psyc 3303

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“Psychopath” and “Sociopath” are used interchangeably by most scientists. Which description best fits someone who exhibits the behaviors described by these terms:

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1

“Psychopath” and “Sociopath” are used interchangeably by most scientists. Which description best fits someone who exhibits the behaviors described by these terms:

Someone who is not bothered if they have to hurt someone else to get what they want

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2

Which of the following best describes the association between autism and ADHD?

Many people with autism have ADHD

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3

How many children in the US currently meet the criteria for autism spectrum disorder?

1 in 44

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4

What is the sex difference in autism diagnoses?

More males

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5

lifetime prevalence schizophrenia

1-2%

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6

schizophrenia crippling characteristics

1/3 homless, 10% employed, few marry or have children, 10-15% commit suicide

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schizophrenia impairment

early onset and lifetime impairment

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schizophrenia cost

10% of all individuals receiving disability funds, $10 million in lifetime costs for each case, $65 billion per year in direct and indirect costs

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9

syd barrett

no formal diagnosis but many believed he had schizophrenia

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10

three clusters of schizophrenia symptoms

positive, negative, psychomotor

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11

positive symptoms

excess or additions to a person’s thoughts, emotions or behavior

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12

negative symptoms

loss of function; deficits of thoughts, emotion or behavior

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psychomotor symptoms

unusual movements or gestures (can be excessive movements or loss of movement)

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delusions

false belief that is held firmly conflicting evidence; persecution, reference, grandeur, control

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hallucinations

perception-like experiences that occur in the absences of an external stimulus that may occur in any sensory modality

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auditory hallucinations

sounds or voices or sounds that are perceived to be outside of one’s head

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visual hallucinations

people of objects that others don’t see

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tactile hallucinations

tingling, burning sensations

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somatic hallucinations

something is happening inside my body

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olfactory hallucinations

foul smells that others do not notice

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21

disorganized thinking and speech

reflects disorganized thinking; tangential and “loose” associations between thoughts, unusual use / mistakes in language, inappropriate affect

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poverty of speech

dramatic reduction in how much a person says and speech that is produced doesn’t have much meaning

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restricted affect

minimal emotional responses and many show little emotion at all and may reflect inability to express emotions even when the individual feels them internally

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apathy (avolition)

drained of energy, loss of interest in typical goals, poor follow through, social withdraw

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25

what accounts for most of the impairment associated with schizophrenia?

negative symptoms

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catatonia

marked decrease in reactivity to the environment

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27

schizophrenia criteria

two or more of the following for at least one month: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, signs persist for 6 months or more, functional impairment

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28

schizophrenia onset

males= late to early teens 20s

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29

schizophrenia risk factors present from very early in life

social dysfunction, attentional difficulties/ ADHD, quirky behaviors, odd and loose thinking

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30

active phase of schizophrenia

meet full DSM-5 criteria with impairment

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31

schizophrenia residual phase

some symptoms and impairment typically remain present and in many cases see some improvement in middle age

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32

outcomes for individuals with schizophrenia

34%= supervised living

25%=living with family member

18%=supervised living

8%= nursing homes

6%= jail and prisons

5%= hospitals

5%= homeless

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33

twin studies pf schizophrenia

80% due to genes

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34

schizophrenia prenatal influenza

2nd trimester (4-6 months) during epidemic= higher rate of schizophrenia in the child

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35

schizophrenia maternal malnutrition

1st trimester malnutrition associated with risk for schizophrenia

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auditory hallucinations are associated with what area of the brain?

