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Forensic Psychiatry > Board Study > Flashcards

Board Study Flashcards

1
Q

Why was helplessness/horror at the event taken out of PTSD criteria when DSM V was made?

A

Some people like police officers are trained to not respond that way

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2
Q

What percentage of population has been exposed to PTSD type stressors?

Of that population, what percentage develop PTSD?

A

82.8%

10%

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3
Q

PTSD overview:
Women vs men?
Malingering %?

A

Women > Men

20-30%. 20% of veterans

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4
Q 
Likelihood to cause PTSD:
Accident victims:
Seeing others killed: 
Physical Assault Victim:
Rape victim:
A

12%
25%
25%
80%

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5
Q

What % of people with PTSD report nightmares?

Normal adults w/nightmares?

Qualities of PTSD Nightmares?

A

75%

5%

increased awakenings, increased body movements, increased REM/NREM abnormalities, earlier in the night, and PTSD nightmares tend to fade in weeks/months

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6
Q

Flashbacks vs memory?

More common in vet vs civil?

A

Only 9% of gulf war vets
More common in clinical and civil situations
Should include sensory reexperiencing (touch, sound, smell); otherwise it might just be a memory

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7
Q

PTSD malingering tests:

A

Morel Emotional Numbing Test, M-FAST, SIMS

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8
Q

Slick Criteria

A

A: External Incentive
B: Neuropsych testing shows exaggeration or feigning
C: Only self-report is available
D: B & C not accounted for by other factors

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9
Q

Good way to test memory for malingering?

A

Recognition is much easier than Recall. (Some people with genuine amnesia do have problems with recognition, however)

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10
Q

Floor effect malingering test examples?

A

Rey Test

b test

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11
Q

What are symptom validity tests?

A

Present stimulus, force choice. They should get at least 50%

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12
Q

Which is gold standard, floor effect or symptom validity tests?

A

Symptom validity test

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13
Q

Symptom Validity tests examples?

A

Coin in the hand

TOMM (Useful in amnesia or concentration problems)

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14
Q

Teaching points from the case of the paranoid Ohio steel worker

A

He had no violence history and made no threats for violence. His family was willing to care for him. However, he killed his wife during lovemaking when his paranoia escalated only hours after going home.

Points:

  • A building crescendo of paranoid fear = high risk for violence (Persecutory delusions are more likely to result in homicide than other psych sx)
  • Clinician should no surrender judgement to the family
  • Posing a threat is different from making a threat
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15
Q

Men are 10x more likely to be violent as women EXCEPT

A

Among the severely mentally ill

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16
Q

Peak age for violence

A

late teens, early 20s

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17
Q

Highest rate of homicide in psychosis

A

during first episode

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18
Q

2 key factors that increase risk of violence in mentally ill persons

A

History of violence

Substance abuse

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19
Q

4 factors that make command hallucinations more likely to be followed

A

Related to delusions
Familiar voice
Makes the person feel superior
Benefits the hallucinator

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20
Q

Delusions most commonly leading to violence

A

Paranoid (persecutory, the more specific, the greater the risk)

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21
Q

26% of tattoos on adult men are

A

of “Mom” or “Mother”

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22
Q

Violence History in your standard assessment

A

Past Use of violence
Substance Abuse
Weapons History
Criminal Arrests

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23
Q

Types of violence

A

Affective: Patterned activation of the autonomic nervous system; threatening vocalizations and postures

Predatory aggression: Planned, goal directed, emotional detachment, seen in antisocial personality

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24
Q

Preparation for affective violence

A 
clenched fist
tightened jaw
expanded chest
staring
feet apart
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25
Q

Highest risk factors of recent violence

A

current etoh use
recent violence
recent victimization

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26
Q

First case to establish Right to Treatment

A

Rouse v Cameron

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27
Q

Father of Right to Treatment

A

Morton Birnbaum

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28
Q

Rouse v Cameron type of treatment

A

Bonafide effort to provide care

individualized treatment plans

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29
Q

Wyatt v Stickney 3 areas of deficiency

A
  1. Failure to provide humane environment
  2. Adequate and qualified staff
  3. Individualized treatment plans
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30
Q

Donaldson v. O’Connor

A

Individualized treatment that would give a reasonable opportunity to be cured

Supreme court case that addressed civil commitment.

