PSYCH 3CC3 Lecture 7: Psychological Assessment

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amberdonkey208

19 Jun 2018

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Psychological Assessment

We've been looking at quasi scientific literature previously.

Data with empirical basis

○

We're now entering the realm of clinical psychiatry

Very few objective data on which to rely.

○

Most of what we'll be talking about if very subjective and expertise-based.

○

Huge impact of Canadian psychologists and psychiatrists in this area - mostly

Ontarians

Categorizing of Assessment

Past Mental State:

Mental state at the time of the crime.

○

This cannot be observed because obviously this is in the past, but still

experts are asked to make a judgement.

○

i.e., Insanity Judgement (U.S.), NCRMD (Canada)

○

Criminal responsibility

○

Present Mental State:

Fitness to Stand Trail

○

Is it the case that the defendant can understand the trial/proceedings.

○

Future Mental State:

Risk of violence or criminal behaviour in the future

○

Huge contribution from Canadians (ON)

○

Fitness to Stand Trial

Canadian Criminal Code: "… Is unable on account of mental disorder to conduct a

defense at any stage of the proceeding before a verdict is rendered or to instruct

counsel to do so, and in particular, unable on account of mental disorder to a)

understand the nature or object of the proceedings, b) understand the possible

consequences of the proceedings, or c) communicate with counsel."

U.S. Criminal Code (Dusky v. United States, 1960): "The test must be whether he has

sufficient present ability to consult with his attorney with a reasonable degree of

rational understanding and a rational as well as factual understanding of proceedings

against him."

Covers most of Canadian criteria, but it's just not as specific.

We don't hear about these assessments occurring a lot.

Occasionally, in a high profile case, there will be this type of assessment,

especially if the specific case presents the defendant in a way that would

warrant it.

○

Specific Issues in Fitness

Understand charges

Does the individual understand what they're accused of doing?

Can they give pertinent information to counsel?

Accurate, detailed information about the event/crime of which they're

accused?

Do they understand the range, nature of penalties?

Do they know what could happen to them depending on the verdicts in

the case?

Do they understand legal strategies and options?

Ie., NCRMD? Guilty? Not guilty?

Can they help choose legal strategies in consultation with their attorneys?5.

Do they understand the adversarial nature of a trial?

Do they understand that the Crown's task is proving guilt while the

Defences' goal is to cast doubt.

Can they show appropriate courtroom behaviour?

Need to be able to control behaviour.

Can they follow trial events, challenge witnesses? 8.

Can they give relevant testimony?

It is not required that the defendant gives testimony in their own case

anywhere.

Can they maintain a relationship with counsel?

There are cases where people are fit to stand trial, but they disagree with

their attorney.

Individuals who are not fit might just not get along with any attorney.

10.

Conducting Fitness Assessments

Typically requested by the defense as a legal strategy.

If the judge accepts the request, 5 days is allowed for the assessment to take

place in a facility where there is a forensic psychiatrist available to provide such

an assessment.

Extension possible to 30 days; detention for the purpose of a fitness

assessment is not to exceed 60 days.

Only medical practitioners (e.g., psychiatrists) can conduct fitness assessments.

Under the law, ironically, a surgeon, neuroscientist could conduct the

assessment - just needs to be a medical practitioner.

Four Types of Fitness Instruments

Tests for psychopathology:

Tools designed to detect mental illness based on DSM criteria

E.g., MMPI

Minnesota Multiphasic Personality Inventory

E.g., MCMI

Millon Clinical Multiaxial Inventory

Neuropsychological batteries:

Tests designed to detect brain or nervous system damage

E.g., Luria-Nebraska, Halstead-Reitan

Intelligence Tests:

E.g., WAIS (Wechsler Adult Intelligence Scale)

E.g., Stanford-Binet

Fitness-specific tests:

Designed specifically to test the fitness of an individual to stand trial.

E.g., MacCAT-CA

E.g., FIT-R

Other fitness instruments:

… there are many other instruments

Stems from the fact that each state has its own standard of testing

Percentage Acceptable

Researchers were asked which tests were appropriate …

Researchers were also asked which ones are not appropriate …

ProjDraw - poor because it uses the characteristics of a drawing to

determine their mental state.

