
- modify distorted thinking
- often combined with social skills, sexual impulse control strategies, empathy training, and relapse prevention
117
treatment for paraphilic disorders - biological
- medications
- hormonal agents to reduce androgens
- SSRIs
118
prevention of paraphilic disorders
- cognitive behavioral therapy and medication approaches
- often treatment only takes place after an individual is charged with a crime
119
developmental psychopathology
the study of disorders of childhood within the context of life-span development
120
two broad domains of childhood disorders
internalizing disorders and externalizing disorders
121
externalizing disorders
- characterized by outward-directed behaviors
- aggressiveness, noncompliance, overactivity, impulsiveness
122
types of externalizing disorders
attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder
123
internalizing disorders
- characterized by inward-focused experiences and behaviors
- depression, social withdrawal, and anxiety
124
types of internalizing disorders
childhood anxiety and mood disorders
125
attention-deficit/hyperactivity disorder (ADHD)
- symptoms of inattention and /or hyperactivity-impulsivity that interfere with school, work, or relationships
- these symptoms and behaviors don't fit with what is expected at a particular age or developmental level
- may have particular difficulty controlling their activity in situations that call for sitting still
- may experience difficulty getting along with peers
- aggressive and intrusive behaviors
- difficulty noticing subtle social cues
126
hyperactive behaviors
- extreme for a particular developmental period
- persistent across different situations
- linked to significant impairments in functioning
127
DSM-5 criteria for ADHD - inattention
manifestations of inattention can include:
- making careless mistakes
- not listening well
- not following instructions
- being easily distracted
- being forgetful in daily activities
128
DSM-5 criteria for ADHD- hyperactivity-impulsivity
manifestations of hyperactivity-impulsivity can include:
- fidgeting
- running about inappropriately
- acting as if "driven by a motor"
- interrupting or intruding
- nonstop talking
129
ADHD
- present in two or more settings
- significant impairment in social, academic, or occupational functioning
130
age of onset of ADHD
- symptoms present before age 12
- for children 6 symptoms of inattention and/or hyperactivity-impulsivity are required
- only 5 symptoms required for ages 17 and above
131
ADHD and comorbidities
often co-occurs with:
- conduct disorder
- anxiety and depression
- learning disorders
- substance use disorders
132
ADHD prevalence
- prevalence estimates 8-11%
- public policy can affect diagnosis rates
- 3x more common in boys than girls
- 60-74% still exhibit symptoms into at least early adulthood, symptoms often persist beyond childhood
133
etiology of ADHD - genetic influences
- adoption and twin studies ---> heritability estimates as high as 70-80%
- seven candidate genes implicated --> dopamine genes of DRD4, DRD5, DAT1; SNAP-25
- however, GWAS studies have not always found the same genes and many genes identified are not specific to ADHD
134
etiology of ADHD - neurobiological influences
- differences in brain structure, function, and connectivity
- dopaminergic areas smaller in children with ADHD
- perinatal and prenatal complications; low birth weight
135
etiology of ADHD - environmental toxins
- food additives may influence ADHD symptoms
- maternal smoking
- no evidence that refined sugar causes ADHD
136
etiology of ADHD - family influences
- parent-child relationship interacts with neurobiological influences to maintain or exacerbate symptoms, but family dynamics do not cause the initial onset of ADHD
- parents give more commands and have more negative interactions
- many parents of children with ADHD have ADHD themselves
- contribute to maintaining or exacerbating ADHD symptoms
137
treatment of ADHd - medications
stimulants (Ritalin, Adderall, Concerta, Strattera)
- reduce disruptive behavior, aggression, and impulsivity
- improve ability to focus attention
- improve concentration, goal-directed activity, classroom behavior
- improve social interactions with parents, teachers, peers
- effective in about 75% of children with ADHD
138
treatment of ADHD - medications and behavioral treatment
- medication plus behavior treatment
- combined treatment slightly better than medication alone and yielded improved functioning
139
treatment of ADHD - psychological treatments
- parental training and changes in classroom management --> behavior monitoring, reinforcement of appropriate behavior
- focus of these programs: improving academic work, completing household tasks, learning specific social skills, do not specifically focus on reading ADHD symptoms
140
conduct and related disorders
intermittent explosive disorder (IED), oppositional defiant disorder (ODD)
141
intermittent explosive disorder (IED)
- recurrent verbal or physical aggressive outbursts that are out of proportion to the circumstances
- aggression is impulsive and not preplanned
142
oppositional defiant disorder (ODD)
- loses temper, argumentative, lack of compliance, deliberately aggravates others, vindictive, spiteful, touchy
- often comorbid with ADHD
143
DSM-5 criteria for conduct disorder (CD)
- defined by the impact of child's behavior on people and surroundings
- pattern of repeated destructive and harmful behavior that can take different forms, including: aggressive behavior, destroying property, lying or stealing, breaking rules
144
conduct disorder (CD)
- children who have callous and unemotional traits
- lack of remorse, empathy, and guilt, and shallow emotions
