PSYC241: Final Exam Flashcards

1
Q

Substance use disorders

A

10 different classes

Recurrent use leads to negative consequences

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2
Q

Four general groupings of indicators of substance use disorders

A

1- impairment of control over use
2- social impairment
3- risky use
4- pharmacological criteria

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3
Q

Substance-induced disorders

A

Intoxication
Withdrawal
Other substance or medication induced disorder
Can be resolved when person stops using substances

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4
Q

Polysubstance abuse

A

Simultaneous misuse or dependence upon two or more substances
On the rise
More common in young people
Combining drugs is dangerous because they’re often synergistic=combined effects are more intense or different than individual effects

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5
Q

Change in DSM-5 related to intoxication vs substance use disorder

A

Eliminated the distinction between abuse and dependence

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6
Q

Substance intoxication

A

Reversible, temporary condition
Must show clinically significant maladaptive behaviour or cognitive changes
AND
Impaired thought processes or motor behaviour

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7
Q

Symptoms related to impaired control (substance abuse disorder)

A

Symptoms related to impaired control:
1- ingestion of substance in bigger amounts over a longer period of time than originally intended
2- desire to cut down or stop without success
3- lots of time spent getting, using and recovering from substance use
4- craving

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8
Q

Symptoms related to social impairment (substance abuse disorder)

A
  • failure to fulfill life role obligations
  • continued use despite social and interpersonal problems
  • loss of activities
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9
Q

Symptoms related to risky use (substance abuse disorder)

A
  • recurrent substance use in situations where it’s physically dangerous
  • continued use despite knowing you have a physical or psychological problems that’s caused by substance
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10
Q

Pharmacological criteria (substance abuse disorder)

A

Tolerance and withdrawal

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11
Q

Common element of polysubstance abuse

A

Alcohol

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12
Q

Three main risks of polysubstance abuse

A

1- physically dangerous (more so than each drug by itself)
2- associated with greater commodity of other psych disorders
3- treatment challenges

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13
Q

DSM-5 diagnostic criteria for alcohol use disorder

A

Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period (1 year)

  • large amounts or longer period
  • desire and failed efforts to cut down control use
  • lots of time spent trying to get alcohol use it recover from it
  • craving
  • failure to succeed in life bc of it
  • continued use despite social problems
  • giving up past enjoyed activities
  • hazardous use
  • continue despite knowledge that it’s ruining your life
  • tolerance (more need and diminished effect)
  • withdrawal (classic withdrawal or taking substances to relieve symptoms of withdrawal
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14
Q

University students statistics (alcohol)

A

Half report black outs
Males greater use than females
Students living on their own or in forms report more drinking

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15
Q

Genetic factors in alcohol use

A

Support significant genetic effect for males (not females)

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16
Q

Alcohol expectancy theory

A

Persons drinking is determined by other reinforcements they get from it

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17
Q

Alcohol and behaviour disinhibition

A

People with alcohol problems tend to have more difficulty controlling impulsive behaviour

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18
Q

Abstinence goals for alcohol

A

Based on the disease model where it’s assumed that alcoholics never be able to control drink in a controlled way
Traditional treatment programs and AA

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19
Q

Transtheoretical model of change (alcohol)

A
Theoretical framework for understanding the process of behavioural change 
Stages of change
-pre contemplation 
-contemplation 
-preparation
-action
-maintenance
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20
Q

Precontemplation (transtheoretical model of change for alcohol)

A

Not ready to change
May not feel like they have a problem
May feel barriers or disadvantages (cons) associated with change are greater than benefits of change (pros)

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21
Q

Contemplation (transtheoretical model of change for alcohol)

A

Thinking about changing behaviours, but not committed to change
Ambivalent
Weighing pros and cons

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22
Q

Preparation (transtheoretical model of change)

A

Decided to change

Developing a plan for change

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23
Q

Action (transtheoretical model of change)

A

Actively working at changing their problem behaviour

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24
Q

Maintenance (transtheoretical model of change)