TAT (thematic aperception test) - shown a drawing and asked three

questions, themes that come up in their responses determine mental

state.

Sentence - asked them to finish a sentence.

Rorschach - used widely in the states; inkblot test

Individual is to see what they have seen in the inkblot

The way it is scored is typically misunderstood by people outside of

the field.

I6PF

MCMI-II

Fitness Interview Test - Revised (FIT-R)

16-item semi-structured clinical interview

Semi-structured because the format of the items might differ from case to

case depending on case details.

Questions divided into 3 sections:

Understanding nature/object of proceedings

Understanding possible consequences of proceedings

Ability to communicate to counsel

Based on their responses to these questions, some assessment will be made by

the clinical professionals.

Popular instrument in part because of the research findings.

Typically a numerical rating to responses; not like this in psychiatry

Zapf & Roesch (1997): 86% agreement between FIT-R and institutional

assessments.

No false negatives.

Process

Judge orders assessment. 1.

Fitness trial

Fit? - Return to courta.

Unfit? - Judge decides.

Conditional discharge (still expected that the patient will receive

treatment)

Hospital custodyii.

Later reassessed.

Fit? - Return to court.a.

Review Board

If unfit, the individual's case will be sent to a review board.a.

If still deemed unfit, they will send them into hospital custody until they

are fit.

They can also discharge the individual. c.

Note: Only way for an unfit individual to later become fit is through pharmacological

intervention (i.e., drugs).

Can patients refuse medication which might render them permanently unfit to

stand trial? No.

The judge can order them to take medication.

In often cases, the individual is open.

Two Elements of a Crime

Two things needs to be established by the prosecution:

Actus reus: the criminal act itself.

○

Mens rea: intent to commit a criminal act.

"The mind of the thing"

The individual had to have intended to do the crime.

Therefore, they have to be mentally fit.

○

History of Insanity Verdict

"insanity" was used to describe NCR

Insanity is not a psychiatric term - appears nowhere in psychiatric,

psychological literature, DSM.

○

It is simply a legal term, which defines a legal standard for criminal

responsibility.

○

For thousands of years, it has been recognized that there are individuals who

commit a criminal act who cannot be held responsible for it by virtue of mental

illness.

i.e., Romans didn't punish "insane" individuals because they thought their

mental illness was punishment enough.

○

Our current legal standards for criminal responsibility in Canada = NCRMD.

Comes largely from the British legal tradition.

Hadfield case (1800): Planned assassination of King.

Ex-soldier, Hadfield was severely injured in war and got many cuts to the

head.

○

Came to believe that if he killed King George III and was hanged for his

crimes, it would hasten the second coming of Jesus Christ.

○

Plan was unsuccessful.

○

Put on trial.

○

At the time, the standard for lunacy … "lost to all sense … incapable of

forming a judgment upon the consequences of the act which he is about

to do."

○

Hadfield didn't meet this because he knew the consequences (hanged,

second coming of Christ)

○

Erskine argued that Hadfield was lost to reality.

His delusions "unaccompanied by frenzy or raving madness" were

insanity.

○

Judge acquits on the order of insanity, orders confinement.

Prior to this, "lunatics" were just sent back into the community

because their were no treatments at the time.

But this judge ordered him to spend the rest of his life in the

Bethlehem Hospital (aka Bedlam).

It was bedlam that

○

British public were not happy with this judgement.

○

Parliament passes Criminal Lunatics Act, mandating detention for the

insane.

○

M'Naughten case (1843): Planned murder of PM.

Our current criteria are directly descended from this case.

○

Mr. M'Naughten was a severely delusional individual who believed in

conspiracies involving the pope, members of the government and a bunch

of people including the PM, Robert Peel.

○

Decided to assassinate Robert Peel.

○

Waited for Mr. Peel to come out and man did come out, and M'Naughten

shot and killed him, but it durned out the be the PM's secretary.

○

Not guilty by reason if insanity.

