Samenvatting Psychiatry for lawyers
Week 1 Introduction
Legaly insanity = ontoerekeningsvatbaar
Sanity = toerekeningsvatbaar
Why psychiatrist evaluate the Bijenkorfmum?
- She tried to commit suicide
- She was the mother, and it’s not natural to kill your child
- The place: weird place, public place
- Servere crime (ernstig delict)
Delusion = waan living in your own world and thinking that’s the real world
Hallucination = has to do with your sense; what you feel, you hear voices, etc.
Schizophrenia = you hear voices which orderd you to commit a crime.
Delusions stay there for years. Sometimes you have a shortlit delusion: take some drugs and
have delusion that you can fly or you’re being prosecuted. Most of the time they are
constantly.
Difference between hallucination and delusion:
- Delusion: has to do with what you think (believes that satanist are pursuing you)
- Hallucinations: has to do with your sense like hearing voices, seeing things/dead
people, smelling things, feeling touch, etc.
If it has to do with your senses directly it’s a hallucination. If it has to do with you
beliefs, it may be a delusion
Combination hallucination and delusion:
- Often you have hallucinations with delusions.
- Sometimes you hear voices and the voices are really making you these things. You
may believe the voices are from Jesus (or another devince person).
Liability (onzekerheid) of psychiatry = we moeten geloven wat mensen zeggen. Er moet in
bepaalde mate vertrouw worden op hetgeen door de verdachte wordt gezegd.
Voorwaarden TBS:
- Servere mental disorder while commited the crime
- Danger for the future
What is a mental disorder? (depression)
Most difficult question for a psychiatrist.
DSM-5 model: specific symptoms, at least 5 of these 9 to speak of a mental disorder:
1. Depressed mood or irritable most of the day
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change of change in appetite
4. Change in sleep: insomnia (te weinig) or hypersomnia (te veel)
5. Change in activity
6. Fatigue (moeheid) or loss of energy
7. Guilt/wothlessness
8. Concentration: disminished ability tot hink or concentrate
9. Suicidality
,Hannibal: some people say he has an anti-social personality disorder
Social disorder of psychopath:
3 (or more) of the following symptoms:
1. Failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedely performing acts that are grounds for arrest
2. Deceitfulness (bedrieglijk)
3. Impulsivity of failure to plan aheid
4. Irritability and aggressiveness
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility
7. Lack of remors
What do we want to know about a patiënt?
1. Childhood
2. Reason why they came to the clinic
3. Why they came now to the clinic
4. How long did it last? Is it the same all the time?
5. Are there things that influence the cause of your symptoms?
6. Early treatments
7. About the family
8. What do you do during the days?
9. Social network
10. Financial situation
11. In danger
12. Substance abuse: drugs, alcohol, smoking, etc.
Other information sources, availible and necessary:
- Observation
o Fast talking: very fast thinking, manic episode? Little sleep, overconfident,
damaging effects on social network
o Tics: sometimes specific movements
o Depressed impression: afraid/anxious/getting emotinal all the time
o Disorientation: in place, in person, in time
Ook kijken naar psychical disorders: DSM 4, maar wordt niet meer gebruikt.
,Week 2 Mental disorders I: Diagnosis, aetiology, forensic psychiatry, drugs,
psychological and social treatment
Controversial
Critics of psychiatry/mental disorders:
- Thomas Szasz: opposes (verzet zich tegen) all mental illnesses, especially ADHD.
The idea of a mental illness helps to force people out of society
- Trudy Dehue: the depression-epidemic: critical towards both psychiatrists and
society. It is the society who wants people be very happy, active. As soon as it’s not
possible to be such a person, active and happy and tweeting all the time, then you
have got to do something to fix that again and so you are considered to be
depressed.
Treatments in psychiatry
- Psychotherapy: vaak 1e keuze van behandeling.
o Psycho-analysis: the troublesome relationship the patiënt has with a person
can be transferred to the therapist who can feel the upset in his patiënt. He
takes on the role of that person and creates a similar kind of relationship with
the patiënt but triest o make the unconsious conflict consious by making
changes in the communication
o Cognitive Bahaviour Therapy (CBT): it addresses what you believe, cognitive
(1) and your behaviour (2). Instead of avoiding you expose yourself to what
you fear, and you resist/prevent your normal anxious reaction (like running
away) fobias
- Medication: anti-depressive medicines are taken for a long time and side effects take
very long. So it is not good for a health perspective.
- Elektro convulsive Therapy (ECT): electroshock-therapy it works, but only for a
short period
o Side effect = memory loss
- Treating physical illness: treating the underlying illness. Thyroid problems (schildklier)
can bet he cause of mental disturbance: you treat the Thyroid problems
- Deep brain stimulation: experimental with Parkinson. Now also with patient who has a
OCD (washing hands, etc). With parkinson it’s not experimental anymore, but in
psychiatry it is.