Broca’s area

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37

schizophrenia has constant large deficits in

executive functions and selective attention

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38

selective attention

atypical response to irrelevant stimuli in the environment and continue to respond strongly to the irrelevant stimulus each time it occurs

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schizophrenic cerebral atrophy

enlarged ventricles, worsens across development and may slow in late adulthood

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40

schizophrenic frontal lobe

smaller and less active; correlated with working memory and selective attention difficulties

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41

schizophrenic cerebellum

motor dysfunction

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42

what causes schizophrenia?

excess dopamine is one key factor but not the whole story

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43

what other neurotransmitters play a role in schizophrenia?

serotonin, norepinephrine, glutamate, acetylcholine

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44

traditional schizophrenia antipsychotics

block dopamine receptors, effective for positive symptoms (65% response), less effective for negative symptoms , extremely sedating, motor abnormalities that can be permanent, still significant impairment in relationships and life

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45

second generation antipsychotics

block dopamine and serotonin receptors, more effective for negative symptoms, much lower risk for extrapyramidal motor abnormalities, very expensive, side effects may still be difficult, impairment remains for many

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46

individual schizophrenia treatments

life skills, occupational support, social skills training, CBT, family therapy, family psychoeducation

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47

community approaches to schizophrenia

coordinated multi-level services, brief hospitalization, supervised residences, life skill support

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48

general criteria for personality disorder

1. enduring pattern of internal experience and external behavior that deviates markedly from cultural expectations

2. patterns are: chronic and stable, inflexible and rigid, present across most areas of life, maladaptive for self or others

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odd cluster

similar to schizophrenia

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dramatic cluster

deceitful, impulsive and emotionally unstable

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anxious cluster

self-critical

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similarities among the personality disorders

cluster-specific features, relationship problems, suspicious/distrustful, self-absorbed, depressed/ negative affect, high comorbidity between personality disorders

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53

paranoid personality disorder (odd)

1. suspect that others are exploiting or harming (no evidence)

2. distrusting, doubts loyalty of friends, family, others

3. reluctant to confide to avoid having it used against them

4. 4% of population; more common among men \n 5. Treatment: very difficult; some success with cognitive-behavioral \n

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54

schizoid personality disorder (odd)

1. detachment from social relationships by choice \n 2. lack of interest / effort in interactions - genuinely prefer to be alone \n 3. restricted emotions: flat, detached

4. 4% of the population, slightly more common among me \n 5. Treatment: difficult, typically don’t feel distre

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55

schizotypal personality disorder (odd)

1. detachment from social relationships by choice

2. lack of interest / effort in interactions - genuinely prefer to be alone

3. restricted emotions: flat, detached

4. 4% of the population, slightly more common among men

5. Treatment: difficult, typically don’t feel distressed

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56

avoidant personality disorder (anxious)

1. intense and chronic feelings of social inadequacy (similar to social and)

2. hypersensitive to negative evaluation, even in close relationships

3. desire friendships and are often socially competent (but view self as \n socially inept)

4. Treatment: antidepressants; cognitive-behavioral approaches

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dependent personality disorder (anxious)

1. intense doubts about competence without direct care from others

2. submissive, clinging, obedient due to fear of separation

3. feel helpless when alone; preoccupied with fear of being left to care for self (remember when we get to narcissistic)

4.Treatment: CBT, help take responsibility for self

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obsessive-compulsive personality disorder (anxious)

1. preoccupation with order, control

  1. inflexibility re: morality, ethics, values

3. difficulty working with others due to control issues

4. Treatment: often no distress, see no need for treatment. CBT can be helpful if invested in it.

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borderline personality disorder (dramatic)

1. stably unstable emotions and self-image

– extreme mood shifts

– small rejections are a large blow to the self

2. unstable relationships with others

– shift between extreme positive/negative views of relationships

– Angry outbursts, emotionally manipulative

– Often early history of trauma and difficult parent-child relationships

3. self-injurious / self-mutilating behaviors

– may distract from emotional pain

– high suicide risk

4. 6% of the population

– 3 times more common in women

5. Treatment is challenging but getting better

– Dialectical behavior therapy (DBT): behavioral and cognitive techniques with a focus on addressing self-injurious behaviors

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histrionic personality disorder (dramatic)

1. Extremely emotional and dramatic

– seem to be "on stage", theatrical

– dramatic but shallow emotional expression

  1. use physical attraction to draw attention

– more attractive than average

– bright and provocative clothes

  1. false intimacy

– perceive relationships as more intimate than they are – see casual acquaintances as deep friendships

– Need constant praise and positive attention

– devastated by interpersonal rejection

  1. 2% of the population

– more common among women

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narcissistic personality disorder (dramatic)