○

Standard established: "At the time of committing the act, he was

labouring under such a defect of reason from disease of the mind as not

to know the nature and quality of the act he was doing, or if he did know

it, that he did not know what he was doing was wrong."

Basically the same as the current standard.

Mens rea

"Right/wrong test" aka M'Naughten Rule

○

Three basic parts:

Defect of reason due to disease of the mind.

Ignorant of nature and quality of the act.

OR unaware, or unable to determine that the act was wrong.

○

American Law Institute (1962):

ALI Standard: "individual is insane if at the time of his conduct as a result

of mental disease or defect he lacks substantial capacity either to

appreciate the criminality (wrongfulness) of his conduct or to conform his

conduct to the requirements of law."

○

Same as M'Naughten, but adds another criteria "or to conform his

conduct to the requirements of law"

Being under the control of a "uncontrollable impulse"

○

Canada Criminal Code (C-30) of 1992:

Not Criminally Responsible on Account of Mental Disorder (NCRMD).

○

Standard: "No person is criminally responsible for an act committed or an

omission made while suffering from a mental disorder that rendered the

person incapable of appreciating the nature and quality of the act or

omission or of knowing that it was wrong."

○

It's basically the M'Naughten standard.

○

Even though going back thousands of years, societies have recognized a lack of

criminal responsibility for people with mental illness or defects, there are still

places today that do not recognize insanity as a criminal defense.

U.S. for example, there's different standards in each state (most ALI) and

there are states that don't allow it (i.e., Western states, Utah, Wyoming).

○

NCRMD

Issue of NCRMD is raised by defense and argued by Crown typically.

But can be raised by Crown after guilty verdict.

Proof standard: "beyond a balance of probabilities"

Unlike the normal standard "beyond a reasonable doubt"

○

E.g., If there's a 51% chance that this individual is NCRMD, you must find

him not criminally responsible.

○

NCRMD = unconditional release unless defendant poses risk to the public.

When released, usually they'll be seeking treatment.

○

Their mental state right now might be very different from the way it was

at the time of the crime.

○

Review boards oversee disposition of NCRMD defendant.

Assessment Methods for NCRMD

Really, what you're looking for is evidence that the individual meets the

M'Naughten rule (or whatever standard in your state)

Clinical Interview (structured or unstructured).

SADS: Schedule for Affective Disorders and Schizophrenia

SIRS: Semi-Structured Interview for Recording Symptoms

Objective Personality Tests

MMPI-2

MCMI

Projective Personality Tests

Rorschach Inkblot tests

Cognitive Intelligence Tests4.

Neuropsychological Tests5.

Specific Forensic Instruments 6.

Borum & Grisso (1995):

Tests employed by psychologists versus psychiatrists.

We find that they both tend to use the same tests, but to different extents.

Most commonly used instrument is the same: MMPI

RCRAS used more commonly by psychologists than psychiatrists.

Most different.

ROR used equally by both.

MCMI used more commonly by psychologists than psychiatrists.

Clinical Interview

Medical/psychiatric history:

When? What? What's been done?

Simple, open-ended questions:

What was happening?

What were you aware of?

What caught your attention?

What thoughts do you remember?

What were you feeling?

Work through the day of the offense:

When did you get up? What were you thinking then/feeling?

What happened next?

Goes through the entire day and as

Work through the days before the offense.

There may be obvious precursors to the mental state.

Problem: it is in the defendant's interest in most case to be found NCRMD

So the self-report may not be totally accurate.

Ideally, the clinician will have information from other people, witnesses,

etc.

In some cases, there will be very obvious indicators, behaviours, etc.

If the evidence is ambiguous, both the defense and the crown will have

their own psychiatrists look at the defendant or the evidence.

It can easily become a "he said, she said" scenario because the

mental state can never be known for certain.

It is common that the defense's psychologists might argue that the

person is NCRMD, while the Crown's psychologist argues that the

person is fine.

Schedule for Affective Disorders and Schizophrenia

Semi-structured diagnostic interview:

Assess many Axis I disorders - non-personality disorders

Takes about 90 to 150 minutes

Part I:

Current symptoms and level of functioning.

