psychopathology 3

substance use

consumption without impairment

substance misuse

problematic, risky, or harmful use

substance use disorder

meets dsm-5 criteria

polysubstance use

use of more than one drug/ substance 

tolerance

• needing more of the substance to achieve the same effect

  • diminished effect with continued use of the same amount

withdrawal

physical and psychological symptoms when reducing/ceasing use

components of substance use disorder

• craving

• diminished control

• withdrawal

  • symptoms experienced when drug is discontinued

  • most severe for alcohol, opinoids, and sedatives/hypnotics 

  • evidence of physiological dependence  

• tolerance

  • nervous system becomes less sensitive to effects of substance, so increased quantities needed for same effect

  • mechanisms

    • metabolic tolerance 

    • pharmacodynamic tolerance

    • behavioral conditioning 

reasons for overdose risk spiking after abstinence

• loss of physiological tolerance

  • after detox, tolerance goes down, previously “normal” dose becomes dangerous 

• loss of conditioned tolerance

  • usual environment triggers body to prepare

  • new setting → no compensatory response → drug hits harder 

public health impact

• cause of preventable death

• linked to accidents 

• enormous economic cost

depressants

• examples

  • alcohol, benzodiazepines (valium, xanax)

  • barbiturates

• core effects

  • decrease cns activity, reduce anxiety, impair coordination

• risks & consequences

  • accidents, aggression, liver disease

  • tolerance and dangerous withdrawal

  • cross-tolerance

prevalence of alcohol use disorder

• more common in men and transgender

• large sex difference in alcohol metabolism 

alcohol use course

• initiation often in adolescence

  • peaks at 18

  • tobacco onset rarely after 25

  • adolescents: heightened reward sensitivity, impulsivity

• younger drinking initiation associated with higher dependence risk

• problematic drinking decreases with age 

• periods of heavy use alternates with relative abstinence

fetal alcohol spectrum disorders

• 6-9 out of 1,000 live births

• spectrum disorder 2-5% in US

stimulants

• examples

  • cocaine, amphetamines (adderall, methaphetamine), nicotine, caffeine

• core effects

  • increase cns activity, heightened alertness, euphoria, decreased appetite

• risks & consequences

  • cardiovascular strain, sleep disruption, paranoia, high potential for dependence

tobacco

• natural source of nicotine

• short term effects

  • stimulation of norepinephrine, dopamine, and serotonin

• long term consequences

  • 3.5 million ppl die prematurely

  • 80% lung cancer deaths

opiod

• examples

  • natural: opium, morphine, codeine

  • synthetic: heroin, oxycodone, fentanyl

• core effects

  • pain relief, euphoria, drowsiness

• risks & consequences

  • overdose (respiratory failure)

  • withdrawal: flu-like symptoms

  • major public health crisis (opioid epidemic)

opiod epidemic

• origins

  • prescription surge (1990s)

  • misleading claims of low addiction risk

• escalation

  • prescription crackdowns → shift to heroin

  • fentanyl enters drug supply (2010s)

• impact

  • 80k US overdose deaths

  • fentanyl drives most fatalities

  • hits rural and marginalized communities hardset

hallucinogens

• LSD

• alter perceptions, trigger panic and psychosis

cannabis

• THC, CBD

• relaxation, increased appetite, altered time perception

• heavy use → memory, motivation, and attention problems 

• issues

  • rising THC potency

  • edibles, vaping

  • debate over medical and recreational use

tranquilizers

• used to decrease anxiety or agitation

sedatives

• general term for drugs that calm people

• examples

  • barbiturates

  • benzodiazepines

behavioral addictions

• def

  • repetitive behavior that becomes compulsive, causes impairment/distress; compulsive behavior without substance

  • gambling (recognized in dsm)

• classificatory debate

  • argued that behavioral addiction research must move beyond simply applying substance use disorder frameworks

    • frequency of behaviors is not an addiction

    • many SUD criteria (tolerance, withdrawal) may not map cleanly to behaviors

      • importance of considering triggers, reinforcement patterns

• moral incongruence rather than impairment 

DSM for substance

• groups

  • substance use disorder

    • long-term problematic use (like alcohol use disorder)

  • substance induced disorder

    • symptoms caused directly by the substance (like intoxication or withdrawal).'

