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BAHAR BATU Assist. Prof. Dr. Slide 2 Slide 3 Lecture Preview Clinical Neuropsychology Geropsychology Forensic Psychology Slide 4 The clinical neuropsychology focuses on brain-behavior relationships, how brain functioning impacts behavior and problems. Neuropsychologists must be well experienced in neuroanatomy, neuropathology and clinical psychology. They assess a range of cognitive abilities such as executive or higher-order cognitive functions, sensory and motor functioning, memory skills, and abstract reasoning. Slide 5 The clinical neuropsychology Most neuropsychologists work in hospital, rehabilitation, or clinic settings. Some specialize in working with children, a field referred to as child neuropsychology. Slide 6 Some of the topics of interest to clinical neuropsychologists: head traumas, Alzheimers disease, stroke, dementia, epilepsy, seizures, tumors, alcohol, malingering, langauge problems, impairment due to injury, impairment due to chemotherapy, AIDS. Slide 7 The clinical neuropsychology Neuropsychologists administer and interpret a wide variety of specialty test batteries such as the Luria- Nebraska Battery and Halstead-Reitan Neuropsychological Battery and the individual test such as the Benton Visual Recognition Test, Wechsler Adult Intelligence Test- IV (WAIS-IV), Stroop and the Wisconsin Card Sorting Test (WCST). Slide 8 The clinical neuropsychology These tests provide information on the cognitive and psychological functioning of people with neuropsychological problems. Neuropsychologists provide consultation and rehabilitation services and conduct research into understanding, assessing, and treating these problems. Slide 9 Epilepsy is a seizure disorder that is defined as excessive electrical discharging of brain cells in a sudden, temporary and recurrent manner. Seizures result in intense muscle spasms, a complete or partial loss of consciousness. Infections, metabolic abnormalities, and biochemical factors contribute to the development of a seizure. Psychological stress provokes seizures among those vulnerable to epilepsy. Slide 10 Slide 11 Epilepsy affects about 1% of the population. Children are more likely to experience epilepsy than adults; children under the age of 5 and at puberty are the most vulnerable. Epilepsy is more likely to occur among lower SES. Etiology: Biopsychosocial factors: genetics, infections, SES, stress, nutrition, prenatal care contribute to the development of epilepsy. Slide 12 Epilepsy Because of the epileptic seizures, attention, concentration, memory, problem solving, motor, and intellectual abilities can be impaired. In addition to neurological functioning, personality and mood are altered by seizures. People with epilepsy are at higher risk for the development of psychiatric problems such as anx, depr, psychosis, and antisocial behavior. Slide 13 Epilepsy Neuropsychologists evaluate the cognitive and personality functioning of patients with epilepsy. Neuropsychologists are asked to differentiate seizures from pseudoseizure disorders and malingering. Some people present with seizures that are psychologically based (e.g., hysterical seizures) or intentionally feigne. Sometimes patients consciously or unconsciously fake having a seizure disorder for medical attention, financial or other reasons. Slide 14 Treatment of epilepsy reflects biopsychosocial perspectives. Anticonvulsant medication such as carbamazepine (Tegretol), Epdantoin and psychotropic medications such as benzodiazepines, antidepressants, and neuroleptics have been used to minimize the frequency, intensity, or duration of seizures. When medications dont work and seizures are localized to the temporal lobe, a temporal lobectomy may be performed. Slide 15 Slide 16 Slide 17 Brain Injuries Accidents causing brain injuries occur from accidents, falls, war wounds, sport injuries, gunshot wounds, and violent assaults. Concussions (jarring the brain) occur during accidents and impact brain functions such as memory, attention, concentration, and orientation. Strokes can impair language, motor skills, personality functioning, and other neurocognitive abilities. Environmental toxins such as poisons, gas fumes, and metals such as mercury and lead can result in brain injuries. Slide 18 Brain Injuries Neuropsychologists evaluate cognitive and psychological functioning and develop rehabilitation programs for brain injured patients. According to the nature of the problem and the special needs of the patient and family, psychotherapy, group support, education, and medical treatment may be involved. Brain injuries are common among soldiers, footballers and boxers. Slide 19 Degenerative Diseases include Alzheimers disease, dementia, Parkinsons disease, Huntingtons chorea, and infectious diseases such as syphilis. Gradual degeneration of neurological functioning results in problems in memory, attention, speech, judgment, and movement. Patients with degenerative diseases develop depr, anx, irritability, personality changes, and loss of social support. These patients needs sensitive care from others. Slide 20 Dementia associated with Alzheimers disease (AD) is the most well-known degenerative disease. AD involves memory loss, failure to recognize well-known people and objects, difficulty in organizing and planning, suspiciousness, and language problems. It is expected to increase in future years due to the increase of aging population. It is more common among people with lower educational levels and women. Slide 21 AD may be due to