Mental disorders, Violence and Offending- Part 2. Flashcards
(33 cards)
In secure mental health services, what is the most common diagnosis?
What is on a spectrum?
In high security hospitals, alongside those that at risk of violent offenses, who else do you have?
Why cant they go prison?
Schizophrenia.
Schizophrenia.
Those at major risk of harming themselves- will be rehabilitated.
Does not have the right services to treat them.
Rare event 1:
What did Christopher Cluntis do?
Where was he sent?
Why is Cluntis case important?
What was there for Christopher Cluntis?
Paranoid schizophrenic- murdered Jonathan Zito- stabbed him 3 times near eye.
Mental institution.
Changed- nation debate- from looking after those with mental illnesses- to looking after public.
An inquiry.
Continuation from rare event 1; Christopher Cluntis:
Who failed him?
What happened prior to the murder?
After this case, what happened?
Clinicians (mental health services), social services, police etc- blame them.
Lots of events like trying to stab people.
Mental health services improved massively- like with better communication.
Rare event 2; Nicholas Salvador:
Explain what happened.
What was he in the middle of?
Did he have previous contact with mental health services?
Was he charged?
Do those that do violent incidents under a psychotic state remember anything at all?
Paranoid schizophrenic- went on a rampage neighbourhood- beheaded a women.
A psychotic state.
No- diagnosed after.
He received not guilty for the reason of insanity.
No.
How much people does schizophrenia affect?
What are people with schizophrenia more likely to commit than the general population?
For men with schizophrenia, how much more likely are they to do this than the general population?
What about women?
Though, what is this risk associated with?
What found this?
1% of people.
Acts of violence and aggression.
Men- 4 times more likely.
Women- 8 times more likely.
Alcohol abuse.
A meta-analysis- Fazel, Gulati et al (2009).
What aggressive and violent behaviours is schizophrenia associated with?
What two things have the strongest association with schizophrenia?
What are patients with schizophrenia more likely to commit?
Damaging property, arson, common assault, homicide, harmful self-mutilation and suicide.
Arson and homicide.
Murder- 20 times more likely.
Heterogenic nature of the illness symptomatology:
What are positive symptoms?
Give examples of positive symptoms.
What are negative symptoms?
Give examples of negative symptoms.
Things that are added.
Hallucinations, delusions and thought disorders.
Things which are taken away.
Avolition, lack of emotions, asociality and poverty of speech.
What is important to the diagnosis of schizophrenia?
What is there a relationship between?
What is the first episode of psychosis more likely to be associated with?
In contrast, what do negative symptoms have?
What is threat/control-override symptoms (TCO)?
Presence of psychotic symptoms.
Active psychotic symptoms and violence- linked to positive symptoms.
Violence.
Reducing effect on the likelihood of committing serious acts of violence.
External agent taking control over actions + being threatened.
What are patients with schizophrenia more likely to have?
What are the most frequently associated substances?
Substance abuse problems.
Alcohol and cannabis.
What Fazel and Gulati et al (2009) do?
What did they conclude?
Compared schizophrenic individuals with or without substance abuse to non-schizophrenics with or without substance abuse.
Modest association between schizophrenia and violence- most risk accounted for by substance abuse comorbidity.
What are important determinants of substance abuse among patients with schizophrenia?
What do violent individuals with schizophrenia tend to be?
What can be induced by substances?
Environmental and demographic factors.
Young + male + low socioeconomic status- linked to more substance abuse as well.
Psychosis.
Comorbidity of schizophrenia and personality disorder:
What co-occurs at high rates with schizophrenia?
What else co-occurs with schizophrenia at elevated rates compared to the general population?
Who has the highest risk of violence?
Axis I + Axis II disorders.
Psychopathy.
Patients with comorbid substance abuse + severe mental disorders like bipolar.
How much psychopathy is in the general population?
Where is it more prevalent?
1%.
Schizophrenia population.
What has elevated risk for violence in schizophrenia been linked to?
What has been associated with comorbid psychopathy?
Comorbidity of borderline + antisocial personality disorders.
Severe forms of violence like homicide.
What is a potentially predictive factor of violence in those with schizophrenia?
When do those with psychopathy + schizophrenia still remain at a high risk of violence?
What does this show?
Comorbidity of personality disorders.
Even after positive symptoms are under control (managed by medication and psychological treatment).
Schizophrenia makes the risk more likely.
Who did a study on schizophrenia, psychopathy and substance use disorder?
What did they find?
Tengstrom and Hodgings et al (2004).
1) Offenders- psychopathy- committed highest number of offenses per year.
2) Offenders- schizophrenia- those with high psychopathy scores- committed more crimes than low scorers.
Continuation from Tengstrom and Hodgings et al (2004) study:
Who committed a similar number of offences?
What is associated with criminal offending?
Psychopaths + schizophrenia offenders (with high psychopathy scores) with and without SUDs.
Offenders- with psychopathic traits, not substance abuse- associated to criminal offending.
Continuation from Tengstrom and Hodgings et al (2004) study:
What is PCL-R?
For schizophrenia offenders, what is the difference between those with high and low PCL-R scores?
What did not influence the age at first conviction?
Tool to diagnose psychopathy.
High PCL-R scores- younger at first conviction- for a criminal offense.
The presence of SUDs- true for offenders with schizophrenia + psychopathy.
What is there a link between?
What are socio-cognitive abilities split into?
What can be a risk factor for violence?
Why?
Violence + impairments in socio-cognitive abilities.
Theory of mind (or mentalizing) + empathy.
Lack of empathy + Theory of mind.
Lead to them to perceive other’s intention as threatening.
What is another way to say TOM?
What does that mean?
What can empathy also be called?
What does it mean?
Give an example.
Cognitive empathy.
Understanding emotions in others.
Affective empathy.
How seeing emotions in others makes you feel.
Like if you see someone crying, you would want to cry too.
What increases the possibility of violence?
What is a characteristic of schizophrenics that commit premeditated aggression?
What do patients who commit impulsive aggression suffer from?
Cognitive mental-state understanding, in the absence of affective mentalizing.
Intact cognitive but affective, mental-state understanding.
Diminished mentalizing abilities.
Neurochemical and neurobiological abnormalities in schizophrenia:
What is dopamine?
What is its functioning linked to?
Neuromodulator (neurotransmitter).
Hedonic responses, prediction of rewarding + aversive events and assignment of incentive/motivational importance to external and internal stimuli.
Continuation with neurochemical and neurobiological abnormalities in schizophrenia:
What is serotonin?
What is its function?
What is another of its important function?
Serotonin- or 5-HT- neuromodulator.
Linked to regulation of mood, aggression and cognitive functioning (including memory and learning) + modulation of social reward and punishment.
Modulates dopamine release.
Continuation with neurochemical and neurobiological abnormalities in schizophrenia:
What is the Catechol O-methyl-transferase (COMT) enzyme coded by?
What is its predominant role?
COMT gene.
Termination of dopamine activity in the prefrontal cortex.