145
one common pathway to Antisocial Personality Disorder in adulthood
ODD --> Conduct Disorder + limited prosocial emotion --> APD
146
conduct disorder (CD) and comorbidities
- substance abuse is common
- comorbid with anxiety and depression
147
two courses of conduct disorder (CD)
- life-course-persistent pattern of antisocial behavior
- adolecence-limited
148
life-course-persistent pattern of antisocial behavior course of CD
beginning to show conduct problems by age 3 and continuing into adulthood
149
adolescence-limited course of CD
- typical childhoods, engagement in high levels of antisocial behavior during adolescence, and typical, nonproblematic adulthoods
- maturity gap between the adolescent's physical maturation and the opportunity to receive rewards for assuming adult responsibilities
- continue to have troubles with substance use, impulsivity, crime, and overall mental health in their mid-20s
150
prevalence of CD
- fairly common: prevalence rates between 5-6%
- more common in boys than girls
151
prognosis of CD
life-course-persistent type of conduct disorder will likely continue to have problems in adulthood, including violent and antisocial behavior
152
etiology of CD - genetic influences
- heritability likely plays a part
- aggressive behavior is more heritable than other rule breaking behavior
- combination of conduct problems and callous/unemotional traits is more highly heritable than conduct problems alone
- aggressive and antisocial behaviors that begin in childhood are more heritable than similar behaviors that begin in adolescence
153
etiology of CD - neurobiological influences
- deficits in regions of the brain that support emotion and empathetic responses --> reduced activation of amygdala, ventral striatum, and prefrontal cortex
- autonomic nervous system --> lower levels of resting skin conductance and heart rate, lower arousal levels, may not fear punishment
- poor verbal skills, difficulty with executive functioning, and problems with memory
- children who develop conduct disorder at an earlier age have an IQ score 1 standard deviation below peers without conduct disorder
154
etiology of CD - psychological infleunces
- deficient moral awareness, especially lack of remorse
- Dodge's cognitive theory of aggression
155
Dodge's cognitive theory of aggression
- deficits in social information processing
- interpretation of ambiguous acts as evidence of hostile intent
- leads to aggressive retaliation
156
etiology of CD - peer influences
- rejection by peers is causally related to aggressive behavior
- rejection by peers predicts later aggressive behavior
- affiliation with deviant peers
157
treatment of CD
most effective when it addresses the multiple systems involved in the life of a child (family, peers, school, neighborhood)
158
treatment of CD - family interventions
- family check-ups (FCU)
- parental management training (PMT)
159
family check-ups (FCU)
- 3 meetings to assess and provide feedback to parents regarding their children and parenting practices
- associated with less disruptive behavior
160
parental management training (PMT)
- teach parents to use positive reinforcement for positive behaviors and time-out and loss of privileges for aggressive or antisocial behaviors
- most efficacious for children with CD and oppositional defiant disorder
161
CD prevention program
fast track
162
Fast Track
- designed to help children academically, socially, and behaviorally
- focuses on areas that are problematic in conduct disorder: peer relationships, aggressive and disruptive behavior, social information processing, and parent-child relationships
- treatment delivered over the course of 10 years
- more intensive treatment years 1-5 and less intensive years 6-10
163
children who received Fast Track for CD prevention
- reduced behavior problems and delinquent behaviors
- better social information processing skills
- decrease in the hostile attribution bias
- less likely to have externalizing or internalizing psychopathology, substance use problems, or antisocial personality disorder
164
internalizing disorders
depression and anxiety
165
depression
- common symptoms in children and adolescents ages 7-17 and adults show: depressed mood, inability to experience pleasure, fatigue, concentration problems, and suicidal ideation
- children and adolescents differ from adults in: more guilt but lower rates of early-morning wakefulness, early-morning depression, loss of appetite, and weight loss
166
prevalence of depression in adolescence
- 15.9% prevalence among adolescent girls
- 7.7% prevalence among among adolescent boys
167
etiology of depression
- genetic influences
- a child with a depressed parent has 4x greater risk than a child without a depressed parent
- gene-environment interactions
- short allele of the serotonin transporter gene AND significant interpersonal stressful life
- early adversity and negative life events
- cognitive distortions and negative attributional style
168
treatment of depression - antidepressants
- antidepressants
- possibility of increased risk of suicide attempts
169
treatment of depression - CBT
- CBT
- in school settings more effective and associated with more rapid reduction of symptoms than family or supportive therapy
- immediate benefits of CBT may not last long for young people
170
prevention of depression
- selective prevention programs
- universal programs
171
selective prevention programs for depression
target youth based on family, environmental, or personal risk factors
172
universal programs for depression prevention
targeted large groups, typically in schools, and provide education about depression
173
selective prevention programs more effective than...