genetically and environmentally caused brain atrophy and plaque formation and low levels of the brain neurotransmitters acetylcholine (ACh), serotonin (5-HT), and noradrenalin (NA). Slide 22 Head trauma, malnutrition, drug and toxin exposure, viral infection, personality, and cultural factors may play a role in the AD. Neuropsychologists evaluate the cognitive and psychological functioning of these patients and assist in making a diagnosis. Slide 23 Treatment of AD Psychologists offer services including psychotherapy, group support, psychoeducational instructions, behavior management, and consultation with physicians, nurses, and other caregivers. Treatment approaches include family members who have a caregiving burden and have a loss of a loved one. Slide 24 Medication includes Aricept which alter the production of glutamate and acetylcholine. Slide 25 Slide 26 http://www.psinema.org/index.php?c=3 Slide 27 Slide 28 Slide 29 Vascular dementia is another type of dementia. It is different from the AD. It is due to cerebral infarct or blood problems. It usually occurs after age 50. Slide 30 In addition to dementia, epilepsy, and brain injuries, neuropsychology provide information of general psychological troubles. Depr is associated with neuropsychological dysfunction such as head trauma. Also, SCH is associated with structural and functional abnormailities in prefrontal cortex. fMRI, new diagnostic tool, become more common. Slide 31 fMRI Slide 32 Conclusion Neuropsychology is interested in how problems with brain impact behavior and psychological functioning. Neuropsychological disorders impact the patient and the patients family. Neuropsychologists can be helpful in assessment, treatment, rehabilitation and research about these disorders. Neuropsychology overlaps with health, child and forensic psychology. Slide 33 Geropsychology The number of elderly people has increased due to industrialization. People who over the age of 65 is accepted as elderly people. Geropsychology is an important and fast-growing new specialty area of clinical psychology. Full-time geropsychologists will be needed in Turkey and the world. Slide 34 Geropsychology Many older people experience urinary incontinence, insomnia, anx, depr, mourning associated with a variety of illnesses that impact their cognitive functioning such as AD and stroke. There is no enough social support services or experiences for elders. Geropsychologists provide prevention, assessment, consultation, and intervention services to help elders and their families deal with the many problems. They provide treatment for depr, anx, assessing cognitive impairment, and help cope with the loss of physical and mental functioning. Slide 35 Degenerative Diseases AD Vascular dementia is the second most common type of dementia. Vascular dementia is a result of cerebrovascular disease. Blood flow to the brain stop, it causes tissue damage. When this happens suddenly, a stroke occurs. Slide 36 Slide 37 Hypertension and atherosclerosis can create vascular dementia. Slide 38 Atherosclerosis. Cholesterol deposits in the large arteries form plaque, restricting the flow of blood. This condition, called atherosclerosis, can result in stroke and heart attack. Slide 39 Degenerative Diseases Cognitive and psychological changes are associated with the physical brain changes. Cognitive and psychological changes depend on both the nature of the patients premorbid functioning and the specific areas of the brain that are affected. Risk of stroke and other vascular dementia increases with age. Slide 40 Slide 41 Degenerative Diseases Parkinsons disease is another degenerative brain disorder. It is due to the brains inability to adequately produce the neurotransmitter, dopamine (DA). The symptoms are involuntary tremors and muscle rigidity. About half of Parkinsons disease patients develop dementia during the advanced stages of the illness. Slide 42 Parkinsons Disease Michael J. Fox Slide 43 Geropsychologists conduct neuropsychological testing to assess the degree of cognitive and psychological damage and the strengths of patients. They participate in individual, family, and group psychotherapy and psychoeducational activities. Slide 44 Psychiatric Issues in Older Adults Anx, depr, substance abuse, and mourning are common among the elderly. Diagnosing and treating these problems can be difficult. Many of the psychological problems experienced by elderly people could be related to comorbid medical problems and medication side effects. Furthermore, we have no idea what is normal and not normal for elderly people to experience, yet. Slide 45 Anxiety About 15% of elderly people experience an anx disorder. The anx is related to health, safety, and concerns about the well- being of loved ones. PTSD is common among the elderly and is often associated with mourning regarding the loss of a spouse or other close relative or friends. Biopsychosocial approaches using medication, CBT, and supportive approaches are successful for dealing with anx. Geropsychologists must work with physicians and family members. Slide 46 Depression Depr can be deadly for elders. The suicide rate among elder men is the highest. Diagnosis and treatment can be difficult. Because elders are more likely to report somatic problems than depressive symptoms. Depr among the elderly is associated with mourning, comorbid medical problems, and medication side effects. Slide 47 Substance Abuse Elderly persons experience problems with older adult onset alcohol abuse and prescription drug abuse. The most common drugs