posted 07-23-2005 08:05 PM            

I had a incident occur yesterday and would like some input and opinions. A lady called me and asked for a private exam to be conducted on herself regarding fidelity type issues. She spoke slowly and interestingly apologetic. This piqued my curiosity, so after agreeing to conduct the exam and setting the appointment I asked her if she was taking any meds, to which she said yes. She reported she had been diagnosed (not recently) with accute clinical depression and took drugs for that, but was not seeing any psychologist or psychiatrist for the continuing disorder. This also made me wonder where she was getting her drugs.

I have in the past, as soley an ethical issue, refused to conduct any exams with someone who has a clinical diagnosis without consultation of their doctor (keeping in mind she said she no longer saw one). This is primarily to ensure I do not interefere with any therapy, etc. I told her this and she told me she had formerly been in therapy and had a full understanding of the disorder and that I knew nothing of psychology, then promptly hung up.

I suppose I could have taken the greedy avenue and just do the test, but I have to sleep with myself (and that's already ugly).

Knowing that depression, in and of itself would have no real bearing on the examination's outcome (as it is not a psychotic type disorder), what are your thoughts on whether this test could or even should have been conducted? And, interestingly enough, this is not the first time this has happened.

Thanks in advance for any opinions,

posted 07-24-2005 08:50 PM            

I have administered examinations to people diagnosed with depression and other psychosis, as long as it was not a recent diagnosis and they were stable on their medication and had been taking the medication for awhile. Of course their suitability for testing was clearly determined during the pre-test.

As specifically for depression, I have found that examinees who were stable on their meds were no different than anyone else.

As far as your caller not seeing a psychologist/psychiatrist, that I find is more common than not. Most of the people I run into are being prescribed anti-depressants from their family practice physician, even long term. I don't know why physicians continue to do this, but they do. In pre-employment testing I am finding about 1 out of 5 applicants are taking anti-depressants.

If I have any doubts, I have the examinee sign a waiver and I speak with their physician before the test.

posted 07-24-2005 10:11 PM            

Sackett, if the lady had called me and I had your same concerns, I would have asked her to see a physician and provide a doctors note stating that that there was nothing present to preclude her from taking the exam.

I think there are a lot of individuals that would get on meds if they knew we would decline to test them because of depression meds. I know all the parolee sex offenders I test would do anything to get out of polys.

posted 07-28-2005 07:04 AM            

I did ask her to get a note from her doctor indicating that taking the exam would be no problem for treatment or therapy, that's when I found out she wasn't seeing one.

Also, I know psychiatric patients lie about their disorders or symptoms, that is what prompted me to say no. She said, a long time ago diagnosis, but not seeing a doctor BUT taking prescription meds; it just sent the flags a-waivin' and say something was too wrong with this lady that I didn't want to discover.

I'm glad I avoided this one and thanks to all for the input.

See you in San Antonio,

posted 07-28-2005 03:15 PM            

I routinely test juveniles and adults on medications for mental health reasons, and have some observations and clinical insights, as I have also done a great deal of psychological testing, psychodiagnostic work, and differential diagnosis around Axis I and Axix II psychiatric issues, developmental disorders and neurologically-based specific learning disorders. I am not a neuropsychologist or psychiatrist, but have worked around psychotropic medications for almost 20 years. I was a psychotherapist for 12 years before going into polygraph 5 years ago.

I routinely test juveniles and adults on medications for mental health reasons, and have some observations and clinical insights, as I have also done a great deal of psychological testing (IQ, personality, mental health, medication response, mental status, learning disorders) psychodiagnostic work, and differential diagnosis around Axis I and Axix II psychiatric issues, developmental disorders and neurologically-based specific learning disorders. I am not a neuropsychologist or psychiatrist, but have worked around psychotropic medications for almost 20 years. I was a psychotherapist for 12 years before going into polygraph 5 years ago.

Here are my carefully thought out ideas.

"Acute clinical depression" is not the correct diagnostic term and will not be found associated with any DSM-IV-TR diagnostic or V code. Major Depressive Disorder would be correct for long term medication treatment patients, and can include psychotic (lack of reality contact) features. If a Major Depression were an acute condition being treated psychopharmacologically, there would be a psychiatrist or other mental health practitioner involved. Generally, acute conditions are diagnosed under the category and diagnostic codes of Adjustment Disorders (which can included depressive, anxious, and other symptoms) and their etiology can be linked to acute external conditions (e.g., divorce, separation, trauma, etc.)

