mental disorder

Question 1

Mental disorder

Answer 1

An abnormal pattern of thoughts, emotions, or behav caused by personal dysfunction and associated w/ significant personal distress or disability
Does NOT imply ‘illness’ and a person w/ a mental disorder can be culpable for criminal behav

Question 2

Classification of mental disorder

Answer 2

DSM-5
Diagnostic and statistical manual of mental disorders (5th edition)
ICD- 11
International classification of diseases (11th edition)
WHO
DSM and ICD closely aligned now

Question 3

Psychosis (schizophrenia)

Answer 3

Difficulty of distinguishing reality from fantasy
Primary symptoms are delusions and hallucinations

Question 4

Delusions (5)

Answer 4

(false beliefs about the world)

Paranoid: other ppl are plotting against the person

Grandiose: one person holds special powers or unique knowledge

Thought withdrawal: thoughts removed from head

Thought insertion: beliefs placed inside one’s head

Somatic: something abnormal or improbably is happening in the body

Question 5

Hallucinations

Answer 5

(sensing or perceiving things or events that others do not)

Most common ones are auditory

Command hallucinations→ false auditory perception of being ordered to do something

Compliance of a command hallucination is more likely if the voice is trustworthy, benevolent, or if the command matches a delusion
–> Quality of a voice and perception of a threat

Question 6

positive symptoms?

Answer 6

delusions, hallucinations

Question 7

negative symptoms (4) schizophrenia

Answer 7

Deficit of psychological functioning or the absence of expected behav or feelings

Flattened affect → lack of appropriate emotion in observable expression and behavs

Alogia → brevity or absence of speech, lack of content in communication (mind goes blank)

Avolution → lack of energy disinterest in usual activities

Question 8

Disorganised symptoms (schizophrenia)

Answer 8

Bizarre behav or confusing speech that reflect severe underlying thought disturbances

Word salad → Nonsensical or unconnected words

Loosening of association→ shifting train of thought

Catatonia→ maintaining rigid posture or complete lack of movement

Waxy flexibility → Remaining in an uncomfortable position

Question 9

Prevalence and etiology (of psychosis)

Answer 9

Around 1%
Affects both sexes, but men more
Manifests earlier in males
Significant genetic contributions, but no gene for schizophrenia
Pre- and perinatal environmental risk factors
Cannabis use when young can increase risk for developing psychosis
Differences in brain structure, functions and interactions

Question 10

Schizophrenia and violence

Answer 10

Proportion of violence crimes is small

Level of violence might be higher

Excessive violence most common when hallucinations and delusions both present

Question 11

Delusional disorder (included in schizo spectrum)

Answer 11

Presence of one or more non-bizarre delusions

Question 12

Types of delusions (non bizarre, delusional disorder)

Answer 12

Delusional jealousy → belief that romantic/sexual partner is unfaithful (suicidal/homicidal ideations)

Erotomanic→ belief that someone of higher status is in love w/ the individual
–> Common in females but if in males more likely to act on it

Grandiose → megalomania behav (delusion of increased self importance)

Persecutory → Belief of being attacked or harassed (most common type of delusion)

Delusional distress → feelings of fear, sadness, and anxiety that can increase risk of violence

Belief maintenance→ increased likelihood of acting on delusions (confirmation bias)

Question 13

Major Depressive disorder (MDD)

Answer 13

-Sadness and loss of enjoyment (anhedonia)

-Mood changes must be extreme
-Most common mood disorder (5-7%)
-Childhood abuse and trauma are influences (environmental, bio (genetic is 40%), psyc influences)

-Extremely depressed state and must last over 2 weeks

Question 14

MDD and violence

Answer 14

-Relationship between depression and juvenile delinquency, esp in girls

-Very few crimes directly related to major depression

-May play a role in mass murders, school shootings, workplace violence and suicide-by-cop

-Situational or chronic? Hard to tell cause and effect

Question 15

Bipolar disorder (BP) → manic depressive disorder

Answer 15

Alternate between manic phase and depressive phase

Recklessly engage in pleasurable activities w/ harmful consequences

Not implicated in violence, but at 15x higher risk of suicide

Very impulsive in manic phase, increased confidence/esteem

Question 16

DID

Answer 16

-Characterized by disruption in normal integration of consciousness, memory, identity, perception, and behav

-Exhibit 2+ separate personalities or identities

-Experience memory gaps and fugue states (end up somewhere and don’t know how they got there)

-Transition between personalities may be sudden

-Generally triggered by a stimuli or trigger

-An ‘alter’ may be violent

Question 17

ex. of DID case

Answer 17

Hillside strangler

Kenneth bianchi attempted to blame his crimes on an ‘alter’ personality, “steve”
Was unsuccessful and deemed a psychopath