• old DSM

  • line between abuse and dependence

  • now it is a spectrum

epidemiology of SUD

• prevalence

  • alcohol is most commonly used and misused

  • 10-12% meet criteria for SUD

  • opioid misuse has surged

  • polysubstance use is common

• demographic

  • higher rates in men

  • faster progression to dependence (telescoping) for women'

  • influenced by cultural, socioeconomic, and policy factors 

prevalence of drug & nicotine use disorder

• SUD for any controlled substance: 9.9%

• lifetime rate of nicotine dependence 24%

• current rate of smoking is 11.5% which is lowest rate 

biological factors for SUD

• genetics and family history

  • family history increases risk from 2-4x

  • twin studies

    • Identical twins: high similarity
      Fraternal twins: less similarity

• neurobiology

  • dysregulation of dopamine reward pathways

    • Addictive drugs release dopamine in a huge surge → brain learns to seek the drug over natural rewards

  • Endogenous opioids, GABA, and glutamate

    • Opioids mimic natural opioid peptides

    • Alcohol affects GABA (inhibition) and glutamate (excitation)

    • Nicotine & stimulants increase dopamine indirectly

  • altered stress response (HPA axis)

sociocultural factors

• people influence

  • selection and socialization

    • alcohol- parental modeling matters more 

    • drug use- peers have greater effect 

treatment for SUD

• detoxification

  • may be medically indicated to reduce withdrawal symptoms

• additional psychopharmacological methods: antabuse, revia, cambral

• CBT

  • identify triggers

  • motivational interviewing

  • relapse prevention

• 12-step problems

  • spiritually oriented

  • high early drop out rates but big sobriety rates for those who stay

  • highly available, free

• 3 common evidence based treatment

  • CBT

  • motivational interviewing

  • medication assisted treatment

12 step programs

• evidence for

  • support for abstinence-based recovery

• evidence against

  • many recover without full abstinence (natural recovery)

  • controlled drinking can be sustainable for some AUD

  • alternatives offer secular and flexible options

harm reduction for SUD

• goal

  • reduce negative consequences of use, even if use continues

• core principles

  • pragmatic, nonjudgemental

feeding disorder

• avoidant, restrictive, or irregular eating without body/shape concerns found in eating disorders

• dsm includes

  • pica

  • rumination disorder

  • avoidant/restrictive food intake disorder

dsm criteria for anorexia nervosa

• restriction of energy intake leading to significantly low body weight

• intense fear of gaining weight

• disturbance in the way one’s body weight is experienced

• restricting or binge/purging type

• dropped amenorrhea criterion

epidemiology for anorexia

• common in women

• lifetime prevalence is 0.5-3.7 but textbook says 0.62% 

• peak ages of onset 14-18 years (bimodal)

• 3rd leading cause of chronic illness in adolescents after asthma and obesity

• crosses over to BN

health consequences of anorexia

• osteopenia and osteoporosis

  • increased bone resorption and decreased bone formation

  • only partial reversal of osteoporosis 

• cardiac complication

  • frequent cause of death in anorexia patients

  • signs: coldness of extremities, dizziness, and palpitations

• renal complications

  • kidney failure (Frequent cause of death), results from dehydration

• cns

  • apathy, poor concentration

• reproduction

  • amenorrhea, low estrogen 

• metabolic

  • cold intolerance

• easy

  • yellow skin, brittle nails, lanugo hair, muscle weakness, and restricted facial expression

dsm criteria for bulimia nervosa

• recurrent episodes of binge eating

• recurrent inappropriate compensatory behaviors in order to prevent weight gain

• at least once a week for 3 months

• self-evaluation is unduly influenced by body shape and weight

compensatory behaviors for bulimia nervosa

• most common = vomiting

• among patients with type I diabetes, giving themselves less insulin than is needed “diabulimia”

physical signs of bulimia

• russell’s sign

  • sores on hand from inducing vomiting

• dental complications from vomiting

• small red dots around eyes

• enlarged parotid glands “chipmunk cheeks”

epidemiology for bulimia nervosa

• black women have lower rates of restrictive dieting, higher rates of laxative use, and same rate of recurrent binge eating 

