Board Study Flashcards
Why was helplessness/horror at the event taken out of PTSD criteria when DSM V was made?
Some people like police officers are trained to not respond that way
What percentage of population has been exposed to PTSD type stressors?
Of that population, what percentage develop PTSD?
82.8%
10%
PTSD overview:
Women vs men?
Malingering %?
Women > Men
20-30%. 20% of veterans
Likelihood to cause PTSD: Accident victims: Seeing others killed: Physical Assault Victim: Rape victim:
12%
25%
25%
80%
What % of people with PTSD report nightmares?
Normal adults w/nightmares?
Qualities of PTSD Nightmares?
75%
5%
increased awakenings, increased body movements, increased REM/NREM abnormalities, earlier in the night, and PTSD nightmares tend to fade in weeks/months
Flashbacks vs memory?
More common in vet vs civil?
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
PTSD malingering tests:
Morel Emotional Numbing Test, M-FAST, SIMS
Slick Criteria
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
Good way to test memory for malingering?
Recognition is much easier than Recall. (Some people with genuine amnesia do have problems with recognition, however)
Floor effect malingering test examples?
Rey Test
b test
What are symptom validity tests?
Present stimulus, force choice. They should get at least 50%
Which is gold standard, floor effect or symptom validity tests?
Symptom validity test
Symptom Validity tests examples?
Coin in the hand
TOMM (Useful in amnesia or concentration problems)
Teaching points from the case of the paranoid Ohio steel worker
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
Men are 10x more likely to be violent as women EXCEPT
Among the severely mentally ill
Peak age for violence
late teens, early 20s
Highest rate of homicide in psychosis
during first episode
2 key factors that increase risk of violence in mentally ill persons
History of violence
Substance abuse
4 factors that make command hallucinations more likely to be followed
Related to delusions
Familiar voice
Makes the person feel superior
Benefits the hallucinator
Delusions most commonly leading to violence
Paranoid (persecutory, the more specific, the greater the risk)
26% of tattoos on adult men are
of “Mom” or “Mother”
Violence History in your standard assessment
Past Use of violence
Substance Abuse
Weapons History
Criminal Arrests
Types of violence
Affective: Patterned activation of the autonomic nervous system; threatening vocalizations and postures
Predatory aggression: Planned, goal directed, emotional detachment, seen in antisocial personality
Preparation for affective violence
clenched fist tightened jaw expanded chest staring feet apart
Highest risk factors of recent violence
current etoh use
recent violence
recent victimization
First case to establish Right to Treatment
Rouse v Cameron
Father of Right to Treatment
Morton Birnbaum
Rouse v Cameron type of treatment
Bonafide effort to provide care
individualized treatment plans
Wyatt v Stickney 3 areas of deficiency
- Failure to provide humane environment
- Adequate and qualified staff
- Individualized treatment plans
Donaldson v. O’Connor
Individualized treatment that would give a reasonable opportunity to be cured
Supreme court case that addressed civil commitment.
Supreme court case about constitutional right to MH treatment
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
Youngberg v Romeo
Supreme Court Case
- Professional Judgement Standard established
- Right to safe conditions
- Right to freedom from bodily restraint
- Right to minimally adequate training (to improve self, i.e. habilitation) for the patient
Professional judgement standard
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
two key theories for forcing treatment
Parens patriae
and
Police powers (protecting others from harm)
Treatment Needs model (or just Needs model) for over-ruling pt’s refusal of care
- Judge not needed to overrule patient
- Rennie v Klein from New Jersey
Rights Driven Model for patient’s refusal of care
- 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
Utah Model about refusal of care
- 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
Washinton v. Harper
May treat prisoner with MH meds if dangerous to self or other
Sell
Meds can be administered to restore competency if
- important gov’t interest
- med furthers state’s interests
- least intrusive means
- Medically appropriate
2 things to try before resorting to using Sell criteria
Either
1. dangerousness
or
2. lacks capacity to give informed consent
First Juvenile Court in the US
Illinois
1899
Goal to rehabilitate wayward youth
Kent v US
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.”
Kent v US 8 factors to consider
- Serious offense
- Person v property
- Probable cause
- trying case in one court
- juvenile’s personal situation
- prior criminal
- public safety***
- Likelihood of rehabilitation***
In re gault
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
Standard of proof for juvenile court to be found delinquent
Beyond a reasonable doubt
- In re Winship 1970
Can juveniles have a jury trial?
No jury trial
- McKeiver v Pennsylvania 1976
If tried in juvenile court, can they later be tried in adult court?
No. No double jeopardy
If a juvenile commits a status offense (not a delinquent offense) can they be held at juvenile hall?
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
Juvenile terms for
- Trial
- Arrest
- Sentence
- Parole
- Judicatory hearing
- Taken into custody
- Disposition
- Juvenile after care
MH disorders in delinquent youth
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
Age of involvement of juveniles that is concerning for future violence
Earlier age is worse
Age 11 is a notable cutoff.