universal programs
174
anxiety in children and adolescents
- fears and worries common in childhood
- more common in girls than boys
- impaired functioning
175
prevalence of anxiety in children and adolescents
3-5%
176
separation anxiety disorder
- constant worry that some harm will befall their parents or themselves when they are away from their parents
- at home, children shadow one or both of their parents
- often first observed when children begin school
- associated with the development of other internalizing and externalizing disorders at later ages
177
DSM-5 criteria for separation anxiety disorder
- experiencing a great deal of distress when separated from a parent or caregiver
- experiencing intense worry that something will happen to a parent or caregiver
- refusing to go to school or show a great bit of trepidation about going to school
- refusing to sleep away from home or trepidation about doing so
- having bad dreams or nightmares about being separated
- experiencing a great deal of physical problems when separated
178
posttraumatic stress disorder (PTSD) in children and adolescents
- exposure to trauma
- intrusively reexperiencing (e.g., flashbacks, nightmares, intrusive thoughts; reenactment play)
- avoidance
- negative cognitions and moods
- distinct symptoms for children ages 6 and younger that capture developmental differences
179
prevalence of OCD in children and adolescents
1-4%
180
obsessive compulsive disorder in children and adolescents
- symptoms similar to those in adults
- most common obsessions: dirt or contamination, aggression, sex or religion become more common in adolescence
- more common in boys than girls
181
etiology of anxiety disorders
- genetic influences
- heritability estimates from 29-50%
- parental control and overprotectiveness play a small role
- emotion regulation and attachment problems
- social influences: experienced bullying, overestimation of danger in social situations and underestimation of ability to cope in social situations
182
treatment of anxiety disorders in childhood and adolescence
CBT: Kendall's Coping Cat program
- confrontation of fears
- development of new ways to think about fears
- exposure to feared situations
- relapse prevention
- parents are also included in a couple of sessions
183
treatment of social anxiety disorder in childhood and adolescence
behavior therapy and group cognitive behavior therapy
184
treatment of OCD in childhood and adolescence
- CBT recommended first line treatment for mild to moderate OCD
- medication plus CBT for severe OCD
185
treatment for PTSD in childhood and adolescence
CBT
186
learning, communication, and motor disorders
- problems in a specific area of academic, language, speech, or motor skills
- progress in school is impeded
- discrepancy between achievement observed vs. what is expected based on developmental stage and IQ
- often of average or above-average intelligence but have difficulty learning specific skills in the affected area
187
specific learning disorder
- difficulties learning and using academic skills
- 1+ symptoms for 6+ months: inaccurate or slow and effortful word reading; difficulty understanding meaning of what is read; difficulties with spelling; difficulties with written expression; difficulties with mastering number sense, number facts, or calculation; difficulties with math reasoning
188
specific learning disorder specifiers
- impairment in reading
- impairment in written expression
- impairment in math
189
communication disorders
speech sound disorder, language disorder, social (pragmatic) communication disorder, childhood onst fluency disorder (stuttering)
190
speech sound disorder
correct comprehension and sufficient vocabulary use, but unclear speech and improper articulation
191
language disorder
problems in developing and using language
192
social (pragmatic) communication disorder
difficulties in using verbal and nonverbal language in social communication
193
childhood onset fluency disorder (stuttering)
difficulty with verbal fluency that is characterized by one or more of the following speech patterns:
- frequent repetitions or prolongations of sounds
- long pauses between words, substituting easy words for those that are difficult to articulate
- repeating whole words
194
up to 80% recover from...