• rates higher among sexual minorities 

health consequences for bulimia 

• electrolyte abnormalities (hypokalemia)

• metabolic alkalosis

• dental erosion

• parotid gland enlargement

• cardiac arrhythmias

dsm for binge eating

• recurrent episodes of binge eating

  • 2 hours

• at least once a week for 3 months

• eating more until uncomfortably full

epidemiology for binge eating

• more common in female and minority groups

• higher prevalence than bulimia

health consequences for binge eating

• obesity

  • not everyone with BED is obese and not everyone who is obese has BED

  • GI issues

  • bariatric surgery complications 

eating disorder mortality

• anorexia has highest mortality rate of any psychiatric disorder

  • up to 21%

  • 0.56% per year

eating disorder variation by culture

• increasing prevalence in asia

• increasing rates among black and latino americans in US

• food insecurity →higher risk of bulimia or binge eating

• bulimia is culture bound, anorexia is not 

eating disorder in men

• muscle dysmorphia

  • body image problems involving desire to increase muscularity

• 30% of teen boys trying to gain weight or bulk up

• 22% of young men engage in muscle enhancing behaviors

  • eating differently

  • supplements

  • anabolic steroids

• more common in gay men

eating disorder etiology

• genetic risk factor

  • heritability: 58-76%

    • anorexia > bulimia

    • as high as schizo or bipolar

  • first degree relatives have higher rates of anorexia and mood 

  • run genetic locus shared with type I diabetes

  • genetic risk emerges id-adolescence 

personality factors 

• restricting anorexia

  • emotional constriction, perfectionism, conscientiousness, obsessiveness, introversion, socially conforming

• bulimia and binge eating anorexia

  • high impulsivity

  • sensation seeking

  • emotional lability 

family factors for eating disorders

• anorexia

  • lots of family enmeshment

• bulimia

  • lots of neglect and hostility

• high rates of childhood sexual disorders among bulimia

orthorexia

• obsession with healthy eating leading to malnutrition

treatment for anorexia

• motivational interviewing

• inpatient hospitalization

  • necessary for those that are 20`30% below expected weight or if cardiac sx occur

  • little research on efficacy 

  • goal: use behavioral principles to restore weight

• family based approach (maudsley family therapy)

  • effective for adolescents within first 3 months

  • very intensive so whole family needs to be on board

  • 20 sessions over 12 months

    • phase 1: weight restoration

    • phase 2: returning control over eating to adolescent

    • phase 3: establishing healthy adolescent identity

  • strong empirical support

treatment for bulimia and binge eating

• CBT

  • targets weight and body concerns

    • considered first-line treatment

• interpersonal psychotherapy

  • targets interpersonal problems

• dialectical behavioral therapy

  • adopted from Linehan’s borderline personality disorder

  • binge/purge viewed as self-harming behavior with maladaptive emotion regulation function

schizophrenia

• brain disorder involving abnormal dopamine signaling that shows a disturbance in thought shaped by psychological stressors  

early conceptualizations

• emil kraepelin

  • divided mental illness into manic depressive insanity (bipolar disporder) and dementia praecox (brain deterioration)

  • believed dementia praecox was due to autointoxication or a poisoning of the brain by toxins produced in the body

  • early biological/degenerative model of psychotic illness 

• eugen bleuler

  • coined the term schizophrenia

  • believed the disorder was characterized by a splitting of psychic functions rather than splitting of personality

