Forensic Psychiatry

Classified in Other subjects

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With regard to organic mental disorders, it is difficult to establish the credibility of those affected by these symptoms but low physical deterioration opportunities to act criminally.
In this cerebral organ involvement is a great irritability that cause some violent hits.
GILLIES talk of a 1%-organic brain disorders in those who come to commit crimes.
Krakowski, maintained that the difference between them was the presence of neurological disorders among those who had done violently. These neurological disorders associated with violence, rather than the crime itself.
In general, the
frequency of crime is low, except when is a product of substance this claim is different..
When it comes to delirium, the onset may cause damage, can lead to a picture of agitation, aggression & then usually entered.
Endogenomórficos boxes, due to the declining of conscience, sometimes we see only behavioral disturbances secondary to the symptoms they present.
Most important for diagnosis is to
assess the level of awareness of the subject.
If we talk about
organic psicosíndrome (dementing disorders), the crime risk is low.

2. Liability for EACH OF DISORDERS
We mustassess all the symptoms, especially consciousness, emotion, perception (whether or not hallucinations), thought.
If there is a
clear picture of delirium = unimpeachable.
We must seek and value the imputation => Cause organic alter consciousness (this is essential), perception, thought, etc..
First you have to see whether or pseudodementia dementia.
If dementia must be evaluated
Here there is no disturbance of consciousness
Must see (rating) the severity of neurological damage and see the psycho-organic or cognitive impairment to dementia.
The functions of the trial, intellectual (we see how they are altered)
The temporal and spatial disorientation (especially when dementia progresses)
Instincts (Sexual Offenses), ability to control these impulses
Emotional lability (mood swings, etc.).
Whether or not paranoid
Usually the defense or extenuating established in almost all cases.
- Definition of Noxa => is the agent or organic cause that causes the disease or mental disorder. It may be viral, infectious ... the noxa can act very virulent or low virulent.
- Classification according to noxa
Noxa highly virulent or highly pathogenic
Chronically (chronic aggression) => produced in the subject an organic Psicosíndrome, a condition called organic psychosis.
Acutely (when you come at once) => subject a place in the acute exogenous reaction, such as delirium.
- Noxa little virulent
a. Aggression acute => results in the transition syndrome or disorder also called endogenomórficos step.
b. Chronic Aggression => leads to an accentuation of personality traits. (Not studied)
- Definition of Noxa => is the agent or organic cause that causes the disease or mental disorder. It may be viral, infectious ... the noxa can act very virulent or low virulent.
- Classification according to noxa
Noxa highly virulent or highly pathogenic
Chronically (chronic aggression) => produced in the subject an organic Psicosíndrome, a condition called organic psychosis.
Acutely (when you come at once) => subject a place in the acute exogenous reaction, such as delirium.
Noxa little virulent
a. Aggression acute => results in the transition syndrome or disorder also called endogenomórficos step.
b. Chronic Aggression => leads to an accentuation of personality traits. (Not studied)
- Dysthymia seizures.
Consist of a mood disorder, meaning euphoric and irritable, where there is great impulsiveness and aggressiveness.
Or in the sense of depression, which also has characteristics
and hypochondriacal anacásticas(sigc obsessive).
Generally tight.
Dysthymia can occur when epilepsy occurs what is called
the forced normalization of Landolt, failing other procedures and try to normalize the epilepsy with medication, so forced the EEG and following that situation can occur when these crises dysthymic.
- Epileptic psychosis. (they are psychotic disorders in individuals with organic personality). Epileptic psychosis may occur with impaired consciousness (drowsiness syndrome of consciousness and delirium dream twilight states) or a syndrome of transition or step. epileptic psychosis are real syndromes transition or step that can be of 2 types (schizophreniform psychosis and affective psychosis). The syndromes of transition or are pictures endogenomórfico step, ie, that appear or affective psychosis schizophreniform psychosis but is truly epileptic psychosis.
Affective disorder usually have the same characteristics as an affective disorder, but with a specific symptom-oriented irritability, hypochondria and obsession. It seems an affective psychosis but epilepsy.
To look like a
schizophreniform disorder schizophrenia, but not just exclusively schizophrenia, schizophreniform disorder is given in epilepsy.

