Transcript Slide 1

Mental disorders, clinical evidence and
memory problems
relevant to IRB proceedings
Janet Cleveland, LL.L, M.Sc.,Ph.D.
Psychologist and researcher
McGill University
Relevance of psych reports for IRB
All divisions
1. Inability to understand proceedings - DR
2. Impaired ability to present one’s case –
procedural acccommodations
3. Ability to testify coherently (credibility)
RPD
4. Plausibility of alleged trauma
5. Mentally ill persons: members of particular
social group?
6. State protection/IFA
ID & IAD – release & stay of removal
7. Danger to the public
- e.g., schizophrenics no more violent than
general population
- drug or alcohol abuse increases risk of
violence
8. Conditions of release/stay of removal
- compliance difficulties inherent to certain
mental disorders
- need for case management & support
Clinical assessment process
Signs observed by clinician
- nonverbal signs, tone of voice, incoherence,
agitation, tears, facial expressions, etc.
Self-reported symptoms
- appearance & evolution of symptoms
- relevant personal & family antecedents
- current psychosocial stressors
Assessment vs. treatment
Investigation and analysis vs. support
Psychological tests
• Limited relevance for IRB proceedings
• Objective test = structured self report
• Cross-cultural validation: rare
Examples of differences: persecutory beliefs
• Detecting malingering
No specific test for veracity of PTSD or
depression claims
MMPI-2: not cross-culturally validated
Detecting malingering
• Veracity of person’s story
Clinicians monitor consistency with clinical
indicators
Not truth of alleged events
• Deception detection: psychiatrists,
psychologists, judges, police, customs officers,
general public…
Scarcely better than chance!
PTSD and depression - prevalence
• PTSD prevalence
- Conflict zones: 13-25%
- Western, non-conflict: 1-4%
• Depression prevalence
- Conflict zones: 13-36%
- Canada: 4-6%
• High comorbidity, esp. asylum seekers
Functional impairment +++
PTSD predictors
• Cumulative exposure to trauma
• Interpersonal violence
– Torture and rape +++
• Current stressors (e.g., exile, uncertainty, lack
of status, isolation, separation from family)
• Also predictors of depression
(+ loss of loved ones, loss of self-esteem, loss of
status)
• Individual vulnerability/resilience
PTSD – evolution over time
• Normal response to abnormal event
• Recovery rates (no treatment)
- By 12 months: 1/3 have recovered
- By 3 years: 2/3 have recovered
• Interpersonal violence (especially sexual
assault and torture) + repeated trauma
 Higher initial PTSD rate
More likely to remain chronic
 Greater impairment
PTSD & depression - impairment
Impairment relevant to IRB proceedings
Ability to tell a coherent/consistent story
Memory
Reluctance to talk about trauma
Emotional incongruence (e.g., apparent
lack of emotion)
Nonverbal behavior
Vulnerability (disorganization, suicidal
reactions, etc.)
Memory – general principles
Not a video recording!
Encoding
• Limited attention
Most information not encoded
 Focus on what is most important in the
moment
• Interpretation
Expectations, stereotypes, knowledge
E.g., young man with pistol/cell phone
Encoding (cont.)
• Poor memory for time (dates, etc.)
Abstract
Inferred, not perceived
• Intense emotions: ‘tunnel vision’
Narrowing of focus on central features
Fewer secondary features encoded
‘Weapon focus’
• Violence, fear, horror
Decreased memory for preceding events
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Storage – recall - narrative
Memory is dynamic
Gist of events retained, secondary details fade
– Even for traumatic memories
Recounting events transforms them into a
coherent narrative
Filling in gaps – ‘scripts’ and inferences
Incorporating new information – source
confusion
Repeated events – consolidation
Hypermnesia – increased recall
Context of recall – impact on memory
Intense anxiety at time of recall
Increases confusion, omissions, incoherence
Especially for individuals who are anxious,
depressed or have other psychological
difficulties
PTSD effects: intrusive memories
Intrusive memories, nightmares, flashbacks
- Involuntary, vivid, distressing
- Physical symptoms (e.g., fast heartbeat)
- Suppression/avoidance of traumatic memories
and triggers
- Negative impact on concentration
- IRB hearing may trigger traumatic memories
PTSD effects: memory for events
• Amnesia?
- Traumatic Brain Injury or HIV/AIDS
Effect of PTSD on memory
School 1. More incoherent, more inconsistencies
vs.
School 2. No negative impact on memory
UNLESS significant dissociative symptoms
Determining factor: stress at time of recall
Consensus on PTSD & recall
Factors that negatively impact attention,
concentration & memory:
- Recall in a high-stress context
- Insomnia
- Depression
- Avoidance of ‘triggers’
- Reluctance to trust following interpersonal
violence
- Dissociative symptoms
Depression – effects on recall
• Moderate/severe depression
Concentration and attention problems
Slowed response (may be mistaken for
dishonesty)
Insomnia – negative impact on memory
 Despair, self-punitive tendencies
Guideline 8 – Vulnerable persons
Why limit to “the more severe ” cases?
Procedural accommodations
 Foster more accurate credibility assessment
Decrease interference of stress
Questioning vulnerable persons
IRB Training Manual on Victims of Torture