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Psychosis in Juvenile Delinquents

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Chelsea Henderson

on 24 October 2012

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Transcript of Psychosis in Juvenile Delinquents

Psychosis in Juvenile Delinquents: The Roots of Rebellion? Chelsea L. Henderson What is psychosis? The Symptoms Schizophrenia Psychosis in Children Prevalence in Delinquents The Interaction between Delinquency and Psychosis
Merriam-Webster: As a disorder...
A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.

The Medical Dictionary: As a symptom...
Psychosis is a symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or nonexistent sense of objective reality. Defining Psychosis What comes to mind when you picture psychosis? Key Symptoms
Loss of Contact with Reality
Positive Symptoms:
Distortion of Perception and Mood
Hallucinations
Delusions
Disorganized Thought or Speech
Negative Symptoms:
Social Isolation
Reduced Work or Education Productivity
Sleep Disturbance
Lack of Motivation
Flattened Affect An Overview of the Diagnostic Make Up Hallucinations: Figments of the Senses Hallucinations may be simply described as any experience involving the perception of something not present. Auditory: the perception of sound in the absence of authentic stimuli (i.e. event narration, commanding voices, and musical replay) Visual hallucinations remain one of the most commonly reported psychotic symptoms.
These visions may range from mild disturbances in visual acuity to complete scene integration. Hallucinations: Figments of the Senses http://www.ted.com/talks/oliver_sacks_what_hallucination_reveals_about_our_minds.html
(3:24) "Psychotic hallucinations...address you. They accuse you. The seduce you. They humiliate you. They jeer at you. You interact with them." Oliver Sacks Tactile: the falsely perceived pressure stimuli to a number of sensory nerves and organs.
Formication


Olfactory: falsely perceived scents
Often linked to memory
A familiar perfume
Decaying flesh


Gustatory: falsely perceived tastes
Commonly reported in cases of Epilepsy Hallucinations: Figments of the Senses Delusion: a fixed false belief resistant to reason or confrontation of fact Positive Symptoms Continued: Delusions Paranoid Delusions
A.k.a. persecutory delusions
The fixed false belief that one is being harmed or persecuted in some manner.
Often present in conjunction with auditory hallucinations.

Delusions of Grandeur
Imply a sense of heightened greatness, power, or influence that is not truly present Other Delusional Forms How do these symptoms disconnect one from reality? Is it harmful to confront a psychotic patient with reality? Psychosis is most prominently identified by a separation from reality.

Psychotic symptoms are divided into positive and negative categories.

Hallucinations may appear in any of the bodily senses.

Delusions of grandeur and paranoid delusions are among the most common.

Common negative symptoms include: Social isolation, reduced work or education productivity, sleep disturbance, lack of motivation, and flattened affect. Broad Review of Psychosis Schizophrenia:
A Rare Look at the Fractured Psyche Schizophrenia is a psychotic disorder marked by impaired thinking, emotions, and behaviors.

Features:
emotional blunting
intellectual deterioration
social isolation
disorganized speech and behavior
delusions
hallucinations

Symptoms typically onset between fifteen and twenty-five.
However, diagnosis is traditionally delayed.
DSM-IV requires six months of persistent symptoms. Defining Schizophrenia Complications:
Unable to filter sensory stimuli
Enhanced perceptions of sounds, colors, and other features of their environment.

Schedule and stress management is key.
When untreated:
withdraw from interactions with others
lose their ability to take care of personal needs and grooming

Risk does increase with family history.
Note: One of John Nash's son also has Schizophrenia

Currently represents 1% of the United States Examples of Schizophrenia Defining Schizophrenia Questions about psychosis? Psychotic symptoms? Schizophrenia? Hallucinations? Delusions? Psychotic symptoms appearing before age eighteen. Early Onset Psychosis Psychosis in Children Too young? Imaginary friends? Hallucinations? Delusions? Age of onset? Misdiagnosis? Prevalence varies greatly between subject sample.

Hard to pinpoint:
Misdiagnosis (i.e. AD/HD or Autism)
Developmental Issues
Assessment methods

In an attempt to facilitate detection and intervention, 'pre-psychotic states' have been identified. Disturbed thought
Alterations in:
Mood
Appetite
Sleep
Behavior
Overall functioning





20% of the general youth have identified mental health difficulties.
The percentage attributed to psychotic symptoms is unclear. Pre-Psychotic States 1 of every 100 people have Schizophrenia.
Onset prior to age 18 is less common.
Onset prior to age 13 is exceedingly rare. Early Onset Schizophrenia How could early onset psychosis insight juvenile delinquency? Commands? Out of Control? Responsible? Delusions? Unidentified? Hallucinations? Due to the separation of psychotic detainees and misdiagnosis, prevalence rates are highly debated. Disagreement in the Field Vreugdenhil et al. (2004) Tiffin (2007) Collins, et al. (2009) Stahlberg et al. (2010) Stoddard-Dare (2011) Studied make adolescent detainees in the Netherlands
204 incarcerated boys
Between age 12 and 18
Diagnostic Interview Schedule for Children, version 2.3
34% of the population screened positive for psychosis
66% of the population expressed some form psychotic experience



Limitations:
Generalization (Only Male)
Earlier versions of the DISC were found to over-report psychosis Vreugdenhil et al. (2004) Practical overview
Early onset psychosis serves as an increased threat to oneself and others.
The peak of violence occurs during psychotic episodes.
Fear overrides inhibition
Command hallucinations and paranoid delusions may be acted upon
The risk of suicide increases following psychotic episode.
This is due to the depressive flux of chemicals following the break.

Emphasized the use of Cognitive Behavioral Therapy in juvenile facilities
Taught to cope with hallucinations
Deconstruct delusions
Solve other symptomatic issues
Does not contain prevalence research, but displays the increased interest in this specific correlation. Tiffin (2007) Summarized previous research:
1 to 4% of juvenile detainees have psychotic disorders
25 to 75% expresses psychotic symptoms
Diagnostic Interview Schedule for Children
230 adolescent detainees
78% of the population held at least one psychotic experience
72% Delusional beliefs
43% Hallucinations
Of those experiencing psychosis, 88% were diagnosed with one or more psychotic disorders.

Offered a possible explanation for this increase in detained population:
Increased use of marijuana
Methamphetamine Collins et al. (2009) Cited a meta-analysis of 25 studies: tenfold increase in psychotic disorders in institutionalized population.
Study:
73% had one or more psychological disorder
12% Psychotic symptoms
3% Psychotic disorders



While these numbers represented a much smaller scale, there was still a notable increase when compared to general juvenile populations. Stahlberg et al. (2010) Youth affected by Bipolar Disorder were eight times more likely to commit a crime than those who did not have this disorder.









While this study was specifically geared toward one psychotic disorder, it does reinforce the trend of increased criminal behavior in psychotic detainees. Stoddard-Dare (2011) We need more research! Summary Early onset psychosis and Schizophrenia are very rare, but do seem to be more prevalent in the institutionalized populations.
The study of pre-psychotic states are opening doors to the understanding of child psychotic experiences.
Psychosis is highly studied in adult criminal populations, but is still emerging in the juvenile populations.
There is no community consensus on the prevalence of psychosis in juvenile institutions.
During psychotic break, juveniles may be especially dangerous to both themselves and others.
Drug use exacerbates psychotic symptoms and may explain the correlation to the delinquent population. Review Any question? The End Psychosis? Juvenile Detainees?
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