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($<=>A<< c(3$ !  4933-11441100-2301391-204 !  _XX  8XXdd8))?)@; ;  MENTALHEALTHISSUESINCRIMINALCASES   ByJonathanGrossmanandPaulCouenhoven  Mentalhealthissuesfrequentlyariseinthecontextofappeals.Theymaybepresentinthetranscripts.Mentalhealthissuesmayalsobelurkinginthebackground,whereyoususpectdefensecounselcouldhaveexploitedadefendantsmentalhealthproblemsbutfailedtodoso.Ineitherevent,youwillprobablyneedtoreadpsychologicalorpsychiatricrecordstoevaluatepotentialissues.Fewofusaretrainedinpsychologyorpsychiatry,anditmaybedifficulttounderstandthespecializedlanguagewhichappearsinthereports.Wewillattempttobrieflydescribecommonsituationswhere#))?##)Ǝ#)?mentalhealthissuesariseonappeal,   mentionsomeoftheissueswhichmayariseinthosecontexts,andprovidesomehelpinunderstandingthementalhealthlanguagewhichmayappearinreportsrelevanttothoseissues.#)?#)?#))?#)?)   #))?##)P#   CONTEXTSINWHICHMENTALHEALTHISSUESARISE      Mentalhealthissuescomeupinseveralcontextsincriminalcases.    Defendant'sCompetency     Fundamentaltoourcriminaljusticesystemistheprinciplethatnoonecanbetriedoradjudgedtopunishmentwhilementallyincompetent.)(Pen.Code,#)Ʊ#)Ԁ1367,subd.(a);Pate  v.Robinson(1966)383U.S.375.)Theterm mentallyincompetentmeansthat asaresult  ofmentaldisorderordevelopmentaldisability,thedefendantisunabletounderstandthenatureofthecriminalproceedingsortoassistcounselintheconductofadefenseinarationalmanner.#)#)(Pen.Code,#)ƶ #)Ԁ1367,subd.(a);#) #)Dropev.Missouri(1975)420U.S.162,  171;#)_ #)Duskyv.UnitedStates(1960)362U.S.402.)    Themostcommonpotentialissueinvolvingcompetencyiswhetherthetrialcourtabuseditsdiscretioninrefusingorfailingtoconductacompetencyhearing.#) #) Ifadefendant " presentssubstantialevidenceofhislackofcompetenceandisunabletoassistcounselintheconductofadefenseinarationalmatterduringthelegalproceedings,thecourtmuststoptheproceedingsandorderahearingonthecompetenceissue.(Pate,supra,383U.S.atpp. %!! 384386;Peoplev.Pennington(1967)66Cal.2d508,516517.#) #)...#) #))Inthiscontext, &"" substantialevidencemeansevidencethatraisesareasonabledoubtaboutthedefendantsabilitytostandtrial.(Peoplev.Frye(1998)18Cal.4th894,951952#)=#)...#)Q#)Ԁ)The ($$ substantialityoftheevidenceisdeterminedwhenthecompetenceissuearisesatanypointintheproceedings.([Peoplev.]Welch[(1999)]20Cal.4th[701,]739.)Thecourts *&& decisionwhethertograntacompetencyhearingisreviewedunderanabuseofdiscretion +'' standard.(1368;Welch,supra,20Cal.4thatp.742.)(#)Ƙ#)Peoplev.Ramos(2004)34  Cal.4th494,#)Ɓ#)507.)Experttestimonyisnotnecessarytoraiseadoubt.(Pate,supra,383  U.S.atp.385,fn.7.) [_E]vidence_Ԁofadefendantsirrationalbehavior,hisdemeanorattrial,andanypriormedicalopiniononcompetencetostandtrialareallrelevantindeterminingwhetherfurtherinquiryisrequired[and]#)#)...#)Ƹ#)Ԁevenoneofthesefactorsstandingalonemay,  insomecircumstances,besufficient.Thereare,ofcourse,nofixedorimmutablesignswhichinvariablyindicatetheneedforfurtherinquirytodeterminefitnesstoproceed;thequestionisoftenadifficultoneinwhichawiderangeofmanifestationsandsubtlenuancesareimplicated.(Drope,supra,420U.S.atp.180.)     