Substance use may cause:
1. An organ involvement, which is studied in organic mental disorders.
2. Behavioral and mental disorders.
The clinic will be the same in all types of substances (hashish, alcohol, heroin ...) within the clinic, they can assess situations: acute, hazardous drinking, harmful use, withdrawal syndrome, dependency syndrome, psychotic state ...

Alcoholic psychoses are divided into 2 groups: (1) psychosis ecotoxicity true and (2) alcoholic encephalopathy.
1. Psicosis ecotoxicity true, which are the causes (or caused) directly or indirectly by alcohol. There are 4 types that are subacute delirium, delirium tremens, hallucinosis and jealousy.
a. Subacute
delirium, is a type of syndrome or table is sometimes the beginning of a delirium tremens of a lesser degree, and sometimes heal without becoming delirium tremens.
Has symptoms similar to delirium tremens but less intense.
All alcoholic psychosis appear when the individual is at least a dependency on alcohol and usually occur in chronic use when carrying a certain time consuming (not shown at the beginning of consumption).
b. Delirium tremens usually occurs after a long intake with significant amounts of alcohol when the subject declines or fails to eat for some reason. And usually there is a significant deficiency vitamin deficiency, especially vitamin B1 and folic acid.
The most typical or characteristic symptoms of delirium tremens are
psychic p, n Eurologos and
c. Alcoholic hallucinosis
It consists of a table characterized by hallucinations, usually of the ear and there may be visual.
Usually delusions to explain the hallucinations.
It is often a table is 1 or 2 months, then heals, but sometimes conflict becomes chronic and esquizofreniza, ie other symptoms of the schizophrenic stock.

d. Alcoholic jealousy
It mainly consists of a frenzy of jealousy that can occur as KÖLLER 3 ways:
The idea of a jealous drinker that sometimes the subject comes to ask for much and refusing sex partner can start to think that your partner is cheating on him with another, going to delirium what at first was not.
2. Chronic alcoholic subjects which usually occurs with some frequency Sexual impotence and the subject may start thinking that your partner is with someone else. Although thinking in principle is done with consistency, you can spend to delirium.
3. Delusional jealousy begins as delirium and that is a subject with certain characteristics and personality of self-injury, Ie it is slightly paranoid, and that is also paranoid delusions of jealousy.
Alcohol is enhancer of this alteration of jealousy

2. Encephalopathies alcoholic, which is the involvement that occurs in the brain by alcohol.
Here they are: Korsakov's
syndrome, the Gayet-Wernicke encephalopathy and dementia => three by appearing brain damage produced by alcohol.
In Korsakov, the key is the amnesic syndrome and confabulations (up stories to fill the gap amnesiac).
A subdelirio can lead to delirium, the latter a Gayet-Wernicke encephalopathy (which is for a lack vitamin B6) and from there to a dementia that has some special characteristics especially lacunar and fixation amnesia.
7. CLINIC schizophrenic disorders
Psychopathological disorders:
1. In thinking
Delusions or first-order primary. They are usually self-referent delusions of prejudice, jealousy, persecution, cosmic, mystical religion.
Delusional perception, occurrences delusional, delusional interpretations.
Disorders of theft, enforcement, dissemination of thought.
2. In affectivity
Symptoms or disorders including:
Emotional ambivalence, dullness, emptiness, and emotional withdrawal.
3. In the psychomotor
Symptoms of the race as flexibility catatonic psychomotor agitation air.
Stupor (lack of relationship functions).
4. In the perception
There pseudoperceptivos disorders such as hallucinations and pseudoalucinaciones in any area possible, the most frequent pseudoalucinaciones hearing. Also, but less, there are illusions.
5. In the will
There is a defect of the will in the sense of being directed by symptoms, and symptoms of negativism will be active (act against what he calls) or passive (not doing what you asked) and the automatic obedience (automatic task, act as an automaton, without any thought).
6. In the conduct
The schizophrenic behavior in general is a function of the symptoms presented by the subject. Very often there is a behavioral disorder.

There is a key symptom in most schizophrenic who is theAUTISM (not as a disease itself as a symptom), which contains a little of all previous symptoms.
Autism is the world of the schizophrenic, domestic, foreign, where they are delusions, hallucinations, strange feelings and his own world of the schizophrenic.