  • not always degenerative 

• kurt schneider

  • first rank symptoms 

dsm for schizophrenia 

• + symptoms

  • hallucinations

  • delusions

  • disorganized speech and behavior

• - symptoms

  • flat affect, avolition, anhedonia, alogia

  • greater link to functional outcomes

• cognitive symptoms

  • global and specific deficits in cognition

  • social cognition deficits

• two or more present during 1 month period has to be at least

  • delusions

  • hallucinations

  • disorganized speech 

• continuous signs for 6 months 

primary psychotic disorders

• schizoaffective disorder

  • threshold level criterion a psychotic symptom

  • presence of a major mood episode (depression or mania) for >50% duration of psychotic illness

  • symptoms present outside of mood episode 

• brief psychotic disorder

  • episode lasts at least 1 day but less than 1 month

• schizophreniform disorder

  • psychotic episode lasting at least 1 month but less than 5 months

• delusional disorder

  • 2 or more delusions lasting 1 month or longer

  • no marked disruption to functioning 

related disorders to schizophrenia

• schizotypal personality disorder

  • pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior 

• schizoid personality disorder

  • pattern of detachment from social relationships and restricted range of emotional expressions

  • ( _ ) with psychotic features

    • many dsm disorders can have specifier or qualitative descriptor 

genetics for schizo

• heritability

  • highly heritable about 70-80%

  • first degree relatives

  • -10% risk

  • monozygotic twins

  • 40-50% concordance

• polygenic and complex inheritance

  • no single schizo gene 

  • risk is polygenic (many genes contributing toward overall symptoms) and pleiotropic (genes that contribute toward schizo also linked to other disorders)

  • genome wide association studies identify genes related to synpatic function, dopamine, and glutamate signaling, and immune pathways

• shared genetic liability

  • substantial genetic overlap with bipolar disorder, major depression, and autism

  • helps explain blurred diagnostic boundaries and psychosis spectrum conceptualizations

biological models for schizo

• dopamine hypothesis 

  • classical model

    • excess dopamine activity, particularly in the mesolimbic pathway, produces positive symptoms

  • modified model

    • dopamine dysregulation- too much subcortical, too little prefrontal

  • evidence for 

    • antipsychotic drug effects (D2 blockade reduces psychosis)

    • drugs that heighten dopamine trigger/increase psychotic symptoms (stimulants like cocaine or amphetamines

• limitations

  • doesn’t explain negative/cognitive symptoms

  • dopamine changes may be downstream, not casual

• neurodevelopment models

  • say early disruptions in brain maturation create lifelong impairment and psychotic symptoms

    • pregnancy complications

    • abnormal fetal development

    • maternal stress during pregnancy

    • birth during winter months???

  • altered synaptic pruning, gray matter loss, or circuit dysconnectivity emerge in adolescence

psychological models

• cognitive models

  • abnormal salience hypothesis

    • benign stimuli feel personally significant

  • cognitive biases maintain delusional beliefs

  • psychological stress and trauma interact with vulnerability to shape symptom content

• learning and social models

  • social defeat hypothesis

    • repeated exclusion or marginalization may sensitize dopamine systems

  • social deafferentation model

    • the social brain, when deprived of input, creates its own (hallucinations, delusions)

  • psychotic experiences gain meaning through reinforcement and interpretation; delusions/voices maintained by cognitive biases

integrated models for schizo

• original diathesis-stress model

  • genetic predisposition/ vulnerability (diathesis) and environmental triggers (Stress) are both necessary but not sufficient for onset of illness

  • longstanding framework

  • strengths: flexible, predicts variability

  • weaknesses: broad, vague

• modern conceptualizations

  • neurodevelopmental elements

    • early brain disruptions (prenatal infection, obstetric complications, adolescent synaptic pruning) create latent risk