TheclassiccaseinCaliforniaisPeoplev.Stankewitz(1982)32Cal.3d80.Inthat   caseapsychiatristtestifiedthedefendanthadparanoiddelusionshispublicdefenderwasincollusionwiththeprosecutor.Ifadefendantissodelusionalorparanoidthathewillnottrusthisattorneyortellhimthetruefacts,thenheisincompetent.Notethatthemistrustmustbedelusional,i.e.,stemmingfromamentaldisorder.Theusualdistrustdefendantshavefortheirpublicdefendersdoesnotshowthedefendantisincompetent.#)#)#)'#)  Undertheapplicablesubstantialevidencetest,moreisrequiredthanmerebizarre  actions[citation]orbizarrestatements[citation]orstatementsofdefensecounselthatdefendantisincapableofcooperatinginhisdefense[citation]orpsychiatrictestimonythatdefendantisimmature,dangerous,psychopathicorhomicidalorsuchdiagnoseswithlittlereferencetodefendantsabilitytoassistinhisowndefense.[Citation.](Peoplev.Davis  (1995)10Cal.4th463,527;Peoplev._Koontz_(2002)27Cal.4th1041,10641065  [competentdespiteproper,untenabledefense,harmfulwitness,ramblingclose];Peoplev.  _Rodrigues_(1994)8Cal.4th1060,11091112[insufficientevidenceforhearingdespitelack  ofcooperationwithcounsel,andtwoexpertsdescribingseizureswhichcouldhavecausedbraindamage,andpossibledrugdementia].)#)j#)  Thus,while,theCaliforniaSupremeCourthasrepeatedlystatedthatacompetencyhearingisrequiredwheneverthereisevidencethatraisesareasonabledoubtaboutthe ! defendant'scompetencetostandtrial'[citation],inpractice,thecourthasessentiallyrequiredthatthedefendantestablishhisincompetencebeforeatrialcourtwillberequiredtoholdacompetencyhearing.Inourview,theholdingsinthesecasesappeartohavelostsightofthefactthat,[_t]he_ԀfunctionofthetrialcourtinapplyingPate'ssubstantialevidencetestisnot %!! todeterminetheultimateissue:Isthedefendantcompetenttostandtrial?_It[s_]solefunctionistodecidewhetherthereisanyevidencewhich,assumingitstruth,raisesareasonabledoubtaboutthedefendant'scompetency.'[Citation.](Peoplev.Harrison(2005)125 ($$ Cal.App.4th725,735, DEPUBLISHED .)#)#) )%%   Ifthecourthaspreviouslyconsideredthecompetencyissue,andhasdetermineda +'' defendantiscompetenttostandtrial,anewcompetencyhearingisonlyrequiredifthereare changedcircumstances.Ifthedefendantmerelyengagesinthesamebizarrebehaviorwhichinitiallyledthecourttoconsiderthecompetencyissue,thisisnotenoughtorequirethecourtholdanothercompetencyhearing.#) !#)Ԁ#)##)Ԁ When,ashere,acompetencyhearinghas  alreadybeenheldandthedefendantwasfoundtobecompetenttostandtrial,atrialcourtisnotrequiredtoconductasecondcompetencyhearingunlessit ispresentedwithsubstantialchangeofcircumstancesorwithnewevidencethatgivesrisetoaseriousdoubtaboutthevalidityofthecompetencyfinding.[Citation.](Peoplev.Marshall(1997)   15Cal.4th1,33;accord,Peoplev.Lawley(2002)27Cal.4th102,136,139[despite   defendantbeingincoherent].)#)\##)  Ifthecourtdeterminesthereisareasonabledoubtaboutcompetency,thedefendant   mustbeexaminedbyexpertsandthedefendanthastherighttoajurytrialontheissueofcompetency.However,thetrialisnotacriminalproceeding.#)&#)Ԁ Althoughitarisesinthe   contextofacriminaltrial,acompetencyhearingisaspecialproceeding,governedgenerallybytherulesapplicabletocivilproceedings.