8. Paranoid Disorders
(O persistent delusions or chronic delusional disorders)
Krepellin defined as parallel minds.
It mainly consists of the existence of a delirious structure, well systematized, it is impossible to destroy with logical arguments and sometimes hallucinatory symptomatology has also (hallucinations), no pseudoalucinaciones.
Usually delusional disorder usually has a well organized person and can go unnoticed for a long time.
Frequent types of delusions in these disorders: from persecution, jealousy, grandiosity, hypochondriasis, erotomanic (think someone is in love with him, etc.).
Usually what happens in the paranoid is that it becomes persecutor persecuted and sometimes they can do is mass murder, manslaughter expanded.
Generally the type of crime is often cold and deliberate in terms of their delirium.
The paranoid is usually in continuous litigation with religious ideas.
Can be especially dangerous when the theme of messianic delusion is (believed the Messiah), which can lead to collective suicide, when he think he is the chosen of God.
In general there is usually no damage but over time may be deteriorating and dysfunctional personality.
9. CLINIC neurotic disorders
It is a normal situation. It is a subject that has become a form of property. Personality may result in something clinical. The neurotic personality is a psychological subject's internal conflict, poor self-image for the subject itself, a bad relationship with itself and form interpersonal skills.
People with neurotic symptoms:
Neurosis has fundamentally dimensional component, this is the disorders go from normality to pathology, depending on which appear overextended.
The clinic is a clinic to understand (as he has a phobia of small dogs because a dog bit him). But the fact of being understandable does not mean it is not pathological, that is not a disorder.
It is a clinical disorder is understandable though.
The pathological nature is based on:
üThe syndromal structure. We will see what the total picture syndromic have (one or more phobias, ...).
ü presentation without triggers (not causal, but triggers).
Q This is basic and fundamental. When it affects the performance of the subject and is a lasting way. Affects their job performance, family, etc..
If you have many phobias, if there are triggers and affects its staff performance, labor, family, that is, then we are talking about pathology.
Must see the overall clinical picture. A phobia is nothing pathological, necessarily.
10. Factitious Disorders and Malingering
It consists of the voluntary production of physical or psychological symptoms, means that it is voluntary on the part of the subject.
Should be ruled out organic and psychiatric diseases and there must be VOLUNTARY in the production of symptoms (physical or emotional).
Voluntary production of physical or psychological symptoms

The key in both factitious disorders, as in the simulation is voluntary.

Factitious Disorders: Production voluntary physical or psychological symptoms in the absence of benefits or objectives recognizable by the subject
Disorders are caused intentionally by the subject, under voluntary control.
No material gain.
Does not seek profit.
It's just the fact of being ill, wants to make that image and you want me to care.

Or disorder or Munchausen Syndrome: Voluntary production of physical symptoms without the presence of benefits or objectives recognizable by the subject
The term was coined by
Asher in 1951, about these stories, which is configured Asher Munchausen syndrome.
In this syndrome mythomania abound, the schizophrenia, intentionally elaborate somatic complaints.
They also called
tramps of HOSPITAL, HOSPITALS, HOSPITAL ADDICTS but it has remained is Munchausen syndrome.
They generally have numerous hospitalizations, numerous consultations and surgery, resulting in various diseases that are voluntarily familiarization and that, therefore, difficult to manage assessment of this syndrome.
They usually have enough knowledge of medical terminology, with a dramatic presentation of symptoms, constant demands for attention, continued complaints of pain, antisocial behavior, irritability and fluctuating clinical course.
Not often you get to suffer disease rather than externally, therefore, is a voluntary production of physical symptoms pretending to play the role of patients and cause concern on the basis of the disease.
There is a big difference with hypochondria, in this case believe the disease while on
Munchausen Syndrome, know they have it until it causes.
§ There is also the Munchausen Syndrome by Proxy.
What is the voluntary production of physical symptoms in children or in people in their care.
The intention is to perform the role of carer of children or people in their care and reach the poisoning, can end up in death of the victims, although not intended, and therefore feel no guilt.
Ø Ganser Syndrome: Production volunteer psychic symptoms without the presence of benefits or objectives recognizable by the subject
Is contained in the ICD 10 in dissociative
disorders (conversion) within a section as varied symptoms and polymorphs.
This syndrome usually appears as a pseudodementia or schizophrenia, which usually does not follow the usual course of these diseases may respond very bizarre behavior (odd, odd), dramatic, with many that could pararespuestas image or impression, ideas of mental illness.
These people know exactly how they must manifest the symptoms and that is why the memory disorders are excessive and very disorganized, generally against the law of Ribot.
Sometimes they cause symptoms of schizophrenia, but with much gesticulation and theatricality.
They usually have hallucinations (visual) - what they say, the rogues - very abundant. Sometimes also hearing.

