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84 Cards in this Set
- Front
- Back
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Breech Confidentiality
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Hospitalization needs to occur
Lost the Client's trust |
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Choose to treat
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Could kill someone
Lawsuit could occur/ lose your job Patient could get better |
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Tarasoff and Duty to warn/ protect
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Kissed her boyfriend Poddar on New Year's Eve. Poddar belonged to a strict indian caste that required that he either marry or kill her. She refused to marry him. Poddar informed his counseler about his choices. Counselor broke confidentality to police and Tarasoff's family, but Poddar still killed her. Led to the Duty to warn the potential victim. APA appealed the decision, judge changed it to duty to protect
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Mentally ill are no more dangerous than others
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only 2.7% of 963 criminally insane were dangerous after release
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Commitment to hospital
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Need to have
Mental Illness Need for treatment (part of dangerousness) Dangerousness |
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Justification for commitment
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Parens Patriae
Police Power |
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Parens Patriae
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Government is the big parent
When you are a danger to your self |
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Police Power
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When you are a danger to others
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Competence to stand trial
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Have to understand the charges against you. Have to be able to contribute to your own defense. If not found competent, admitted to State Hospital for treatment to achieve competence. If competence can not be achieved, then stay in State Hospital until deemed no longer dangerous
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Competence to be executed
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Have to understand what is going to happen to you
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Guilty with diminished capacity
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Get a lesser sentence because of mental illness
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Guilty but mentally ill (GBMI)
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Person is found responsible for the crime, is sentenced and sent to prison
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Not guilty by reason of insanity (NGRI)
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Person is found not responisible for the crime, and is not sentenced. Sent to a State Hospital until they are deemed not dangerous. Idaho, Montana, and Utah have thrown the law out.
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Irresistible Impulse Act (Elbow Rule)
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1834
Have to have a mental illness that results in a person not being able to choose between right or wrong behavior. If a police officer were at the elbow of the person, they would still do the behavior. |
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M'Naghten Rule
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1843
David M'Naghten tried to kill the British Prime Minister, but got the secretary instead. Got off because he had a mental illness. Queen Victoria wanted a tighter rule. Requires that a mental illness is present and results in the person not knowing the their actions were wrong, or not understanding their actions. |
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Durham Test
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1954
Durham was charged with breaking and entering. Test holds that is the act is the result of a diseased mind or mental defect, the person is not responsible |
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American Law Institute (ALI)
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1962
Group of lawyers and judges got together to fix the system. At the time of conduct mental illness must be present. Lack substantial capacity to either appreicaite the criminality of the conduct or conform your behavior to the law. The mental disease or defect could not be one in which the definition included breaking the law. Problems with deciding of mental illness was present at the time of conduct and "lack of substantial capacity" not clearly defined |
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Insanity Defense Reform Act
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1984
Came after John Hinckley's assination attempt. Standard of Federal Courts No more irresistible impulse rule "lack substantial capacity changed to "unable to appreciate". Mental illness must be severe (almost psychosis) Burden of proof was moved from the prosecutor to the defense Even if found NGRI, the person must serve the same time in a State Hospital as they would have in a prison. |
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Reliability
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Consistency. assumes that the thing that is being measured does not change. Innterrater and Test restest
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Inter rater
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Show an interview to multiple therapist and they should all come up with the same diagnosis. The diagnostic system should be accurate.
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Test Retest
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Taking the test at different times should yield the same results. IQ does not change between repeat testings
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Validity
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Does the test measure what it says it measures. Face, Content, Criterion, constuct.
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Face Validity
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Does it appear to measure what it says it does.
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Content
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Every single test item measures what it claims to measure, all the items must tap into the depth, width, and weight of the thing being tested. An aggressiveness test can not only have questions on hitting, fighting, kicking, etc.
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Criterion
Concurrent Predictive |
Standard, you measure and evaluate according to an accepted comparison test.
Take your insturment and asminister it at the same time as the criterion to see if they match Based on the scores, you should be able to predict future scores and behaviors. |
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Construct
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What is being measured. Take new test and ensure that it actually measures what it is made no measure and not another construct. You should be able to predict scores on other construct tests. An person with high aggression scores will score high on assertiveness and low on selflessness and love and will not get the same results on an assertiveness test as they did on the aggression test.