(Peoplev._Skeirik_(1991)229Cal.App.3d444,  455.)Therighttoajurydeterminationofcompetencyisstatutory,however,notconstitutional;thus,counselmayeffectivelywaiveitwithoutapersonalwaiverfromthedefendant.(Peoplev.Masterson(1994)8Cal.4th965,969,972;see1369.)Adefendant  ispresumedcompetentunlessthecontraryisprovenbyapreponderanceoftheevidence.(1369,subd.(f);Peoplev.Medina(1990)51Cal.3d870,881-886.)Onappeal,the  reviewingcourtdetermineswhethersubstantialevidence,viewedinthelightmostfavorabletotheverdict,supportsthetrialcourt'sfinding.(Peoplev.Marshall(1997)15Cal.4th1,31.)  Evidenceissubstantialifitisreasonable,credibleandofsolidvalue.(Ibid.)(Peoplev.  Lawley(2002)27Cal.4th102,131.)#)U'#)  К Notguiltybyreasonofinsanity      Ifapersonunderaninsanedelusionastoexistingfacts,commitsandoffenseinconsequencethereof,ishetherebyexcused?Towhichquestiontheanswermustofcoursedependonthenatureofthedelusion:but,makingthe#)0,#)...#)-#)Ԁassumption#) .#)...#)Y.#)Ԁthatthe_labours_ " under#)Ơ.#)...#)./#)Ԁpartialdelusiononly,andisnotinotherrespectsinsane,wethinkhemustbe # consideredinthesamesituationastoresponsibilityasifthefactswererespecttowhichthedelusionexistswerereal.Forexample,ifundertheinfluenceofhisdelusionhesupposesanothermantobeintheactofattemptingtotakeawayhislife,andhekillsthatman,ashesupposes,inself_defence_,hewouldbeexemptfrompunishment.Ifhisdelusionwasthatthedeceasedhadinflictedaseriousbodilyinjurytohischaracterandfortune,andhekilledhiminrevengeforsuchsupposedinjury,hewouldbeliabletopunishment.[Citations.]#)u/#)(Peoplev._Rittger_(1960)54Cal.2d720,731732,quoting#)p2#)M'Naghten'sCase(1843)10 *&& Clark&Fin.200,211[8Eng.Rep.718,722]#)3#).) +'' #)Ƶ3#)  #)4#)...#)g4#)ԀCaliforniacourtsframedthisstate'sdefinitionofinsanity,asadefensein  criminalcases,uponthetwoprongedtestadoptedbytheHouseofLordsinM'Naghten's  Case(1843)10Clark&Fin.200,210[8Eng.Rep.718,722]: [_T]o_Ԁestablishadefenseon  thegroundofinsanity,itmustbeclearlyprovedthat,atthetimeofthecommittingtheact,thepartyaccusedwaslaboringundersuchadefectofreason,fromdiseaseofthemind,asnottoknowthenatureandqualityoftheacthewasdoing;or,ifhedidknowit,thathedidnotknowhewasdoingwhatwaswrong.'[Citations.](Peoplev.Kelly(1992)1Cal.4th   495,532.)#)Ʈ4#  Apersonislegallyinsanewhen,byreasonofmentaldiseaseormentaldefecthe   wasincapableofknowingorunderstandingthenatureandqualityofhisactorincapableofdistinguishingrightfromwrongatthetimeofthecommissionoftheoffense.The% G %G9word wrongasusedinthisinstructionisnotlimitedtolegalwrong,butproperlyencompassesmoralwrongaswell.Thus,thedefendantwhoisincapableofdistinguishingwhatismorallyrightfromwhatismorallywrongisinsane,eventhoughhemayunderstandtheactisunlawful.'(Peoplev.Coddington(2000)23Cal.4th529,608.))    The rightwrongprongismorefrequentlyinvokedincasesraisinganinsanitydefense.Itismoreunusualthatadefendantissodelusionalheorshedoesnotevenunderstandthenatureoftheactcommitted.(E.g.,killssomeonewhileindelusionalstatebelievingheiskillingaVietCongenemywhoisattackinghim.)