Van Deth (partly)
1. First consider if there is a psycho-organic disorder: disorder with brain destruction/brain
lesions (hersenletsel)
, 2. Is it the consequence of substance related disorders? : is a person intoxicated
(dronken)?
3. Psychotic disorders: schizophrenia and delusional disorder
4. Mood disorders: 2 types:
a. Depressive
b. Bipolar: manisch depressief
5. Anxiety disorder
Aetiology: ontstaanswijze
Much is still unknown about the cause of mental illnesses. There are several methodological
approaches to search for diseases and treatment:
- Epidemiological
- Genetics
- Biochemical studies
- Neuropathology
- Electrophysiology
- Psychology
Phineas Cage (accidents)
Cage werkte bij spoorweg met dynamiet. Dynamiet explodeerde en raakte gewond, want
stok kwam in schedel. Cage herstelde wonderbaarlijk, maar ging zich anders gedragen.
Ongeluk hadden zijn voorste kwab beschadigd, waardoor hij zich impulsief en agressief ging
gedragen.
Important that accidents can lead to a mental disorder
Treatment psycho-organic disorder? Dementia, delirium, trauma, accidents
There is not much we can do. If you have this kind of this trauma, you have to live with your
disabilities.
Substances
Intoxication ------- dependence (je wordt afhankelijk) -------- brain lessions (je bent er
afhankelijk van en als je het niet krijgt, wordt je nerveus.
Op lange termijn intoxication kan leiden tot geheugenverlies, etc.
Controversial
Psychiatry is controversial. Sommige mensen vinden dat een mental illness een mythe is.
sommige mensen controleren of de deur op slot zit. Het is echter geen illness of een dokters
issue. Thomas Szasz was een psychiatry, maar was van mening dat mental illness een
mythe is. Er wordt een filmpje laten zien waarin wordt uitgelegd wordt wat ADHD is. Vele
jonge jongetjes worden hiermee gediagnosteerd. Thomas Szasz legt uit waarom dit geen
ziekte is. Hij is van mening dat een ziekte over het gedragen of niet-gedragen van een mens
geen ziekte kan zijn.
Over de jaren heen is mental illness als een probleem voor patienten gezien, maar ook in
een maatschappij. Als iemand een milde depressie heeft, dan is het functioneren veel lager.
Het wordt gezien als een probleem. In de krant staan wel eens discussie of het een disorder
is, aangezien er in de hersenen niets gevonden wordt.
Week 1 Introduction
Legaly insanity = ontoerekeningsvatbaar
Sanity = toerekeningsvatbaar
Why psychiatrist evaluate the Bijenkorfmum?
- She tried to commit suicide
- She was the mother, and it’s not natural to kill your child
- The place: weird place, public place
- Servere crime (ernstig delict)
Delusion = waan living in your own world and thinking that’s the real world
Hallucination = has to do with your sense; what you feel, you hear voices, etc.
Schizophrenia = you hear voices which orderd you to commit a crime.
Delusions stay there for years. Sometimes you have a shortlit delusion: take some drugs and
have delusion that you can fly or you’re being prosecuted. Most of the time they are
constantly.
Difference between hallucination and delusion:
- Delusion: has to do with what you think (believes that satanist are pursuing you)
- Hallucinations: has to do with your sense like hearing voices, seeing things/dead
people, smelling things, feeling touch, etc.
If it has to do with your senses directly it’s a hallucination. If it has to do with you
beliefs, it may be a delusion
Combination hallucination and delusion:
- Often you have hallucinations with delusions.
- Sometimes you hear voices and the voices are really making you these things. You
may believe the voices are from Jesus (or another devince person).
Liability (onzekerheid) of psychiatry = we moeten geloven wat mensen zeggen. Er moet in
bepaalde mate vertrouw worden op hetgeen door de verdachte wordt gezegd.
Voorwaarden TBS:
- Servere mental disorder while commited the crime
- Danger for the future
What is a mental disorder? (depression)
Most difficult question for a psychiatrist.
DSM-5 model: specific symptoms, at least 5 of these 9 to speak of a mental disorder:
1. Depressed mood or irritable most of the day
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change of change in appetite
4. Change in sleep: insomnia (te weinig) or hypersomnia (te veel)
5. Change in activity
6. Fatigue (moeheid) or loss of energy
7. Guilt/wothlessness
8. Concentration: disminished ability tot hink or concentrate
9. Suicidality
,Hannibal: some people say he has an anti-social personality disorder
Social disorder of psychopath:
3 (or more) of the following symptoms:
1. Failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedely performing acts that are grounds for arrest
2. Deceitfulness (bedrieglijk)
3. Impulsivity of failure to plan aheid
4. Irritability and aggressiveness
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility
7. Lack of remors
What do we want to know about a patiënt?
