Differential Dx for California shooter?

[Yoyomama88]

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I realize we have a very limited history, but what is your differential?

A) Narcissistic Personality Disorder/ Anti-social B) Pure Evil C) Autism-Spectrum?

 

[shoenberg3]

Kinda curious myself although obviously it would be impossible to make a proper diagnosis.
Here's link to the 140-page "manifesto" that outlines his life and motivations


http://www.scribd.com/doc/225960813...s-shooting-suspect-My-Twisted-World-manifesto

 

[Leo Aquarius]

I feel this tragedy highlights the fact that this country needs to stop stigmatizing psychiatry and start fostering mental health care if it wants to help prevent future tragedies like this one. It's about time America take mental health seriously.

How thick the irony is. The killer was the son of a Hollywood director, Hollywood being the bastion of anti-psychiatry anti-psychology banter. Well there ya go Hollywood. Time to wake up and smell the smoke.

 

[st2205]

The top two in my differential I'd consider:

-Self-inflicted GSW
-Acute blood loss

A few others I'd consider, but much further down on the differential.

 

[OldPsychDoc]

Good blog post (as always) from Dr George Dawson: http://real-psychiatry.blogspot.com/2014/05/rampage-killing-public-health-approach.html

 

[birchswing]

It's a tragedy.

http://en.wikipedia.org/wiki/Goldwater_rule

 

[erg923]

Narcissism, narcissistic rage/injury. Not the PD diagnosis mind you, just a description. And not even a complex one at that. He was mad women, or something? They are mean and yada yada. Well, join the club numbnuts. No I did not read it and and no I am not interested in doing so.

PS. It looks, uh, lengthy, which only adds to my assertion.

 

[OldPsychDoc]

http://www.theonion.com/articles/desperate-nation-tries-getting-on-board-with-mass,33894/

 

[MLT2MT2DO]

The top two in my differential I'd consider:

-Self-inflicted GSW
-Acute blood loss

A few others I'd consider, but much further down on the differential.

The fact I find this hilarious makes me wonder if I should be working up a Psych DD on myself.

 

[OldPsychDoc]

The fact I find this hilarious makes me wonder if I should be working up a Psych DD on myself.

http://www.sciencedaily.com/releases/2011/09/110926151735.htm

 

[whopper]

Anyone discussing the possible differential dx should firmly add the caveat that this is purely speculation based on limited data.

While I agree with the Goldwater rule, several times in the media, something like this happens and people turn to us psychiatrists for answers. Due to the Goldwater rule, our answers are often-times limited and in the eyes of others, meaningless at a time where they need some meaning.

I think some type of discussion needs to happen but it's hard to determine what exactly can be said that can help.

 

[Shikima]

Good time to bring up the poor funding, resources and interest in good mental health therapeutics.

 

[Chimed]

What a tragedy--heart breaking. I went to UCSB as an undergrad and know that area well. Unfortunately, when I was there another student plowed his car into a crowd and killed 4 students. He was found NGRI. http://www.independent.com/news/2012/sep/04/conditional-release-david-attias/

 

[Chimed]

Good time to bring up the poor funding, resources and interest in good mental health therapeutics.

Yeah, it's sad that it takes something like this to bring up this issue. You'd think the incredible amounts of mentally ill people in populating our prisons and on the streets would be enough to cause a public outcry.

My hope is that one of the parents of the victims will become a sorta of John Walsh (from America's Most wanted) or the father of the Amber Hagerman (who got the Amber Alert system pushed through) like figure to push very hard for reform in both the mental health system as well as better guns laws.

 

[notdeadyet]

My hope is that one of the parents of the victims will become a sorta of John Walsh (from America's Most wanted) or the father of the Amber Hagerman (who got the Amber Alert system pushed through) like figure to push very hard for reform in both the mental health system as well as better guns laws.

That would be nice. I was hopeful exactly that would happen after the movie shooting. Then after Sandy Hook. Both for naught.

I'm keeping my fingers crossed but if 20 dead elementary school kids wasn't enough to inspire significant change, I doubt 6 dead college kids will.


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[MacDonaldTriad]

I think we should be very careful as mental health professionals not to reinforce the public’s perception/wish that we be able to things that we cannot do.
“If someone murders someone, that means their mentally ill, right?”
“If someone is mentally ill, that means they can be helped right?”
“If that homicidal person had only gotten the help he needed, this would have never happened, I want to find out who should have done this, and they should be held accountable.”
I think the worst examples of poor ethics are the mental health professionals who agree to be interviewed on the news after these events. They haven’t evaluated anybody. They only know what the news tells them, and they attempt to add to our understanding while the news directors try and lead them places they shouldn’t go.

