Recognizing Signs and Symptoms of Mental Disease and

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Recognizing Signs and Symptoms of Mental Disease and Disorders MITIGATION INTENSIVE TUCSON, AZ APRIL

Recognizing Signs and Symptoms of Mental Disease and Disorders MITIGATION INTENSIVE TUCSON, AZ APRIL 2011

► “The defense team should contain at least one member qualified by training and

► “The defense team should contain at least one member qualified by training and experience to screen individuals for the presence of mental or psychological disorders or impairments. ” § Guideline 4. 2(A)(2).

Screening; Not Diagnosis ► Who is a Mitigation Specialist? § Not an evaluating expert

Screening; Not Diagnosis ► Who is a Mitigation Specialist? § Not an evaluating expert § Not a testifying expert § Not the fact investigator

Screening; Not Diagnosis ► Basic Tools § Complete Record Collection § Client Intake §

Screening; Not Diagnosis ► Basic Tools § Complete Record Collection § Client Intake § Life History Interviews

Basic Record Collection ► Thorough Record Collection on your Client and his/her family going

Basic Record Collection ► Thorough Record Collection on your Client and his/her family going back three generations and over by two degrees § Educational, Medical, Mental Health, Drug/Alcohol Treatment, Prison, CPS, Criminal Records, Military, Financial, Welfare, Social Security, Public Housing, Employment, Attorneys in prior cases, Public records for law enforcement files in prior cases, Courthouse searches of criminal, civil, family law, property, tax, marriage, probate, etc.

Basic Life History Investigation • Family members – three generations and two degrees •

Basic Life History Investigation • Family members – three generations and two degrees • Neighbors • Friends • Spiritual leaders • Day care providers • Classmates • Teachers • Medical professionals as fact witnesses • Co-workers and supervisors • Fellow inmates, guards, prison/jail medical and psych personnel • Former “victims” • Former co-defendants • Current relationships • Anyone who has ever had contact with your client and/or his family

Proper Investigation Takes Time ► No group interviews. ► No phone interviews. No calling

Proper Investigation Takes Time ► No group interviews. ► No phone interviews. No calling ahead of time. ► No tape-recording of interviews unless team decides to do so for a specific reason. ► Initial visits without an agenda ► NO CHECK LISTS OR FORMS ► ALWAYS GET RELEASES ► ALWAYS GET ARTIFACTS

Proper Investigation Is NOT Guided By the Client ► Don’t allow client/witnesses to do

Proper Investigation Is NOT Guided By the Client ► Don’t allow client/witnesses to do your job ► Seek sources independent of client/family ► Investigate without pre-judgment ► You don’t need conclusions from clients or witnesses ► You don’t even need cooperation from clients or witnesses

Brain Based Behavior ► Distractable ► Hyperactive ► Perseveration ► Social disabilities (inappropriate social

Brain Based Behavior ► Distractable ► Hyperactive ► Perseveration ► Social disabilities (inappropriate social interactions) ► Confusion ► Mediating emotion (impulse control) ► Unlikely to promote social integration and reproductive success ► Increased grimacing

Failure to Understand Disability ► View child as § Non compliant § Willfully stubborn

Failure to Understand Disability ► View child as § Non compliant § Willfully stubborn § Unmotivated (lazy) § Weird

Misperceptions ► Rather than § Confused § Unable to pay attention to several components

Misperceptions ► Rather than § Confused § Unable to pay attention to several components § Involved in repetitive routines § Focused on less relevant aspects of situations § Social disabilities in ►Relationships ►Problem solving ►Social rules

Consequences ► Easily set up by others ► Tries unsuccessfully to fit in ►

Consequences ► Easily set up by others ► Tries unsuccessfully to fit in ► Impaired ability to know what is a good idea and what is not ► Unable to grasp complex social relationships