  • environmental elements

    • interaction with later stress, substance use, or trauma triggers symptoms

  • neurodegenerative elements

    • research suggests accelerated aging across neural and biological systems

    • slightly faster cortical thinning, inflammation, and oxidative stress that can accumulate over time

prodromal phase for schizo

• subtle early changes

• social withdrawal 

• can last weeks to years

• clinical high risk for psychosis 

  • research/clinical designation for people showing attenuated psychotic symptoms or a steep decline in functioning

  • about 20-35% transition to a full psychotic disorder within two years

  • focus of early-intervention efforts

acute phase for schizo

• emergence of threshold level characteristic psychotic symptoms

  • hallucinations, delusions

• accompanying features

  • heighted emotional arousal, fear

  • decline in self-care

• typically begins in late adolescence to early adulthood

  • men: often earlier onset (late teens to early 20s)

  • women: often later (mid to late 20s)

• common precipitating events

  • major life stressors

  • cannabis use

• often represents the first clear recognition of illness by family or clinicians

• frequently leads to first hospitalization or crisis evaluation

• duration: typically 1-6 months before partial remission

• treatment response

  • antipsychotic medication reduces positive symptoms

  • supportive psychotherapy

  • family involvement

residual phase

• reduction in acute symptoms but ongoing difficulties

• negative symptoms cognitive deficits, social and occupational impairment

medication for schizophrenia

• antipsychotic medications

  • primary mechanism: block dopamine D2 receptors in mesolimbic pathway

  • most effective in reducing positive symptoms

  • limited effects on negative and cognitive symptoms

• medication classes

  • first generation (typical) antipsychotics

    • effective for psychosis but high risk of extrapyramidal symptoms and tardive dyskinesia 

  • second generation (atypical) antipsychotics

    • lower risk of EPS; broader receptor activity (dopamine and serotonin)

    • higher risk of metabolic effects

    • clozapine

      • most effective for treatment-resistant schizophrenia but carries risk of agranulocytosis 

limitations of medication treatment for schizo

• partial response

  • 30% of patients hae persistent symptoms despite treatment

• side effects

  • metabolic syndrome, sedation, weight gain→ major contributors to poor adherence

• long-acting injectables

  • improve adherence and reduce relapse risk

• emerging targets

  • glutamate modulation, inflammation, and personalized medicine approaches

integrated treatment

• CBT for psychosis

  • focuses on coping strategies and reducing distress rather than eliminating symptoms

• family psychoeducation

• social and functional rehabilitation

  • skills training

  • emphasizes recovery as participation in life

• coordinated specialty care

  • early intervention model for first episode psychosis

  • combines psychotherapy, medication, family education, and supported education/work

  • shown to improve outcomes when started soon after onset

category vs continuum for schizophren

• dimensional models

  • psychosis exists on a continuum

• RDoC and HiTOP frameworks

  • move beyond categories to study dimensions (cognition, reward, social processing)

• blurring boundaries

  • overlap with mood, developmental, and cognitive disorders

• schizophrenia and schizoaffective debate

  • many patients shift between diagnoses over time; shared genetics and symptom overlap challenge categorical distinctions 

somatic disorder

• defining features

  • physical symptoms or fears about illness that cannot be explained by organic impairment

  • unnecessary medical treatment

  • excessive worry about symptoms

  • last more than 6 months

  • prevalence 5-7%

  • often comorbid with depression or anxiety

  • more than one severe somatic complaint

functional neurological symptom disorder

• previously known as conversion disorder

• neurological like symptoms linked with psychological roots

• onset linked to stress or conflict

• ex

  • blindness, deafness

illness anxiety disorder

• formally known as hypochondriasis

• preoccupation with having or acquiring a serious illness

• few or no physical symptoms 

• health related checking or avoidance

• lasts more than 6 months

• 1-2%, gender balanced

factitious disorder (munchausen’s syndrome)

• imposed on self

  • intentional symptom production or falsification

  • motivation: assume the “sick role”

  • no external reward (distinguishes from malingering)

