PSYCH: Legal and Ethical Issues

Civil Commitment Laws

  • Refers to legal proceedings determining individuals as mentally disordered, allowing for possible involuntary hospitalization.

Mental Illness

  • A term previously used for psychological disorders but is now considered less preferred due to its implication of medical disease processes. Current terminology focuses more on psychological health rather than strictly medical definitions.

Dangerousness

  • The popular belief that mental patients are more likely to be violent is inaccurate; studies show that the tendency for violence is not significantly higher among them compared to the general population.

Deinstitutionalization

  • The process of systematically removing people with severe mental illness or intellectual disabilities from large institutions, like psychiatric hospitals, to promote better integration into society.

Transinstitutionalization

  • Refers to the shift of individuals with severe mental illness from larger psychiatric hospitals to smaller group residences or community settings, aiming for more personalized care.

Competence

  • The legal ability of defendants to understand their charges, engage with the trial process, and aid in their own defense. This includes comprehension of court proceedings and participants' roles.

Criminal Commitment

  • A legal procedure where an individual found not guilty due to insanity is mandated to be treated in a psychiatric facility instead of serving prison time.

Diminished Capacity

  • Refers to a legal defense strategy where evidence of an abnormal mental condition impacts the defendant's culpability, possibly reducing charges from serious crimes to lesser ones that require less intent or knowledge.

Duty to Warn

  • A crucial ethical responsibility for mental health professionals to breach confidentiality when a client poses a specific threat to an identifiable victim. This ensures proactive measures for potential victims' safety.

Expert Witness

  • A qualified individual with specialized training and experience allowed to provide opinion testimony in court. Their insights help the court understand complex aspects of cases involving mental health issues.

  • Neurodevelopmental disorders: Neurologically based disorders that are

revealed in a clinically significant way during a child’s developing years.

Attention deficit/hyperactivity disorder (ADHD): Developmental

disorder featuring maladaptive levels of inattention, excessive activity, and

impulsiveness.

  • Inattention

  • Hyperactivity

  • Impulsivity

Causes of ADHD

  • Genetic Influences

    • DAT1 – dopamine transporter gene

  • Neurobiological Influences

    • Smaller brain volume

  • Psychosocial Influences

    • Low self-esteem

  • Environmental Influences

    • Maternal smoking

    • The role of toxins

Treatment of ADHD

  • Stimulant medications

  • Behavioral treatment: reinforcement programs

Specific learning disorder: Neurodevelopmental disorder characterized by

academic performance that is substantially below what would be expected

given the person’s age, intelligence quotient (IQ) score, and education.

  • Reading

  • Mathematics

  • Writing

Autism spectrum disorder (autism): A neurodevelopmental disorder

characterized by significant impairment in social interactions and

communication and restricted patterns of behavior, interest, and activity.

  • Impairment in social communication and social relationships

    • Prosody: Vocal characteristics such as tone and stress; people with autism spectrum disorder often have trouble recognizing and interpreting these vocal cues.

    • Joint attention: Attention shared by two persons toward an

object after one person has indicated interest in the object to theother person; this social interaction is limited or absent in people with autism spectrum disorder.

  • Restricted or repetitive behaviors and interests

Causes of Autism Spectrum Disorders:

  • Genetic Influences: Oxytocin receptor genes

  • Neurobiological Influences: Amygdala larger at birth

  • Psychosocial Influences: Failed parenting, lack of self-awareness

  • Naturalistic teaching strategies: Instructional techniques that are used

    with children having neurodevelopmental disorders and that move away

    from traditional desk instruction toward more natural social interactions.

  • Intellectual developmental disorder (IDD): A diagnosis received when

one achieves a significantly below-average score on a test of intelligence and

by limitations in the ability to function in areas of daily life.

  1. Intellectual Functioning

  2. Adaptive Functioning

Cultural–familial intellectual disability: Mild intellectual disability that may be caused largely by environmental influences.

Down syndrome: Type of intellectual disability caused by a

chromosomal aberration (chromosome 21) and involving characteristic

physical appearance. Sometimes known as trisomy 21.

Fragile X syndrome: Pattern of abnormality caused by a defect in the X

chromosome resulting in intellectual disability, learning problems, and

unusual physical characteristics.

Lesch-Nyhan syndrome: X-linked disorder characterized by intellectual

disability, signs of cerebral palsy, and self-injurious behavior.

Phenylketonuria (PKU): Recessive disorder involving the inability to break

down a food chemical whose buildup causes intellectual disability, seizures,

and behavior problems. PKU can be detected by infant screening and

prevented by a specialized diet.

Schizophrenia: Devastating psychotic disorder that may involve

characteristic disturbances in thinking (delusions), perception

(hallucinations), speech, emotions, and behavior.