To my knowledge there is no published research or theoretical rationale suggesting that any non-psychotic mental health conditions nor any medications (for mental health or medical purposes would cause erroneous polygraph examination results. Clinical commonsense suggests that persons who function optimally while taking properly prescribed medications might also produce polygraph test data of optimal interpretable quality while taking any necessary medications. However, persons who require the careful administration of multiple medications (psychotropic or other) to function adequately during a school-day or work-day, cannot arguable be considered "normal" persons, and might be predicted to fall outside the normal range in a normal statistical distribution of measured functional, mental health, behavioral, or physiological characteristics.

Obviously, the application of normative testing methods, normative test interpretations rules, and normative decision thresholds to individuals known to lie outside the normative population or sample upon which a test or method is developed or intended should always be regarded with caution, and test results might be considered qualified. This is not to say that test results are likely to be inaccurate – interpretable test data probably means exactly what it appears to mean. This only suggests that it is not empirically responsible to apply normative methods, normative data, and normative interpretation and decision guidelines to clearly exceptional persons (it would be bad science) without caution. In many fields professional opinions offered under these circumstances are termed "qualified."

I include these careful constructed ideas in the examination report as needed.

There is data (old research) indicating that polygraph test results may not be valid (empirical reliability is not the same as validity or accuracy) with psychotic individuals (lack of reality contact) or mentally retarded persons (memory, logic, language, conceptual, and temporal organization difficulties).

r

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[This message has been edited by rnelson (edited 07-28-2005).]

posted 08-18-2005 12:28 PM            

Stern B.A., Krapohl D.J. (2004). The Efficacy of Detecting Deception in Psychopaths Using A Polygraph, Brett A. Stern and Donald J. Krapohl. Polygraph, 33(4), 201-213.

It examines the research done on this topic by Raskin and Hare (1978), Hammond (1980), and Patrick and Iacono (1989). The conclusion is that the research reviewed suggests that:

quote:

---

when psychopaths engage in deception, his or her deception is no more difficult to detect than deception practiced by non-psychopaths.

---

posted 09-09-2005 01:14 PM            

The 2003 NRS report offers similar information regarding psychopaths.

It is very important that people note that psychopathy and psychosis are very different diagnostic and clinical phenomena.

Psychopaths are notable non-psychotic (i.e., not actually out of touch with reality) though they are sometimes grandiouse, while psychotic persons (persons with psychotic disorders) lack reality contact - by definition.

Psychopathy is a personality disorder best defined by the work of Dr. Robert Hare (who was doing research with Raskin in about 1978) though is not included in the DSM-IV-TR diagnostic manual Axis II section.

Psychopathy and other personality disorders cannare noteabley resistant to treatment with medications. People tend not to change their core-personalities during their lifetimes - else we wouldn't recognize them as they age, change jobs, politics, appearance, manner of dress, friends etc. Personality disorders are notably resistant to most forms of talk-psychotherapy, and a good deal of research with psychopaths suggests that most, if not all, forms of therapy tend to be correlated with increased rates of recidivism - though they also tend to get excellent reports from their therapists. The clinical challenge is to identify psychopaths and not treat them but "manage" them.

Psychopathy is estimated in prevalence at about 1 percent of the population - though selection bias means that law enforcement workers will experience a greater proportion. Prison polulation prevalence has been estimated sometimes as high as 10 to 25 percent - depending on the country and prison.

Psychopaths are not omniscient - nor highly intelligent. They tend to present as very intelligent, though upon psychometric testing most appear about average. They are very reckless, impulsive, manipulative, oportunistic, and versatile criminals. Superficial charm is one halmark of psychopathy - though spending any ammount of time around them tends to lead quicly to a painful awareness of their bothersome qualities. The worst psychopaths are the sadistic psychopaths, and the worst of those are the highly intellegent ones. The most concerning psychopaths, of course, are those sadistic psychopaths, who are highly intelligent and also have very good social skills. (Now you see a couple of good examples among our known serial killers.)

Where violence is a known phenomena of teenaged and young adult males, psychopaths tend not to outgrown violence (or criminality) during their lifetimes (like most people do), and the rates of violence among psychpaths is well above average.

Psychotic disorders are acute or florid, Axis I, disorders involving a noteable lack of contact with reality - and often result in psychiatric hospitalization. There is no diagnosis of "psychotic," though psychotic disorders include common chronic mental health disorders like schizophrenia, and other chronic mental health problems, delusional disorders, (and my personal favorite - Folie a deaux - in which two or more persons share a psychotic delusion). Delusional disorders can be diagnosed as "non-bizarre" (could occurr in reality) such as the CIA spying on them, or "bizarre" (could not occur in reality) such as Elvis Presley spy on them from a flying saucer - even if on behalf of the CIA (sorry Elis fans). Bipolar disorders are by definition psychotic disorders, though not all persons with bipolar disorder are psychotic (out of touch withy reality). Some common mental health problems, such as depression, can also be diagnosed "with psychotic features." Generally speaking, psychotic disorders, like psychopathy, do not respond well to pscychotherapy - as they don't always contact the therapist from a reality-based perspective. However psychotic disorders can be quite effectively treated with a variety of older and, especially, newer medications including neuroleptics (antipsychotics), mood-stablizers (lithium), sometimes anticulvsants (for reasons not completely understood), and some of the newer antidepressants (SSRIs).