used by the elderly include diuretics, cardiovascular medications, sedatives, analgesics, and laxatives. Older persons metabolize alcohol more slowly, it leads to higher blood concentrations. Geropsychologists must be attentive to the potential of substance abuse among elders. Slide 48 Forensic psychology is defined as the application of psychology to legal issues. Forensic psychologists specialize in utilizing principles of human behavior to inform the judicial and legal systems. They are trained as clinical psychologists with a specialty in forensic work. They conduct psychological evaluations with defendants and present their findings as an expert witness in court. They provide evaluations for child custody, or be asked to predict dangerousness or determine if an individual is suitable to stand trial. Slide 49 Forensic psychologists assist in documenting mental distress, pain and suffering, and brain injury in legal action. Injury may include physical accidents or psychological traumas associated with sexual harassment, rape, violence, discrimination, and others stressful experiences. Forensic psychologists work in legal cases: involuntary commitment, the insanity defense, child custody, violence against women, and jury selection. Slide 50 Involuntary Commitment The laws allow someone to be committed to a psychiatric hospital if they are in serious and immediate danger of hurting themselves or others. Some people may have suicidal or homicidal thoughts, some must be protected from harming themselves or others. But freedom is a basic human right. Depriving a person of this important right through forced is involuntary commitment to a psychiatric hospital. Slide 51 Throughout the history, commitment to a psychiatric hospital or prison was used as a means of controlling people or punishment because of political, religious, or personal beliefs and activities. To commit someone against their will has been abused and continues in many countries. Slide 52 Involuntary Commitment K-Pax- Kevin Spacey, 2001 Slide 53 Changeling- Angelina Jolie, 2008 Primal Fear- R. Gere & E. Norton. 1996 Slide 54 Lady-Michelle Yeoh, 2011 Slide 55 Slide 56 It is often unclear if someone is indeed in serious danger of hurting themselves or others. Predicting dangerous behavior is very difficult. Forensic psychologists evaluate a patient using assessment techniques such as clinical interviews, cognitive tests, and both objective and projective personality tests to determine if someone is at high risk for harm to self or others. Slide 57 In a survey, WAIS-III, MMPI-2 scales were recommended to be used in evaluations. The Psychopathy Checklist- Revised (PCL-R) was recommended for risk for violence evaluations. Projective instruments such as drawings, sentence completion tests, and the TAT were found to be unacceptable to use for forensic issues. Slide 58 Insanity Defense The MNaghten Rule (1843) was named after Daniel MNaghten who attempted to kill the prime minister of England because he felt that the government was persecuting him. He mistakenly killed the prime ministers secretary. His symptoms were consistent paranoid SCH according to DSM- IV. The MNaghten Rule suggests that someone is not responsible for his criminal actions if he suffers from a disorder that makes him unaware of what he is doing or that what he is doing is wrong. Slide 59 The Insanity Defense Reform Act of 1984 states that someone can be found innocent due to reasons of insanity if he is unable to understand that criminal behavior was wrong at the time of the crime due to a mental disease or MR. Slide 60 Forensic psychologists evaluate these accused offenders to determine if they suffer from a mental illness that might meet the legal criteria of insanity. They provide expert opinion to the court to assist in determining if the accused person should be held responsible for their crime.They complete clinical interviews and conduct psychological evaluations to inform their judgments. Slide 61 J. Dahmer J. Hinkley Slide 62 Dahmer Dahmer was a notorious serial killer and sex offender in 1991. His long list of offenses involved sex, cannibalism, necrophilia, and dismemberment. Since he was a child, he had shown symptoms of withdrawal and avoidance of any social interactions. He would collect dead animals, then dissect, dissolve, or mutilate them in various ways. He committed the first murder in 1978, bludgeoning to death Steven Hicks, a hitchhiker because the guy wanted to leave and I didnt want him to. In September 1987, he picked up Steven Tuomi at a gay bar and killed him out of impulse, claiming no memory of the event later in trial. In 1988, he was also arrested for giving drugs and sexual fondling a 13 year old boy, Somsack Sinthasomphone. As a registered sex offender, he would then proceed to commit 15 more murders, storing the corpses in vats. Dahmer kept trophies of his victims such as human skulls and genitalia in the closet and saving biceps and the human heart in the freezer for later consumption. This happened up to the year 1991 when Tracy Edwarts, a would-be victim overpowered Dahmer, ran through the streets and waved for the police car. In the trial, Dahmer pled not guilty by reason of insanity. The plea was subsequently rejected and Dahmer was convicted of all 15 murder charges and sentenced to 15 consecutive life sentences. The case was seen by many as the death of the insanity plea. They contended that if a deranged criminal like Dahmer is rejected on the insanity plea, then no other criminal would qualify for the defense. Slide 