SIMULATION (Rent = O Panic As can get in return ...)
Production consists of voluntary, conscious and intentional physical or mental symptoms, with the presence of external benefits or objectives recognizable by the subject.
Yudofsky divides the simulation into different types:
1)Events staged: scenes through organizing certain events, very gestural. As if in a theater, on stage.
2) Data manipulation (medical) such as impaired analytical.
3) Invention of Symptoms: The person reads a treatise he knows exactly what is a disease and the simulation with the intention of getting something.
4) Simulation opportunistic fortuitous accidents, neck, etc ...
a. Sobresimulación: It is an exaggeration of symptoms for normal to get something.
b. Metasimulación: it consists in the simulation of past symptoms and diseases, always to get something

It can mimic schizophrenia, depression, cervical pain, and so on. what matters is knowing how to differentiate when we are faced with illness and when to a simulation that is not.
THE DECEPTION is to hide voluntary, knowingly and intentionally actual physical or mental symptoms for external gain or targets recognizable by the subject.
They can be mild and pass review objectives of driving but can also be serious as concealing symptoms not to avoid a suicidal idea.
11. Etiopathogenic factor of conduct disorder

* Dispositional factors (predisposing):
§ Hereditary:
· Prevalence in men: 2 to 4%.
· Prevalence in women: 0.5 - 1%.
· Prevalence in twins: 60%.
Fraternal twins · prevalence: 37%.

They are usually genetic (hereditary).
It is known that chromosomal abnormalities are hereditary (XO Turner, Klinefelter XXY, trisomy 21 (down) XYY ,...), are conditions that may predispose to a disorder.
- Dysfunctions electroencephalographic: When there are waves in such large numbers can be diagnosed from minimal brain dysfunction, where there is an abnormality of the brain structures that generally will not file any clinic but will give certain subject characteristics such as impulsivity, irritability, explosive reactions, and so on.
This will predispose, but not the cause of the disorder.
Prematurely acquired somatic factors: ie: encephalopathies that may predispose children to conduct disorder
Other studies say it may also influence other alterations as predisposing.
* Psychobiographical sensitizing factors: one of the most important elements in learning and personality development of the subject at first is the family function, then the social and the environment. All are essential as sensitizing of conduct disorder.
filiarcado would be an important factor as sensitizing factor, but also any kind of psychological factor as frustrations, conflicts, traumatic experiences ... all are factors sensitizers.
* Triggers
At first there may be triggers, but can not any.

11. Conduct disorder CLINIC
In a child can not settle this disorder, occurs after adolescence, when the personality is configured when it may properly speak of disruption.
There are 2 groups of initiation.
- 1st stage, in youth, which generally have a good prognosis.
- 2nd stage that begins about 30 years, but is forged over the years, the prognosis is usually worse.
The fundamental and basic disorder is the failure of human relationships. They are not capable of human interpersonal relationships, with no feelings of guilt, aggression, immaturity, lack of moral and ethical principles.
There is an emotional anomaly of the basic structures which include irritability, excitability, impulsiveness, atimia (emotional coldness, are not able to feel what another person may feel, they have no empathy), explosive behavior, intolerance to frustration, not interested in either the historical past or present relationships, fundamentally there is a disturbance of affect (atimia) by which the subject is unable to feel a connection with another person.
12. Etiopathogenic factors of depressive disorders
Is multifactorial
Genetic family aggregation, Twins, Polymorphism
Sociocultural Marginality, Migration, Pressure
Uprooting Psychic, Life Events, Frustration
Somatic serotonin syndrome, adrenergic syndrome, Syndrome dopaminergic
All these factors determine the occurrence of depression and will be joint action by all the women who produce it.
* Psychic
Within the psychic disturbances of depression are the thought:
Decreased ability to concentrate, lower self-esteem, loss of interest, guilt and thoughts of death.
Thought-enllentecido to the inhibition of thought.
Hopeless, helpless, hapless.