1. Childhood
2. Reason why they came to the clinic
3. Why they came now to the clinic
4. How long did it last? Is it the same all the time?
5. Are there things that influence the cause of your symptoms?
6. Early treatments
7. About the family
8. What do you do during the days?
9. Social network
10. Financial situation
11. In danger
12. Substance abuse: drugs, alcohol, smoking, etc.
Other information sources, availible and necessary:
- Observation
o Fast talking: very fast thinking, manic episode? Little sleep, overconfident,
damaging effects on social network
o Tics: sometimes specific movements
o Depressed impression: afraid/anxious/getting emotinal all the time
o Disorientation: in place, in person, in time
Ook kijken naar psychical disorders: DSM 4, maar wordt niet meer gebruikt.
,Week 2 Mental disorders I: Diagnosis, aetiology, forensic psychiatry, drugs,
psychological and social treatment
Controversial
Critics of psychiatry/mental disorders:
- Thomas Szasz: opposes (verzet zich tegen) all mental illnesses, especially ADHD.
The idea of a mental illness helps to force people out of society
- Trudy Dehue: the depression-epidemic: critical towards both psychiatrists and
society. It is the society who wants people be very happy, active. As soon as it’s not
possible to be such a person, active and happy and tweeting all the time, then you
have got to do something to fix that again and so you are considered to be
depressed.
Treatments in psychiatry
- Psychotherapy: vaak 1e keuze van behandeling.
o Psycho-analysis: the troublesome relationship the patiënt has with a person
can be transferred to the therapist who can feel the upset in his patiënt. He
takes on the role of that person and creates a similar kind of relationship with
the patiënt but triest o make the unconsious conflict consious by making
changes in the communication
o Cognitive Bahaviour Therapy (CBT): it addresses what you believe, cognitive
(1) and your behaviour (2). Instead of avoiding you expose yourself to what
you fear, and you resist/prevent your normal anxious reaction (like running
away) fobias
- Medication: anti-depressive medicines are taken for a long time and side effects take
very long. So it is not good for a health perspective.
- Elektro convulsive Therapy (ECT): electroshock-therapy it works, but only for a
short period
o Side effect = memory loss
- Treating physical illness: treating the underlying illness. Thyroid problems (schildklier)
can bet he cause of mental disturbance: you treat the Thyroid problems
- Deep brain stimulation: experimental with Parkinson. Now also with patient who has a
OCD (washing hands, etc). With parkinson it’s not experimental anymore, but in
psychiatry it is.
Van Deth (partly)
1. First consider if there is a psycho-organic disorder: disorder with brain destruction/brain
lesions (hersenletsel)
, 2. Is it the consequence of substance related disorders? : is a person intoxicated
(dronken)?
3. Psychotic disorders: schizophrenia and delusional disorder
4. Mood disorders: 2 types:
a. Depressive
b. Bipolar: manisch depressief
5. Anxiety disorder
Aetiology: ontstaanswijze
Much is still unknown about the cause of mental illnesses. There are several methodological
approaches to search for diseases and treatment:
- Epidemiological
- Genetics
- Biochemical studies
- Neuropathology
- Electrophysiology
- Psychology
Phineas Cage (accidents)
Cage werkte bij spoorweg met dynamiet. Dynamiet explodeerde en raakte gewond, want
stok kwam in schedel. Cage herstelde wonderbaarlijk, maar ging zich anders gedragen.
Ongeluk hadden zijn voorste kwab beschadigd, waardoor hij zich impulsief en agressief ging
gedragen.
Important that accidents can lead to a mental disorder
Treatment psycho-organic disorder? Dementia, delirium, trauma, accidents
There is not much we can do. If you have this kind of this trauma, you have to live with your
disabilities.
Substances
Intoxication ------- dependence (je wordt afhankelijk) -------- brain lessions (je bent er
afhankelijk van en als je het niet krijgt, wordt je nerveus.
Op lange termijn intoxication kan leiden tot geheugenverlies, etc.
Controversial
Psychiatry is controversial. Sommige mensen vinden dat een mental illness een mythe is.
sommige mensen controleren of de deur op slot zit. Het is echter geen illness of een dokters
issue. Thomas Szasz was een psychiatry, maar was van mening dat mental illness een
mythe is. Er wordt een filmpje laten zien waarin wordt uitgelegd wordt wat ADHD is. Vele
jonge jongetjes worden hiermee gediagnosteerd. Thomas Szasz legt uit waarom dit geen
ziekte is. Hij is van mening dat een ziekte over het gedragen of niet-gedragen van een mens
geen ziekte kan zijn.
Over de jaren heen is mental illness als een probleem voor patienten gezien, maar ook in
een maatschappij. Als iemand een milde depressie heeft, dan is het functioneren veel lager.
Het wordt gezien als een probleem. In de krant staan wel eens discussie of het een disorder
is, aangezien er in de hersenen niets gevonden wordt.