#)Ƙ:#)#)G<#)  InPeoplev.Skinner(1985)39Cal.3d765,thedefendantwasdiagnosedasa  paranoidschizophrenic.Hestrangledhiswifewhileonleavefromamentalhospital.Hebelievedthatthemarriagevow"tilldeathdouspart"bestowedonhimaGod-givenrighttokillhiswifeifshehadviolatedorwasinclinedtoviolatethemaritalvows,andthatbecausethevowsreflectthedirectwishesofGod,thekillingwasmorallysanctioned.  AnotherexampleisfoundinPeoplev.Stress(1988)205Cal.App.3d1259,where ! adelusionaldefendantbelievedhehadtokillhiswifeinordertogainaforumtowarnAmericansaconspiracyexistedbetweentheprofessionalathleticleagues,thetelevisionnetworks,thefederalgovernmentandotherstoinsurethatprofessionalathleteswerenotdraftedforserviceinthewar.Inhisview,hiswifesdeathwasanecessarysacrificeforthegreatergood.#)Ɗ<#)  #)ƙ@#)Insanitycannotbebasedonadiagnosisofanantisocialpersonalitydisorder.(People ($$ v.Fields(1983)35Cal.3d329,372.)#)@#)Itcannotbebasedsolelyondrugoralcoholuse#)A#)(Pen. )%% Code,#)5B#)Ԁ25.5),butsuchusecanbeapartialcause.(Peoplev.Robinson(1999)72 *&& Cal.App.4th421.)#)ƛB#) +'' Ї Lackofspecificintentorotherrequiresmentalstate     Thereisnolongeradefenseofdiminishedcapacity,butthedefendantcanarguealackofspecificintentormaliceaforethought.(Peoplev.Saille(1991)54Cal.3d1103,  11161117.)    #)TC#)PenalCode #)E#)Sections28and29permitintroductionofevidenceofmentalillness   whenrelevanttowhetheradefendantactuallyformedamentalstatethatisanelementofachargedoffense,butdonotpermitanexperttoofferanopiniononwhetheradefendanthadthementalcapacitytoformaspecificmentalstateorwhetherthedefendantactuallyharboredsuchamentalstate.(#)UE#)Peoplev.Coddington(2000)23Cal.4th529,582.)#)"G#)     Forexample,anexpertcannotsaysheorhebelievesthedefendant,duetomentalillness,lackedthecapacitytopremeditateordeliberate.Norcananexpertsaysheorhebelievesthedefendantdidnotpremeditateordeliberate.Buttheexpertcansaythedefendanthadamentalillnesswhichwouldcausethedefendanttoactimpulsively,withoutthinkingorconsideringtheconsequencesofhisconduct.#)ơG#)   Forcedmedicationattrial     Thecourtcanforcemedicationinordertomakedefendantcompetentonlyif(1)animportantgovernmentinterestatstakewhichisdiminishedifthedefendantwillbehospitalizedforawhile,(2)involuntarymedicationwillsignificantlyfurtherthestateinterestsinatimelyprosecutionandfairtrial,(3)involuntarymedicationisnecessarytofurtherthoseinterestsasopposedtocontemptorotherremedies;and(4)administrationofthemedicationismedicallyappropriate.(Sellv.UnitedStates(2003)539U.S.166,180  183;Peoplev.O'Dell(2005)126Cal.App.4th518,569572.)Theunjustifiedforced  administrationofmedicationcouldviolatethedueprocessrighttoafairtrialundertheFourteenthAmendment.(Rigginsv.Nevada(1992)504U.S.127,137.)[ Inextremecases,   the_sedationlike_Ԁeffect[of_antipsychotic_Ԁmedication]maybesevereenough(akinesia)toaffectthoughtprocesses.ItisclearlypossiblethatsuchsideeffectshadanimpactuponnotjustRiggins'outwardappearance,butalsothecontentofhistestimonyondirectorcrossexamination,hisabilitytofollowtheproceedings,orthesubstanceofhiscommunicationwithcounsel.(internalquotationmarksomitted)] %!!  Sentencing  '## #)ƜI#)  [_E]vidence_Ԁaboutthedefendantsbackgroundandcharacterisrelevantbecauseofthebelief,longheldbythissociety,thatdefendantswhocommitcriminalactsthatareattributabletoadisadvantagedbackground,ortoemotionalandmentalproblems,maybe +'' lessculpablethandefendantswhohavenosuchexcuse.