  • psychologically complex, often rooted in early neglect/need for nurturance

• imposed on another

  • same criteria but on another person 

malingering

• intentionally faking symptoms to receive tangible benefits

• not a formal diagnosis but listed as a v code (other conditions that may be a focus of clinical attention)

social shit w somatic 

• gender

  • all somatic symptom disorders are much more common in women except for illness anxiety disorder (equal)

• somatic symptoms disorders more common among

  • lower socioeconomic status

  • less than a high school education

  • african americans

  • puerto rico 

• role of cultural norms

  • higher rates in latin american cultures

  • korean syndrome 화병

  • some cultures express emotional concerns physical because of limited insight or social tolerance of psychological complaints 

etiological models of somatic symptom disorders

• perils of diagnosis by exclusion

• freud/psychodynamic

  • consequence of traumatic experiences overwhelming coping abilities

    • primary gain

      • symptoms protect conscious mind by expressing the psychological conflict unconsciously

    • secondary gain

      • symptoms help a patient avoid work, gain attention, etc.

• cognitive behavioral

  • learned assumption of sick role, positive and negative reinforcement

  • alexithymia (deficit in ability to recognize and express emotions)

  • misattribution of normal somatic symptoms

dissociative disorder

• dissociation

• two or more distinct personality states within an individual that take control over behavior

• characterized by persistent, maladaptive disruptions in the integration of memory, consciousness, identity, or perception

• symptoms are involuntary, not psychotic

• frequently related to trauma

dissociative amnesia (+- fugue)

• dissociative amnesia

  • sudden inability to remember extensive and important personal information

  • response to trauma or extreme stress

  • not result of head trauma or organic cause

  • can be localized (specific period) or generalized (Entire life)

• dissociative fugue

  • sudden, unplanned travel away from home

  • inability to recall the past, confusion about identity, or the assumption of a new identity 

depersonalization/ derealization disorder

• persistent detachment from 

  • self→ feeling outside one’s body (depersonalization)

  • world→ surroundings feel unreal (derealization)

• triggered by trauma

• ~2%

DID

• formally multiple personality disorder

• two or more distinct personality states within an individual that take control over behavior

• some memory loss occurring between personalities

• personalities can range from two to hundreds

• considered controversial because prevalence is based on a small sample

  • heavy reliance on retrospective reports

  • memories can be selectively recalled or distorted

  • DID cases are from clinicians who already believe in the disorder so there is bias

etiology of dissociative disorders

• trauma

  • clear role in dissociative amnesia & fugue

  • likely DID

  • data retrospective

• iatrogenesis (sociocognitive model)

• genetics

  • no evidence

• research for both etiology and treatment is limited

personality

• enduring patterns of thinking and behavior 

personality disorder

• An enduring pattern of inner experience and behavior that deviates markedly from cultural expectations, is rigid, leads to distress, and is stable across time.

• must affect these four areas of functioning

  • cognition (perceiving things)

  • affect (range, intensity)

  • interpersonal functioning

  • impulse control 

epidemiology for personality disorders

• prevalence

  • 10-14% have a PD in community samples

• gender

  • overall equal

  • antisocial personality disorder has clearest gender diffs (5x more common in men)

• age

  • not diagnosed in children

antisocial personality disorder

• must show at least 3 of these behaviors occurring since 15

• person must be 18 to diagnosis

• must be evidence of conduct disorder before 15

• behavior cannot be explained by another disorder like schizo or bipolar

dialectical behavior therapy

• marsha linehan received treatment development grant to target suicidal behavior

  • required a diagnosis of borderline personality disorder 

• core: you can accept yourself and also change unhealthy behaviors 

• as a world view

  • reality is whole and interrelated

  • reality is complex and in polarity

  • change is continual and transactional 

borderline personality disorder

• a pervasive pattern of instability of interpersonal relationships and maked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by 5+ 

