Recognizing Signs Recognizing Signs and Symptoms of and Symptoms of

Mental Disease and Mental Disease and DisordersDisorders

MITIGATION INTENSIVEMITIGATION INTENSIVE

TUCSON, AZ APRIL 2011TUCSON, AZ APRIL 2011

►““The defense team should contain The defense team should contain at least one member qualified by at least one member qualified by training and experience to screen training and experience to screen individuals for the presence of individuals for the presence of mental or psychological disorders mental or psychological disorders or impairments.”or impairments.” Guideline 4.2(A)(2).Guideline 4.2(A)(2).

Screening; Not DiagnosisScreening; Not Diagnosis

►Who is a Mitigation Specialist?Who is a Mitigation Specialist?

Not an evaluating expertNot an evaluating expert

Not a testifying expertNot a testifying expert

Not the fact investigatorNot the fact investigator

Screening; Not DiagnosisScreening; Not Diagnosis

►Basic ToolsBasic Tools

Complete Record CollectionComplete Record Collection

Client IntakeClient Intake

Life History InterviewsLife History Interviews

Basic Record CollectionBasic Record Collection

► Thorough Record Collection on your Thorough Record Collection on your Client and his/her family going back three Client and his/her family going back three generations and over by two degreesgenerations and over by two degrees Educational, Medical, Mental Health, Educational, Medical, Mental Health,

Drug/Alcohol Treatment, Prison, CPS, Drug/Alcohol Treatment, Prison, CPS, Criminal Criminal Records, Records, Military, Financial, Welfare, Social Military, Financial, Welfare, Social Security, Public Housing, Employment, Security, Public Housing, Employment, Attorneys in prior cases, Public records for law Attorneys in prior cases, Public records for law enforcement files in prior cases, Courthouse enforcement files in prior cases, Courthouse searches of criminal, civil, family law, searches of criminal, civil, family law, property, tax, marriage, probate, etc.property, tax, marriage, probate, etc.

Basic Life History InvestigationBasic 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 TimeProper Investigation Takes Time

► No group interviews.No group interviews.► No phone interviews. No calling ahead No phone interviews. No calling ahead

of time.of time.► No tape-recording of interviews unless No tape-recording of interviews unless

team decides to do so for a specific team decides to do so for a specific reason.reason.

► Initial visits without an agendaInitial visits without an agenda► NO CHECK LISTS OR FORMSNO CHECK LISTS OR FORMS► ALWAYS GET RELEASESALWAYS GET RELEASES► ALWAYS GET ARTIFACTSALWAYS GET ARTIFACTS

Proper Investigation Is NOT Proper Investigation Is NOT Guided By the ClientGuided By the Client

► Don’t allow client/witnesses to do your Don’t allow client/witnesses to do your jobjob

► Seek sources independent of Seek sources independent of client/familyclient/family

► Investigate without pre-judgmentInvestigate without pre-judgment► You don’t need conclusions from clients You don’t need conclusions from clients

or witnessesor witnesses► You don’t even need cooperation from You don’t even need cooperation from

clients or witnessesclients or witnesses

Brain Based BehaviorBrain Based Behavior

► DistractableDistractable► HyperactiveHyperactive► PerseverationPerseveration► Social disabilities (inappropriate social Social disabilities (inappropriate social

interactions) interactions) ► ConfusionConfusion► Mediating emotion (impulse control)Mediating emotion (impulse control)► Unlikely to promote social integration and Unlikely to promote social integration and

reproductive successreproductive success► Increased grimacingIncreased grimacing

Failure to Understand Failure to Understand DisabilityDisability

►View child asView child as Non compliantNon compliant Willfully stubbornWillfully stubborn Unmotivated (lazy)Unmotivated (lazy) WeirdWeird

MisperceptionsMisperceptions

►Rather thanRather than ConfusedConfused Unable to pay attention to several Unable to pay attention to several

componentscomponents Involved in repetitive routinesInvolved in repetitive routines Focused on less relevant aspects of situationsFocused on less relevant aspects of situations Social disabilities inSocial disabilities in

►RelationshipsRelationships►Problem solvingProblem solving►Social rulesSocial rules

ConsequencesConsequences

►Easily set up by othersEasily set up by others►Tries unsuccessfully to fit inTries unsuccessfully to fit in► Impaired ability to know what is a Impaired ability to know what is a

good idea and what is notgood idea and what is not►Unable to grasp complex social Unable to grasp complex social

relationshipsrelationships

Team Observations Team Observations During InterviewsDuring Interviews

►Skin: Clear Acne Pale Abrasions

Observations During Observations During InterviewsInterviews

►Eyes: Dilated Rapid Movements Dull Normal

Observations During Observations During InterviewsInterviews

►Hygiene: Unclean Clean Feces and Urine Food Drool Chapped/Cracking Lips

Observations During Observations During InterviewsInterviews

►Appearance: Disheveled Neat

Observations During Observations During InterviewsInterviews

►Mood: Suicidal Crying Lethargic Guarded, suspicious Depressed Agitated Hopeless

Observations During Observations During InterviewsInterviews

►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 Observations During InterviewsInterviews

► 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 Observations During InterviewsInterviews

► 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 Observations During InterviewsInterviews

►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 Observations During InterviewsInterviews

►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 Observations During InterviewsInterviews

►Feelings: Fear Shame Guilt Remorse Giddy/silly Anxious Sexually provocative

Observations During Observations During InterviewsInterviews

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

Observations During Observations During InterviewsInterviews

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

Family ObservationsFamily Observations

►Always on the goAlways on the go►Talks a lotTalks a lot► Interrupts othersInterrupts others►Life of the partyLife of the party► ImpatientImpatient►ObnoxiousObnoxious►Risk takerRisk taker►SpenderSpender

Family Observations (cont)Family Observations (cont)

►Nail biterNail biter►Sick a lotSick a lot►RudeRude► InsensitiveInsensitive►SpoiledSpoiled►Shakes legShakes leg►Couldn’t sit stillCouldn’t sit still