A

Working on keeping up with changes and preventing relapse

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25
Q

More details about transtheoretical model of change

A

Spiral model

Relapse is common and is normalized

Interventions made to match individuals stage of change

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26
Q

Integrating MI and TMC (substance abuse disorders)

A

Use MI at all stages of change
MI: way of interacting with clients; a stance
Use in assessments and diff types of interventions

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27
Q

General principles of MI (substance abuse disorders)

A

Belief that lasting change is unlikely to occur until individuals can resolve their ambivalence

Ambivalence=expected and understandable experience for individuals thinking about change

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28
Q

Miller MI: general principles (substance related disorders)

A
  • express empathy (reflective listening, ambivalence is normal)
  • develop discrepancy between present behaviours and future goals/values
  • roll with resistance (don’t argue and change what you’re doing)
  • support self efficacy
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29
Q

MI: strategies (substance related disorders)

A

OARS

  • open ended questions
  • affirmations (belief that patient’s doubts in their ability to change is bad for progress; affirm/reinforce resourcefulness, previous attempts to change, qualities of patient that facilitate change)
  • reflective listening (statements not questions, simple and complex reflections)
  • summarizing (type of complex reflection, selective and directive but make sure to include both sides of ambivalence, transitioning between tasks, at end of session)
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30
Q

What to summarize in MI? (Substance related disorders)

A

Pros associated with change
Cons associated with present behaviour
Intentions to change
Space between where person wants to be and their current behaviours

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31
Q

Harm reduction model (substance related disorders)

A

Focus: reducing consequences substance use (ex: needle exchange programs)
Implemented usually with counselling, edu, outreach programs

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32
Q

Schizophrenia

A

Prevalence: 1%
Most diagnosed between age 20 and 40
Men and women at equal risk but men show symptoms earlier and more severely

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33
Q

Positive symptoms of psychosis

A

More obvious symptoms of psychosis

  • delusions
  • hallucinations
  • disorganized speech and thought disorder
  • grossly disorganized or catatonic behaviours
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34
Q

Negative symptoms of psychosis

A

Absence or loss of typical behaviours

  • flat effect
  • avolition
  • alogia
  • anhedonia
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35
Q

Delusions

A

Impossible beliefs that last even if there’s evidence that contradicts them

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36
Q

What delusions are most common in schizophrenia ?

A

Persecutory delusions

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37
Q

Hallucinations

A

People see hear smell feel things that aren’t really present
Hearing voices =most common in schizophrenia
Misinterpretations of sensory perceptions

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38
Q

Disorganized speech and thought disorder

A

Loosening of associations

Least common of the positive symptoms

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39
Q

Flat effect

A

Negative symptom of schizophrenia

Limited emotional expression

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40
Q

Avolition

A

Negative symptom of schizophrenia

Lack of energy, limited ability to persist in daily routines (grooming and hygiene problems)

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41
Q

Alogia

A

Negative symptom of schizophrenia
Can take several forms;
-poverty of speech
-poverty of content of speech (vague and repetitive, doesn’t communicate much info)

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42
Q

Anhedonia

A

Negative symptom of schizophrenia

Inability to experience pleasure

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43
Q

Motor symptoms and catatonic behaviour (schizophrenia)

A

Go from agitation to immobility

Catatonic behaviour= holding body in weird positions and not letting people change how you’re positioned

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44
Q

Proposed changes about schizophrenia diagnosis for DSM-5

A

DSM-IV (4)
2+ of the following for a significant period of time during a 1 month period
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behaviour
-negative symptoms

Change to DSM-5 is it should include symptoms 1-3 (delusions, hallucinations and disorganized speech)

Note: only 1 required if:
1- delusions are bizarre
2- hallucinations=running commentary or convos between 2+ people

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45
Q

Subtypes of schizophrenia (5)

A
1- paranoid (delusions have themes, auditory hallucinations and absence of markedly impaired cog functioning; most common, least disabling, later onset than other subtypes, best prognosis)
2- disorganized
3- catatonic
4- undifferentiated 
5- residual
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46
Q