In depression can be reached psychosis with delusions and hallucinations that can get lost convinced the body or parts of it, loss of soul with ideas of religious conviction or guilt and finally the frenzy of mine which the patient believes in total ruin.
These symptoms are not predictable, although these symptoms are often endogenously.
* Vital Rhythms
worse in the morning (vital) Worst afternoon (Reactive)
Worse seasonal spring and fall (vital)
Sleep: insomnia (conciliation, maintenance, early morning awakening) drowsiness, hypersomnia. Sleep.
Food: Anorexia, appetite, hiperorexia, bulimia, lost weight.
Sexuality: Lower the pale.
Energy: fatigabalidad, anergy, pain.
* Behavioral: crying, agitation, inhibition, isolation, abandonment, decreased hygiene.
Difficulty in controlling an impulse that can be harmful in recurrent
The individual may or may not consciously resist the impulse and the action plan can not.
Increasing sense of tension in the form of emotional distress immediately before executing the action
Welfare gratification or relief at the time of the conduct. This feature means that the act is ego-syntonic in that it is consistent with the patient's immediate conscious desires.
Existence of negative feelings such as guilt, self-reproach, guilt and shame following the act when considering the consequences.
Is the presence of frequent and repeated episodes of gambling, whichdominate the life of the patient to the detriment of the values and social obligations, labor, material and family the same.
Those affected by this disorder may risk his job, accumulate large debts, lying or breaking the law to get money or avoid paying their debts. The patients described the presence of an intense craving to play that is difficult to control with persistent thoughts and images of the act of the game and the circumstances surrounding it.
Guidelines for Diagnosis:
The essential charge is the presence of betting play a constant and often reiterated that persists and increases in spite of its adverse social consequences such as loss of personal wealth in period of at least one year
Differential diagnosis.
Mania or hypomania: Pathological Gambling Behavior
Game socially accepted: Ability to cut, limited losses, limited duration
Professional players: Added ability to control and discipline
Behavior characterized by the repetition of acts or attempts to set
fire to property or other objects for no apparent reason with a continued emphasis on issues related to fire and combustion.
These people may also be interested in an abnormal way for fire trucks or other equipment to fight fire with other issues related to fires and calls the fire department.
Concept: Pleasure to steal
Disorder characterized because the individual repeatedly fails in the attempt to resist impulses to steal objects that are not used for personal use or profit
By contrast objects can be discarded or given away to hide.
Concept: disproportionately high elevation of mood. Ranges from the euphoric-expansive to the uncontrollable.
The extreme euphoria leads to unusual behavior, and disproportionate
Syndrome: secondary, manic (mania
for organic motifs)
Disease: affective disorder
Emotional disorders: Euphoria, expansive, irritability, omnipotence, increased vitality.
Disorders of thought:
Esteem angry, racing thoughts (Taquipsiquia) flight of ideas, push of speech, distractibility.
Background increases (number and size)
Megalomaniacal delirium injury.
Behavioral disturbances
Prodigality, aggressiveness, hyperactivity, agitation, deshinibición.
The term diagnosis of mental retardation (MR), consists of low IQ and adaptive deficits, and was developed by the American Association of Mental Retardation in 1992, and the DSM-IV Disorders in infancy, childhood and adolescence.
90% of individuals with low intelligence are diagnosed at age 18 and requires three features:
1. Below average intelligence (IQ 70 or below).
2. Impairment of adaptive capacity.
3. Beginning in childhood.
The DSM-IV-TR subclassified the severity of mental retardation based on IQ scores (Table).
19. CLINIC IN MENTAL RETARDATION (mild, moderate, severe, profound).
The various international and European classifications consider mental retardation as: "An incomplete or arrested mental development that produces a deterioration of the full features of each period of development, such as cognitive, language, motor and socialization" It is, therefore, RM multidimensional vision in its biological, psychological, educational, family and society.
Based on these results, the classification systems (DSM-IV and ICD-10) have established several cutoff to classify the presence and / or magnitude of RM, need to set the following breakpoints:
Mild Mental Retardation .............................. CI 69-50
Moderate Mental Retardation .................. CI 49-35
Severe Mental Retardation ......................... CI 34-20
Profound Mental Retardation .................... IQ under 20