Question 18

PTSD → traumatic event is the cause

Answer 18

-Trauma-and-stressor related disorder that can lead to a dissociative state

-Only disorder w/explicit cause: trauma

-Symptoms include: flashbacks where the individ relives the event and is unaware of current situation

-May act violently during flashback

-May mitigate responsibility in cases of battered women

-Partial defense

Question 19

Not Criminal Responsible on Account of Mental Disorder (NCRMD)

Answer 19

-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 of the act or omission or of knowing that it was wrong

-At the time of the offense, a disturbance of the mind rendered the offender incapable of knowing the act was wrong

-3 outcomes: absolute discharge, conditional discharge, custody order

-Lack of mens rea

-DEFENSE

Question 20

NCRMD myths

Answer 20

-Removes culpability → unique incarceration

-Is dangerous→ more likely to dmg property than ppl

-Sentenced to life in psychiatric hospital → treatment, medications, therapy, rehab

-Likely to reoffend and end up bad in CJS → 17% of reoffending

Question 21

Fitness to stand trial

Answer 21

State of accused mind at time of trial

Offender must demonstrate their mental disorder prevents them from understanding the possible consequences

–> Understanding the nature or object of the proceedings

–>Communicating w/counsel

Question 22

Mental disorder and violence

Answer 22

-Mental disorder in criminal pop

-Crime in psychiatric pop

-Mental health and crime in a community sample

Question 23

MD in criminal pop

Answer 23

Prevalence of MD in incarcerated pops is 50-80% higher than in general pops

Rates vary by study as some include personality disorders and substance use disorders

Direct comparisons of major mental disorders 2-3x higher in incarcerated pops

Depression is the most common MD

Psychotic disorders do not exceed 5% of offending pop

Question 24

Crime in psychiatric patients

Answer 24

Early perspectives believed psychiatric patients were less violent

Research indicates this group has higher rates of arrest and conviction

May be because they are caught more easily and less well defended

Violence may be connected to substance abusers with MD, but not MD alone

Question 25

MD + crime in a community sample

Answer 25

Previous 2 perspectives are biased to specific pops

Compare behav of community members w/ MD to those w/o MD

Problems regarding sampling and measures

Research shows community members w/MD are more likely to have criminal and violent convictions

Question 26

Mental disorder and Crime

Answer 26

On its own is not a good predictor

Schizzo most associated w/ violence but the group is heterogenous

Males who develop schoizo and exhibit early antisocial behav are persistent offenders

History of violence can predict current violence

Risk factors are similar for mental disordered and non mentally disordered people

Crimes committed by the seriously mentally ill are generally not a direct result of their illness

No single factor is a strong predictor

Most ppl w/ an MD do not engage in crime/violence

Question 27

Criminalization of mental disorder

Answer 27

Ppl w/ mental disorders are more likely to be processed as offenders in the CJS than as patients in the mental health system

They engage in nuisance or disruptive behave

Not more likely to offend just more likely to be arrested, convicted and imprisoned

Question 28

Deinstitutionalization

Answer 28

Inverse relationship w/ pops in psychiatric and prison instit

Goal of deinstit to provide community based care did not manifest

Many ppl w/mental disorder ended up unhoused or in CJS

Question 29

Police discretion

Answer 29

Arrest 20% more ppl with MD symptoms than without

Almost always law enforcement who responds to mental health emergencies

Ppl w/MD less likely to conceal crimes or deny involvement, so clearance is higher

Question 30

threat /control-override symptoms

Answer 30

Symptom based theory of crime where crim behav of person w/ MD is attributed to their altered perceptions

Principle of rationality-within-irrationality is that violence committed by person w/ MD is a rational response to irrational symptoms

Threat symptoms cause smo to feel like they are going to be harmed

Control-override symptoms leave a person w/ diminished feeling of self control and free will

Question 31

Substance abuse

Answer 31

MD + Substance abuse = increased risk of criminal behav

Substance use may be higher in ppl with MD due to nature of their symptoms

Substances may be more intoxicating to minds of people whose perceptions are already impaired

Question 32

Social situation (socioeconomic)

Answer 32

Higher rates of MD (mental disorder) among those of low SES

Higher violence in psychiatric patients in poorer neighbourhoods

Good social support networks can minimize violence

Larger networks can be detrimental

Question 33

Victimization

Answer 33

More likely to be victims of violence than engage in crime

Can increase risk of violent behav

Witnessing a crime is a risk factor

Question 34

Treatment

Answer 34

Reduced risk of violence when following a prescribed medication regimen

Medication can lessen effects of symptoms, but cannot ‘cure’ MD

Challenges w/ compliance
Insight is a person’s appreciation for their mental disorder

Question 35

Tense Situations

Answer 35

MD → Violence
Threat/control override symptoms → violence
Bizarre symptoms → violence
Substance use → violence
Antisocial personality → Violence
Neurobio factors → violence
Social environment factors → Violence