Lecture 7 - Mental Disorders Flashcards
Mental disorder
A behavioural or mental pattern that causes significant distress or impairment of personal functioning.
Mental Disorder relationship with violence
Violence is associated with current, serious MD
- Past MD alone is not a good predictor of violence
- Schizophrenics at high risk for violence
Majority of people with MD do not commit violence
The DSM-V
It is a standard guidebook for clinicians that helps them diagnose mental disorders
Schizophrenia
A mental illess that impairs perception and expression of reality
Symptoms of Schizophrenia
An individual must have two of the following for at least 1 month unless treated:
*At least one symptom must be 1, 2, or 3
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catonic behvaviour (Innappropriate, unpredictable, disconnected from environment)
- Negative symptoms
Delusion
a false belief that involves misinterpretation of perceptions or experiences
Bizarre: Bizarre delusions are highly implausible and not understandable. they involve scenarios that are impossible or extremely unlikely to occur
Ex. Believing someone is being mind-controlled by aliens
Non-bizarre: involve situations that could occur in real life, though they are not actually happening to the person.
Ex. Believing your wife is cheating without any evidence
How long must signs persist to be considered Schizophrenia
continuous signs of disturbance must persist for at least 6 months, with least one month of active symptoms.
- ongoing for at least 6 months; serious impact on functioning.
- 6 month period distinguishes Schizophrenia from other disorders
Effects Schizophrenia has on functioning
Level of functioning in one or more areas such as work, interpersonal relations, self-care are lower than they were prior to the onset
How are disorders in the DSM-V measured
severity is rated by a quantitative assessment of the primary symptoms of psychosis
- Each of the symptoms is rated on a 5 point scale, according to its severity
(5 meaning very severe, 0 meaning not present)
Catatonia
A complex neuropsychiatric syndrome characterized by a wide range of motor and behavioural abnormalities
- Catatonia can occur in context with disorders like schizophrenia, bipolar disorder, and major depressive disorder
Ex.
* inappropriate/bizarre postures
* Unstimulated, excessive motor activity
Features associated with schizophrenia
- Innapporpraite effect
Ex. Laughing for no apparent reason - Dysphoric mood
Ex. Depression, anxiety, anger - Disturbed sleep pattern
Ex. Daytime sleeping; nighttime activity - Lack of eating or food arousal
Risk factors for schizophrenia
- Environmental
Ex. Winter birth, urban-born - Genetic and physiological
Ex. 10x greater risk if you are a 1st degree relative, pregnancy compications - Culture-related diagonostic issues
Ex. proportion of hallucinations is higher in some regions compared to others
Development and course of schizophrenia
Diagnosis typically emerges between the late teens and mid-30s.
- onset prior to adoclescence is very rare
Persecutory Delusion
- Most common type of delusion
involve the belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group.
Ex. Believing you are being followed, or mistreated
Referrential delusions
involve the belief that certain gestures, comments, environmental cues, or other elements in the environment are directed specifically at oneself.
Ex. When hearing someone talk, you believe they are gossiping about you
Hallucination
A perception, in the absence of a stimulus, that is believed to be genuine.
*Can involve any of the 5 senses (Taste, smell, etc.)
* Hearing is the most common
Difference between delusions and hallucinations
Delusions are distortions of thought and belief, while hallucinations are distortions of sensory perception.
In hallucinations you believe the false perception is as real as an any experience.
In delusions, you hold a belief towards something with clear evidence against it
3 types of disorganized speech
Derailment: jumping between topics
Tangentiality: Answering questions in an unrelated way
Incoherence: Speech that is not understandable
Examples of grossly disorganized behaviours
- Childlike
- Unpredicatble agitation
- Inappropraite sexual
Delusional disorder
Delusions that last at least one month, without other forms of schizophrenia
Subtypes: Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified
Erotomanic delusion
Delusion that someone is in love with the individual
Grandiose delusion
Conviction of having some great talent which is unrealized, or thinking you have made an important discovery
Jealous delusion
central theme of the individual’s delusion that their spouse or lover is unfaithful
Persecutory delusion
Delusion that involves the individuals belief that he or she is being conspired against, cheated, spied on, followed, harassed, poisoned, etc
Somatic delusion
Delusion involves Bodily functions or sensations
Mixed delusion
There is no one subtype of delusion that is prominantly displayed
Unspecified
No delusion type in specifc is prominent
Mood disorders
A disorder characterized by “episodes” of various duration
An episode is a period of specific symptoms
3 types of episodes:
- Depressive
- Manic
- Hypomanic
Depressive Episode
A 2 week period in which an individual experiences depressive symptoms.