(Penryv.Lynbaugh(1989)492  U.S.302,#)O#)319,quotingCaliforniav.Brown(1987)479U.S.538,545(conc.opn.of  OConnor,J.)seealsoWigginsv.Smith(2003)539U.S.510,535#)Q#);seealsoAtkinsv.  Virginia(2002)536U.S.304[retardation].)#)R# Morethananyothersinglefactor,mental  defecthavebeenrespectedasareasonforleniencyinourcriminaljusticesystem.(Caro  v.Woodford(9thCir.2002)280F.3d1247,1258,citing4WilliamBlackstone,   Commentaries*24*25.))   #)ƝT#) Conditionsofprobation      ThereislittlecaselawinCaliforniaconcerningwhenthecourtcanorderadefendanttotakemedicationasaconditionofprobation.Arguably,thefactorsinSellwouldapply.   (See#)T#)UnitedStatesv.Williams(9thCir.2004)356F.3d1045,1056;cf.#)IV#)Welf.&Inst.Code,   #)V#)Ԁ5345etseq.)#)BW#)    MentallyDisorderedOffenders     TheelementstoanMDOcommitmentareasfollows.  First,theprisonermusthave  aseverementaldisorderthatisnotinremissionorcannotbekeptinremissionwithout  treatment.'(2962,subd.(a).)Second,thedisordermusthavebeenoneofthecausesof  orwasanaggravatingfactorinthecommissionofacrimeforwhichtheprisonerwassentencedtoprison.'(2962,subd.(b).)Third,theprisonermusthavebeenintreatment  fortheseverementaldisorderfor90daysormorewithintheyearpriortotheprisoner'sparoleorrelease.'(2962,subd.(c).)Fourth,beforetheprisoner'sparoleorrelease,thetreatingphysicianandotherspecifiedmedicalauthoritiesmustcertifythateachofthenotedconditionsexists,andthatbyreasonofthedisorder,theprisonerrepresentsasubstantial  dangerofphysicalharmtoothers.'(2962,subd.(d)(1).)[]ThefinalcriterionfortreatmentasanMDOundersection2962issetforthinsubdivision(e),[thedefendantmustbeinprisonafterbeingconvictedofalistedoffense].(Peoplev.Anzalone(1999)19   Cal.4th1074,1077.) SexuallyViolentPredatoryOffenders  #   TocommitsomeoneundertheAct,thestatemustprove [1]apersonwhohasbeenconvictedofasexuallyviolentoffenseagainsttwoormorevictimsand[2]whohasadiagnosedmentaldisorderthat[3]makesthepersonadangertothehealthandsafetyofothersinthatitislikelythatheorshewillengagein[predatory]sexuallyviolentcriminalbehavior.(Cooleyv.SuperiorCourt(Martinez)(2002)29Cal.4th228,246,quotingWelf. )%% &Inst.Code,6600,subd.(a)(1).) +''   Mentaldisorderincludesparaphilia(Peoplev.Butler(1998)68Cal.App.4th421,  441442),pedophilia(Peoplev.Mercer(1999)70Cal.App.4th463,466),antisocial  personalitydisorder.(Peoplev.Burris(2002)102Cal.App.4th1096,10981110;see  Kansasv.Crane(2002)534U.S.407,412[4060percentofprisonpopulationso  diagnosed].)#)ƒW# HabeasCorpus      Bealerttohintsintherecordthedefendantismentallyillandthepossibilitydefensecounselfailedtoproperlyinvestigatetheissuebyobtainingmedicalrecordsandconsultingwithexperts.Anattorneywhofailstoinvestigatepossiblementalhealthissues,eitherattrialorsentencing,))?) _deprive[s_]himselfofthereasonablebasesuponwhichtoreachinformed   tacticalandstrategictrialdecisions.(Peoplev.Frierson(1979)25Cal.3d142,163#)?b##b#.)     