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31
Q

Supreme court case about constitutional right to MH treatment

A

None. To date the Supreme Court has not addressed a constitutional right to treatment

In Donaldson v. O’Connor, the Supreme Court did say that you can’t civilly commit a non-dangerous individual who is capable of surviving safely by himself or with the help of willing/responsible family members

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32
Q

Youngberg v Romeo

A

Supreme Court Case

  1. Professional Judgement Standard established
  2. Right to safe conditions
  3. Right to freedom from bodily restraint
  4. Right to minimally adequate training (to improve self, i.e. habilitation) for the patient
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33
Q

Professional judgement standard

A

Liability exists only when the decision is such a substantial departure from accepted professional judgement that the decision is clearly not based on such a judgement

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34
Q

two key theories for forcing treatment

A

Parens patriae
and
Police powers (protecting others from harm)

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35
Q

Treatment Needs model (or just Needs model) for over-ruling pt’s refusal of care

A
  • Judge not needed to overrule patient

- Rennie v Klein from New Jersey

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36
Q

Rights Driven Model for patient’s refusal of care

A
  • Rogers v Okin -> Pts have a right to refuse until determined incompetent by a judge. Only emergencies can have forced medications
  • Guardianship of Roe -> Judge should decide. based on substituted judgement (previous preferences, religious beliefs, family culture)
  • Rogers v commissioner -> Judge should decide (not guardian). Should be based on Substituted Judgement again
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37
Q

Utah Model about refusal of care

A
  • Pt has mental illness
  • substantial danger to self/others
  • lacks capacity for rational decision making
  • no less restrictive alternative
  • Local MH can provide treatment
  • Basically, the pt has to be found incompetent in order to be involuntarily commited
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38
Q

Washinton v. Harper

A

May treat prisoner with MH meds if dangerous to self or other

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39
Q

Sell

A

Meds can be administered to restore competency if

  • important gov’t interest
  • med furthers state’s interests
  • least intrusive means
  • Medically appropriate
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40
Q

2 things to try before resorting to using Sell criteria

A

Either
1. dangerousness
or
2. lacks capacity to give informed consent

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41
Q

First Juvenile Court in the US

A

Illinois
1899
Goal to rehabilitate wayward youth

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42
Q

Kent v US

A

1966
Supreme court
If a judge wants to send a juvenile to adult court, there must be 3 things:
- a hearing
- access to records
- written statement by judge explaining situation

“Juveniles receive the worst of both worlds . . . neither protection of adults, nor care of children.”

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43
Q

Kent v US 8 factors to consider

A
  • Serious offense
  • Person v property
  • Probable cause
  • trying case in one court
  • juvenile’s personal situation
  • prior criminal
  • public safety***
  • Likelihood of rehabilitation***
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44
Q

In re gault

A

1967
Gault put away for 6 years w/no lawyer, hearing, or notice. Led to the “criminalization” of juvenile court:

Juveniles have no right to an appeal
Do have right to 
- notice of charges
- cross examine witnesses
- counsel
- privilege against self incrimination
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45
Q

Standard of proof for juvenile court to be found delinquent

A

Beyond a reasonable doubt

- In re Winship 1970

46
Q

Can juveniles have a jury trial?

A

No jury trial

- McKeiver v Pennsylvania 1976

47
Q

If tried in juvenile court, can they later be tried in adult court?

A

No. No double jeopardy

48
Q

If a juvenile commits a status offense (not a delinquent offense) can they be held at juvenile hall?