63 J. Hinkley The next entry on the list is probably the most famous one yet. In 1981, Hinckley developed an obsession with the movie Taxi Driver, in which Jodie Foster stars as a child prostitute and Robert Deniro plays Travis Bickle, who plots to assassinate the presidential candidate in the film. He personally watched the movie 15 times consecutively and grew infatuated with Jodie Foster. Hinckley then began to stalk the actress by relocating to New Haven, Connecticut, near Yale University where she was enrolled. He signed for a Yale writing class, slipped her poems and messages through her door and calling her persistently. As he grew more desperate in his attempts, he even considered taking his own life in front of her to gain her attention. Eventually he decided to attempt an assassination on President Ronald Reagan. As the president left the Hilton Hotel, he shot six times at Reagan, wounding a few other people in the process. One of the bullets ricocheted and hit the president on the chest, who later succumbed to his injuries. Hinckleys defense team pled for insanity defense and succeeded, he was acquitted of all of his 13 charges of assault, murder and weapon counts. Due to the high profile of the case, the public perceived the insanity defense as a loophole in the legal system which allowed a clearly guilty criminal to dodge incarceration. The controversy laid in the fact that prior to the assassination attempt, the insanity defense was only used in 2% of the felony cases and in those cases failed over 75% of the time. Nonetheless, most states were pressured to reenact reforms of legislation regarding the use of the insanity defense. Slide 64 Child Custody About half of all marriages end in divorce, with the question of the childrens custody. Many years ago, children from divorced families were routinely given to the father. During the past 30 years, the mother has been awarded the children and the father has been allowed visitation rights and ordered to pay child support. In more recent years, these patterns have been challenged, joint custody arrangements are being worked. Joint custody: both parents retain custody of their children after divorce and that arrangements are made regarding living and financial matters to accommodate the needs and wishes of both parents. Slide 65 Since many divorces are highly conflictual, cooperation between parents about the care of their children is difficult to establish in joint custody arrangements. Children are often placed in the middle of conflict. When divorced parents remarry, the complexity often increases. In addition to child custody arrangements due to divorce, when child abuse, abandonment, and neglect occure, the complexity often increase. Slide 66 SHARON STONE OLUNUN VELAYET DAVASINI KAYBETT.. 'Temel gd'nn unutulmaz yldz Sharon Stone, evlat edindii olu Roan'n velayetinin kendisine verilmemesi davasn st mahkemeye tamt. Mahkeme tutananda, annenin olunun ayak kokusu problemini zmek iin botox yaptrmak istedii bilgisi geti. Hakim, annenin 8 yandaki bir ocuun medikal bir problemi iin bu kadar tepki gstermenin ocuk iin olduka 'incitici' olduunu syledi. Roan'n velayetini gazeteci babas Phil Bronstein'a veren geen ylki mahkeme kararn teyit eden yarg, bu kararna gereke olarak, Bronstein'n evinin ocuk iin daha uygun olduunu gsterdi. Yarg, Stone'un olunu grme hakkn ise korudu. Stone ve Bronstein, 6 yl sren evliliklerini 2004 ylnda bitirmilerdi. Stone'un, Roan'dan baka kendisinin evlat edindii Laird ve Quinn adnda 2 olu daha bulunuyor. Slide 67 The best interests of the child keep in mind. Forensic psychologists evaluate parents,and children to assist the court in determining who should have legal custody of children and what arrangements should be outlined for not only custody but visitation and other parental responsibilities. Slide 68 Child Custody Slide 69 Violence against Women The majority of women have been raped and have been physically assaulted by their partner. 20 % of women reported that they were sexually abused when they were children. These women experience PTSD. Forensic psychologists might be asked to evaluate survivors or perpetrators of abuse. Individual and group treatments are useful. Slide 70 Slide 71 A Thousand Acres (Secrets) Slide 72 Jury Selection Forensic psychologists work as consultants to attorneys concerning jury selection. Jury characteristics such as gender, race, SES, occupation and interests may contribute to the likelihood that a jury will be sympathetic to the defendant or plaintiff. Forensic psychologists consult with attorneys about how to best interact with the jury. Presentation styles and methods of argument enhance the chances that the jury will be favorable to the attorneys point of view. Slide 73 Conclusion Forensic psychology is another fast-growing subspecialty. They assist courts in determining many legal decisions. Forensic psychology overlap with clinical child psychology in child custody work and neuropsychology in the case of work-related accidents. Slide 74 Other Subspecialties In addition to health, child, neuropsychology, and forensics, there are other subspecialties and areas of expertise. There are specialties within subspecialties. Some clinical psychologists specialize in conducting neuropsychological evaluations among elderly persons who experience strokes. Others focus on treatment of children from specific minority populations. Others specialize in psychopharmacology. New subspecialties regularly emerge reflecting psychologys growing and changing evolution. Slide 75