What were they like at their worst?

Part II:

Past episodes.

What diagnoses, what treatments?

Supplements, not replaces, clinical judgements.

Projective Tests: E.g., Rorsach Test

Based on psychodynamic perspective: Assume primacy of unconscious factors in

personality, behaviour.

An individual's psychopathology might not even be known to the

individual consciously.

Projection of unconscious factors onto ambiguous stimulus.

Unconscious factors = fears, wishes, thoughts, etc.

Because of the unconscious nature of these factors… we cannot know

what the nature of the response is going to be.

Tests involve minimal structure, therefore, and minimal restrictions on

response.

Standardized administration and scoring:

But interpretation of scores depends on clinical judgment.

Rorschach Inkblot Test

Oldest of all personality tests, goes back to 1921

Developed by Swiss Psychologist, Herman Rorschach

Developed 10 symmetrical inkblots.

The ones he developed are still used today.

Psychologists are not supposed to reveal the actual blots used in the test.

Only blot #1 can be used.

5 blots are black and grey.

2 blots are black, grey and red.

3 are multi-coloured.

Always shown in the same order.

Administration of the test:

Free association phase: "What do you see in the blot?"

Inquiry phase: "Where do you see it?"

"What aspects of the blot led you to see that particular thing?"

Testing the Limits: "Do you see a …?"

This is not always done.

There are sets of standardized things that people see for each

inkblot.

If you have an individual who doesn't see any of the normal things,

you then kind of probe them.

Test time: 45-60 minutes

Each phase is repeated for each of the inkblots..

Scoring

Location: whole or part of the blot?

Determinants: colour, shape, movement?

Shape is the most common determinants.

Content: object, animal, human?

Living? Dead?

Original or Popular: common response or not?

Form Level: Is percept congruent with the blot?

The person's percept reasonable?

This step requires the clinician's interpretation.

Relationships: Themes in percepts across blots?

Do they commonly involve things? (e.g., violence, relationships with

parents, etc.)

It's not easy to cheat this system because the scoring is so random.

Trained clinicians are the only ones who know.

On objective tests, you can easily just be like "lol I hear voices ahhh" and

people will be like "ok, crazy."

Objective Tests

Not based on specific perspective: no assumption about models of personality

(unlike projective, which is based on a psychodynamic view).

Only assumption is that the individual in question has information

consciously at their disposal about their state of mind.

Overt/explicit feelings, attitudes, characteristics.

Tests restrict kind and number of response.

Very much unlike projective tests which put no restrictions on the

responses.

Clear and standardized administration and scoring: little clinical judgment

required; computerization possible.

Minnesota Multiphasic Personality Inventory (MMPI)

Most popular

Hathaway &n McKinley (1942), University of Minnesota Hospitals

Developed to assist in diagnosis of psychiatric patients.

Ground breaking in the way in which tests were constructed.

Previously based on face/content validity with the disorder in question.

Based their tests on empirical validity.

Selected many "Yes"/"No"/"Can't Say" items.

Whether they were true

Gave items to 200 patients, 724 non-patients.

Wanted to see how patients with different diagnoses answered these

questions compared to non-patients.

How did they differ?

Chose items that discriminated between patient groups for scales: little clinical

judgment required; computerization possible.

MMPI I = 550 Yes/No/Can't say statements about individual, MMPI II = 567

"I am very energetic"

"People are out to get me"

"I am happy most of the time"

"I believe I am an condemned person"

10 clinical scales

3 validity scales

Designed to ensure that the individual is answering honestly and without

any bias.

MMPI Scoring

Raw score, which varies from scale to scale because there's a different #

of items on each scale.

Because the number of items differ by scale, they normalize it.