2 proposed changes for DSM-5 about schizo

A

Removal of subtypes - accepted

Clinician-rated dimensions of psychosis symptom severity - accepted

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47
Q

5 sections of warning signs

A

Behavioural

Thinking and speech

Social

Emotional

Personality

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48
Q

Another proposed change for DSM-5: attenuated psychotic symptoms syndrome

A

All six of the following:
1- characteristic symptoms of delusions/hallucinations/disorganized speech (at least one and in attenuated/weakened form)
2- frequency/currency (present for a month and occur once a week)
3- progression (begun and worsened in past year)
4- distress/disability/treatment seeking (symptoms are distressing and disabling for the patient)
5- symptoms aren’t better explained by another disorder
6- clinical criteria for any DSM-5 psychotic disorder have never been met

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49
Q

Attenuated psychosis syndrome

A

Added as example of “other specified schizophrenia spectrum and other psychotic disorder”

Included as condition for further study

50
Q

Etiology of schizo

A

Strong evidence for genetic contribution (higher rates in biological relatives and parents)

Negative symptoms appear to have a stronger genetic component

51
Q

Dopamine

A

Original belief: schizo related to an excess in dopamine

Current belief: actually related to oversensitive dopamine receptors

52
Q

What do antipsychotic meds do for schizophrenia?

A

Block post-synaptic dopamine receptors

Amphetamine use can cause symptoms consistent with paranoid schizo and amphetamines cause a release of dopamine into the synaptic cleft and prevent their inactivation

53
Q

Is dopamine most strongly related to positive or negative symptoms of schizo?

A

Positive symptoms

Whereas amphetamines worsen positive symptoms
And
Antipsychotics reduce positive symptoms

54
Q

Evaluation of the dopamine theory of schizo

A

Discrepancy between drug action and changes in behavioural symptoms

  • antipsychotics block dopamine receptors but no changes in positive symptoms for a couple weeks
  • to see therapeutic gains: antipsychotics must lessen receptor activity to below normal (Parkinson’s like symptoms)
55
Q

Expressed emotion

A

Within families, over involvement and negative interpersonal communication directed at family member with schizo

Can play a role in relapse
Not specific to schizo

56
Q

Congenital and developmental considerations

A
Viral exposure (influenza, rubella)
Complications during birth
57
Q

Medication for schizophrenia

A

Chloropromazine - first antipsychotic, severe side effects

Risperidone and olanzapine - newer and less side effects

Meds improve positive and some negative symptoms (do little for cog impairments, social skills and occupational/daily living skills)

58
Q

Three types of psychological treatment for schizo

A

1- CBT: symptom focused, helps with negative symptoms

2- family therapy: support, reduce negative emotional expression

3- social skill training: skills-based, purpose to help with functional disabilities associated with schizo

59
Q

Multiple areas of assessment for childhood behavioural disorders

A

Developmental/medical history

Social functioning

Edu functioning

60
Q

Role of child psychologist

A

Liaison between family, care providers, school

61
Q

Three branches of mental disorders in childhood

A

1- externalizing problems (under controlled behaviour; ADHD ODD Conduct disorder)

2- internalizing problems (over controlled behaviour; SAD, selective mutism, RAD, anxiety and mood disorders)

3- other (eating disorders and psychotic disorders)

62
Q

Attention deficit/ hyperactive disorder (ADHD) prevalence

A

In more boys than girls
Mostly in children/teens
Rate increase 10x in psychiatric pops

63
Q

ADHD diagnostic criteria

A

Six or more of these symptoms for at least 6 mos:

  • inattention
  • hyperactivity
  • impulsivity
  • symptoms prior to age 12
  • symptoms present in 2+ settings
  • symptoms interfere or reduce quality of social academic or occupational functioning
  • symptoms not better explained by other mental disorder
64
Q

ADHD inattentive type

A

Difficulties in listening, learning and remembering
More common in girls than boys
Associated with more academic problems (especially in math)
Social problems less obvious than with other types of ADHD

65
Q

ADHD hyperactive/impulsive type

A

Tend to get in trouble, talk to themselves and others, interrupt others, move and fidget and highly reactive

  • more common in boys
  • higher rate of comorbid conduct problems
  • motor symptoms decrease with age
  • fidgeting and restlessness persist into adulthood
66
Q

