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Lecture 7

CRIM 103 Lecture Notes - Lecture 7: Major Depressive Disorder, Dysthymia, Meta-Analysis

Course Code
CRIM 103
Jennifer Wong

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Mental Disorders (MDs) =
Disorder of the mind
Interferes substantially with the ability cope on a daily basis
May be temporary or long-term
Historically, MDs have caused fear and contempt Do therapy and sessions as treatment in these days
not always responsible for their behaviours
Mentally disordered Offenders in the Criminal Justice System
Overrepresentation of serious MDs in prisons
Fazel & Dansch (2002) meta-analysis of offenders in 12 countries 3.7% male and 4% female for
psychotic illness
o Depression: 10% M and 12% F
o APD rate: 47% M and 21% F
Motiuk & Porporino (1991): Canadian incarcerated males
o 21% depression (major depression, dysthymic, bipolar)
o 44% anxiety (phobia, generalized anxiety, panic)
o 57% ASPD
o 47% alcohol abuse/dependence, 41% drug use/dependence
MDs and Violence
MacArthur Research Network:
o 1,000 psych patients followed 1-yr- post-release
o Past MD alone not good predictor of violence
o Violence IS associated with current, serious MD
Partic when have history of violence
o Schizophrenics at higher risk for Violence, esp.
With high PCL-R score: 11% --combination of schizophrenia and PCL-R high score
With substance abuse problems: e.g. Rasanen 25x currently, suffering serious mental
o Majority of people with MD do not commit violence
Importance of diagnosis:
1. Communication with other doctors
2. understand the illness; prediction, risks
3. treatment
4. risk management
DSM-V: Standard guidebook for clinicians
o Classification system
o 5th Ed., 2013
Schizophrenia (indiscrimination between giggling and crying)
Mental illness that impairs perception and expression of reality
Disturbances in cognition, emotional responses, behaviour
Generally begins in early in life, often social, economic impairment
Ongoing for at least 6 months; serious impact on functioning
DSM diagnosis: 2(or more) of following for 1-month period:
o Positive symptoms:
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Hallucinations Psychotic Dimension
Disorganized speech
Grossly disorganized/ catatonic behaviour -Disorganized Dimension
o Negative symptoms: (substantial portion of the morbidity associated with schizophrenia but are
less prominent in other psychotic disorders)
Affective flattening, alogia (manifested by diminished speech output 실어증), avolition
(decrease in motivated self-initiated purposeful activities)
Diminished emotional expression (reductions in the expression of emotions in the face,
eye contact, intonation of speech (prosody), and movements of the hand, head, and
face that normally give an emotional emphasis to speech)
What is a Delusion? (e.g, alien tracking your cell and sending txt or listening the calls)
A false belief that involves misinterpretation of perceptions or experiences
o Based on incorrect inference about external reality
o Firmly sustained despite what most others believe and incontrovertible proof to contrary
Common themes
o Persecutory (belief that one is going to be harmed, harassed, and so forth by an individual,
organization, or other group), referential (belief that certain gestures, comments,
environmental cues, and so forth are directed at oneself)
Bizarre (implausible and not understandable to same-culture peers and do not derive from ordinary life
experiences) -which is impossible ex. replaced organ without scar or trace vs. non-bizarre delusion
spy or following someone
What is a Hallucination?
A perception, in the absence of a stimulus, that is believed to be genuine vivid and clear
Can involve any of the 5 senses
o Auditory most common
o Visual
o Olfactory
o Gustatory
o Tactile
occur while falling asleep (hypnagogic) or waking up (hypnopompic)
Disorganized Speech
Derailment (loose association)
o Jumping topics
o Answering questions in an unrelated way
o Speech that is incomprehensible, word salad
Grossly Disorganized Behaviour/ Catatonia (marked decrease in reactivity to the environment)
Grossly disorganized behaviours, e.g.,
o Childlike or silly
o Unpredictable agitation shouting, swearing in public
o Inappropriate sexual behaviour
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Catatonic motor behaviours, e.g., negativism (resistance to instruction), mutism and stupor (complete
lack of verbal or motor responses), catatonic excitement (purposeless and excessive motor activity
without obvious cause)
o Maintaining rigid posture
o Inappropriate/ bizarre postures staring, grimacing (twisted expression on face)
o Unstimulated, excessive motor activity
Catatonia may occur bipolar or depressive disorders with catatonia and in medical conditions
Schizophrenia Facts
Prevalence 0.3 0.7%
Age of onset: M- 18 ~ 25 yrs; F- 25 to mid-30s
M:F ratio is close to 1:1
Onset typically slow and gradual
o 20% favourable course; 80% require support or deteriorate
Genetic predictors
o 1st degree relatives have 10x greater risk
Enviro predictors
o Winter birth, urban-born, prenatal virus of gamine, obstetric complications, CNS infection in
early childhood
Delusional Disorder
Delusions that last at least 1 month
o Without other symptoms of schizophrenia
Other than impact of delusions, no marked impairment in psychosocial functioning
Subtypes: -read and fill
o Erotomanic (another person is in love with the individual), grandiose (having some great (but
unrecognized) talent or insight or having made some important discovery), jealous (his or her
spouse or lover is unfaithful), persecutory (he or she is being conspired against, cheated, spied
on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit
of long-term goals), somatic (bodily functions or sensations), mixed (no one delusional theme
predominates), unspecified (dominant delusional belief cannot be clearly determined or is not
described in the specific types (e.g., referential delusions without a prominent persecutory or
grandiose component)
Mood Disorders
Charaterized y episodes of various duratio
o Episode = period of specific symptoms
3 main types of episodes
o Depressive
o Manic
o Hypomanic
What is a Depressive Episode?
2-week period in which individual experiences, nearly every day:
o Depressed mood
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