Lecture 5 Flashcards
Difference between psychopaths and psychosis?
- Psychopaths know right from wrong
- Psychosis do not, think their actions are right
What are the public perceptions of mental illness and violence?
1) Exp used vignettes depicting problems with schiz, alcohol, and compulsive phobia
- Members of public were given vignettes and what their perceptions were
- Few Americans identified the problems as mental illness but found it very threatening
2) Used semantic differential - scale where people are defined
- Mentally ill classified as dangerous, dirty, unpredictable and worthless
3) Stereotypes of mentally ill are getting worse
4) Idea that increase in public health literacy improves attitude = trend for people to endorse biology for mental illness, produces increase in desire to social distance from people with schiz
What is the Stigma from Mental Illness?
- 9/10 MI say they have suffered stigma/discrimination
- People with MH problems are least likely to find work, be in a relationship, find housing and substance abuse
What are stigma reducing programmes?
- Attention has moved to efforts to reduce stigma through campaigns and specific courses
- Narrative review of published reports on programmes = modest changes in short-term attitudes but little change in knowledge = little data on long-term changes in perceived stigma by people with mental disorders
- Children: tested effectiveness of ‘The Guide’ on 534 students in Canada = teaching about mental illness
- Students who took guide showed increase mental health knowledge and decreases stigma = effect is not strong and controls seem to get worse = only worked for those going to university
- Changed to Welsh people at age 13-14 and developed new measure: knowledge, stigma to others, self-stigma, anticipated stigma, good mental health behaviour, help-seeking disclosure
What are the methods of investigation for mental illness and violence?
- Examine number of patients with psychotic illness in a prison and compare it control population
- Using multiple studies and using them to the advantage of them
- Might be over-represented in prison e.g violence used to help define illness and more likely to sent to prison, and likely to be major differences in age, social status etc.
- Examine records of patients with and without psychotic illness to see levels of violence in past: BUT violence often used to define illness
- Examine community to see proportion of people who become violent and psychotic = measures cross-sectional - no causality
- Examine patients discharged from hospital to examine rates of violent crimes - issues with ethics vis danger and effects of confounds
What were the rates of violence over 6-12 months?
- General population - 2% commit crime
- People with illness but have been treated - 8%
- Inpatient and then discharge - 13%
- First-episode psychosis - 37%
What are probable compounds?
- Need to control for variables that vary between population and control sample
- e.g Age, gender, social class, institutionalisation, social problems
What was a study looking at people’s views?
- Mental illness causes drift in social class
- MI causes for people to be in institutions
- So correcting for this attenuates the relationship between MI and violence
2) Meta-analysis + calculated effect sizes for predicting general and violent recidivism - Shows predictors of recidivism are the same for mentally disordered offenders as normal offenders = criminal history had large effect sizes
- No obvious role for mental health variables in prediction of violent behaviour
What is the VRAG?
- Violence risk appraisal guide
- Measures a persons’ risk in the future
- Diagnosis of schiz lowers score = protective factor
- Examined 618 patients charged with violent crime = followed up after discharge and found negative relationship between Schiz and violent reoffending
What was the study about a birth cohort?
- Examined violence and mental disorder in birth cohort = no sample biases = 961 adults born in 1972-3 in NZ
- Violence recorded by criminal record and self-report = interview established presence of mental disorder and classification
- Measured personality style - Alienation Style
- Found relationship with alcohol/substance increased chances of reoffending
- People with Schiz disorders were 2.5X more likely to be violent in past 12 months = many cases due to excess perceptions of threat
What was a recent meta-analysis for Schiz?
1) Schiz associated with violence and violent offending = due to substance use co-morbidity
2) Significant increased risk for violence among subgroups in this population
3) Increased odds ratio of 2x to 4x of increased violence
- Could be differences in measures looking at violence OR fact that someone psychotic is managed better than someone who is just violent
Difference between schizophrenia and symptoms?
- Schiz is a broad group and some patients are ‘safe’ whereas others are not
- They can experience delusions, threat and therefore control override, and hallucinations
Schiz and Threat Control Override?
- These symptoms are worrying precursors of violence = patients see others as out to get them
- OR override proscriptions against violence e.g man kills babies to save them from devil
- Screening questions to determine presence of these delusions
Study looking at Delusion and Threat Control Override?
- Looking at people who were proscriptive
- Looked at 278 israelis and had to self-report levels of violence over past 5 years
- Self-report and psychiatric interview for mental illness
- Found elevated rates of violence and weapon use e.g 7 & 10% of people responded to ‘People wishing to do harm’ and ‘Violent thoughts put in head’ respectively
- Delusions are associated with violent behaviour
2) Data from MacArthur Risk Assessment Study of patients discharges from psychiatric hospital - Interview in hospital prior to discharge, interviewed them every 10 weeks for 1 year = self-report and collateral info used to judge incidents of violence
- Delusions do not predict higher rates of violence amongst recently discharged patients = even true when type of context is taken into account
Why were there differences in the studies?
- Prospective vs retrospective design
- More detailed and stricter criterion for acceptance of delusion
- Putting both together replicates previous TCO findings
