Forensic Psych Quiz 1

Personnel fitness for duty (police officers)

• Personality assessment inventory 

• Grade level / IQ

• Polygraph 

• Training - physical exercise 

• Stress training - mental stamina 

Personality assessment inventory

• Looks at depression, anxiety, schizophrenia 

• Dominance vs warmth (need high dominance, less warmth)

• Leadership (need high leadership but not too high)

• Gives us trends to look for

Hostile negotiation

• Figure out the wants of the person

• Don’t negotiate!

  • Talk them through the options 

• Goals 

• Allow to be heard

More likely to commit suicide when:

• coming up from a depressive episode 

• feeling invincible during a manic episode 

• going back on meds

Duty to Warn / Tarasoff’s case

Therapist can inform 3rd party (who is identifiable) and break confidentiality if there is a known risk to the other person

Detention centers - for people charged with crimes

• ARRESTED → pre-trial process/holding 

  • INTAKE at the detention center of jurisdiction 

  • Specialized populations 

    • Will go to inmate mental health unit or general populations unit

    • Seen by psychiatrist and/or psychologist to determine this 

  • Questions about mental health (medications)

    • Medications can be refused 

  • Typically holds until AFTER bail review/adjudication

    • Adjudication (charge is resolved)

__ for less than year

__ for over a year

Jail for less than year

Prison for over a year

Examples of when psychologists are brought in to a jail

• Triage of care 

• Crisis management 

  • Suicidal/homicidal 

    • Brought into butt naked room (padded room)

  • Reckless behaviors 

• Short term groups 

  • Anger management 

  • Dual diagnosis 

• Short term individual therapy

Prison psychology

• Trained first as a correctional officer 

• Safety first 

• Crisis management 

• Rioting 

  • Using respect often your best course of action 

• No negotiation

Prevalence of anxiety disorders

18.1% of population, yearly

33.7% in lifetime

Generalized anxiety disorder

• Restlessness or feeling wound-up or on edge 

• Being easily fatigued 

• Difficulty concentrating or having their minds go blank 

• Irritability 

• Muscle tension

• Difficulty controlling the worry

• Sleep problems (difficulty falling or staying asleep or restless, satisfying sleep)

• Can have specifiers (for example with panic attacks)

Phobia disorder

Anxiety or extreme fear when confronted with a specific object or situation that is out of proportion to the actual threat

Panic disorder

• Sudden and repeated attacks of intense fear

• Feelings of being out of control during a panic attack

• Intense worries about when the next attack will happen 

• Fear or avoidance of places where panic attacks have occurred in the past 

• Typically not seen alone, usually associated with another disorder

MDD prevalence

7% of population

Most common groups for MDD

• 18-29 = most common group, followed by 60+ years

• Females - 3xs more likely than males beginning in adolescence

Bipolar disorder often starts out as __

depression

• Can start with manic episode then a depressive episode

If someone has bipolar disorder, then is given antidepressant, they will become _

manic

MDD course modifiers

• Substance use - much harder to treat cause you have to help them ween off of what they're addicted to

• BPD

• Anxiety

Manic episode symptoms

3 or more of the following 

• inflated self esteem and grandiosity

• decreased need for sleep

• more talkative than usual or pressure to keep talking 

• flight of ideas or subjective experiences that thoughts are racing 

• distractibility 

• increase in goal directed activity

• excessive involvement in activities that have high potential for painful; consequences 

Bipolar prevalence

0.6%, same for males and females

Bipolar onset age

Onset is generally around 18 years old with abnormalities in sleep, caffeine use, generally pervasive

Bipolar is more common in __ income vs _  income countries, more common for those who are not _

high vs low income 

married

Bipolar is _X more common if a family member has it

10

Bipolar is much worse if someone has mania and then becomes psychotic because then they need __

mood stabilizers

When mood stabilizers are used if manic and it gets better —> patient has _

If patient is still psychotic —> they probably have _

bipolar

schizoid affective disorder

Associated disorders with substance use

• Many “Axis I” disorders - any of clinical syndrome that is not a personality disorder or intellectual disabilities (ex. depression) 

• Trauma - most common comorbidity 

• Personality disorders - main ones are antisocial personality disorder (reckless disregard of the law), borderline personality disorder, and narcissistic personality disorder (most common substances are alcohol and cocaine)

Complex trauma syndrome

• Exposure to repeated trauma for long periods of time 

  • Whereas PTSD is one instance of trauma

• Causes dissociative, depersonalization states 

• Mood lability, without insight 

• Memory impairments → memory lapse for periods of time

• NOT A CLINICAL DIAGNOSIS IN DSM-5, but recognized by psychologists for purposes of evaluation