Pychotic persons, in general, engage in violence at rates no more frequent that the general non-psychotic population. However psychotic persons who engage in violence are at greater risk for continued for recurrent engagement in violence when compared with non-psychotic non-psychopathic persons who engage in violence.

Psychopathy and Psychosis is essentially the difference between Bundy and Hinckley.

The fact that psychopaths are not psychotic is exactly why the polygraph works. The fact that "pathological liar" is not a ligitamate DSM-IV-TR Axis I or II diagnostic category tell us sometime. Pathological liars are not psychotic - they don't "believe their own lies." They know why they lie and when they lie. They lie to achieve goals. They lie to avoid consequences. They lie for fun. But they know when they lie. People who believe, experience (hear, see, smell), or perceive things that are not real are psychotic. Psychotic persons are not good polygraph subjects - refer to Abrams' work from the mid-1970s. Clinical commonsense should tell us that persons who interact with or experience things that are not real, cannot be relied up to react predicable to polygraph stimulus questions. Who amoung us (non-psychotics) knows what a psychotic persons react to - and I wouldn't suggest sharing a psychosis (Folie a deaux) just to find out... (Oddly, I've treated juveniles from two different families with this disorder and they are almost intractable, as they tend to reinforce each other's delusions and engagement in the psychosis.)

Research and theory pertainging to psychotic and psychopathic disorders cannot be easily generalized to each other.

posted 09-09-2005 01:17 PM            

The 2003 NRS report offers similar information regarding psychopaths.

It is very important that people note that psychopathy and psychosis are very different diagnostic and clinical phenomena.

Psychopaths are notably non-psychotic (i.e., not actually out of touch with reality) though they are sometimes grandiouse, while psychotic persons (persons with psychotic disorders) lack reality contact - by definition.

Psychopathy is a personality disorder best defined by the work of Dr. Robert Hare (who was doing research with Raskin in about 1978) though is not included in the DSM-IV-TR diagnostic manual Axis II section.

Psychopathy and other personality disorders are notably resistant to treatment with medications. People tend not to change their core-personalities during their lifetimes - else we wouldn't recognize them as they age, change jobs, politics, appearance, manner of dress, friends etc. Personality disorders are known to be resistant to most forms of talk-psychotherapy, and a good deal of research with psychopaths suggests that most, if not all, forms of therapy tend to be correlated with increased rates of recidivism - though psychopathes also tend to get favorable reports from therapists who are naive to psychopathy. The clinical challenge is to identify psychopaths, and not treat them but "manage" them.

Psychopathy is estimated in prevalence at about 1 percent of the population - though selection bias means that law enforcement workers will experience a greater proportion - so will polygraph examiners and counselors in forensic settings. Prison polulation prevalence has been estimated sometimes as high as 10 to 25 percent - depending on the country and prison. (The US may be becomming quite good at raising psychopaths - and sometimes putting them in positions of leadership or authority.)

Psychopaths are not omniscient - nor highly intelligent. They tend to present as very intelligent, though upon psychometric testing most appear about average. They are very reckless, impulsive, manipulative, oportunistic, and versatile criminals. Superficial charm is one halmark of psychopathy - though spending any ammount of time around them tends to lead quickly to a painful awareness of their bothersome qualities. The worst psychopaths are the sadistic psychopaths, and the worst of those are the highly intellegent ones. The most concerning psychopaths, of course, are those sadistic psychopaths, who are highly intelligent and also have very good social skills. (Now you see a couple of good examples among our known serial killers.)

Where violence is a known phenomena of teenaged and young adult males, psychopaths tend not to outgrown violence (or criminality) during their lifetimes (like most people do), and the rates of violence among psychpaths is well above average.