Dementia praecox: Latin term meaning “premature loss of mind,” an early

label for what is now called schizophrenia, emphasizing the disorder’s

frequent appearance during adolescence. Called démence précoce in France.

Associative splitting: Separation among basic functions of human

personality (for example, cognition, emotion, and perception) seen by some

as the defining characteristic of schizophrenia.

Psychotic behavior: Severe psychological disorder category

characterized by hallucinations and loss of contact with reality.

Positive symptoms (of schizophrenia): Symptoms of schizophrenia

that generally refer to symptoms around distorted reality such as

hallucinations and delusions.

  1. Delusion: A false belief or judgment about external reality, held

despite incontrovertible evidence to the contrary, occurring especially

in mental conditions.

  1. Paranoia: People’s irrational beliefs that they are especially important

(delusions of grandeur) or that other people are seeking to do them

harm.

  1. Delusions of persecution: (believing that they are someone close to

them will be attacked or deceived)

  1. Hallucination: A sight, sound, smell, taste, or touch that a person

believes to be real but is not real.

Negative symptoms (of schizophrenia): Symptoms of schizophrenia

that involve deficits in normal behavior in such areas as speech, blunted

affect (or lack of emotional reactivity), and motivation.

  1. Avolition: (lack of motivation) Apathy, or the inability to initiate or

persist in important activities.

  1. Alogia:( (lack of regular speech) Deficiency in the amount or

content of speech, a disturbance often seen in people with

schizophrenia.

  1. Anhedonia: (lack of pleasure) Inability to experience pleasure,

associated with some mood and schizophrenic disorders.

  1. Asociality: Lack of interest in social interactions.

  2. Flat affect: Apparently emotionless demeanor (including toneless

speech and vacant gaze) when a reaction would be expected.

  • Disorganized symptoms (of schizophrenia): Symptoms of

schizophrenia that include rambling speech, erratic behavior, and

inappropriate affect (for example, smiling when you are upset).

  1. Inappropriate affect: Emotional displays that are improper for the

situation.

  1. Disorganized speech: Style of talking often seen in people with

schizophrenia, involving incoherence and a lack of typical logic

patterns.

  1. Catatonia: Disorder of movement involving immobility or excited

agitation. Sometimes accompanies psychotic disorders or mood

disorders.

  1. Catatonic immobility: Disturbance of motor behavior in which the

person remains motionless, sometimes in an awkward posture, for

extended periods.

Other Psychotic Disorders

  1. Schizophreniform disorder: Psychotic disorder involving the

symptoms of schizophrenia but lasting less than 6 months.

  1. Schizoaffective disorder: Psychotic disorder featuring symptoms of

both schizophrenia and major mood disorder.

  1. Delusional disorder: Psychotic disorder featuring a persistent belief

contrary to reality (delusion) but no other symptoms of

schizophrenia.

  1. Substance-induced psychotic disorder: Psychosis caused by the

ingestion of medications, psychoactive drugs, or toxins.

  1. Psychotic disorder associated with another medical condition:

Condition that is characterized by hallucinations or delusions and that

is the direct result of another physiological disorder, such as stroke or

brain tumor.

  1. Brief psychotic disorder: Psychotic disturbance involving

delusions, hallucinations, or disorganized speech or behavior but

lasting less than 1 month; often occurs in reaction to a stressor.

  1. Attenuated psychosis syndrome: Disorder involving the onset of

psychotic symptoms such as hallucinations and delusions, which puts a

person at high risk for schizophrenia; designated for further study by

DSM-5.

Prodromal stage: Second of E. Morton Jellinek’s four stages identified in

the progression of alcoholism, featuring heavy drinking but with few outward

signs of a problem.

Causes of Schizophrenia

  1. Genetic Influences

    1. Twin studies

    2. Endophenotyping

  2. Neurobiological Influences.

    1. Dopamine hypothesis:

    2. Hypofrontality

  3. Psychological Influences

    1. Double bind communication: According to an obsolete,

unsupported theory, the practice of transmitting conflicting

messages that was thought to cause schizophrenia.

  1. Expressed emotion (EE): Hostility, criticism, and

overinvolvement demonstrated by some families toward a family

member with a psychological disorder. This can often

contribute to the person’s relapse.

  1. Schizophrenogenic mother: According to an obsolete,

unsupported theory, a cold, dominating, and rejecting parent

who was thought to cause schizophrenia in her offspring.

Treatment of Schizophrenia

1. Medical Treatment

a. First-generation antipsychotic medications (Neuroleptics)

b. Second-generation antipsychotic medications

i. Side effects

2. Psychological Treatments

a. Token economy: Social learning behavior modification system

in which individuals earn items they can exchange for desired

rewards by displaying appropriate behaviors.