  • emotion dysregulation

  • interpersonal dysregulation

  • self dysregulation

  • behavioral dysregulation

  • cognitive dysregulation

• core feature

  • instability in emotions, self-image, and interpersonal relationships, accompanied by impulsivity and fear of abandonment

• most effective treatment: DBT

biosocial theory 

• biological factors →emotion dysregulation←invalidating environment

biological vulnerability

• emotional sensitivity

• emotional intensity

• slow return to baseline 

invalidating environment

• rejects communication of experiences

  • actively self-invalidate and depend on social environment cues

• punishes emotional displays and intermittently reinforces emotional escalation

  • oscillate between emotional inhibition and extreme emotional styles

• oversimplifies problem solving 

  • form unrealistic goals

comprehensive dialectical behavioral therapy

• individual therapy

  • weekly individual sessions 

  • keeps patient in treatment

  • treatment hierarchy

    • life threatening behaviors

    • treatment interfering behaviors

    • quality of life interfering behaviors 

• group skills training

  • mindfulness

  • distress tolerance

  • emotion regulation

  • interpersonal effectiveness

• 24 phone coaching

  • aim: generalize skill usage across contexts 

  • up to 15 mins at a time 

  • structure

    • brief overview of situation

    • what did they try

    • what should they do

    • they do it

• DBT consultation team 

  • therapy for therapist

  • prevent burnout

APA code of ethics

• first introduced in 1952, last amended in 2017

• includes

  • principles

    • aspirational 

    • general

      • nice

      • responsibility

      • integrity

      • justic

      • respect

    • violations not defined or enforceable

  • standards

    • enforceable

    • applies to a specific task

confidentiality

• belongs to patient

• limits

  • danger to self

  • danger to others

  • child abuse

    • victim under age 18

    • mandated reporters

  • elder abuse (not for NY)

tarasoff vs regents of the uni, of cali.

• introduces duty to warn

  • psychologists must break confidentiality to warn potential victims when

    • there’s a treat to harm

    • there’s an identifiable victim

complications of duty to warn

• sometimes no specific victim

• risk is not always clear

• attempts to warn public are often stonewalled by bureaucracy

• what constitutes harm and victim 

• when victim is minor

  • legal perspective

  • clinical perspective

  • ethical guidelines 

multiple relationships

• psychologist is in a professional role with a person

• has a relationship with the person 

• has a relationship closely associated with the person

• will have a future relationship with the person 

insanity defense

• criminal responsibility

  • requires that a person 

    • has been proven to have committed the act, and

    • was legally sane at the time

• sane/insane

  • legal terms

    • insane: not legally responsible for actions because of mental disease

• m’naughten test

  • whether the defendant could distinguish right from wrong at the time of the offense

• ngri vs gbmi

  • NGRi

    • focuses on mental state at the time of the crime

    • used rarely and succeeds even more rarely

      • more difficulty bc of Hinckley verdict

    • result is treatment at hospital, not freedom 

  • GBMI

    • results in criminal conviction with mental health treatment in prison

competence to stand trial

• refers to defendant’s current mental state

• proceedings are suspended when a defendant is judged to be incompetent 

• more people institutionalized for this reason than ngri/gbmi 

civil commitment

• what it is

  • legal process that allows involuntary hospitalization of a person with a mental illness when certain criteria are met

• typical criteria

  • mental illness

  • danger to self, danger to others, or grave disability (unable to care for basic needs)

• key points

  • focuses on safety, not punishment

  • requires legal authority

  • duration is short term

  • balances individual rights with public safety

  • inpatient or outpatient

  • patients retain rights, such as treatment in least restrictive environment and refusal of treatment

main sociocultural factors contributing to eating disorders

• thing-ideal internalization

• fatphobia

• weight discrimination

• orthorexia trends

• media emphasis on appearance

difference between APA general principles and ethical standards

• principles are aspirational values guiding psychologists

• ethical standards are enforceable rules that can lead to sanctions for violations

core idea of Beneficence and Nonmaleficence

• psychologists must strive to help others and avoid causing harm in all professional activities