ADHD comorbidity

A

50% of kids with ADHD have comorbid diagnoses

  • oppositional defiant disorder
  • conduct disorder
  • learning
  • anxiety
  • depression
  • substance abuse
67
Q

Developmental trajectory of ADHD

A

Increased risk in developing another psych disorder

  • begin substance abuse earlier
  • more risk of self injury like car accidents
  • greater academic problems
  • less jobs
  • become parents earlier
  • have more STDs
  • more divorce and separation
68
Q

ADHD brain structure and functioning

A

Smaller brain size

  • abnormalities in prefrontal cortex (executive functioning) and basal ganglia (higher motor control, learning, memory, cognition, emotion regulation)
  • abnormalities in dopamine and noradrenaline
69
Q

How much of the risk of ADHD is genetic?

A

More than half

70
Q

ADHD prenatal risk factors

A
Prenatal toxin exposure:
Poor diet
Mercury and lead exposure
Pregnancy and delivery complications
Exposure to alcohol and smoking
71
Q

ADHD psychosocial risk factors

A
Low socio-economic status
Large family size
Paternal criminality
Poor maternal mental health 
Child maltreatment 
Foster care placement 
Family dysfunction
72
Q

ADHD treatment

A
  • stimulant meds helpful in increasing concentration and reducing impulsivity/over activity (lots of side effects like decreased appetite, weight loss, trouble sleeping, etc)
  • combo treatments: meds and parent training
  • treatments need to change as child grows to be developmentally appropriate
  • drug holidays no longer recommended
73
Q

Oppositional defiant disorder

A
Pattern of negativistic, hostile and defiant behaviour 
Loses temper
Argues with authority figures
Doesn't listen
Annoys people on purpose
Blames others
Angry and resentful
Has been vindictive or spiteful in the last 6 mos
74
Q

Conduct disorder

A
Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms of rules are violated 
3+ in last 12 mos and at least 1 in last 6 mos
-aggression to people or animals
-destructing property
-deceitful need or theft
-serious violations of rules 
Specify if:
-lack or remorse/guilt
-callous/lack of empathy
-unconcerned about performance
-shallow or deficient affect
75
Q

ODD vs conduct disorder

A

Less severe in nature than CD
Doesn’t include aggression towards people and animals, destruction of property, pattern of theft or deficit
Includes problems of emotional dysregulation that are not included in definition of CD

76
Q

ADHD in relation to ODD

A

ADHD is comorbid with ODD
to make additional diagnosis of ODD, determine that the individual’s failure to conform to requests of others is not only in situations that demand sustained effort and attention

77
Q

ODD and CD are comorbid with…

A

Learning disorders
ADHD
Substance use

78
Q

Developmental trajectory

A

Minority trajectory: ODD -> CD -> antisocial PD

Most common for kids with early and severe symptoms

79
Q

Compared to CD only, children with comorbid ADHD and CD tend to have…

A

Younger age of onset
More severe symptoms
More aggressive symptoms

80
Q

ODD and CD psychosocial risk factors

A

Maternal stress and smoking during pregnancy
Poor parenting
Peer rejection and associating with deviant peers
Parental psychopathology
One parent families
Large family size
Teen preg

81
Q

Etiology of ODD and CD: gene-enviro interactions

A

Childhood maltreatment can be a risk for problems when combined with either:
1- low monoamine oxidase A (MAOA: gene that produces enzyme that breaks down serotonin, norepinephrine and dopamine)
2- high genetic risk for conduct problems

82
Q

ODD and CD and gender

A

Slightly more with boys than girls diagnosed with ODD

3-4 times more boys than girls diagnosed with CD

83
Q

Developmental trajectory of girls with CD

A

Factors associated with girls with CD:
Teen pregnancy
Suicidal behaviour
Romantic involvement with antisocial makes (assortative mating; associated with escalating negative behaviour, discord in relationship, poor parenting of future kids)

84
Q

Four treatment methods examined in controlled trials for CD

A

1- problem solving skills training: targets deficits in problem solving skills, social perception and social attribution
2- pharmacological treatment
3- parent training
4- school and community based treatment

