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Abstract

This is a 17-year-old boy, who started substance use from an early age. In childhood I have behavioral disorders with poor school performance and poor socio-environmental stimulation, in the context of a highly dysfunctional family with the absence of continental adult figures. His criminal record is recorded from the age of 8 years and substance use from 12 years. The difficulty arose in the Court whether or not it was attributable. Finally, he was imputed. After the studies, it turned out that the young man according to the DSM V was structuring a psychopath personality.

Keywords: Teenage; Impulsivity; Abuse toxic substance

Development of the case

This is a 17-year-old boy, who started substance use from an early age. In childhood I have behavioral disorders with poor school performance and poor socio-environmental stimulation, in the context of a highly dysfunctional family with the absence of continental adult figures. His criminal record is recorded from the age of 8 years and substance use from 12 years. The young man is evaluated in these offices of the INTERDISPLINARY AUXILIARY BODY (CAI) of the Courts of Minority and Family, Mendoza, Argentina, for a robbery. To be evaluated four times the adolescent was referred by the Court in order to carry out the psychological and psychiatric examinations in order to determine if it was included in the provisions of Article 34, Argentine Criminal Code (CP) paragraph 1, [1], given the background that it registered, other comorbid conditions such as high impulsivity and an episode of epileptic crisis began to appear. Various studies were carried out such as EEG (electroencephalogram) to which was added after an audience with Mr. Magistrate intervening, a PET (Positron Emission Tomography) that yielded the following result: reduction of frontal areas, cingulate area hypometabolism of Orbital frontal cortex, suggesting that impulsivity would be related to the lack of control of some dorsal frontal regions on the tonsil (lack of cortical control over limbic region: emotionality). The study confirms a) lower metabolic activity in the cingulate gyrus (cortex) and hyperactivity of the amygdala (limbic system). It concludes that there would be a divorce in the connection between the cortex and the limbic system. The dorsal cortical part (functionally inhibitory under normal conditions and the limbic system (tonsil among others) would be slowed in its impulsivity by the frontal cortex. The techniques applied in CAI were open and semi-directed individual clinical interview. Visomotor Guestaltico test (BENDER) [2], and WAIS-III intelligence test for adults were applied [3]. Better performance in the execution areas than the verbal ones. When the young person has adequate socio-environmental stimulation, he can function in a more optimal way, and the deficits he presents are related to one of environmental and cultural deprivation that have facilitated the young person to have few cognitive abilities to respond to his environment. Of the results, the young man presents an intellectual performance compatible with a mild mental disability (clinically evaluated). His superior psychic functions are preserved during the evaluation. It is lucid, vigil and oriented spatially, the critical judgment is weakened due to its mild intellectual disability but without delusions or deliroids. Mental processes have lost speed, accuracy, and efficiency they had before, manifesting as disorganization or involution in their responses. The young man presents deficits in his responses mainly due to socio-cultural deprivation as a central element, understood as the lack of environmental reasons of cultural transmission, reducing his ability to modify cognitive structures and to respond adequately to the sources of stimulation to which he adds The consumption of toxic substances. Also from the scores obtained, the psychopathy index arises, which allows us to observe that the young person can handle situations, plan consecutive and causal situations, also presenting the ability to accept and internalize social patterns. The young man playing sports in an open area fled, went to a friend's house, in order to look for psychoactive substances (pills), staying there. The young man does not describe an attack compatible with epilepsy but if he had suffered it, he was not registered, nor does his behavior agree with these crises, given that he did not suffer from a confusional crisis or disorder of conscience nor would he have fled, his friend's house. He has also presented violent interactions with operators and interns. Traits of marked emotional immaturity, psycho-affective instability, emotional dependence, need for external support, self-centeredness and self-centeredness are perceived, perceiving their environment as hostile with suspicion where it is observed that such perception and impulsive disorders of the same can lead to risk of violence for third parties. Although the young man has a specific type of thinking with deficits in the anticipation and behavior planning processes; it is detected that it can include the disvaluation of negative actions and can discriminate the lawful acts of the illicit and the consequences that these may entail [4,5]. Impulsivity can lead to the consumption of problematic substances. On the latter the young man has partial awareness of disease. This affects long-term adherence to treatments. It does not arise from his account of ideation of death or self-harm. From the conflict with the law, the young man remembers some aspects and not others, but the lack of memory is related to the passage of time and not due to disorders of conscience or memory. He manages to understand the devaluation of his actions and the damage that his behavior can cause to third parties. From the technique administered and from the clinical evaluation, it is observed that it predominates in the young emotional affectation that decreases its functioning with a single indicator of organicity (BENDER visomotor guestaltic test) which is not enough to arrive at a diagnosis of organic deterioration.

Conclusions

According to the DSM V [6], the young person gathers the indicators of a conduct disorder and Specifiers of stimulant consumption disorder course (consumption disorder of amphetamine-type substances, cocaine use disorder and consumption disorder of other stimulants or unspecified stimulants). The intervening professionals consider that the young person is not included in the exemptions of art. 34 of the CP neither at the time of the event nor at the present time. It was suggested to Mr. Magistrate that due to the psychic characteristics of the young man and his consumption of toxic substances, arbitrate protective measures in a suitable place for the young man, taking into account both aspects raised. The young person requires psychological and psychiatric follow-up sustained over time and neurological inter consultation. Strict social follow-up of the case is suggested.

References

1. Covelli JL, et al. 2009. "Imputability and Culpability". 1st Edition. Page 646. Dosyuna Ediciones Argentinas. Argentina. Penal Code 2013, compiled by Fernando M. Zamora. 63rd ed. Buenos Aires, Zavalía. ISBN 978-950-572-061-3.

2. Bender Lauretta. 2003. Test guestaltico visomotor B.G.: Usos y Aplicaciones clinicas. 1. ed. 17. reimp. - Buenos Aires: Paidos. 264. Ref.: https://bit.ly/36Y4k9q 

3. WAIS III (COMPLETO) por WECHSLER, DAVID. ISBN: 9789501263459 - Tema: Técnicas psicométricas intelig - Editorial: PAIDÓS - Waldhuter la librería. Ref.: https://bit.ly/2SgYBGs

4. Berkowitz L. 1996. "Aggression-Causes-Consequences- and-Control". Ed. Descleè De Bouner. ISBN 7884330011749.

5. Vazquez Gonzalez C. 2003. "Risk factors of criminal behavior in childhood and adolescence". Module III of the program of the University Expert Course in "Juvenile delinquency and juvenile criminal law", Chapter 5 (pages 121 to 168), of the work: "Juvenile Delinquency. Criminal and criminological considerations. Ed. Colex. Madrid.

6. American Psychiatric Association. (2014) DSM-5. Diagnostic and Statistical Manual of mental disorders (2014) Editorial Panamericana Médica. ISBN 9788498358100. Ref.: https://bit.ly/2UpLqWl 

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