stuttering, most of them without professional intervention, before the age of 16
195
motor disorders
Tourette's disorder, developmental coordination disorder, stereotypic movement disorder
196
Tourette's disorder
one or more vocal and multiple motor tics that start before age 18
197
developmental coordination disorder
difficulties in the development of motor coordination not explainable by intellectual disability or a disorder such as cerebral palsy
198
stereotypic movement disorder
repetition of purposeless movements over and over that interferes with functioning and could even cause self-injury
199
intellectual disability
- intellectual deficits (e.g., in solving problems, reasoning, abstract thinking) determined by intelligence testing and broader clinical assessment
200
three components of intellectual disability
- significant problems in intellectual functioning
- significant problems in adaptive behavior across contexts
- problems begin before age 18
201
severity of intellectual disability assessed in three domains:
- conceptual (intellectual and other cognitive functioning)
- social
- practical
202
individualized educational program (IEP)
- school based intervention for intellectual disability
- based on the person's strengths and weaknesses and on the amount of instruction needed
203
etiology of intellectual disability - genetic/chromosomal influences
- Down syndrome
- Fragile-X syndrome
- Phenylketonuria --> amino acid buildup
204
etiology of intellectual disability - environmental influences
- maternal infectious disease
- lead or mercury poisoning
- encephalitis and meningococcal meningitis in infancy or early childhood
205
treatment of intellectual disability
- residential treatment
- behavioral treatments: divide target behavior into small components, applied behavioral analysis
- operant conditioning to increase target behaviors and reduce inappropriate or harmful behaviors
- cognitive treatments
- computer-assisted instruction
206
autism spectrum disorder (ASD) - social and emotional deficits
- problems with the social world
- rarely approach others
- may look through people
- problems in joint attention
- pay less attention to speaking faces, particularly the eyes and mouth regions
- theory of mind: may not understand that other people have different desires, beliefs, intentions, and emotions
- may recognize emotions without understanding them
207
ASD- communication deficits
- early language disturbances
- echolalia
- pronoun reversal
- literal use of words
208
echolalia
immediate or delayed repeating of what was heard
209
pronoun reveral
refer to themselves as "he" or "she"
210
ASD - repetitive behaviors
- repetitive and ritual acts
- become extremely upset when routine is altered
- focused and preoccupied on specific things
- engage stereotypical behavior, peculiar ritualistic hand movements, and other rhythmic movements
- become attached to inanimate objects
211
DSM-5 criteria for autism spectrum disorder (ASD)
significant problems in social communication and social interactions, such as:
- problems in understanding other people's emotions, reluctance to approach others, trouble with back-and-forth conversations
- problems in maintaining eye contact, showing facial expressions, or using gestures to communicate with other people
- problems in forming and keeping peer relationships
repeated and ritualistic behavior patterns, interests, or activities, such as:
- repeating the same speech, movements, or use of objects over and over again in a fairly fixed and stable manner
- extreme desire to maintain routines or behavior rituals; can become very upset if required to change
- preoccupation with just a small number of interests or objects
- very sensitive to sensory input or unusually interested in the sensory environment, such as being enchanted by lights or spinning objects
212
ASD age of onset
early childhood and evidence in the first months of life
213
ASD prevalence
- affects 1 out of 54 children
-4x higher rates in boys than girls
214
ASD comorbidity
comorbidity with intellectual disability, specific learning disorder, separation anxiety, social anxiety, general anxiety, and specific phobias
215
ASD prognosis
- diagnosis is stable over time
- children with higher IQs who learn to speak before age six have the best outcomes
- many independently functioning adults with ASD continue to show impairment in social relationships
216
ASD - genetic influences
- heritability estimates of between .50 and .80
- linked genetically to a broader spectrum of deficits in communication and social interaction
- shared environmental factors accounts for over half of risk for developing ASD
- GWAS studies show 5 unique loci and 7 that overlap with genetic risk for schizophrenia and depression
217
ASD etiology - neurobiological influences
- brain size: although normal size at birth, brains of autistic adults and children are larger than normal
- enlarged cerebellum, caudate nucleus
218
Treatment of ASD
- intensive operant conditioning
- joint attention intervention and symbolic play used to improve attention and expressive skills
