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”
Dispositions
what is it, may include
Document that includes various conditions imposed on the person UST or NCR that are supposed to keep the public safe.
- Place of residence
- Mandatory urine toxicology screens
- Refraining from contacting certain persons / group of persons
- Upon consent, taking prescribed medications
- Seeing a representative of the hospital at a given frequency
types of discharge
absolute,conditional, detention order
- Absolute Discharge (for NCR only): Must be ordered if there is no finding that the accused represents a significant threat to the safety of the public
- Conditional Discharge: The accused poses a significant threat to the safety of the public, but the hospital does not veto the conditions of their discharge (e.g. community living arrangements or return to hospital)
- Detention Order: The accused poses a significant threat to the safety of the public and the hospital can veto the conditions of their discharge
making of a deposition
4 requirements
- The safety of the public, which is the paramount consideration;
- The mental condition of the accused;
- The reintegration of the accused in to society; and
- The other needs of the accused