1. extreme sense of self-importance

– Grandiose, arrogant

– believe unique or special, that others envy them

2. but VERY fragile sense of self

– need constant admiration/control

– Sense of self is easily punctured when challenged

– envious of others' success

  1. exploit others for their own benefit (often con artists)

– very low empathy, almost like others are irrelevant - just tools to get what they want

  1. frequently in relationships with dependent PD

  2. 6% of the population

– three times more common in males

6. extremely difficult to treat

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antisocial personality disorder (dramatic)

1. disregard for and direct violation of the rights of others

– strong links to criminal behavior

– early delinquent and aggressive behavior before age 18

  1. impulsive and reckless: physical fights

– physical fights

  1. deceitful, manipulative

  2. emotional aspects

– lack of remorse about negative behaviors

– about half have elevations of "psychopathy"

- this predicts the worst outcomes

5. 4% of the population

– about 3 times more frequent in males

  1. Treatment: ineffective, especially with psychopathy

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odd PD genetic risk and brain correlates

shared with schizophrenia spectrum

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dramatic PD genetic risk and brain correlates

prefrontal (executive dysfunction)

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anxious PD genetic risk and brain correlates

shared with anxiety disorders

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66

psychopathy genetic risk and brain correlates

underactive and under-responsive amygdala

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67

environmental risk for personality disorders

family conflict/ abuse (especially dramatic PD) and low social support

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68

personality disorder cognitions

negative attributions about ambiguous situations

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69

psychopathy

1. about half of the individuals with antisocial personality disorder have high psychopathy (different from psychopathology!)

– Sociopath and sociopathy have basically the same meaning

2. Prioritize own needs and desires above all else

– very little experience with guilt

– don't care if others are hurt / upset

– lack of emotional bonds with others

3. emotionally flat, but reactive/explosive if challenged

– low fear

– impulsive, often seek out danger

4. Have "cognitive empathy": retain the ability to understand

(cognitively) what is another person thinking

5. impaired "emotional empathy": weak ability to emotionally experience what another person is feeling

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autism DSM-5 criteria

  1. social communication and social interaction

  2. restricted and repetitive behaviors, interests or activities

  3. symptoms present in early childhood

  4. symptoms limit and impair daily functioning

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autism social communication and interaction

deficits in social and emotional reciprocity, nonverbal communication used for social interaction, developing and maintaining relationships

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autism restricted and repetitive behaviors, interests or activities

stereotyped or repetitive speech, motor movements or use of objects, excessive adherence to routines of ritualized patterns, excessive resistance to change, highly restricted, fixated interests abnormal intensity or focus, hyper or hypo-sensitivity input or unusual interest in sensory aspects of environment

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autism and symptoms that limit and impair daily functioning

level 1= “requiring support”

level 2= “requiring substantial support”

level 3= ‘requiring very substantial support”

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DSM-5 changes

  1. combination of autism disorder, asperger’s disorder, and pervasive developmental disorder-not otherwise specified

  2. first inclusion of sensory systems (hyper or hypo-reactivity to sensory input or unusual interests in sensory aspects of environment

  3. creation of the spectrum

  4. severity levels created

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75

autism comorbidities

  1. ADHD (50%+)

  2. Anxiety (40%)

  3. Depression (30%)

  4. OCD (30-40%)

  5. intellectual disability (50-70%)

  6. Epilepsy (30%)

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autism associated characteristics

  1. motor deficits

  2. self-injurious behavior

  3. self-harm

  4. executive dysfunction

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autism motor deficits

unusual gait and walking on tip toes

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autism self-injurious behavior

headbanging and hitting/bititing self

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autism self harm

3x more likely in autistic individuals

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autism executive dysfunction

emotional dysregulation and lack impulse control

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autism and sleep difficulties

2x more likely to have insomnia and difficulty staying asleep

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autism prevalence

  1. 1 in 44

  2. more prevalent in males with 2:1 and 4:1 ratio

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83

autism family studies

  1. very strong family risk (15-30x population risk)

  2. related symptoms in family members without autism

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autism twin studies

  1. genes account for 80-90% of the risk

  2. many genes with small individual effects

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85

autism genetic risk factors

  1. exome sequencing (102 risk genes identified and 85% idiopathic)

