Forensic Psych Week 3 Class Notes
Forensic Psych Week 3 Class Notes PSY BEH 161C
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This 5 page Class Notes was uploaded by Rebecca Sumrow on Sunday October 16, 2016. The Class Notes belongs to PSY BEH 161C at University of California - Irvine taught by N. SCURICH in Fall 2016. Since its upload, it has received 3 views. For similar materials see FORENSIC PSYCHOLOGY in Psychology And Social Behavior at University of California - Irvine.
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Date Created: 10/16/16
Forensic Psychology – 10/12/16 Class Notes The DSM – Defining & Diagnosing Mental Disorders • Clinical psychologists determine ad diagnose a mental disorder and treatments. Contrarily, forensic psychologists do not intend to treat but instead identify, report and answer a question. • What is the DSM” • It gives a brief overview of the process of the disorder • It describes the course of the disorder, does it remain stable or does it vary throughout lifetime. • What do we care about diagnosis? There are a few reasons why we would want to have a book with the specific criteria listed. ⇒ You want to communicate with other psychologists accurately with uniform terms and descriptors. Common definitions. ⇒ For treatment purposes we need to have a common understanding of what we are talking about. If there is a cure for depression but the definition of depression is not standardized, the use and dissemination of information is difficult. ⇒ General acceptance is important to forensic psychology. The DSM provides validity to the definitions and diagnostic criteria to aid in admissibility to court. ⇒ DMS is chiefly concerned with behavior that is observable. It doesn’t look at biological or structural disorders. For example, epilepsy is not a disorder categorized in the DSM because it is a structural issue. • DSMs • Noting that disorders grew with each release but many of the releases don’t provide specific criteria for the disorder. It is important to have specific criteria to eliminate variations within the same disorders. • In 1980 in DSM III the specific criteria were added. • The text revision is still referenced. • The DSM 5 took 12 years to release. The APA set up working groups of experts in a specific field (ie schizophrenia, bipolar disorder) they met and looked at specific criteria and decided what should and should no be included. • The APA created a website during the creation of the DSM 5 and asked for the input of the general public. • A lot weighs on a diagnosis. If you are dangerous you cannot be detained but if you are mentally ill, you can be detained without a conviction of crime. Those with diegnosis can have a constriction of their liberty. • The ICD: the DSM for the rest of the world. The release of the 11th edition, has been delayed many times and is now expected in 2017. Insurance companies are requiring the ICD codes. • If a disorder is present in the ICD but not the DSM there can be admissibility difficulty in court. • We will focus on the DSM5. • What is a “mental disorder”? • A syndrome means s cluster of symptoms. • Why does a disorder usually require a “distress”? Some pedophiles are not distressed by their disorders. Avoided personality disordered people don’t mind that they like to be alone. • Certain behaviors are in the realm of normal reactions but at the point that is becomes clinically significant (qualify for a diagnosis) is different. • The DSM is clear that this is not just deviant behavior. • Beware of medical student syndrome. Disorders are statistically rare and are infrequent. Forensic Psychology – 10/12/16 Class Notes The DSM – Defining & Diagnosing Mental Disorders • DSM-IV-TR: Multiaxial Approach • 5 axes: ⇒ axis 1 and 2 contained disorders ⇒ axis 1 clinical disorders can flux overtime. ⇒ axis 2 discusses personality disorders, they don’t change overtime. ⇒ axis 3 reference things that may be associated with disorders. ⇒ Axis 5 related to relationships socially and occupationally. • The DSM 5 got rid of this approach. • DSM-IV-TR: Multiaxial Approach • Axis 1 is everything besides mental retardation and personality disorders. • The law is still hung up on the DSM4 and have not adopted the DSM5. • DSM-5: Classes of mental disorders • One long list of disorders which effectively clumps things that were not previously legally useful. Categories & Examples of Mental Disorders • Psychotic Disorders • Ridged false beliefs even when presented with evidence of the contrary that inhibit a person’s ability to function. • Hallucinations are false perceptions where something is perceived when it isn’t there. • Brief psychotic disorder is psychosis that lasts less than a month. • Schizophreniform disorder. • Schizophrenia psychotic features for more than 6 months. • Schizophrenia • The prevalence rate varies overtime but is fairly constant. • Research suggests that there is clearly a genetic component. If you have a first-degree relative you are more than 10 times more likely to have it. • Males develop it much earlier than man on average but the prevalence over a lifetime is similar. • Diagnostic Criteria • Positive symptoms: something is happening or an addition ⇒ Catatonic: repetitive movements. ⇒ Catatonic immobility: someone who assumes an unusual position and doesn’t move. • Negative symptoms: something is missing or not happening that should ⇒ Affective flattening, alogia (loss of speech), avolition (lack of energy or interest). • Specify episode: describes the duration and presentation of the symptoms (partial or full remission, first or multiple episode) • Interview with a Patient with Schizophrenia • As you assess a patient you have to be able to ask questions to reveal criteria and recognize criteria as they are presented. • Sub-types of Schizophrenia • DSM5 they removed the subtypes of schizophrenia. For example, paranoid schizophrenia vs disorganized vz catatonic. • The reason they were removed is that they are not consistent over time and they may manifest symptoms of certain categories overtime to different degrees. • Trauma-and stressor-related disorders Forensic Psychology – 10/12/16 Class Notes The DSM – Defining & Diagnosing Mental Disorders • Anxiety is a worry or a fear but in order to be a clinical diagnosis the fear or worry must be out of proportion or unrealistic and interfere with daily life. • Characteristics describe how people respond to trauma. ⇒ Anhedonic (inability to experience pleasure from things that used to make you happy) ⇒ Dissociative symptoms: depersonalization type = feeing detached from yourself life you are in a dream. De-realization = dreamlike feeling. • PTSD Diagnostic Criteria • Exposure can be by direct exposure, by learning about it, repeated exposure to stimuli. Exposure cannot be through media or watching TV. You don’t have to be the victim but you are exposed. • Intrusion symptoms: distressing memories or dream. Dissociative flashback is where someone loses awareness of reality and believes they are reliving the event. • Avoidance of stimuli that are associated with the trauma. • Negative changes in mood or beliefs. People who have suffered can change how they think about the event, sometimes internalizing and self blaming. They oftentimes withdraw. • Hyper-arousal: erratic and angry outbursts. DSM calls “exaggerated startle response”. Disturbances in sleep, or reckless behavior. Hyper-vigilance: they are constantly looking for threats. • Duration of symptoms is more than a month. • Dissociative Disorders • Basically these people cannot recall important past events or sometimes they forget their identity and/or assume a new identity. Amnesia. Types: dissociative amnesia or the loss of memory for a period of time. • We will look at Dissociative Identity Disorder (used to be called multiple personality disorder). • Types of Dissociative Disorder • If a person cannot remember at all what their other identity did while in another identity would be DID. • This is not a psychotic disorder. Each alter is in touch with reality but they cannot be aware of what the other alters do. • Drug or alcohol abuse blackouts do not count. • It is extremely controversial within the scientific community. It is accepted that it exists but the controversy is if abuse is required as a precondition since it is usually assumed to be a coping mechanism. • Is it ethical to punish both alters for the behaviors of one. • Depressive Disorders • Major depressive disorder/ • Used to be called “mood disorders” • Hallmark of depressive disorder is recurrent thoughts of suicide. • Weightless is another way to discern normal levels of sadness vs clinical levels of depression. • A patient with 3 symptoms for 10 days you don’t meet criteria. Where do we draw the line? • One of the most prevalent disorders in the population. 1 in 5 can have clinical levels of depression in lifetime. • More prevalent in woman then men. • Tends to reoccur throughout lifetime. • Bipolar Disorder • Must have mania and depression. Forensic Psychology – 10/12/16 Class Notes The DSM – Defining & Diagnosing Mental Disorders • Mania tends to proceed mania. • Dipolar disorder usually develops by age 20. • Suicide is common. • Must have the criteria of a major depressive disorder combined with manic symptoms. • Speech is full of puns and rhyming or jokes. • They tend to participate in illegal or risky acts. • Example of Mania Symptoms • With all disorders you must rule out drugs or alcohol to discriminate the effects of the drugs from mania. • Bipolar Disorder • Bipolar I: Criterion C. Mania: overly happy and off the wall. So manic that they have psychotic features. • Bipolar II: Criterion E. Mania: they are happier than they normally are but they are not extreme. There are no psychotic features. • Personality Disorders • Personality types can be classified by different types like introvert vs extrovert. These are not disordered. • Personality emerges by adolescence. • Behaviors are stable and they wont change. They will persist throughout life. • Many of them cause distress or social/occupational impairment. • Not due to using drugs or alcohol. • Types: narcissistic (grandiose views of themselves. Need for attention and admiration). Avoidant (they are reclusive). Paranoid personality (doesn’t trust others, holds grudges). • Antisocial Personality Disorder • Deceitfulness (sometimes they lie for no gain, they just do it impulsively) • Most important: is that they have a diagnosis of conduct disorder before age 15. Kids who vandalize, fight, injure animals, truancy. • Debate regarding the need for diagnosis or if a historical recollection of these behaviors is enough. • 80% of children who have conduct disorder will develop antisocial personality disorder. • 75-80% of felons in prison have antisocial personality disorder. • If the majority of prisoners have this disorder, is it a disorder? Is it abnormal and in what sense? • Issues in Classification • Conceptual issues in the classifying of a person as disordered and note disordered. ⇒ Categorical vs. Continuous entity: The number of symptoms moves the threshold from normal to pathological. ⇒ At some point during the continuum it will become a disorder as symptoms rise. ⇒ In the categorical approach, you either have the disorder or you don’t. • Reliability: in psychometric means consistency. ⇒ Inter-rator reliability. Two clinicians look at the same person and note the same symptoms and/or criteria for the same diagnosis. ⇒ Reliability is quite low. 0 is bad, 1 is perfect. .65 Schizophrenia. .8 bipolar disorder. ⇒ Thomas Szaus (Hungarian professor) believes that mental disorders are a myth. He was popular in the 70’s. The DSM is concerned with a behavior. He suggests that a non-structural basis to a disorder means that it is not real. The laws in the 70’s were not as developed and they were used to control people in Szaus opinion. Forensic Psychology – 10/12/16 Class Notes The DSM – Defining & Diagnosing Mental Disorders ⇒ The 2nd issue was that the research was less developed. We now know that there are genetic roots and components to some disorders. • What makes things abnormal? ⇒ Statistical infrequency (very few people fall within the range). ⇒ What is normative behavior? ⇒ Egosyntonic (accepting and not bothered by the behavior) vs. egodystonic (bothered by the behavior). Problem with this is that this measure leaves out people who are negatively impactful on others but are happy with how they are. • Use of DSM in Forensic Settings • In the preface, there is an entire section that addresses the use of the DSM in forensic settings. It is a warning really. • Due to this warning, the legal standard is not bound by the DSM. Even if someone diagnostically disordered, they may not legally have the diagnosis. • We see this in insanity, there is a legal definition. Just because the defendant is severely disordered, that doesn’t mean that the legal criteria for a mental disorder has been met. • Insanity in regards to sexual offenders, they are concerned with volitional control.
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