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Standardization
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Assessments should have standardized instructions on how to give the assessment. It should be given the exact same way every time.
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Norms
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The test should be normed and standardized to the people taking the test so it is possible to see what the scores mean and to compare them.
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DSM I
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1952
Instruction manual that is used to diagnose. Takes symptoms and finds them in a disease. Based on Psychobiological theory. Aldolf Meyer |
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DSM II
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Atheoretical
Hierarchical, listing most severe symptoms first Multiaxaial |
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5 Axis
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One- Severe problems
Two- Personality Three- Medical Issues Four- Psychosocial stressors Five- Global Assessment Functioning |
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DSM III
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1980
Tried to make the criteria more descriptive and operationalize it (made time frames). Incorporated research. Increased in reliability and validity. |
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DSM III-R
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1987
Added NOS categories. |
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DSMI IV
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1994
Added multicultural disorders |
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DSM IV TR
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2000
Text revision, current edition. New research and modification in some areas |
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DSM Issues
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Type of Classification: Categorical, assumes that disorders do not overlap. Dimensional and prototypical (putting forward only the best example of the disorder.)
Sociopolitical Document: Abnormal behavior is defined by social norms which are closely related to politics and society's view on issues. Not everything gets into or out of the DSM with research. |
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DSM limitations
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Labeling people
limited reliabilty and validity describes disorders only, not how they develop or possible treatment assumes clear boundaries focuses only on the individual, not on the envirmoent and surroundings |
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Values of Classification
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Easy to communicate and know a lot of information
Helps focus research efforts. |
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Brain Electrical Activity Mapping (BEAM) Scan
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Sophisticated type of EEG. Analyzes brain waves and activity from moment to moment
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Functional Magnetic Resonance Imaging Scan (FMRI)
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Identifies parts of the brain that are active during certain tasks
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Magnetic Resonance Imaging Scan (MRI)
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Uses magnetic fields
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Positron Emission Tomography (PET)
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Study the functioning of various parts of the brain. Uses glucose.
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Computed Tomograhpy (CT/ CAT) Scan
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uses x rays to reveal abnormalities on the shape and structure of the brain.
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Electroencephalograph (EEG)
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Detects brain waves
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Structured Interview
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More rigid, cant go off on tangents
standardization and comprehensive make the reliability and validity better. Cn be regimented and unfeeling, even paraprofessionals can do it. Can be invasive, getting information that does not apply to the patient's problem. |
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Semi/ Unstructured interview
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Greater flexibility than structured, with less reliably and validity and comprehension
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Behavior Assessment
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Everything is considered data
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Physical Exam
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Physical/ biological problems can present as mental health issues.
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Mental Health Status Exam
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M.D.s are trained to do the exams. 15 minutes of questioning that can highlight trouble spots (memory, compute numbers, logic, and reasoning). If problems found then refer to neuropsychologist.
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Sensorium
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Client was oriented 3x
Does the client know who they are, where they are, and the date. |
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Neuro Imaging
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spot diseases, damages, activity
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Neuro Psych Assessments
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Luria-Nebraska
Halstead-Reitan each is a battery of tests that take about 10 hrs to complete |
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Value of Tests
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Reliability, validity, and expertise of the clinician
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Statistical Significance
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.05 or lower, never get to 0.
Means that 5 times out of 100 the same results occur because of random assignment not drug/treatment |
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Clinical Significance
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Are these results meaningful?
A study could have a statistical significance of .001, but the drug does not actually make much of a difference |
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Objective Tests
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Limited # of responses.
Higher reliability, validity. Standardized MMPI |
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Minnesota Multi Phasic Personality Inventory
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Empirical/ Criterion Keying
Measurable, scientific Took pure, clean samples, got statements from them, made answers true or false. Found that statements discriminate between disorders. 10 clinical scales to identify disorders, does not have face validity. 4 Validity scales: Can not say Scale (how many left unanswered), L scale (Detects people who are trying to fake good), F scale (Detects people who are trying to fake bad), K scale ( People who have the disorder but do not show it on test). Special scales identify other disorders. Content scales are face valid. Had 566 questions. |
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MMPI II
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Complaints were that the tst was based on Minnesotans and the control group was the patient's visitors.