Is ADHD associated with an increased risk for violent offending?
Yes
Fare v Michael
1979
US Supreme court
Miranda rights apply to minors
J.D.B. v North Carolina
Juvenile case
2011
US Supreme court
When deciding if miranda rights apply, you must consider the circumstances around the questioning
What age should make you question competency
age 12
What part of competency do adolescents do worst on
plea bargaining
Is NGRI available to juveniles
Most states do not offer NGRI
3 types of waivers that make a juvenile be tried in adult court
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
Graham v Florida
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
Miller v Alabama
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
Most beneficial treatment for juvenile delinquents
MST - Multi-system therapy
First correctional facility in US
Walnut Street Prison in Philadelphia
4 possible reasons to punish
1. Specific deterrence 1(a). General deterrence 2. Incapacitate the criminal 3. Rehabilitation 4. Retribution
The most common type of correctional facility
Lock-up
Most common self-reported disorder in correctional setting?
MDD
Most Common DSM dx in correctional setting
Substance use. True for male or female
Second most common DSM dx in correctional setting
antisocial personality disorder
In what setting is suicide most common?
Lock-ups
Most common method of suicide in corrections
Hanging
Jail suicide vs prison suicide
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
In Re Lifeschutz
Psychotherapist privilege
Whalen v Roe
S.Ct. Controlled substances, Privacy, and databases like CURES
Doe v Roe
Pt privacy, Therapist book published
People v Stritzinger
Pt-therapist privilege trumped by reporting child abuse UNLESS the abuse has Already been reported
State v. Andring
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
Jaffee v Redmond
S.Ct. Therapist-pt privileges applies to social workers doing therapy (1st federal court)
Federal Rules of Evidence 501
Establishes the existence of privilege in the Federal system
Nathanson v Kline
Overturned by Canturbry. Reasonable Practitioner Standard
Canterbury v Spence
Objective standard of Informed consent established (Prudent person)
Kaimowitz v Michigan
Informed consent not possible when institutionalized (for irreversible procedures)
“To be legally adequate, a subject’s informed consent must be competent, knowing and voluntary.”
Clites v Iowa
Tardive Dyskinesia requires informed consent. Damages were awarded
Don’t use meds just for staff convenience.
Cruzan v Director
S.Ct. Missouri state correct to overrule parents desire to remove life-support
Zinerman v Burch
S.Ct. Cap. to consent to voluntary Psych Hosp. -> They need to be competent to admit
Hargrave v Vermont
Psych advance Directive can’t be ignored d/t Mental Illness
Belchertown v Saikowitz
Substituded Judgment should be used by the judge.
Tarasoft v Regents
Duty to protect if a serious threat is made
Lipari v Sears
Duty to protect even w/o specific victim (Duty to detain)
Jablonski v US
Even w/o specific threat, psych/hosp was liable (Foreseeable victim)
Naidu v Laird
Forseeable risk. Psychotic shouldn’t have been d/c’d even tho voluntary
Frye v US
general acceptance in the particular field in which it belongs
Barefoot v Estelle
S.Ct. hypothetical questions is permissible, even if no evaluation
Daubert v Merrell pharm
Frye superceded by Federal rules of evidence 702
Kumbo Tire v Carmichael
Daubert applies to scientific engineering expertise & others
Allen v Illinois
S.Ct. Commitment under sex dev. Predator act was civil: no 5th amd. Rights
Sprecht v Patterson
S.Ct. 14th amd. SVP have rt to counsel, notice, evidence, cross-ex, etc.
Kansas v Hendricks
S.Ct. Due process was not violated by SVP act.
Kansas v Crane
S.Ct. “Complete lack of control” not required to commit SVP
Megan’s Law
Requires community registration of SVPs. Later upheld as constit. By S.Ct.
Adam Walash act
Created national database of SVPs.
US v. Comstock
S.Ct. You can civilly commit SVPs in federal prison (for federal offenses)
Rouse v Cameron
Recognized right to tx. “Bonafide effort to provide care.” Ind. Tx. plan.
Wyatt v Stickney
- Humane environment (pt rights) 2 adeq. Staff. 3 ind tx plan
Donaldson v O’Connor
The state cannot constitutionally confine, w/o more a safe person
Youngberg v Romeo
Rt to safe conditions, no bodily restraint, training/habilitation b/c 14th amd
“Professional judgement standard: substantial departure”
Rennie v Klein
Treatment Driven/Needs driven model. No judge needed to force meds. Administrative review in-house sufficient
Rogers v Commissioner
Rights Driven - Massachusetts. Judicial review required
Guardianship of Roe
Father cannot make tx decisions. Only judge dispassionate enough.
“Substituted Judgement model - Patient rights model.
Utah Model
Civil commitment requires determination of incapacity
Washington v Harper
Force meds on prisoners if violent & best interest. No judicial required
Sell v US
Force meds for competence. 4 questions to answer
State v Perry
Louisiana: forcing meds for comp. To execute not allowed
