Recognizing Negative Symptoms of Schizophrenia

Civil Commitment and Rights

• The state's authority to commit disturbed individuals is based on its duty to protect the individual and society.
• Emergency commitment requires immediate action, as waiting for commitment proceedings can put lives at risk.
• Criticisms of civil commitment include:
  • Difficulty in assessing a person's dangerousness.
  • Vague legal definitions of "mental illness" and "dangerousness".
  • Questionable therapeutic value of civil commitment.
• Rights retained by individuals who are civilly committed include:
  • Right to treatment: humane environment, qualified staff, individualized treatment plans, and minimized restrictions.
  • Right to the least restrictive environment: outpatient, inpatient, or combination.
  • Treatment must be time-limited: 90, 180, or 365 days, with the option to re-petition for additional time.
  • Right to refuse treatment: informed consent is required, unless the patient is DTS, DTO, or acutely psychotic.

Neurocognitive Disorders

• Mild neurocognitive disorder:
  • Displays modest decline in at least one area of cognitive functioning, such as memory, attention, or language ability.
  • Cognitive deficits do not interfere with everyday independence.
• Symptoms of neurocognitive disorders (A-words):
  • Memory impairment (short-term, then long-term).
  • Aphasia (language disturbance).
  • Apraxia (inability to carry out motor activities).
  • Agnosia (failure to recognize or identify objects).
  • Disturbance in executive functioning.
  • Changes in emotional and personality function.

Aphasia

• Expressive Aphasia (Broca's area):
  • Ideas are present, but the individual cannot express them in spoken or written language.
• Receptive Aphasia (Wernicke's area):
  • Can understand tone and expressions, but not words.
  • Can speak, but sentences do not make sense.

Neurocognitive Disorders (continued)

• Difference between mild and major neurocognitive disorders:
  • Mild: modest decline, able to function independently.
  • Major: substantial decline, interferes with independence.
• Briefly describe various neurocognitive disorders:
  • Alzheimer's disease: most common type, marked by memory impairment, usually occurring after age 65.
  • Pick's disease (Frontotemporal neurocognitive disorder): rare, affecting frontal and temporal lobes.
  • Huntington's disease: inherited, with memory problems, personality changes, and severe twitching and spasms.
  • Creutzfeldt-Jakob disease: rare, with symptoms including spasms of the body.
  • Parkinson's disease: slowly progressive, marked by tremors, rigidity, and unsteadiness.

Alzheimer's Disease

• Genetic, structural, and biochemical causes:
  • Neurofibrillary tangle.
  • Senile plaques (amyloid plaques).
  • Shrinkage of the brain.
• Treatments:
  • Drug therapy.
  • Cognitive-behavioral therapy.
  • Support for caregivers.
• Prevention:
  • Aerobic exercise and mental activity.
  • Reducing risk factors for TBI and strokes.
  • Vitamin B12, D, and E have a positive effect against cognitive decline.
  • Estrogen and/or NSAIDs have a protective effect.

Insanity Defense

• Insanity defense: a person is so mentally incapacitated that they did not have mens rea (guilty mind) when they committed the act.
• Compare and contrast different insanity defense tests:
  • M'Naghten rule (1843): did not know what they were doing or did not know it was wrong.
  • Irresistible Impulse rule (1934): driven by an irresistible impulse to perform the act.
  • Durham rule (1954): crime was a product of a mental disease or defect.
  • American Law Institute (ALI) rule (1962): unable to either know their behavior was wrong or control their actions.
  • Insanity Defense Reform Act (1984): did not know their behavior was wrong due to a mental disease or intellectual disability.
• Problems with the insanity defense:
  • Controversial, with perceived abuse of the system.
  • Used infrequently, with only 26% of attempts resulting in acquittal.
  • Defendants found Not Guilty by Reason of Insanity may serve as much time as those found guilty.

Competency and Guilty but Mentally Ill

• Competency to stand trial:
  • Defendants must understand what is happening in the courtroom and be able to participate in their own defense.
• Guilty but Mentally Ill (GBMI):
  • Defendants are incarcerated for their crime, but their mental illness is recognized.
  • No guarantee of treatment for their mental illness.

Patients' Rights

• Right to treatment:
  • Legal right to receive adequate treatment.
• Right to refuse treatment:
  • Legal right to refuse certain forms of treatment.
• Other patients' rights:
  • Right to aftercare and an appropriate community residence.
  • Right to an appropriate community residence, such as a group home.