Raw scale scores transformed into standard scores: mean = 50, standard

deviation = 10

High scores = 70+ ( +2 s.d.) = pathology

MMPI Clinical Scales (*note: names no longer reflect what we're measuring

because the names are no longer relevant in terms of the DSM)

Scale 1 - Hypochondriasis (Hs): High = cynical critical, demanding, self-

centred

"I do not tire quickly"

"I feel weak all over much of the time"

"I have very few headaches"

Scale 2 - Depression (D): High = moody, despondent, pessimistic, shy

"My sleep is fitful and disturbed"

"I certainly feel useless at time"

Scale 3 - Hysteria (Hy): High = outgoing, repressed, naïve, immature

"It takes a lot of argument to convince most people of the truth" (F)

"I think most people would lie to get ahead" (F)

"What others think of me does not bother me" (F)

Scale 4 - Psychopathic Deviate (Pd): High = impulsive, hedonistic,

antisocial

"I believe that my home life is as pleasant as that of most people I

know" (F)

"I have never been in trouble with the law" (F)

"I have never used alcohol excessively" (T)

E.g., Meryl Lynch

Scale 5 - Masculinity-Femininity (MF): High M = sensitive, aesthetic,

passive, feminine. High F = aggressive, rebellious, unrealistic.

"I would like to be a florist"

"I like science"

"I enjoy reading love stories"

Scale 6 - Paranoia (Pa): High = suspicious, aloof, guarded, overly sensitive

"I am sure that I get a raw deal from life" (T)

"I believe I am being followed" (T)

"I have no enemies who really wish to harm me" (F)

Scale 7 - Psychasthenia (Pt): High = tense, anxious, obsessional, phobic.

"Life is a strain for me much of the time" (T)

"Almost every day something happens to frighten me" (T)

"I have more trouble concentrating than others seem to have." (T)

Scale 8 - Schizophrenia (Sc): High = withdrawn, shy, unusual thoughts

Still used to detect schizophrenia today … but just because you

score high on these, doesn't mean you HAVE schizophrenia.

"I have strange and peculiar thoughts" (T)

"No one seems to understand me" (T)

"I often feel as if things were not real" (T)

Derealization - not typical in schizophrenia, but often appears.□

Scale 9 - Mania (Ma): High = sociable, outgoing, optimistic, restless,

impuslive, flighty, confused

"Once a week or more often I become very excited" (T)

"I do not blame a person for taking advantage of someone who lays

himself open to it" (T)

"I have periods of such great restlessness that I cannot sit long in a

chair" (T)

Scale 0 (or 10) - Social Introversion-Extraversion (Si): High = modest,

withdrawn, inhibited. Low = sociable, outgoing, confident.

"I find it hard to make talk when I meet new people" (T)

"I like to be in a crowd who plays jokes on one another" (F)

"I seem to make friends about as quickly as others do" (F)

** you're not expected to be able to match the statements with the

names of the scales because they usually appear on more then one, but

know the names.

MMPI Validity Scales

Detect persons not answering honestly or appropriately.

Inattention, carelessness

Problems reading, understanding questions

Boredom, lack of motivation

Faking good; faking bad

Three validity scales:

Lie Scale (L):

15 items to detect 'faking good'. Items reflect common

weaknesses.

□

E.g., "Sometimes I get so mad I want to cry" (F), "I always tell

the truth" (T), "I do not like everyone I know" (F).

□

Defensiveness Scale (K):

30 items to detect more subtle defensiveness. □

High = "faking good"□

Low = "faking bad" or excessive self-criticism□

E.g., "I certainly feel useless at times" (F), "At times I feel like

smashing things" (F), "At times I feel like swearing" (F)

□

Careless Scale (F):

60 items rarely agreed to.□

E.g., "My soul sometimes leaves my body" (T), "Someone has

control over my body" (T), "I see things, animals, or people

around me that others do not see" (T)

□

Reasons for high F score:

Reading difficulty

Faking bad

Psychosis (e.g., schizophrenia)

Plea for help through exaggeration of symptoms

Adolescent defiance, hostility, negativism

On MMPI I - adolescents used to score the same

as psychopaths, same with elderly.

◊

They now have their own scoring keys.

◊

□

MMPI Scoring

Because it is an objective test, it can be both administered and scored by

a computer.

Presented on a graph with the old validity scales on the left and 10 scales

on the left.

Our concern is elevated clinical scale scores.