- medications (antipsychotics)
219
elderly
over the age of 65
220
myths about late life
- aging involves inevitable cognitive decline --> severe cognitive problems do not occur for most
- older adults are unhappy --> more skilled at emotion regulation, attend more to positive, display less psychophysiological response to negative emotion
- late life is a lonely time --> interests shift away from seeking new social interactions to cultivating a few close friendships
221
common problems experienced in late life
- physical decline and disabilities
- sensory acuity deficits
- loss of loved ones
- social stress of stigmatizing attitudes towards elderly
- cumulative effects of a lifetime of stressors
- decline in quality and depth of sleep
222
problems experienced in late life - polypharmacy
- prescribing multiple drugs to a person
- 40% of elderly people are prescribed at least 5 medications
- 20% prescribed dangerous medications
- increases the risk of adverse drug reactions
223
special considerations in the study of aging
- age effects
- cohort effects --> different generations have different experiences during each stage of life
- time-of-measurement effects --> social/historical influences present at time measurement is made
224
selective mortality
when someone is no longer available for follow-up in a study because of death (longitudinal studies)
225
prevalence of psychological disorders in late life
- less common in the elderly than in younger adults
- most people with PDs in late life are experiencing a continuation of symptoms that began earlier
226
psychological disorders in late life
- DSM criteria are the same for older and younger adults
- particularly important to rule out medical explanations
227
treatment for psychological disorders in late life
- similar to treatments that work in earlier life
- many medications can cause serious side effects in elderly
- psychotherapy first line of approach for anxiety
228
dementia
- deterioration of cognitive abilities causing impairment
- most common symptoms is diminished memory, especially for recent events
- many different causes
229
psychiatric symptoms of dementia
- 50% experience depression
- sleep disturbances common
- delusions and hallucinations can occur
- difficulty with impulse control
230
mild cognitive impairment (MCI)
- most dementias develop slowly over a period of years
- behavioral deficits often emerge before noticeable impairment
- early signs of decline before functional impairment
231
DSM-5 criteria for mild cognitive disorder/impairment (MCI)
- modest cognitive decline from previous levels in one or more domains based on concerns of the patient, a close other, or a clinician
- impairment in one or more cognitive domains compared to expectations for the patient's age and educational level or compared to baseline testing
- preservation of ability to function independently
- cognitive deficits not due to vascular, trauma, or other medical conditions
- infection, sleep loss, thyroid disease, vitamin deficiencies
232
DSM-5 criteria for major neurocognitive disorder (dementia)
cognitive or behavioral symptoms that:
- reported by the patient or knowledgeable informant or are shown on an objective cognitive assessment
- interfere with the ability to function at work or at usual activities
- represent a decline from previous levels of functioning and performing
- impairments are observed in at least 2 domains: memory, reasoning/judgment, visuospatial, language, personality/behavior
233
prevalence of dementia
- less than 2% before the age of 65
- increases dramatically as people age
- more than 1/3 of people in their 90s
- age of onset is becoming later over time in United States and Europe
- appears lower in sub-Saharan Africa and high in Latin America
234
types of dementia
- Alzheimer's disease
- frontotemporal dementia
- vascular dementia
- Lewy body dementia
235
Alzheimer's disease
- irreversibly brain tissue deterioration
- death usually occurs within 12 years
- usually begins with: absentmindedness and gaps in memory for new material, leaving tasks unfinished or forgotten, difficulty finding words
- apathy, depression, disorientation
- as brain deterioration progresses, the severity of symptoms increase
- at first, people are often unaware of their cognitive problems
- progresses to becoming oblivious of surroundings
236
brain changes in Alzheimer's disease
- plaques: protein deposits
- neurofibrillary tangles: protein filaments composed of tau
- tangles can now also be detected in cerebrospinal fluid
- immune responses to plaques lead to inflammation
- loss of synapses and neuronal death
237
etiology of Alzheimer's disease - biological influences
- heritability between 60-80%
- 19 specific genetic loci identified
- most genes that increase risk are related to immune function and cholesterol metabolism
- polymorphism of a gene on chromosome 19
238
etiology of Alzheimer's disease - lifestyle factors
- greater risk: social isolation, insomnia, depression
- lower risk: fish consumption, Mediterranean diet, education, exercise, engagement in cognitive activities