Psychotic disorders are acute or florid, Axis I, disorders involving an observable lack of contact with reality - and often result in psychiatric hospitalization. There is no diagnosis of "psychotic," though psychotic disorders include common chronic mental health disorders like schizophrenia, and other chronic mental health problems, delusional disorders, (and my personal favorite - Folie a deaux - in which two or more persons share a psychotic delusion). Delusional disorders can be diagnosed as "non-bizarre" (could occur in reality) such as the CIA spying on them, or "bizarre" (could not occur in reality) such as Elvis Presley spy on them from a flying saucer - even if on behalf of the CIA (sorry Elis fans). Bipolar disorders are by definition psychotic disorders, though not all persons with bipolar disorder are psychotic (out of touch withy reality). Some common mental health problems, such as depression, can also be diagnosed "with psychotic features." Generally speaking, psychotic disorders, like psychopathy, do not respond well to pscychotherapy - as they don't always contact the therapist from a reality-based perspective. However psychotic disorders can be quite effectively treated with a variety of older and, especially, newer medications including neuroleptics (antipsychotics), mood-stablizers (lithium), sometimes anticulvsants (for reasons not completely understood), and some of the newer antidepressants (SSRIs).

Pychotic persons, in general, engage in violence at rates no more frequent than the general non-psychotic population. However psychotic persons who engage in violence are at greater risk for continued for recurrent engagement in violence when compared with non-psychotic non-psychopathic persons who engage in violence.

Psychopathy and Psychosis is essentially the difference between Bundy and Hinckley. Both can be very dangerous. However all psychopaths are dangerous, while only some psychotics are very dangerous (though we usually say they are a danger to themselves or others in order to warrant a hospitalization).

The fact that psychopaths are not psychotic is exactly why the polygraph works. The fact that "pathological liar" is not a ligitamate DSM-IV-TR Axis I or II diagnostic category tell us sometime. Pathological liars are not psychotic - they don't "believe their own lies." They know why they lie and when they lie. They lie to achieve goals. They lie to avoid consequences. They lie for fun. But they know when they lie. People who believe, experience (hear, see, smell), or perceive things that are not real are psychotic. Psychotic persons are not good polygraph subjects - refer to Abrams' work from the mid-1970s. Clinical commonsense should tell us that persons who interact with or experience things that are not real, cannot be relied up to react predicable to polygraph stimulus questions. Who amoung us (non-psychotics) knows what a psychotic persons react to - and I wouldn't suggest sharing a psychosis (Folie a deaux) just to find out... (Oddly, I've treated juveniles from two different families with this disorder and they are almost intractable, as they tend to reinforce each other's delusions and engagement in the psychosis.)

Research and theory pertainging to psychotic and psychopathic disorders cannot be easily generalized to each other.

r

posted 09-09-2005 02:07 PM            

About 80% of our criminals qualify for APD, but only a portion of those are pyschopathic, which I think should be a factor at sentencing, since they don't get any better. Even though we can test them as any other person, I don't want to see them back in my office again a short time down the road, but now that's more of a political than polygraph issue.

posted 09-09-2005 06:29 PM            

Diagnostic work is very complicated and differential diagnosis is even more so.

In order to improve reliability (which sets the uper limit of validity) the DSM committees had to come to terms with the fact that most people (even therapists, doctors, psychiatrists, and psychologists) are not that good at it.

To assure that most professionals would end up in the same ballpark, most diagnosis are made based upon observable behavioral features - which means primarily overt social behaviors. This makes sense, but when you start limiting personality issues to behavior al descriptions (and in the case of APD most of these observable social behaviors are criminal in nature), you are not really talking about personality but behavior. As a result, Antisocial Personality Disorder has been somewhat unitentionally over-synonymous with criminality. This is now entrenched in our understanding and it is not appropriate to diagnose APD without a sufficieny variety and pattern of observable problem behavior that violate social norms and negative affect the rights of others.

Some disagreable folks do not engage in criminal behaviors and these usually end up with some other personality disorder diagnosis, such as narcissism, obsessive-compulsive personality disorder (as distinct from obsessive compulsive disorder), hystrionic, borderline or other PD.

Psychopathy, as described by Robert Hare is a combination of an intensely self-centered personality structure (independent of criminal behaviors), coupled with a variety and pattern of reckless antisocial behavior that violates social norms and negatively impacts the rights of others. So, APD might by simplistically understood as pertaining to factor 2 in the PCL-R scheme, while intense narcissism might be simplistically understood as pertaining to factor 1 of the PCL-R. A sufficient volume of problems must be involved in both areas to achieve a diagnosis of psychopathy.

It is not a good idea to use these terms frivolously, as that only depletes the accuracy of our diagnostic statements, and imposes potentially life-altering decisions and expectations pertaining to an individual.

Many, if not most juveniles, espeicially those omnipotent violent young males whom we encounter so much in the course of our work, are somewhat antisocial, and violence is strongly correlated with youth and young adulthood. Most people outgrow these behaviors by midlife - psychopaths do not.

To my knowledge there is no published research or theoretical rationale suggesting that persons with APD would be able to beat the polygraph.

r