Complex trauma syndrome - tend to experience symptoms consistent with _

BPD

PTSD includes experiences with

• Dissociation 

• Depersonalization 

• Derealization - strong sense of denial (common for kids exposed to sexual trauma)

• Delayed expression (> 6 months)

Associated disorders/features with PTSD

• Major depression

• Anxiety disorders

• Substance use disorders → gambling 

• Psychosis (not hallucinations, but paranoia)

• High arrest rate

  • Disorderly conduct

  • Domestic disputes 

  • Assault 

• High divorce rate

PTSD prevalence

7.8% overall

• 10.4% female

• 5% males

Key features of schizophrenia spectrum disorders

• Delusions - false beliefs

• Hallucinations - change in perceptual realities (sensory)

• Disorganized speech

• Grossly disorganized/abnormal motor behavior (including catatonia)

• Negative symptoms

Types of hallucinations

• Usually auditory 

• Visual hallucinations are less common 

• Tactile hallucinations are common in drug use 

• Olfactory hallucinations are very rare

Types of disorganized speech

• Loose associations

• Word salad 

• Neologism - make up new words

Catatonia

not engaging in behavior with any purpose/goals

(ex. staring in the trash can, water into ear from water fountain, repeating words)

Delusional disorder

• Presence of 1 or more delusions with a duration of 1 month or longer 

• Has never experienced hallucinations 

• Apart from impact of delusions, functioning is not markedly impaired and behavior is not obviously bizarre or odd

Delusional disorder treatment

Delusions are very hard to treat - can try antipsychotics, if they don’t work you probably can’t treat it 

Erotomanic type (delusional disorder)

delusions of being in love with someone or someone being in love with them 

Most common type of delusional disorder

Grandiose type

Persecutory type (delusional disorder)

feeling like someone is targeting/sabotaging them

Somatic type (delusional disorder)

persistent, false beliefs about the body

• pretty infrequent

Schizophrenia symptoms

2 or more of the following, each present for a significant portion of time during a 1 month period 

• Delusions 

• Hallucinations 

• Disorganized speech 

• Grossly disorganized or catatonic behavior 

• Negative symptoms 

  • Really hard to mimic

Disturbance for at least 6 months 

Symptoms of schizophrenia go down with _, but people usually go off of them because of side effects

antipsychotics

Associated features of schizophrenia

• Inappropriate affect (they are not aware of this)

• Anxiety and phobias

• Cognitive defects

• Lack of awareness

• Hostility and aggression 

• Overall reduction of brain size, leaky ventricles

  • Cognition and IQ goes down over time, even with treatment

  • Verbal ability is the last to go but processing speed and learning memory go down

Schizophrenia prevalence

0.3 - 0.7%, slightly lower in females

Schizophrenia onset

Females: late 20s

Males: early to mid 20s

Environmental risk factor for schizophrenia

• Stress

• Substance use

• Lack of sleep

• Lack of support system

Schizophrenia comorbidites

• Depression - feel like no one believes you, cant hold a job, constantly feel tormented - all of these can lead to depression

• Low IQ - decreased cognitive functioning over time 

• Substance use

Schizoaffective disorder

• An uninterrupted period of illness during which there is a major mood episode 

• Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode 

• Symptoms of schizophrenia AND symptoms for a major mood episode are present

Schizoaffective disorder: _ affect

visual affect instead of flat

Schizoaffective disorder types

bipolar type or depressive type

Does schizoaffective disorder have a change in intellectual functioning?

No

• So, it has a better prognosis than schizophrenia

Schizoaffective disorder:

If symptoms go away on antipsychotic —> _

If still have mood symptoms —> _

schizophrenia

schizoaffective disorder 

Schizoaffective disorder prevalence

0.3%

higher in females than males

Schizoaffective disorder onset

early adulthood

Schizoaffective disorder comorbidities

• Substance use 

• Anxiety 

• PTSD

Borderline personality disorder 

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts 

• Recurrent suicidal behavior, gestures, threats, self-mutilation - this is more of a cry for help instead of actually wanting to commit suicide 