Threw out bad questions and added new ones. total of 567 questions. added three more clinical scales and more special scales. New research had to be done on the new test. |
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Projective Tests
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Unlimited response options
Test stimuli ambiguous so that different people give different responses and project something about themselves Can have validity, but little reliability. |
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Rorschach Ink Blot Test
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Best projective Test
He saw patients pointing things out in the clouds that he couldn't see, all of them had schizophrenia. Became as bad as the House Tree Person Test. |
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John Exuer
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Standardized Rorschach Ink Blot Test. made a comprehensive scoring system, both reliability and validity improved to acceptable levels. Test helps determine whether a client has a psychosis or mood disorder
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P.T. Barnum Effect
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Something for everyone.
A sucker born every minute. It is easy to buy into things that you have little knowledge about. |
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Indices of Organicity
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Memory Loss
Severe Symptoms (can't wait to tell people about the patient) All else out (Does not quite match up with DSM) Movement Disorders Anorexia (does not always have a social influence) Psychosis after age 50 |
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Ways patient distracts test administrator
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Irritability
Distraction Confabulation |
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Diffuse Brain Damage
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Wide spread global.
Dementia Delirium substance abuse diseases stroke oxygen deprivation |
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Dementia
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Memory Loss in addition to a loss of another cognitive ability (agnosia, ataxia, aphasia)
Only conclusive after autopsy Neuropsych assessment is pretty accurate, but not perfect. Patient is alert Insidious onset |
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Delirium
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Memory loss
confused, disorganized, can not focus or concentrate, can not have a conversation not alert rapid onset (usually a biological cause, will destroy the brain if not treated, most states of delirium can be resolved) |
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Focal Brain Damage
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Localized
Open or closed head injury Closed is usually the worst injury because the brain absorbs the shock which results in swelling or pressure on the brain. Rotational injuries (shaken infant syndrome) Coupcontra Coup Rapid deceleration |
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Amnestic disorders
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memory loss with no dementia
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Alzheimer's
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Sundowning
Mortality Diagnosis is only confirmed after autopsy with the presence of amyloid plaque and neurofibrillary tangles |
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Nun Study
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Nuns around 100 years old donated their bodies to science.
All of them had Alzheimer's but it was not noticeable because they had more dendrite connections to lose because they had spent their life learning new things. |
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Vascular Dementia
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Have lots of mini strokes that cause the dementia
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Pick's Disease
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Similar to Alzheimer's, but without the presence of tangles and plaques
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HIV
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Can cause dementia
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Creutzfedlt-Jakob Disease
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Human form of mad cow disease. Death withing a year. Brain develops holes like a sponge
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Aphasia
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Impaired ability to understand or express speech
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Ataxia
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Loss of muscle coordination
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Agnosia
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A disturbance of sensory perception usually affecting visual perception.
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Civil Commitment
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Person is legally placed in a hospital against their will because they have been judged mentally ill and a threat
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Criminal Commitment
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Person is placed in hospital because of a criminal act
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Right to Refuse Treatment
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Rogers V. Okin 1979
Patients can not be medicated against their will. Patient goes before review panel and later a judge to determine if the medication must be taken. 10% of patients refuse medication, 70 to 90% were overriden. Refusal period usually lasted only 3 days |
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O'Conner v. Donaldson
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1975
Donaldson was put into a hospital by his father. Even though he was not dangerous. He received no treatment during his 14 yr stay. Court ruled that hospitals could not hold non dangerous patients against their will if they can live in society. |
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Youngberg V. Romeo
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1982
Right to confinement in less restrictive conditions |
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Minimum Standard of care
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1972, Wyatt v. Stickney
A humane psychological and physical environment Qualified staff in numbers sufficient to administer adequate treatments Individualized treatment plans |