Forexample,in))?)Peoplev.Mozingo(1983)34Cal.3d926#)?ud##d#ԀtheSupremeCourt))?)heldtrial  counselprovidedineffectiveassistanceinfailingtoinvestigateaninsanitydefenseeventhoughdefendantrefusedtoenteraninsanitypleaandrefusedtocooperatewithanypsychiatrists.#)?5e##Te#ԀCounseldidnotbothertoinvestigatementalhealthissuesbecausethe  defendantrefusedtoenterapleaofinsanity.TheSupremeCourtheld))?)counselshouldhave   _undertak[en_]sufficientinvestigationofpossibledefensestoenablecounseltopresentaninformedreportandrecommendationtohisclient.#)?:g##Yg#(Id.,atp.934.)    Ifyouthinktrialcounselmayhavefailedtoadequatelyinvestigatementalhealthissuesattrialoratsentencing,youwillhavetodotheinvestigationtoshowcounselsomissionwasprejudicial.Obtainreleasesfromtheclient(sampleincludedwiththematerials)andgettheclientsmedicalrecordsfromprisons,jails,andanyhospitalswherehereceivedtreatment.Ifyouthinkthereisapossibleclaimofineffectiveassistanceofcounsel,youshouldconsiderapplyingforfundstohireamentalhealthexpertwhocanhelpyoudeciphertherecordsandrenderanopinionhowtheycouldhavehelpedyourclient.Asampleapplicationforexpertfundsisincludedinthesematerials.) ! #)ƕk# CaseLawontheSideEffectsof_Antipsychotics_  #   Psychotropic(or_antipsychotic_)drugshavebecomeaprimarytoolofpublicmentalhealthprofessionalsfortreatingseriousmentaldisorders,replacingsuchearliermeasuresaslobotomy,insulinshock,andelectroshock.Inmanypatientstheyminimizeoreliminatepsychoticsymptoms.Theyalsopossessaremarkablepotentialforunderminingindividual ($$ willandselfdirection,therebyproducingapsychologicalstateofunusualreceptivenesstothedirectionsofcustodians.'(_Keyhea_Ԁv._Rushen_(1986)178Cal.App.3d526,531,fn.and *&& citationsomitted.) Theseinclude_thorazine_,_prolixin_,_stelazine_,_serentil_,_quide_,_tindal_, +'' _compazine_,_trilafon_,_repoise_,_mellaril_,_tractan_,_navane_,_haldol_,_moban_,and_vesprin_.(Id.at  p.531,fn.1.) Thedrugsalso,however,havemanyserioussideeffects.Reversiblesideeffectsinclude_akathesia_Ԁ(adistressingurgetomove),akinesia(areducedcapacityforspontaneity),pseudoParkinsonism(causingretardedmusclemovements,maskedfacialexpression,bodyrigidity,tremor,andashufflinggait),andvariousothercomplicationssuchasmusclespasms,blurredvision,drymouth,sexualdysfunction,druginducedmentaldisorders,and,onrareoccasions,suddendeath.Apotentiallypermanentsideeffectoflongtermexposure,forwhichthereisnocure,istardive_diskenesia_,aneurologicaldisordermanifestedbyinvoluntary,rhythmic,andgrotesquemovementsoftheface,mouth,tongue,jaw,andextremities.(Id.atp.531;seealso_Riese_Ԁv.St.MarysHosp.andMed.Ctr.(1987)   209Cal.App.3d1303,13111312.)  _Antipsychotic_Ԁdrugs,sometimescalled_neuroleptics_'orpsychotropicdrugs,'are   medicationscommonlyusedintreatingmentaldisorderssuchasschizophrenia.(Washingtonv.Harper(1990)494U.S.210,214.) Thedrugsadministeredtorespondent  included_Trialafon_,_Haldol_,_Prolixin_,_Taractan_,_Loxitane_,_Mellaril_,and_Navane_.