A

No
- Juvenile Justice and delinquency prevention act of 1974
Also limits placement of juveniles in adult institutions. Can’t be in sight or sound of adults

49
Q

Juvenile terms for

  • Trial
  • Arrest
  • Sentence
  • Parole
A
  • Judicatory hearing
  • Taken into custody
  • Disposition
  • Juvenile after care
50
Q

MH disorders in delinquent youth

A 
Substance use disorder most common
17% go on to develop antisocial PD
>90% exposed to trauma, but
11% w/PTSD
10% w/past suicide attempt
51
Q

Age of involvement of juveniles that is concerning for future violence

A

Earlier age is worse

Age 11 is a notable cutoff.

52
Q

Is ADHD associated with an increased risk for violent offending?

A

Yes

53
Q

Fare v Michael

A

1979
US Supreme court
Miranda rights apply to minors

54
Q

J.D.B. v North Carolina

A

Juvenile case
2011
US Supreme court
When deciding if miranda rights apply, you must consider the circumstances around the questioning

55
Q

What age should make you question competency

A

age 12

56
Q

What part of competency do adolescents do worst on

A

plea bargaining

57
Q

Is NGRI available to juveniles

A

Most states do not offer NGRI

58
Q

3 types of waivers that make a juvenile be tried in adult court

A

Prosecutorial-discretionary
Statutory - Automatic if age/crime
leads to largest number of juveniles in adult court
Judicial - Judge decides
Most common type of waiver, but less commonly used

59
Q

Graham v Florida

A

2010
US Supreme court
Does sentencing a juvenile to life w/o possibility of parole for a non-homicide offense violate 8th amendment?
Yes. That’s not allowed. Punishment would be disproportionate

60
Q

Miller v Alabama

A

2012
US Supreme court
Does sentencing a juvenile to life w/o possibility of parole for a homicide offense violate 8th amendment?
No. You can give an LWOP sentence, but it CANNOT BE MANDATED. You usually have to have a hearing to determine why

61
Q

Most beneficial treatment for juvenile delinquents

A

MST - Multi-system therapy

62
Q

First correctional facility in US

A

Walnut Street Prison in Philadelphia

63
Q

4 possible reasons to punish

A 
1. Specific deterrence
1(a). General deterrence
2. Incapacitate the criminal
3. Rehabilitation
4. Retribution
64
Q

The most common type of correctional facility

A

Lock-up

65
Q

Most common self-reported disorder in correctional setting?

A

MDD

66
Q

Most Common DSM dx in correctional setting

A

Substance use. True for male or female

67
Q

Second most common DSM dx in correctional setting

A

antisocial personality disorder

68
Q

In what setting is suicide most common?

A

Lock-ups

69
Q

Most common method of suicide in corrections

A

Hanging

70
Q

Jail suicide vs prison suicide

A

Most acute timeframe: during waking hours. Maybe near a court hearing (stressful), or receiving bad news (break-up)

Leading cause of death in jail: Suicide
Younger and over 55 are the two peaks

Violent crime more likely to commit suicide

71
Q

In Re Lifeschutz

A

Psychotherapist privilege

72
Q

Whalen v Roe

A

S.Ct. Controlled substances, Privacy, and databases like CURES

73
Q

Doe v Roe

A

Pt privacy, Therapist book published

74
Q

People v Stritzinger

A

Pt-therapist privilege trumped by reporting child abuse UNLESS the abuse has Already been reported

75
Q

State v. Andring

A

Group therapy has privilege (this is state specific). Child abuse trumps privilege, but Balance and discretion should be used to know how much should be revealed if The police already have knowledge of the child abuse

76
Q

Jaffee v Redmond

A

S.Ct. Therapist-pt privileges applies to social workers doing therapy (1st federal court)

77
Q

Federal Rules of Evidence 501

A

Establishes the existence of privilege in the Federal system

78
Q

Nathanson v Kline

A

Overturned by Canturbry. Reasonable Practitioner Standard

79
Q

Canterbury v Spence

A

Objective standard of Informed consent established (Prudent person)

80
Q

Kaimowitz v Michigan

A

Informed consent not possible when institutionalized (for irreversible procedures)

“To be legally adequate, a subject’s informed consent must be competent, knowing and voluntary.”