2-point and 3-point high score profiles.

E.g., 2-4 elevated profile (scale 2 and 4 peaks) - what does this mean

for psychopathology?

D/Pd□

Usually individuals in trouble with the law or their family. □

Impulsive, unable to delay gratification. Little respect for

social standards. May abuse alcohol, drugs.

□

Energetic, sociable, outgoing, but feels introverted, self-

conscious, inadequate.

□

Problems with MMPI

Original norming sample limited, outdated.

These tests were originally given to a group of individuals living in/around

Minneapolis.

Very limited, homogenous sample.

Rural, skilled or semi-skilled white Minnesotans with 8 years of education.

Non-patients might respond differently today.

Cultural, subcultural differences on some scales.

Might be capturing these differences instead of psychopathology.

Meaning of scores varies with age, sex.

Adolescent profile like adult psychopath; same for elderly.

In the new MMP, there's a separate scoring system just for these groups.

Some items outdated, sexist, offensive.

E.g., "Streetcar"; "sleeping powder"; "cutting up"

"I like to take a bath" - people don't normally take baths anymore, they

shower.

"I like mechanics magazines" - magazines aren't as popular

Some items emphasized Christian beliefs.

"I go to church almost every week"

Some items re: sexual behaviours, elimination behaviours offensive.

Some items were repeated.

Even 5 times …

Lengthens the test

Might have been done for reliability.

MMPI-2 Changes

Addressed the problems …

New normative sample.

2600 participants from 7 states.

Better racial/ethnic mix.

More representation from higher SES.

Included large adolscent sample

Offensive, outdated items dropped.

13% of items reworded.

New scoring forms/keys for adults, adolescents.

Statements added.

25-30 brand new statements.

Designed to assess things that weren't a part of the original clinical scales.

E.g., Drug abuse, suicide risk, type A behaviour, marital adjustment, work

attitudes, amenability to psychotherapy.

Took subsets of questions from the MMPI and used them to assess things

that weren't considered on the original MMPI.

Now 567 rather than 550 statements.

3-4 new validity scales added.

Because the MMPI was widely used in prison populations (e.g., assess risk of

reoffending) they produced a prison-based test for forensic use. Tests for the

following:

Need for mental health assessment/programming

Socially deviant behaviour/attitudes

Extraversion

Leadership ability/dominance

Hostile peer relations

Conflict with authorities

Positive responses to supervision

Positive responses to academic programming

Positive responses to vocational programming

Millon Clinical Multiaxial Inventory (MCMI)

Developed by Theodore Millon in late 1970s, based on his model of

psychopathology/personality disorders.

Well-known for his ideas in personality theory/psychology.

Chose large number of true/false items based on theoretical considerations.

Not empirical validity like MMPI.

Theoretical - "individuals should answer like this if they have this"

E.g., "I often think of ending my life", "I feel sad all the time", "I do not

care if I win or lose."

Normed on 200 clinical patients.

175 items, 20 clinical scales; 22 on MCMI-II (1987)

MCMI-III Development (1994)

Developed based on concerns about the validity/reliability of the MCMI and

MCMI-II

Added 1132 items to norming pool.

Developed on 998 patients from U.S. and Canada.

52% outpatients, 26% inpatients, 8% corrections.

88% 18-45, 82% high school, 18% university.

86% white, 9% black, 3% Hispanic

Standardized on 1200 patients.

175 items, 24 clinical scales.

MCMI-III Personality Disorder Scales

11 Moderate Disorder Scales

1-Schizoid

Aloof, apathetic

Problem relationships

2A-Avoidant

Socially anxious, expecting rejection

2B-Depressive

Downcast, gloomy

3-Dependent

Passive, submissive, lack autonomy

4-Histrionic

Gregarious, seek attention, manipulative

Dramatic

5-Narcissistic

Self-centred, arrogant, exploitative

6A-Antisocial

Irresponsible, vengeful, independent

Recognized personality disorder in the DSM

6B-Aggressive

Controlling, abusive, humiliate others

7-Compulsive

Orderly, organized, perfectionistic

8A-Passive-Aggressive

Argumentative, oppositional, negativistic

8B-Self-Defeating

Allows others to abuse, take advantage of them

Self-sacrificing martyrs

3 Severe Pathology Scales (Axis 2)

S-Schizotypal

Self-absorbed, idiosyncratic, eccentric, cognitively confused.