• Affective instability → marked reactivity of mood

• Chronic feelings of emptiness 

• Inappropriate intense anger or difficulty controlling anger 

  • This can look like mania 

• Transient, stress related paranoid ideation or severe dissociative symptoms 

  • Can look like psychosis 

  • Feel like they go in and out of reality

  • Not aware of surroundings 

Associated features of borderline personality disorder

• Self-sabotaging behaviors 

  • Fear of the unknown 

• Psychotic-like symptoms during times of stress

  • Dissociative 

• Suicide or accidental suicide 

  • Use of drugs or prescription meds 

  • Cutting themselves 

• Job loss, divorce common due to unstable relationships

BPD comorbidites

• Mood disorders

• Substance use

• Eating disorders

• PTSD

• ADHD

• Other personality disorder

BPD is most often seen in males or females

females (75%)

BPD prevalence

2% in general population

• 10% in outpatient settings

• 20% in clinical populations 

BPD is _X more common among first-degree relatives

5

Common crime for BPD

killing their own children

Antisocial personality disorder

A pervasive pattern of disregard and violation of the rights of others, occurring since 15 years old, 3 or more of the following:

• failure to conform to social norms with respect to lawful behaviors

• deceitfulness

• impulsivity

• irritability

• reckless disregard for safety of self or others

• consistent irresponsibility

• lack of remorse

Antisocial personality disorder prevalence

3rd of population

Antisocial personality disorder treatment

resistant to treatment

• but tend to grow out of it overtime

• typically seen with malingering

Antisocial personality disorder is more common in males or females

males

Narcissistic personality disorder

• Have an exaggerated sense of self-importance 

• Have a sense of entitlement and require constant, excessive admiration 

• Expect to be recognized as superior even without achievements that warrant it 

• Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate 

• Believe they are superior and can only associate with equally special people 

Narcissistic personality disorder is more common in males or females

males

Narcissistic personality disorder comorbidities

• Substance use (common with stimulants like cocaine)

• Other personality disorders 

• Depression

Other specified XX disorders

when symptoms don't meet the full criteria for a specific diagnosis but the clinician chooses to specify the reason why

Unspecified XX disorders

symptoms don't meet the criteria for a specific disorder, and the clinician chooses not to specify the reason, often due to a lack of sufficient information

5 ethics principles

1. Beneficence and non-maleficence 

2. Fidelity and responsibility 

3. Integrity - honesty  

4. Justice - treating everyone in an appropriate manner, standardized 

5. Respect for People’s Rights and Dignity

10 ethical standards

1. resolving ethical issues 

2. competence 

3. human relations 

4. privacy and confidentiality 

5. advertising and other public statements 

6. record keeping and fees 

7. education and training 

8. research and publication 

9. assessment

10. therapy

Therapy goals

• Promote insight 

  • Gain confidence/increase self-esteem 

• Psychoeducation 

• Individual, group, and family therapy

• Violence reduction 

• Increase interpersonal skills 

• Process crime 

• Readiness for the community

Cognitive behavioral therapy

• Look at interactions between thoughts, feelings, and behavior 

• Identify core beliefs → challenge 

• Determine which cognitive distortions are at play 

• Agenda and assign homework

Dialectical behavior therapy

• Mindfulness 

• Emotional regulation 

• Interpersonal skills training 

  • Normal conversational skills 

• Distress tolerance

  • Distraction from stress

Motivational interviewing

• Listening for change talk 

• Collaboration with therapist 

• Meeting client where they are (OARS)

  • Open listening

  • Affirmation

  • Reflection 

Summaries - verify what the patient said, repeat it back to them

OARS (motivational interviewing)

• Open listening

• Affirmation

• Reflection 

Interpersonal therapy

• Group or individual 

  • Generally use self to be able to make changes 

  • Identify deficits in:

    • Interpersonal conflicts/social deficits 

    • Intrapersonal conflicts/role conflicts 

    • Grief 

    • Identity transitions

Trauma-informed care

• Trauma timeline 

  • CBT component involved 

  • Talk about positives that came out of trauma 

• Changing perceptions 

• Behavior therapy 

• Remaining safe 

• Grounding techniques

Psychoeducation

• Asking a patient what is their diagnosis?

• Asking a patient what is violence?

• How does the interaction between diagnosis and violence occur?

Violence reduction

• Identify risk factors 

  • Medication changes, decreases 

  • Symptoms of mental illness

  • Triggers 

  • Drug use 

• Mitigating risk factors 

• Knowing what to do for help

Biggest violence risk factor

• Medication changes, decreases 

  • On the largest dose of medication, they have side effects. Doctors on outside lower the doses (teach patients to say no but doctors will reinforce their opinion)

Wellness recovery action plan

• Support system

• Regular therapy appointments 

• Adhering to medication

• Emergency situations