A) Mild Mental Retardation
Accounts for 85% of all overdue and are considered "educable". In most cases there is no organic etiology, whichever constitutional and socio-cultural factors, so often overlooked in the first years of life since their appearance is usually normal although there may be some form of psychomotor retardation, getting to emphasize the delay stage coinciding with the school where the demands are greater.
Regarding aspects of personality are often stubborn, opinionated, often as a way of reacting to the limited capacity of analysis and reasoning. The will may be weak and can be easily handled and influenced by other people with few scruples and, therefore, induced to commit hostile acts.
How does he feel rejected, they often prefer to deal with the lowest age at which they can dominate. The best intellectual level, being more aware of their limitations, they feel self-conscious, sad and sullen.
In adult life can be handled somewhat independently, working in offices with good performance in manual tasks.

Represent 10%. The organic etiology is usually presented as somatic and neurological deficits. Although many may look physically "normal", different deficits in the course of evolution are apparent from infancy. Speculates on the origin of genetic and chromosomal abnormalities, encephalopathy, epilepsy and pervasive developmental disorders (PDDs) including autism and childhood psychosis. They can acquire basic habits that allow them some independence but must be guided in many aspects.
His intellectual ability is intuitive and practical. They can acquire knowledge but are reduced to simple mechanisms. memorized, with little capacity to understand the meanings and relationships between the elements learned.
Still, are educated through special education programs, but always looked sluggish and constrained basis.
The character that dominates these children is the appearance of hyperkinesis with frequent tantrums. They like to claim the attention of the adult and may use any method to get it, especially children who have diminished their capacity for verbal expression. Sentiment is very labile with exaggerated expressions of his feelings and can move from an adult's emotional quest to show him disobedient behavior and even provocative and aggressive.
Severe Mental Retardation

They provide a 3-4%. The etiology in these cases is clearly mostly organic, similar to that described in Mental Retardation Moderate but with greater involvement in all areas both somatic, neurological or sensory impairment, rising to reveal a general delay in development from the earliest moments of life.
They acquire basic motor mechanisms and learning habits of personal care is very slow and limited, always needing help and supervision. Those who come to communicate verbally, they do so with few words or phrases elementary mispronunciation. They can take some simple and practical knowledge of their personal data, family and personal objects commonly used but this content may not be persistent because of its difficulty to fix them in the long-term memory.
The crisis highlights the behavior of anger and aggression by their lack of reasoning, leading to self-harm. Frequent disorders are usually of motor habits: sucking, rocking, bruxism, and psychotic symptoms: stereotypy, mannerisms, echolalia, etc..
In adult life can adapt to family and community life, always be tutored, work programs can be inserted into occupational therapy in very simple tasks.
D) severe mental retardation

They represent only 1 or 2% of those diagnosed as retarded. The etiology is always organic produce serious changes at all levels with significant motor impairment.
Within this category, sometimes overlapping other disorders that may be susceptible to differential diagnosis and in which profound mental retardation is one of its symptoms. We are referring to atypical autism or different genetic syndromes that often present with mental retardation Some authors differentiate between two types:
1 - Vegetative Type: There are only primitive reflexes corresponding to the sensorimotor stage. They have serious problems and physical illness. Always need assistance and care.
2 - Type Trainers: You can achieve some elementary functions motor and visual-spatial, not arriving with language development but may get to speak with some shouts or sounds or understand simple orders.
General Clinic of mental retardation:
In mental retardation shows a slowing of development in general in all areas of operation, which is reflected in the following areas:
Cognitively: There may be an orientation towards the concrete, self-centeredness, distractibility and short attention span. The sensory hyperactivity behaviors can lead to overflowing, the avoidance of stimuli, and the need to process stimuli at low intensity levels.
Emotionally: they have difficulty expressing feelings and emotions both perceive yourself as others. The expression of emotion can be changed disability (hypertonia, hypotonia).
Speech delay, that can inhibit the expression of negative affect, leading to instances of apparent emotional hyperactivity including impulsive anger and low frustration tolerance.
Adaptive difficulties: the complexities of normal daily interactions can test the cognitive limits of MRI. In extreme cases, can lead to impulsive, uncontrolled violence and destructiveness. The changes in daily life can force cognitive abilities and coping skills, which sometimes leads to frustration.
Primitive emotional reactions: the frustration and stress may involve aggressive behavior, self-injurious or self-stimulating.

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