PSYCH 412 1st EditionExam # 2 Study Guide Lectures: 5 - 9Lecture 5 (October 2nd)I. Issues in Mental Healtha. Social Issuesi. Deinstitutionalization – This is the movement of people who have severe mental illnesses out of the large psychiatric hospitals that they were livingin and back into their communities, where a network of community mental health centers would serve them1. With deinstitutionalization, there were services that were supposed to be provided and put into the communities that these severely mentally ill people were living in such as residential care, day treatment programs, crisis intervention, outpatient services, and vocational rehabilitation programs2. This did not happen due to lack of funding and resources. The people who left the institutions faltered.ii. This created the revolving door problem, people would be constantly in and out of hospitals and the hospitalization rates skyrocketed.iii. “Trans-institutionalization” – this is where many of the people who wouldhave been in psychiatric facilities getting treatment are now in other institutions such as jails, prisons, nursing homes, and non-psychiatric hospital wards.b. Legal Issuesi. A basic premise of criminal law is that all of us are responsible being who exercise free will and are capable of choices and legality has a significant influence of the mental health field.ii. People who are accused of committing a crime but who are mentally ill are subject to possible criminal commitment. This goes off the premise that a diseased mind cannot be a guilty mind. If a person who commits a crime is not of “sound mind” they cannot be held criminally responsible for their crime.iii. A person who is subject to criminal commitment can be:1. Involuntarily sent to a psychiatric facility to be assessed for competency to stand trial2. Can be involuntarily sent to a psychiatric hospital if found not guilty of the crime due to their mental illness.iv. Competence to stand trial1. Is the defendant currently able to work with her or her lawyer with a reasonable degree of understanding?2. Does the defendant have factual and rational understanding of theproceedings against him or her?v. Insanity defense1. This is the basic idea that a defendant should be not be held accountable for a crime if it is attributable to a severe mental illness or defect.2. NGRI - not guilty by reason of insanity3. The insanity plea is used in less than 1% of all court cases and is generally unsuccessful.vi. M’Naghten Rule1. This rule was formed in British courts, our handling of the mentally ill committing crimes is based on this rule.2. If the defendant was suffering from a mental illness such that theydid not understand the nature and quality of the act they engagedin, if they did know this, the defendant did not know what he or she was doing was wrong.vii. Civil Commitment1. Civil commitment concerns individuals who are mentally ill and dangerous but who have not committed a crime they are subject to civil commitment to a psychiatric hospital.2. Grounds for civil commitmenta. Person is mentally ill as legally defined by the state and b. Person is a danger to themselves orc. Person displays imminent danger to others.3. This can then lead to involuntary hospitalization if they person fits these standards for grounds of civil commitment.viii. Emergency Detention1. Local police can take any person acting in a dangerous manner to a psychiatric hospital against their will if the police believe the person may be mentally ill and the hospital can hold them up to 72 hours.ix. Patient rights1. Even when people are hospitalized against their will they still have patient rights such as the right to treatment, the right to the least restrictive alternatives, and the right to refuse treatment.x. Confidentiality – this is an ethical standard that protects patients from disclosure of personal information without their consent.1. Tarasoff Decisiona. This limits confidentiality when a client threatens to harm another person. The therapist then has the following duties:2. Duty to warna. A therapist can breach confidentiality when a patient threatens harm to another person and the therapist has a duty to warn the intended victim if the patient is judged to pose a serious danger of doing violence to others.3. Duty to protecta. When a therapist determines that their patients are likely to be dangerous to another identifiable person(s), the therapist must take whatever steps that are reasonably necessary to protect the potential victim(s).Lecture 6 (October 9th)I. Abnormal/maladaptive anxietya. Abnormal anxiety is chronic or it happens all the time and occurs with extreme intensity and interferes with the individual’s functioning. Anxiety also has several components.i. Subjective Component1. For normal anxiety the person experiences a vague sense of worrywhich is unpleasant and concerning, this makes them worried andapprehensive. 2. For abnormal anxiety, the person feels dread and impending doom.ii. Physiological Component1. For this component, normal people will feel increased arousal, such as increased heartbeat and blood pressure.a. For abnormal anxiety, people feel this increased arousal but more intensely, they will also feel dizziness, shortness of breath, sweating, sleeplessness, and muscle tension.iii. Cognitive Component1. This is where the person’s thoughts become centered around something bad happening, for the abnormal this just happens with much more intensity and the person feels that this thing is going to absolutely happen.iv. Behavioral Component1. This is where the person with this extreme anxiety, goes out of their way to avoid the things that cause them anxiety and they have more rigid behavior.II. Comorbiditya. This is where a person suffers from two or more disorders at the same time. 50% of people who are diagnosed with one disorder have another diagnosable disorder and 15% of all people with disorders have an anxiety disorder.III. Generalized Anxiety Disordera. This is where a person feels excessive anxiety and/or worry about a number of everyday life events or activities, the person has trouble controlling this worry. This occurs more days than not and to be diagnosed it has to have had been going on for at least six months. They experience prolonged, vague, unexplained but intense anxiety that does not appear to be related to a particular subject, situation, or event. They can also experience restlessness, muscle