  2. single gene models

    1. fragile X syndrome

      1. FMR1 gene

    2. Phelan McDermid syndrome

      1. 22q13 deletion

    3. Down syndrome

      1. Trisomy 21

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autism environmental risk factors

  1. sperm and egg cells from older individuals

  2. preterm birth

  3. exposure to German measles in utero

  4. environmental exposure to toxins

    1. tooth fairy study

    2. zinc-copper metabolization

    3. some medication

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87

autism neurochemistry

poorly understood

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autism neuroanatomical findings

  1. larger brain volumes

    1. earlier rain shrinkage

  2. atypical connectivity patterns

    1. less connectivity between regions

    2. agenesis of corpus callosum

    3. parieto-occipital tracts involved

      1. sensory and multisensory integration

    4. temporal tracts

      1. social emotional processing

  3. all imaging findings complicated by the heterogeneity of the disorder

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autism neuropsychological correlates

  1. IQ deficit

  2. language impairment

  3. poor executive control

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autism behavioral intervention

  1. Applied Behavioral Analysis (ABA)

    1. Focus on attention, behaviors, imitation, communication, social and \n play skills

    2. Highly structured behavioral teaching strategies

      1. Reinforcement

  2. Involvement of parents and trained staff

    1. Gradual transition to naturalistic environments

    2. Extremely intensive

      1. (20 – 40 hrs/week for 2+ years)

    3. initiation by 2 – 4 years of age is best

t

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autism ABA pros

  1. Empirically supported

    1. Gains in

    2. Intellectual functioning

    3. Language development

    4. Skills of daily living

    5. Social functioning

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autism ABA cons

  1. Expensive

  2. Focus on eliminating behaviors, \n not building skills

  3. Based on neurotypical standards

    1. Ok for problem behaviors

    2. What about social norms?

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autism pharmacological interventions

  1. Generally, treat distressing symptoms, not ASD itself

    1. Stimulants for attention/impulsivity

    2. SSRIs for depression/anxiety

  2. Off-label uses of drugs

    1. Atypical antipsychotics for repetitive behavior

    2. Oxytocin for social impairment

    3. Propranolol for SIB, sensory overload

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limitations in our understanding of ASD

  1. Differential diagnosis

    1. ASD vs. ID

  2. Research on a heterogeneous population

    1. Washes out results

    2. Results do not apply to everyone!

  3. Lack of autistic voices in science and public health

    1. Trying to fit neurodiverse individuals into a neurotypical “box”

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psychopathology

  1. Reliability (mandatory)

  2. Deviance (mandatory)

  3. Distress (most cases, but not necessarily all)

  4. Dysfunction (mandatory)

  5. Danger (possible, but not true for most)

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96

Criminal commitment

crime has been committed by someone who is mentally unstable at the present time and in need of treatment rather than jail

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Mentally incompetent to stand trial

  1. Rare that this is successful, and when it is it tends to be for a limited period of time

  2. Often the defendant argues strongly against this (and may want to defend themselves, like the Unabomber)

  3. if successful, wait until competent for trial

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Guilty but mentally ill (14 states)

  1. Doesn't change guilt

  2. potential mitigating factor for sentencing

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99

Not guilty of crime by reason of "insanity"

  1. Legal term not a clinical term

  2. 1955

    1. American Law Institute: not criminally responsible for a crime if

      1. Mental disorder or defect prevented from knowing right from wrong at the time of the crime

      2. Mental disorder made it impossible to control themselves and follow the law (this was later dropped)

  3. 1983

    1. American Psychological Association

      1. experiencing a mental disorder at the time of a crime does not by itself mean the person was insane (again the legal term)

      2. defendant must also have been unable to determine right from wrong at the time of the crime

  4. The APA guideline is now the standard for all federal cases and the majority of states

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concerns about “not guilty by reason of insanity”

  1. will lots of defendants try to use it to avoid punishment

  2. Will the defense just hire a biased psychologist to assess the defendant and declare them not guilty?

  3. Could it allow dangerous criminals to escape punishment?

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