MEDICAL CONDITIONS manifesting
SECONDARY PSYCHIATRIC DISORDERS
Presentation by Sharon J. Kernen,Ph.D.Comprehensive Forensic & Clinical
Neuropsychological Assessments Contact: 505-263-8055 [email protected]
New Mexico Criminal Defense Lawyers Association June 7, 2013
Psychiatric disorders may co-exist with many medical conditions and may provide cause for consideration of diminished capacity and may involve almost any age group. The brain anatomy most generally affected will be the frontal cortex, with embedded association pathways that virtually carry connections to all cerebral locations. Beyond the frontal cortex, the limbic cortex is also frequently involved. For purposes of this presentation we will focus on traumatic brain injury and dementia.
Analytical and positive
Emotional, reactive and
negative
Numerous conditions succumb to a variety of psychiatric disorders and the following are some, but not all, that may engender psychosis and are for references only:
Alzheimer’s dementia
Vascular dementia
Frontotemporal dementia
Lewy Bodies dementia
Parkinson’s
HIV
Creutzfeldt-Jacob (mad cow disease)
Cerebral malaria
Neurosyphilis
Viral encephalitis
Brain tumors
Normal pressure hydrocephalus
Temporal lobe epilepsy
Endocrine, adrenal, thyroid, parathyroid
Hepatic encephalopathy (liver failure)
Uremia and dialysis
Vitamin B deficiencies
Cerebral ischemia/anoxia (brain bleeds or oxygen deprivation
Temporal lobe strokes
Addison’s disease
All forms of dementia
Amyotrophic lateral sclerosis (Lou Gehrig’s)
Cushing’s disease (exposure to too much cortisol, usually use of corticosteroids)
Hepatic encephalopathy
HIV
Huntington’s disease
Hypercallcemia (high blood serum levels of calcium)
Hypocalcemia (low blood serum levels of calcium)
Hypothyroidism
Limbic encephalitis
Lyme disease
Malaria
Sleep apnea
Lupus
Vitamin B12 deficiency
Cardiovascular conditions
Diabetes Mellitus
The following may be the basis for severe depression. Any life-threatening condition can generate a depressive disorder.
The most common medical condition represented in incarcerated populations is traumatic brain injury (TBI) and is also one of the most difficult to defend in terms of diminished capacity.
The Golden Rule: Get the medical records from time of injury, particularly neuroimaging reports, MRI or fMRI!
Why? Requires proof in order to argue the severity of the injury.
Collateral Information
Individuals who, because of knowledge of before and after cognition and behaviors, can bolster the efficacy of reports.
Psychiatric conditions as sequelae to TBI that may affect culpability.
Cognitive deficits: memory, attention, and processing speed Most commonly malingered condition Personality changes Acquired sociopathy Dampening of emotional experience Impoverished expressiveness Poorly modulated emotional reactions and psychosis
Disturbances in decision-making, especially in the social realm Disturbances in goal-directed behavior Lack of insight into acquired changes Phineas Gage: Ventral medial prefrontal (VMPF)
Additional sequelae to TBI Aggression Hypersexuality Hallucinations/Delusions Onset of Schizophrenia Depression Suicidal ideation
DEMENTIA
Not just an old age problem Effects of dementia are not as obvious in the highly intelligent or highly educated Consider psychosis as a possible factor when criminal activities are involved Case Study
Thank you for your attention and the opportunity to participate in the discussion!
Top Related