85
Q

Intermittent explosive disorder

A

Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either of the following:
1- verbal aggression or physical aggression towards property/animals or other people happening twice a week on average for a period of 3 mos (physical aggression doesn’t include damage or destruction of property or physical injury to others)
2- three behavioural outbursts involving damage or destruction of property and or physical assault involving injury against animals or other people occurring in 12 month period

86
Q

Separation anxiety disorder

A

At least 3 of the following symptoms for at least 4 weeks:
Stress when leaving parent
Worry about parents safety
Worry about being separated long term from parent
Reluctance to go places without parent close by
Nightmares about separation
Complaints about physical symptoms when separation is anticipated

87
Q

Childhood anxiety disorders

A
Equally common between boys and girls
Precursor to future health problems 
-other anxiety disorders either same (homotypic continuity) or different (heterotypic continuity) than original diagnoses 
-behaviour probs
-depressive disorders
-eating disorders
-suicidality
-substance abuse
88
Q

Etiology of child anxiety disorders

A
Amygdala problems 
Heritable component 
-direct observation or instruction
-personal experiences 
Stress during pregnancy causes this
89
Q

CBT for childhood anxiety disorders

A

Coping cat
Psychoeducation about anxiety
Helps parents and children learn new ways to cope with anxiety
Exposure to anxiety provoking situations

90
Q

Meds treatment for childhood anxiety disorders

A

Some support for selective serotonin reuptake inhibitors SSRIs
But there’s side effects

Support for CBT and meds together

91
Q

Affects of childhood depressive disorders

A
  • depressed or sad mood (headaches)
  • irritability (stomach aches)
  • easily annoyed or angered (difficulties attending concentrating, eating difficulties)
  • anhedonia (hopelessness, decrease activity, sleeping difficulties)
92
Q

Issues looked at in mental health and the law

A
Involuntary hospitalization
Involuntary treatment 
Risk assessment
Competence to stand trial
Criminal responsibility 
Ethics
93
Q

Forensic psych: therapeutic vs forensic assessment

A

Therapeutic assessment: conducted for diagnostic and treatment planning purposes

Forensic assessment: conducted to aid legal decision-making (fit or not to stand trial)

94
Q

Therapeutic vs forensic: main areas of divergence

A
Scope of assessment
Importance of client perspective 
Voluntariness
Autonomy 
Pace and setting
95
Q

Three sources of law of structure of the Canadian legal system

A

Constitutional law: charter guarantees rights and freedoms can’t be denied to those with mental disorders

Statutory law: civil mental health law and criminal law

Common law: parens patriae - duty of state to care for citizens who can’t care for themselves

96
Q

Health professionals role in mental disorders and the law

A

Provide opinions on existence and impact of mental disorders in cases
Expert witness testimony
Consultation

Mental disorder=impairment of psychological functioning that is internal, stable and involuntary (more narrow a definition than the one used by health pros)

97
Q

Involuntary hospitalization

A

Pose a risk to themselves or others due to mental disorder
Civil commitment
Infringe on basic rights of citizens
Must meet 3 criteria:
1- suffering from mental disorder
2- unwilling/unable to consent to hospitalization
3- at risk of causing harm to self or others

98
Q

Involuntary treatment

A

Temporary substitute decision maker appointed by state or private representative of patient

  • best interests principle and capable wishes principle
  • compulsory treatment orders (outpatient involuntary treatment in Ontario, Newfie, sask, less restrictive, failure to comply leads to involuntary hospitalization, no positive evidence for it)
99
Q

Best interests principle

A

Treatment should be picked to maximize likelihood of good outcome

100
Q

Capable wishes principle

A

Patients own wishes should have the more importance in decision making

101
Q

Risk assessment occurs in what areas?