239
cognitive reserve
some people may be able to compensate for the disease by using alternative brain networks or cognitive strategies
240
frontotemporal dementia
- loss of neurons in frontal and temporal lobes
- similar lifestyle factors influence FTD as for Alzheimer's disease
- multiple subtypes
- often misdiagnosed
241
age of onset of frontotemporal dementia
typically begins in late 50s, progressing rapidly
242
prevalence of frontotemporal dementia
affects less than 1% of the population
243
behavioral variant subtype of frontotemporal dementia
- deterioration in at least 3 areas: empathy, executive function, ability to inhibit behavior, compulsive or perseverative behavior, tendencies to put nonfood in mouth, apathy
- striked emotional processes more profoundly than Alzheimer's
244
etiology of frontotemporal dementia
can be caused by many different molecular processes:
- Pick's disease
- high levels of Tau
- strong genetic component
245
vascular dementia
- caused by cerebrovascular disease --> most commonly stroke
- same risk factors as cardiovascular disease
- strokes and vascular dementias are more common in African-Americans than in Caucasians
- symptoms vary greatly depending upon location of stroke
246
dementia with Lewy Bodies
- protein deposite (Lewy bodies) form in the brain and cause cognitive decline
- symptoms hard to distinguish from Parkinson's and Alzheimer's diseases
- prominent visual hallucinations
- fluctuating cognitive symptoms
- sensitivity to physical side effects of antipsychotic medications
- intense dreams involving movement and vocalizing
247
prevalence of dementia with Lewy bodies
affects 1% or less of elderly individuals
248
Huntington's disease
- neurocognitive disorder with memory problems and cognitive symptoms similar to Alzheimer's disease
- nerve cells in the brain (particularly basal ganglia) gradually break down and die (neurodegeneration)
- involves distinctive symptoms of chorea: involuntary jerky movements, problems with voluntary movements due to muscle rigidity or contractions and may affect gait or speech
249
etiology of Huntington's disease
- autosomal dominant disorder caused by a defect in a single gene
- offspring of a parent with Huntington's have a 50% change of developing the disorder
250
treatment of dementia - medications
- some medications help to slow decline, but cannot restore functioning
- cholinesterase inhibitors --> increase acetylcholine to reduce motor symptoms, many discontinue due to side effects
- medications to improve cardiovascular health and to treat depression or agitation
251
treatment of dementia - ongoing prevention research
- prevent development of plaques and tangles
- reduce changes of mild cognitive impairment
- study people with early biological markers
252
treatment of dementia - ongoing prevention research
- supportive psychotherapy
- exercise and cognitive training to prevent cognitive decline before it begins
- behavioral approaches
253
supportive psychotherapy for prevention of dementia
education about disease and care for patient and family
254
behavioral approaches for prevention of dementia
- external memory aids
- music to reduce agitation and disruptive behavior
- psychotherapy to reduce depression
- increasing pleasant and engaging activities
255
signs of delirium
- worsening or change in a person's mental state that happens suddenly
- confusion, sleepiness, disorientation
- can be distressing especially when don't know cause
- clouded state of consciousness: extreme trouble focusing attention, cannot maintain a coherent stream of thought, difficult to engage in conversation
- speech may become rambling and incoherent
- trouble answering questions
- disorientation of time, place, and name
- memory impairment of recent events
- perceptual disturbances
- disturbances in the sleep/wake cycle
- drowsy during the day, yet awake and agitated at night
- vivid dreams and nightmares are common
256
delirium
- rapid onset and can fluctuate during the course of a day
- lucid intervals where person becomes alert and coherent
- daily fluctuations help distinguish delirium from other syndromes, especially Alzheimer's disease
- can occur at any age: common in children and older adults
- often misdiagnosed
257
DSM-5 criteria for delirium
- disturbance in attention and awareness
- a change in cognition not better accounted for by a dementia
- rapid onset (usually within hours or days) and fluctuation during the course of a day
- symptoms are caused by a medical condition, substance intoxication or withdrawal, or a toxin
258
treatment of delirium
- complete recovery if underlying cause is treated
- atypical antipsychotic medications are also used
- usually takes 1-4 weeks to clear
- reduce risk factors for delirium within the hospital setting: sleep deprivation, immobility, dehydration, visual and hearing impairment
- family should learn about delirium symptoms and its reversible nature to avoid interpreting the onset of delirium as a new stage of a progressive dementia
259