81
Q

Clites v Iowa

A

Tardive Dyskinesia requires informed consent. Damages were awarded

Don’t use meds just for staff convenience.

82
Q

Cruzan v Director

A

S.Ct. Missouri state correct to overrule parents desire to remove life-support

83
Q

Zinerman v Burch

A

S.Ct. Cap. to consent to voluntary Psych Hosp. -> They need to be competent to admit

84
Q

Hargrave v Vermont

A

Psych advance Directive can’t be ignored d/t Mental Illness

85
Q

Belchertown v Saikowitz

A

Substituded Judgment should be used by the judge.

86
Q

Tarasoft v Regents

A

Duty to protect if a serious threat is made

87
Q

Lipari v Sears

A

Duty to protect even w/o specific victim (Duty to detain)

88
Q

Jablonski v US

A

Even w/o specific threat, psych/hosp was liable (Foreseeable victim)

89
Q

Naidu v Laird

A

Forseeable risk. Psychotic shouldn’t have been d/c’d even tho voluntary

90
Q

Frye v US

A

general acceptance in the particular field in which it belongs

91
Q

Barefoot v Estelle

A

S.Ct. hypothetical questions is permissible, even if no evaluation

92
Q

Daubert v Merrell pharm

A

Frye superceded by Federal rules of evidence 702

93
Q

Kumbo Tire v Carmichael

A

Daubert applies to scientific engineering expertise & others

94
Q

Allen v Illinois

A

S.Ct. Commitment under sex dev. Predator act was civil: no 5th amd. Rights

95
Q

Sprecht v Patterson

A

S.Ct. 14th amd. SVP have rt to counsel, notice, evidence, cross-ex, etc.

96
Q

Kansas v Hendricks

A

S.Ct. Due process was not violated by SVP act.

97
Q

Kansas v Crane

A

S.Ct. “Complete lack of control” not required to commit SVP

98
Q

Megan’s Law

A

Requires community registration of SVPs. Later upheld as constit. By S.Ct.

99
Q

Adam Walash act

A

Created national database of SVPs.

100
Q

US v. Comstock

A

S.Ct. You can civilly commit SVPs in federal prison (for federal offenses)

101
Q

Rouse v Cameron

A

Recognized right to tx. “Bonafide effort to provide care.” Ind. Tx. plan.

102
Q

Wyatt v Stickney

A
  1. Humane environment (pt rights) 2 adeq. Staff. 3 ind tx plan
103
Q

Donaldson v O’Connor

A

The state cannot constitutionally confine, w/o more a safe person

104
Q

Youngberg v Romeo

A

Rt to safe conditions, no bodily restraint, training/habilitation b/c 14th amd

“Professional judgement standard: substantial departure”

105
Q

Rennie v Klein

A

Treatment Driven/Needs driven model. No judge needed to force meds. Administrative review in-house sufficient

106
Q

Rogers v Commissioner

A

Rights Driven - Massachusetts. Judicial review required

107
Q

Guardianship of Roe

A

Father cannot make tx decisions. Only judge dispassionate enough.

“Substituted Judgement model - Patient rights model.

108
Q

Utah Model

A

Civil commitment requires determination of incapacity

109
Q

Washington v Harper

A

Force meds on prisoners if violent & best interest. No judicial required

110
Q

Sell v US

A

Force meds for competence. 4 questions to answer

111
Q

State v Perry

A

Louisiana: forcing meds for comp. To execute not allowed

Forensic Psychiatry (4 decks)

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