MEDICAL CONDITIONS manifesting

SECONDARY PSYCHIATRIC DISORDERS

Presentation by Sharon J. Kernen,Ph.D.Comprehensive Forensic & Clinical

Neuropsychological Assessments Contact: 505-263-8055 kershar@comcast.net

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!