criminal commitment
occurs when someone with a psychological disorder is alleged to have committed a crime; confines a person to a forensic or mental hospital either for: determination of competency to stand trial, or after acquittal by reason of insanity
260
insanity defense
defendant not responsible for an illegal act if it is attributable to a psychological disorder or intellectual disability that interferes with rationality, pleaded in fewer than 1% of cases
261
American Law Institute (ALI) Guidelines (1962)
a person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or conform his conduct to the requirements of law
262
Insanity Defense Reform Act (1984)
- tightened the ALI guidelines
- mental disease or defect must be "severe"
- extreme passion or "temporary insanity" do not count
- shifted the burden of proof from the prosecution to the defense
263
not guilty by reason of insanity (NGRI)
- no dispute over guilt; both sides agree that the person committed the crime
- accused not held responsible for the crime because of person's insanity at the time of the crime
- indefinite commitment to a forensic hospital
264
guilty but mentally ill (GBMI)
- found guilty and responsible for the crime
- higher likelihood of incarceration than not guilty by reason of insanity (NGRI)
- mental illness plays a role in sentencing
- can be committed to hospital for treatment until no longer mentally ill
- then sent to prison to serve remainder of sentence
265
current insanity please
- two most commonly used insanity pleas are not guilty by reason of insanity (NGRI) and guilty but mentally ill (GBMI)
- in 2020, the US Supreme Court ruled that states can determine whether or not they wish to allow any insanity defense
- four states do not allow for any insanity defense: Kansas, Idaho, Montana, and Utah
266
competency to stand trial
- must be decided before it can be determined whether a person is responsible for the crime
- accused must be able to participate in his or her defense
- if deemed incompetent: trial is delayed and the accused is to receive treatment to restore competency to stand trial, bail is automatically denied
- cannot be committed for determination of competency for a period longer than the maximum possible sentence
- if medication can produce rationality, trial can be held
- forced medication to restore competency can be used only in very limited circumstances
267
civil commitment
- in any state, individuals can be committed to a psychiatric hospital against their will if they: have a psychological disorder and are a danger to self or others
- commitment should end when person is no longer dangerous
268
formal vs. informal civil commitment
- formal requires a court order
- informal may be used for emergencies before a formal court order can be obtained
269
informal emergency civil commitment
- initially no court involvement is needed
- physical certificate (PC) allows a person to be detained without a court order
- ranges from 24 hours to 20 days among most states
270
prevention detention and problems in the prediction of dangerousness
when substance abuse is not a factor, people with psychological disorders are no more likely to commit violent crimes than the average person
271
prediction of dangerousness
factors that influence accuracy of violence prediction
- repeated violent acts in the past
- individual returns to same environment in which past violent acts were committed and individual's pre-detention mental state and physical abilities have not changed
- person is judged to be on the brink of a violent act
- person is not engaged in treatment
272
protection of patient rights
- only those who cannot be adequately looked after in less restrictive settings are placed in hospitals
- provide treatment that restricts the person's liberty to the least possible degree while remaining workable
- state required to provide treatment after civil commitment
- requirements for mental hospitals
- a civilly committed person's status must be periodically reviewed
- right to refuse treatment
273
ethical restraints on research
- ethical restraints to avoid unnecessary harm, risk, humiliation, and invasion of privacy to participants
- Institutional Review Board (IRB) approval necessary
- researchers must receive training in research ethics
- sufficient information must be provided to allow an individual to make an informed decision to participate; informed consent
- freedom to withdraw at any point, without penalty
- importance of examining each person individually for ability to give informed consent
274
privileged communication in clinical care
communication between parties in a confidential relationship that is protected by law
275
limits to a person's right of privileged communication
- patient is an imminent danger to self or others
- patient reports abuse of others who cannot take care of themselves
- a person has accused a therapist of malpractice
- a person is under 16 years old and a victim of a crime
- a person initiated therapy in hopes of evading the law for having committed a crime or for planning to do so