Team Observations During Interviews ► Skin: § § Clear Acne Pale Abrasions

Team Observations During Interviews ► Skin: § § Clear Acne Pale Abrasions

Observations During Interviews ► Eyes: § § Dilated Rapid Movements Dull Normal

Observations During Interviews ► Eyes: § § Dilated Rapid Movements Dull Normal

Observations During Interviews ► Hygiene: § § § Unclean Clean Feces and Urine Food

Observations During Interviews ► Hygiene: § § § Unclean Clean Feces and Urine Food Drool Chapped/Cracking Lips

Observations During Interviews ► Appearance: § Disheveled § Neat

Observations During Interviews ► Appearance: § Disheveled § Neat

Observations During Interviews ► Mood: § § § § Suicidal Crying Lethargic Guarded, suspicious

Observations During Interviews ► Mood: § § § § Suicidal Crying Lethargic Guarded, suspicious Depressed Agitated Hopeless

Observations During Interviews ► Mood (cont. ) § § § § Catatonic (rigid, mental

Observations During Interviews ► Mood (cont. ) § § § § Catatonic (rigid, mental stupor) Dysphoric (unpleasant) Labile (mood swings) Euphoric (elation) Manic (deranged excitement) Irritable Viscous (clinging, does not want visitor to leave)

Observations During Interviews ► Speech: § Voice monotonous, excessively loud, excessively soft § Tangential

Observations During Interviews ► Speech: § Voice monotonous, excessively loud, excessively soft § Tangential (unable to have goal directed associations; never gets from desired point to desired goal) § Incoherent (thoughts that are not understandable) § Perseveration (persistent response to prior discussion; getting stuck) § Loose associations (ideas shift from one subject to the next) § Derailment (deviation of train of thought)

Observations During Interviews ► Speech (cont. ) § Flight of ideas (rapid, continuous talking;

Observations During Interviews ► Speech (cont. ) § Flight of ideas (rapid, continuous talking; play on words) § Coprolalia (compulsive utterance of obscenities) § Circumstantiality (indirect speech, over inclusion of details, parenthetical remarks) § Pressured (rapid speech, difficult to interrupt, motormouth) § Poverty of content (conveys little information but adequate in amount)

Observations During Interviews ► Thought: § Delusion (false belief) § Auditory hallucination (sounds that

Observations During Interviews ► Thought: § Delusion (false belief) § Auditory hallucination (sounds that are not present) § Visual hallucination (seeing things not present) § Paranoia (being persecuted) § Idea of reference (false belief that one is being talked about by others)

Observations During Interviews ► Thought (cont. ) § Thought broadcasting (one’s thoughts can be

Observations During Interviews ► Thought (cont. ) § Thought broadcasting (one’s thoughts can be heard by others) § Thought control (one’s thoughts being controlled by other persons or forces) § Delusion of grandeur (exaggerated conception of one’s power/importance) § Preoccupation of thought (centering thought content on particular ideas)

Observations During Interviews ► Feelings: § § § § Fear Shame Guilt Remorse Giddy/silly

Observations During Interviews ► Feelings: § § § § Fear Shame Guilt Remorse Giddy/silly Anxious Sexually provocative

Observations During Interviews ► Movement: § § § § § Touching Licking Rocking Drumming

Observations During Interviews ► Movement: § § § § § Touching Licking Rocking Drumming objects with fingers Leg shaking Pacing Slow/retarded Disrobing Tremors

Observations During Interviews ► Tics: § § § § § Snorting Clearing throat Grimacing

Observations During Interviews ► Tics: § § § § § Snorting Clearing throat Grimacing Turning head Verbalizations Moving eyebrows Darting eyes Arms/legs moving Expansive movements

Family Observations ► Always on the go ► Talks a lot ► Interrupts others

Family Observations ► Always on the go ► Talks a lot ► Interrupts others ► Life of the party ► Impatient ► Obnoxious ► Risk taker ► Spender

Family Observations (cont) ► Nail biter ► Sick a lot ► Rude ► Insensitive

Family Observations (cont) ► Nail biter ► Sick a lot ► Rude ► Insensitive ► Spoiled ► Shakes leg ► Couldn’t sit still