Recognized personality disorder in the DSM.

C-Borderline

Labile affect, erratic behaviour, emotionally intense, possibly self-

destructive.

Dramatic shifts in emotional states and reactions to others.

Recognized personality disorder in the DSM.

P-Paranoid

Rigid, defensive, mistrusting

Delusions of influence/persecution

May become angry, belligerent

Recognized personality disorder in the DSM.

7 Moderate Syndrome Scales (more like Axis 1, but don't quite meet the criteria

for DSM disorders)

A-Anxiety

Anxious, tense, apprehensive, over-aroused

H-Somatoform

Vague physical complaints with no organic causes

Hypochondriacal

N-Bipolar-Manic

Overactive, impulsive, excessive energy

Recognized disorder in DSM.

D-Dysthymia

Depressed, pessimistic, low self-esteem

Recognized disorder in DSM - basically a low-grade version of

depression.

B -Alcohol Dependence/Abuse

Problems with alcohol, or associate personality traits.

Recognized in the DSM

T -Drug Dependence/Abuse

Problems with drugs, or associate personality traits.

R - Post-Traumatic Stress Disorder

Intrusive, unwanted memories or nightmares, flashbacks

Recognized in DSM.

3 Severe Syndrome Scales (More involved in the assessment of criminal

responsibility)

SS - Thought Disorder

Psychotic thought disorder

Hallucinations, delusions

Fits schizophrenia very closely

CC - Major Depression

Severely depressed, unable to function

Low energy, feel hopeless

Less likely to commit a crime because they just don't have the

energy.

PP - Delusional Disorder

Acutely paranoid

Delusions and irrational thinking

May become belligerent - often leads to criminal behaviour that

often leads to people being deemed not criminally responsible.

RE: Paranoid Schizophrenia

MMPI-III Modifying Indices (… basically validity scales)

X - Disclosure

Willingness to admit symptoms, problems.

High or low scores invalidate profiles.

Y - Desirability

Tendency to choose items that make one look good, no problems.

Z - Debasement

Tendency to highly, exaggerate problems and symptoms.

V - Validity Index

Choosing two out of three seldom-chosen items invalidates profile.

MCMI-III Scoring

Raw scale scores converted to Base Rates (BR)

Much like MMPI where we normalize the raw scores.

Range from 0 to 115

60 = median raw score for all patients on that scale.

75 = minimum for patients meeting DSM-IIII criteria for disorder condition

75 to 84 = "clinically significant personality style or syndrome"

MCMI-III Correction Report

Relevant to forensic

MCMI-III Report

E.g., 38A0

"Insecure, low self-esteem. Don't trust others to be reliable

dependable. Resent needing others, fear their needs will not be

met. May need a therapeutic relationship in which therapist

assumes dominant role, and offers parental guidance and

protection."

MCMI-III Corrections

7 pages - E.g., escape risks, violent risks, personality patterns, clinical

syndromes, etc.

Very extensive

MCMI-III Issues

High test-retest reliability on personality scales; less on clinical syndrome scales.

Normative sample small, unrepresentative of minority groups.

High degree of scale overlap; high inter-scale correlations (0.40-0.85).

A number of the items are duplicated.

Concern is are we measuring different things or the same thing?

Most items scored "true"; vulnerable to acquiescence bias (positive response

bias)

Because scores on each scale are mostly contributed to by positive

response.

For this reason, you may get biased scores on these scales because there's

a tendency to have an acquiescence bias.

Anyone with this bias will have a higher score on these scales.

Weak assessing major psychotic disorders, minor personality disorders.

These major psychotic disorders are the most influential in determining

"insanity"

Scores on the three major scales are not as predictive of actual clinical

diagnoses as other scales are.

Some scales weak in diagnosing related personality disorders; better at

identifying styles.

