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Law and Psychiatry
University of Florida School of Law
Johnston, E. Lea

 
LAW & PSYCH
Johnston – Spring 2015
1/6/15
 
·         Mental disorder – pg. 6 – a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
o   Syndrome/pattern cannot be “an expectable and culturally sanctioned response to a particular event.”
·         Ambiguity in the definition
o   Distress?
o   Disability?
§  Different levels of each
o   An expectable and culturally sanctioned?
o   Important loss of freedom
·         Mental disorders are not amenable to precise definition
·         Abilities and disabilities within a particular disorder may vary wildly
·         Symptoms are changeable over time
·         Symptoms often overlap with other mental disorders
·         Often there are not physiological detectable signs capable of being measured
·         Often professionals are not in complete agreement as to the ideology or cause of the mental disorder
·         There can be genetic precursors to mental disorders – debated
 
Mental Disorders and the Law
·         What is a professional trying to do when they render a diagnosis?
o   Come up with a treatment plan – use recognized language between the field that other treatment providers use such that a treatment can be rendered and provided
·         What is a legal standard, like insane, trying to accomplish?
o   Provide an excuse for an individuals actions
·         Why does insanity provide an excuse in the legal system?
o   It diminishes culpability – diminished capacity and expect less of them once they meet the legal definition for insanity
o   We understand why they did what they did – they have a mental disorder and because of it they did not understand the nature of their act
§  Lacked the ability to control their actions and thus they are not responsible
o   Ideas of proportionality
o   Care about moral culpability of the person – insanity speaks to someone’s lack of culpability
o   Very different from a diagnosis
·         Is a DSM diagnosis necessarily translate into a legally recognized mental disorder? No
o   The law cares about the level of impairment that a person has either at the time of the crime or at the particular stage of the criminal justice process, or executing a will, etc.
o   One’s level of impairment can level dramatically even within a particular diagnosis
·         Sometimes having a recognized mental disorder, a specific diagnosis, can be important and necessary in the law
o   In some states you must have a mental disorder for things like an insanity defense or findings of incompetence or civil commitment
o   Can be necessary for the application of a legal rule but not sufficient
 
DSM
·         Provides a common language, standard of criteria
·         Organize psychiatric diagnosis:
o   Access 1 – all diagnostic categories except for mental retardation and personality disorders
 
·         Schizophrenia
o   Symptoms:
 
1/7/15
 
DSM-5
 
Major Depressive Disorder
·         Five or more of the following symptoms have seen present during the same 2 week period and represent a change form previous functioning: at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure
o   Depressed mood
o   Diminished interest
o   Weight loss
o   Change in sleep
o   Psychomotor agitation or retardation
o   Decreased energy
o   Decreased concentration
o   Thoughts of death or suicidal ideation
·         The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning***
o   Will see in all diagnoses
·         The episode is not attributable to the physiological effects of a substance or to another medical condition
·         Not better explained by another disorder
·         Never had a manic episode or hypomanic episode
·         18-29 is at the greatest risk – 3 times more likely than 60 or older
·         Females > males 1.5 to 3 time
·         Any age for first appearance
·         Suicide risk is increased
·         Treatment Options:
o   Antidepressants
§  Psychiatrists
§  Works on different neurotransmitters in the brain – serotonin and norepinephrine
§  SSRI
§  SSNI
§  Tricyclics – older ones – more side effects, more disruptive
§  MAOI – oldest class, even more dangerous – need to avoid certain foods
o   Psychotherapy – talk therapy
§  Psychiatrist, psychologist, social worker, masters in counseling, anyone
§  Cognitive behavioral therapy – restructure negative thought patterns, help them interpret interactions in a more positive and realistic manner, recognize things that contribute to their depression, identify ways to change their behavior and in effect change their mood
§  Interpersonal therapy – understand and work through troubled relationships
o   Electroconvulsive therapy (ECT)
§  Shock therapy
§  Commonly used – very safe and effective
§  Side effects – confusion, disorientation and memory loss
§  Usually short term
§  Ca

reatment for co-occurring substance issues
§  Most common co-occurring disorder
§  Needs specialized dual diagnosis treatment programs – treat both the mental illness and the substance abuse
o   Rehabilitation
§  Social and vocational training to improve functioning
§  Job counseling and training
§  Money management
§  Public transportation use
§  Communication skills
o   Family education
§  Education about illness, relapse prevention and treatment options
§  Support services
o   Cognitive behavioral therapy
o   Self help groups
§  Increasing
§  Professionals not typically involved – peer support
§  Facing same problems
§  Provides networking
§  Advocate for research and increased treatment programs
Bipolar Disorder
·         Manic Episode
o   Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least one week
o   During the period, three or more of the following are present:
§  Inflated self esteem
§  Decreased need for sleep
§  More talkative
§  Flight of ideas or racing thoughts
§  Distractibility
§  Increased goal directed behavior
§  Excessive involvement in activities with risk of painful consequences
o   Mood disturbance is sufficiently sever to cause marked impairment in functioning
o   Not attributable to the use of a substance
·         Males = females
·         More common in higher income people
·         Higher in separated, divorced or widowed
·         Treatment:
o   Mood stabilizers and antidepressants
§  Lithium
o   Not to flatten them out but to bring the swings to a smaller margin
o   Education
o   ECT – really good for pregnant women
o   Sleep medications
o   Herbal Supplements
·         Meridian is the community mental health center in Gainesville – won’t take you if you don’t have insurance
o   No insurance – mental health program for the homeless out of a church downtown – Helping Hands clinic, two times a month, and two times a month for women