 

[Chimed]

That would be nice. I was hopeful exactly that would happen after the movie shooting. Then after Sandy Hook. Both for naught.

I'm keeping my fingers crossed but if 20 dead elementary school kids wasn't enough to inspire significant change, I doubt 6 dead college kids will.


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I hear you, but that's not necessarily true. It will just take one parent to be motivated enough with good communication skills to take up the cause. The examples I sited with both John Walsh and Hagerman (The father of the "Amber Alert" girl) are both examples of one tragedy motivating them to take up a campaign after the tragedy.

I think we should be very careful as mental health professionals not to reinforce the public’s perception/wish that we be able to things that we cannot do.
“If someone murders someone, that means their mentally ill, right?”
“If someone is mentally ill, that means they can be helped right?”
“If that homicidal person had only gotten the help he needed, this would have never happened, I want to find out who should have done this, and they should be held accountable.”
I think the worst examples of poor ethics are the mental health professionals who agree to be interviewed on the news after these events. They haven’t evaluated anybody. They only know what the news tells them, and they attempt to add to our understanding while the news directors try and lead them places they shouldn’t go.

I couldn't agree with your comments more. It will not help anyone if people think that mental health professionals have some kind of magic ball to predict which one of their patients are going to engage in violent behaviors. As I'm about to finish my forensic fellowship, it's still clear that it's extremely difficult to say a crime committed due to mental illness can be prevented just because they're in mental health treatment. BUT, engagement in treatment and training patient care providers about violence risk factors can help.

 

[notdeadyet]

It will just take one parent to be motivated enough with good communication skills to take up the cause. The examples I sited with both John Walsh and Hagerman (The father of the "Amber Alert" girl) are both examples of one tragedy motivating them to take up a campaign after the tragedy.

Oh, we as a country can rally around grieving parents and motivate. But the result almost always focuses on Catch/Punish the Bad Guy. Like your mentions above. Or Polly Klaus.

But improved services and treatment? Not so much. Rage and revenge seems to cross the bipartisan provide. Healing and helping not so much...

 

[smalltownpsych]

Social isolation as a result of living in a fantasy land MMORPG led to decreased social competence and inflated sense of self-worth. After all, he was probably really good at the game, too bad that didn't impress the girls. I doubt if he even had a mental illness other than being depressed because of the aforementioned factors. I would suggest that his parents probably should not have let him spend so much time in the virtual world while he was supposed to be learning how to handle real-life.

 

[EMDO2018]

I watched his YouTube video titled "Retribution" In a span of 2 minutes he mentioned 10 times how perfect he was. Can you treat a person like this? Was there any helping him?

 

[tishage]

Yeah, it's sad that it takes something like this to bring up this issue. You'd think the incredible amounts of mentally ill people in populating our prisons and on the streets would be enough to cause a public outcry.

My hope is that one of the parents of the victims will become a sorta of John Walsh (from America's Most wanted) or the father of the Amber Hagerman (who got the Amber Alert system pushed through) like figure to push very hard for reform in both the mental health system as well as better guns laws.

Psychiatrists and other MH professionals can and should have a role in pushing hard for positive reforms in our MH systems. We should not rely on others, given our position in mental health. But I agree that it seems that the drivers of MH reform tend to be from outside the system (ie: parents, etc), as opposed to within, which is problematic

 

[Chimed]

Psychiatrists and other MH professionals can and should have a role in pushing hard for positive reforms in our MH systems. We should not rely on others, given our position in mental health. But I agree that it seems that the drivers of MH reform tend to be from outside the system (ie: parents, etc), as opposed to within, which is problematic

I agree in theory. But having a lay person as an advocate is helpful because it helps the general public relate better to that person, especially if they're passionate and have a compelling story.

 

[Trismegistus4]

I read part of the guy's autobiography (it's not a manifesto) and a few of the articles about this case, including the one where they interviewed one of his friends he mentioned several times in the autobiography. Based on what I've read, avoidant personality disorder seems like the closest thing we could get to a DSM diagnosis for him.

The kid was regularly engaged with a psychiatrist and numerous counselors. What do you people talking about "mental health reforms" believe could have been done to prevent this?