A

Criminal and civil law

102
Q

Approaches to risk assessment (3)

A

Unstructured clinical judgement (ideographic and qualitative)

Actuarial decision making approach (nomothetic and quantitative)

Structured professional judgement (bring together the other two, individual and comprehensive set of risk factors)

103
Q

Violence risk assessment

A

Prediction rate increases when clinicians use quantitative methods

Usually over predict dangerousness

Considers these factors:

  • nature severity frequency of violence
  • imminence of violence
  • likelihood violence will occur

Risk management is important

104
Q

Three common tools for risk assessment

A

1- PCL psychopathology checklist (interviewer rated measure, many versions available)

2- SAVRY structured assessment of violence risk in youth (structured interviews rated measure)

3- HCR 20 historical clinical risk management scheme 20 (guided and structured approach)

105
Q

Unfit to stand trial (UST)

A

Unable to participate actively or effectively in their own defends due to a mental disorder

Trial may be suspended while treatment given

Unable to understand nature or object of trial, possible consequences, communicate with counsel

Issue can be raised by defendant, judge or prosecution before or at trial

Evaluations can be done to assist in determining if defendant is UST (fitness interview test revised FIT-R)

Found unfit -> pleas are set aside and defendant can be ordered to have treatment

Cases reviewed every two years

106
Q

Criminal responsibility: mens rea vs actus rea

A

Criminal offense consists of
Actus rea= prohibited act

Mens rea=bad intention

107
Q

M’Naghten rule

A

Not found guilty because reason of insanity

Either doesn’t understand what he did or doesn’t understand what he did is wrong

108
Q

Three outcomes if found “not criminally responsible on account of a mental disorder” (NCRMD)

A

Absolute discharge
Conditional discharge
Detention in hospital with periodic assessment

109
Q

Purpose of adult sentencing

A
Address unlawful behaviour
Separate offenders from society
Help rehabilitate offenders
Reparation for victims and community 
Make offenders responsible
110
Q

Sentencing options for adults in Canada

A
Absolute or conditional discharge
Probation
Restitution 
Fines and community service 
Conditional release
Imprisonment 
**no death penalty in Canada
111
Q

Types of parole options in Canada

A

Temporary absence
Day parole
Full parole
Statutory release

112
Q

General psych ethics -4 CPA guidelines

A

Respect for the dignity of persons
Responsible caring (minimize harm and maximize benefits)
Integrity in relationships (be honest, straightforward, minimize bias and avoid conflicts of interests)
Responsibility to society (promote welfare of all humans beings)

113
Q

3 exceptions to rule of confidentiality

A

Harm to themselves

Harm to others

Reveal info concerning child abuse or neglect

114
Q

DSM-5 criteria for defining personality disorders

A

Criterion A: manifesting in multiple areas
B: enduring, rigid, consistent
C: causes distress
D: stability and long duration
E: cannot be accounted for by another disorder

115
Q

3 DSM-5 personality clusters: cluster A

A

Odd and eccentric

Paranoid: suspicious of others
Schizoid: emotionally detached
Schizotypal: eccentric behaviour and social isolation

116
Q

3 DSM-5 personality clusters: cluster B

A

Dramatic, emotional, erratic

Antisocial: disregard for others, rule breaking, impulsive
Borderline: labile mood, unstable relationships
Histrionic: attention seeking, dramatic social displays
Narcissistic: grandiosity, egocentric

117
Q

3 DSM-5 personality clusters: cluster C

A

Anxious and fearful

Avoidant: sensitive to criticism, avoidance of intimacy despite desire for affection
Dependant: cannot function alone, gives up own needs
Obsessive-compulsive: inflexible and needs perfection

118
Q

Changes to axis in Dsm-5

A

Removed!
Diagnostic criteria unchanged

Insurance often didn’t pay for axis 2 disorders

119
Q

Egosyntonic vs egodystonic symptoms

A

Egosyntonic: don’t see their functioning as a problem (personality disorders)

Egodystonic: cause person distress (axis 1 disorders)

120
Q

Features of antisocial personality disorder

A
Nonconformity
Callousness 
Deceitfulness
Irresponsibility 
Impulsivity 
Aggressiveness
Recklessness
121
Q

Two types of etiology of psychopathy

A

Fundamental psychopath: result of biological disposition

Secondary psychopath: result of negative experiences in childhood (neglect or abuse)