1. 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

2. 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.

3. Analytical and
positive
Emotional,
reactive and
negative

4. 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

5.  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.

6. 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.

7. 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.

8. Collateral Information
Individuals who, because of knowledge of before
and after cognition and behaviors, can bolster
the efficacy of reports.

9. 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

10. 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)

11. Additional sequelae to TBI
 Aggression
 Hypersexuality
Hallucinations/Delusions
Onset of Schizophrenia
 Depression
 Suicidal ideation

12. 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

13. Thank you for
your attention and
the opportunity to
participate in the
discussion!