Many scales have low convergent validity with other psychiatric rating

instruments.

i.e., they don't correlate with other tests trying to measure the same

thing.

Millon's model of personality disorder is not validated.

Problem because he chose his scales on the basis of his theories.

This is not the preferred model of personality.

Test too new to have generated supporting research.

Rogers:

"the MCMI-II should not be used in insanity evaluations based on its

diagnostic invalidity. For Axis II disorders, elevation of a designated scale

as evidence of the corresponding disorder is likely to be wrong 82% of the

time. The numbers are not much better for Axis I disorders in which a

designated scale is wrong 69% of the time. These levels of inaccuracy are

below the threshold for admissibility of relevant testimony."

Sounds like an awful measurement tool just based on these accuracy

numbers.

Rogers Criminal Responsibility Assessment Scales (R-CRAS)

Published 1984

Designed to "quantify essential psychological and situational variables at the

time of the crime and to implement criterion-based decision models for criminal

responsibility."

Essentially you quantify (put numbers on) the probability that a person

met the criteria for insanity at the time of the crime.

Clinician conducts a regular clinical interview, but uses the R-CRAS to put a

number on the extent to which an individual meets the criteria.

30 variables, each rated on 5 or 6 point scale by the interviewer:

0 = no information

1 = not present

2 = clinically insignificant

3 - 6 = increasing levels of clinical significance.

Rogers considers magnitude estimations an important advance over

presence/absence judgments.

Assesses responsibility using ALI criterion:

"if at the time of his conduct as a result of mental disease or defect he

lacks substantial capacity either to appreciate the criminality

(wrongfulness) of his conduct or to conform his conduct to the

requirements of law"

R-CRAS Variables

R-CRAS variables

E.g., Malingering - pretending you have symptoms of a mental disorder,

but you really don’t.

This is a huge concern in these cases.

E.g., Organic mental disorder - injury to the brain that causes insanity.

E.g., Mental retardation - low IQ, intelligence.

E.g., Affective disorders, schizophrenia symptoms

E.g., Awareness of criminality, evidence of planning

R-CRAS Summary Variables

A1 - Presence of Malingering

A2 - Presence of Organicity

A3 - Presence of major psychiatric disorder

A4 - Ability to comprehend criminality ("definite loss of cognitive controls"

A5 - Loss of behaviour control

A6 - Loss of control due to:

Organic disturbance, psychiatric disturbance, etc.

R-CRAS Reliability

Test-retest reliability at 3 weeks:

12 variables have r > 0.6

8 variables have r > 0.4

3 variables have r < 0.4

Inter-rater reliability (expert agreement);

Malingering - 85%

Major mental disorder - 80%

Cognitively aware of crime - 87%

Able to control criminal behaviour - 89%

But experts interviewing, same as R-CRAS

Some people are simply conducting clinical interviews without the R-CRAS

and doing the same exact thing and making highly correlated judgments.

Substantive (face) validity:

Do elements in scale address elements of the construct? (content

validity).

Yes, they do because that is what the test was designed for.

Structural validity:

Do individuals judged insane by R-CRAS have characteristics of insanity?

Absence of malingering

More severe psychological impairment

Greater loss of cognitive/behavioural control.

Of course the do, because that is what was asked and what was judged - it

has to be true.

But doesn't this have to be so?

R-CRAS uses the same criteria to assess insanity, so individuals will

naturally match criteria of insanity.

Melton et al call these results "trivial and tautological"

E.g., they have to be true, circular reasoning.

External (criterion) validty:

Are individuals judged insaneb by R-CRAS found insane at trial?

75% insane by R-CRAS, insane at trial

95% sane by R-CRAS, sane at trial

But R-CRAS expert testimony is part of trial evidence (criterion

contamination) - therefore, they're using the R-CRAS to determine their

own judgment.

We don't have an independent assessment of insanity in this criteria

because the judgment of the jury is influenced/contaminated by

your statement about the person.

"you told me he was insane and I believed you"

Psychological Assessment

Friday, March 9, 2018

8:43 PM

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