Symptoms include: Depressed mood, loss of interest in all activities, Loss of energy, Insomnia, etc.
These depressive episodes are not due to medical condition, substance use, medications, toxin exposure, bereavement
Manic Episode
Abnormally and persistently elevated, expansive, or irritable mood for more than one week
Must have 3 of:
- Inflated self‐esteem/grandiosity
- Decreased need for sleep
- Talkativeness
- Flight of ideas
- Distractibility
- Increased goal‐directed activities
- Increased sex drive and sociability
- Psychomotor agitation
- Excessive involvement in pleasurable activities w/ high potential for painful consequences
Hypomanic episode
- same as manic episode except it must
- occur for a minimum of 4 days (instead of 7 which is manic)
- Activities are usually organized (not bizarre)
Abnormally and persistently elevated, expansive, or irritable mood for more than one week
Must have 3 of:
- Inflated self‐esteem/grandiosity
- Decreased need for sleep
- Talkativeness
- Flight of ideas
- Distractibility
- Increased goal‐directed activities
- Increased sex drive and sociability
- Psychomotor agitation
- Excessive involvement in pleasurable activities w/ high potential for painful consequences
Major Depressive Disorder
5 of the following symptoms are present during the same *2 week period**:
- At least one must be depressed mood or loss of interest or pleasure
- Depressed mood
- Loss of interest/pleasure in nearly all activities
- Significant changes in appetite or weight
- Insomnia
- Changes in psychomotor activity
- Loss of energy
- Feelings of worthlessness or guilt
- Difficulty thinking, concentrating, or making decisions
- Recurrent thoughts of death or suicide
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Females have higher
Do males and females have the same chance of getting major depressive disorder
Females are 1.5 - 3x more likely
Peak ahge of onset for major depressive disorder
the 20s
Mortality rate
It is high - 15% die by suicide
Risk factors forMajor Depressive Disorder
- Neuroticism
- adverse childhood experience
- Stress ful life events
- Genetics
Bipolar Disorders
Recurrect episodes of distrubance in mood
2 types:
Bipolar 1 - 1+ Manic episode
*Lasts at least one week
Bipolar 2 - 1+ Major depressive episode AND 1+ hypomanic episode
Strongly linked to violent crime
Personality Disorders
Enduring pattern of inner experience and behaviour that deviates markedly from cultural experiences
- Inflexible, pervasive, begins in adolescence, stable over time and causes significant distress or impairment in functioning
Changes in 2 of the following: Cognition, affectivity, interpersonal functioning, impulse control
Cluster A
odd and eccentric
- Paranoid
- Schizoid
- Schizotypal
Cluster B
Dramatic, emotional, erratic
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Cluster C
Anxious or fearful
- Avoidant
- Dependant
- Obsessive-Compulsive
Fitness to Stand Trial
Assesses whether an individual is capable of understanding the charges against them and whether they can particpate adequately in their defense during a criminal court process
- Acute psychosis is a common reason for being unfit to stand trial
Mental Health Act
Provincial legislation desgned to help treat/protect people with severe mental disorders, and to protect the public
Fitness Interview test
A 30 minute test done to assess whether accused is able to:
1.Understand the nature or object of the proceedings
2. Understand the possible consequences of the proceedings
3. Communicate with counsel
Unfit to stand trial
If individual is unfit to stand trial then treatment my be ordered without consent
Procedural issues for criminal responsibility
- Accused is presumed NOT to suffer from a mental disorder until the contrary is proved on the balance of probabilities
- Burden of proof is on party that raises the issue
NCRMD defense
Not criminally responsible on account of mental disorder
- argues it is wrong to punish individuals lacking requisite mental state
Two Barnch Test
Says that no person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of:
- appreciating the nature and quality (understanding consequences)
- Knowing the act was wrong
