M3 D2 Flashcards
\Cluster B
Histrionic Personality Disorder
features, Tx, interventioms
Features
- Attention seeking, life of the party, extraverted, exaggerated and theatrical behaviours
- Externally validated – seeks immediate gratification – seduction, manipulation, self-centeredness, validation, attention and comfort
- Uncomfortable with single relationship
- Become distressed when not centre of attention
Treatment
- Psychotherapy: Focus on emotional clarification.
Cluster B
Narcissistic Personality Disorder
Features
- Grandiose, inexhaustible need for admiration, arrogance, manipulative, exploits others, seeks success and lack of empathy
- Believe that they are superior, unique, special (inflated self-worth)
- They define the world through their own self-centred view
- incapable of accepting critique – fear lack of power
- these people’s self-esteem is very low (overcompensation), feel intense shame and have a fear of abandonment
Treatment
- Do not see themselves as having problems – they will be in other types of therapy (couples therapy / family therapy)
- If individual therapy – CBT (de-structuring faulty thinking)
- No approved pharmacological therapies
Cluster B
Borderline Personality Disorder
features,tx, interventions
Features
- Instability of interpersonal relationships
- fear of abandonment, self identity is disturbed & unstable, and abrupt shifts in emotion
- Ambivalence – from solitude to need for intense social support
- When personal expectations are not met: intense shame, self-hate and self directed anger
- substance use, frequent self-harm and suicide attempts (in periods of dissociation) – possible psychotic episodes.
- Intense, lability in affect
- Dichotomous thinking, projective identification (blame others for what happens to them).
Tx
- DBT.
- Antidepressant, mood stabilizers, antipsychotics
Cluster B
Antisocial Personality Disorder
Features
- Pervasive pattern of disregard for, and violation of, the rights of others, violent
- Manipulative, lies, lacks empathy
- Fail to adapt to the ethical and social standards of community
- Easily irritated, often aggressive – seeks immediate gratification (disinhibition)
Tx
- none specifically
Cluster C
Avoidant Personality Disorder
Features
- Constantly feels inferior and rejected (very low self-esteem)
- Avoiding interpersonal contacts and social situation (very rigid routine)
- Perceive themselves as socially inept
Treatment
- Psychotherapy (individual and group): focussed on trust and assertiveness to process anxiety provoking symptoms
- Pharmacotherapy: Antianxiety (anxiety), beta-adrenergic antagonist (hyperactivity), antidepressants (social anxiety), serotonergic agents (sensitivity to rejection)
Cluster C
dependant personality disorder
features, Tx
Features
- Submissive pattern; incapacity to make decisions; constantly in need of advice and comfort
- fearful of separation and abandonment
- Cling to others – needs to be cared for
- Tendency to devalue one self
Treatment
- Psychotherapy: CBT (target thoughts that result in fearful behaviour)
- Pharmacotherapy: Solely for the management of symptoms
Cluster C
Obsessive Compulsive Personality Disorder
Features
- Rigidity, perfectionism, and control
- excessive preoccupation with rules, details = incapacity to meet deadlines
- Tendency to be dominant, rigid and inflexible = related to the fear of making mistakes or to lose control
- Difficulty to share emotions
Treatment
- Psychotherapy: group therapy and behavioural therapy (learn coping skills to manage anxiety)
- Pharmacotherapy: Clomipramine and other serotonergic agents (obsessions, anxiety and depression)
OCD vs obessive complusive personaliy disoder
Obsessive Compulsive Disorder
- Obsessive thoughts and compulsions.
- Acknowledgement that obsessions and compulsions are unreasonable
Obsessive Compulsive Personality Disorder
- Unhealthy focus on perfectionism
-Actions are ‘right’ and persons feel comfort in these self-imposed rules of perfectionism
law
Intercept 0-5
Intercept 0 - community services
- crisis line
- continuumm
intercept 1 - law enforcemnt
- 911
- local law enforcement
intercept 2 - initial detention/court hearing
- initial detention
- first court appearabce
Intercept 3 - jails/courts
- specialty court
- Jail
- dispositional court
intercept 4 - Reentry
- prison and jail reentry
intercept 5 - community corrections
- parole
- probation
unfit to stand trial
what is it, 3 reaspons
Unable on account of mental disorder to conduct a defence at any stage of the proceedings before a verdict is rendered or to instruct counsel to do so
- understand the nature or object of the proceedings,
- understand the possible consequences of the proceedings, or
- communicate with counsel;
treatment order
what, when is it used? criteria
If found “unfit to stand trial”: court will decide that the person needs to be treated for the purpose of making them fit to stand trial
- Treatment is likely to make the person fit (max 60days)
- Any potential harm associated with the treatment does not outweigh the anticipated benefits
- Treatment must be least restrictive and least intrusive - as decided by the judge
- Consent isn’t needed
- Independent from the MHA
Not Criminally Responsible
3 criteria, who?, exclusion criteria,how is it proven?
No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder
- mental disorders that alters a persons appreciation of what is ‘good’ and what is ‘bad’ cannot be ‘morally’ blamed for the crime they’ve committed – this is the focus of the assessment
- exclusion criteria include self-induced intoxication, mental disorders that do not alter the appreciation of what is good and bad
- Person may undergo various psychological testing to clarify diagnosis, assess neurocognitive functioning, rule out malingering (faking symptoms)
Types of Persons NCR or UST
- Mainly diagnosis of psychotic spectrum disorders (schizophrenia, schizoaffective disorder and bipolar disorders
- Co-morbid personality disorders (narsisitic, BPD, antisocial)
- Co-morbid substance use disorders
- Other problems: poor literacy, long institutionalization (loss of social abilities), risk of violence, risk of being abused
provincial reveiw board
composition?
Purpose: Make and/or review disposition orders for persons NCRMD or UST
- Composition: Five members appointed by the Lieutenant Governor in Council of the province
- At least 1 psychiatrist – and if only 1 psychiatrist another member with training and experience in mental health and qualified to practice psychology or medicine
- Chair must be a judge, a retired judge or a person qualified to a judicial office
- Quorum requires at least 3 members including the judge and psychiatrist
- Decisions are made by majority vote
determining safety of the public
what do we need to determine this
Determining Significant Threat to the Safety of The Public
- The nature of the harm that may be expected
- The degree of risk that the particular behaviour will occur
- The period of time over which the behaviour may be expected to manifest itself
- The number of people who may be at risk
- the threat must [also] be ‘significant’, both in the sense that there must be a real risk of physical or psychological harm occurring to individuals in the community and in the sense that this potential harm must be serious. A minuscule risk of grave harm will not suffice”