(Id.atp.  214,fn.1.)TheSupremeCourtheld:8  Thepurposeofthedrugsistoalterthechemicalbalanceinapatient'sbrain,leadingtochanges,intendedtobebeneficial,inhisorhercognitiveprocesses.Whilethetherapeuticbenefitsof_antipsychotic_Ԁdrugsarewelldocumented,itisalsotruethatthedrugscanhaveserious,evenfatal,sideeffects.Onesuchsideeffectidentifiedbythetrialcourtisacute_dystonia_,asevereinvoluntaryspasmoftheupper% H %Hzbody,tongue,throat,oreyes.Thetrialcourtfoundthatitmaybetreatedandreversedwithinafewminutesthroughuseofthemedication_Cogentin_.Othersideeffectsinclude_akathesia_Ԁ(motorrestlessness,oftencharacterizedbyaninabilitytositstill);_neuroleptic_Ԁmalignantsyndrome(arelativelyrareconditionwhichcanleadtodeathfromcardiacdysfunction);andtardivedyskinesia,perhapsthemostdiscussedsideeffectof_antipsychotic_drugs.Tardivedyskinesiaisaneurologicaldisorder,irreversibleinsomecases,thatischaracterizedbyinvoluntary,uncontrollablemovementsofvariousmuscles,especiallyaroundtheface.TheState,respondent,andamicisharplydisagreeaboutthefrequencywithwhichtardivedyskinesiaoccurs,itsseverity,andthemedicalprofession'sabilitytotreat,arrest,orreversethecondition.% I %I~Afairreadingoftheevidence,however,suggeststhattheproportionofpatientstreatedwithantipsychoticdrugswhoexhibitthesymptomsoftardivedyskinesiarangesfrom10%to25%.AccordingtotheAmericanPsychiatricAssociation,studiesoftheconditionindicatethat60%oftardivedyskinesiaismildorminimalineffect,andabout10%maybecharacterizedassevere.+''   Ї(Id.atpp.229230,citationsomitted.)    TheCaliforniaSupremeCourthasmadesimilarobservationsaboutmentalhealthmedication:8  Nodoubtsuchcommonlyuseddrugs,the_phenothiazines_,havebeenofconsiderablebenefittomanymentallyillpatients.Useofthesedrugshasgreatlyreducedthenumberofmentallyillindividualsrequiringhospitalization,andthefrequencyandlengthofhospitalizations.Buttheyalsohavebeenthecauseofconsiderablesideeffects.Reversiblesideeffectsinclude_akathesia_Ԁ(adistressingurgetomove),akinesia(areducedcapacityforspontaneity),pseudoParkinsonism(causingretardedmusclemovements,maskedfacialexpression,bodyrigidity,tremor,andashufflinggait),andvariousothercomplicationssuchasmusclespasms,blurredvision,drymouth,sexualdysfunction,anddruginducedmentaldisorders.Apotentiallypermanentsideeffectoflongtermexposureto_phenothiazines_Ԁistardivedyskinesia,aneurologicaldisordermanifestedbyinvoluntary,rhythmic,andgrotesquemovementsoftheface,mouth,tongue,jaw,andextremities,forwhichthereisnocure.Onrareoccasions,useofthesedrugshascausedsuddendeath.     8   ` Althoughanewgenerationof_antipsychotic_Ԁdrugs,thesocalled_atypicals_,havebeenregardedasbeingmorebenignandeffective,considerablecontroversyremainsoverboththeirefficacyandtheextentandnatureoftheirsideeffects.Moreover,mostatypical_antipsychotics_Ԁaredifficulttoadministerwithoutapatient'scooperation,becauseunliketheoldergenerationofmedications,thenewerdrugsaregenerallynotavailableinformsthatcanbeinjected.Also,_phenothiazines_Ԁarecheaperthan_atypicals_andarestillthemostwidelyusedclassofdrugstotreatpsychosis.Thebasicconstitutionalandcommonlawrighttoprivacyandbodilyintegrityisthereforeespeciallyimplicatedbytheforcedadministrationofmedicationswithsuchpotentialadverseconsequences    (Inre_Qawi_(2004)32Cal.4th1,1415,citationsomitted.) %!!   &""   COMMONDIAGNOSES    AxisI     Clinicaldisorder=Problemswithperceptions,feelings,orrelationshipswhichcausesstressorimpairmentineverydayfunctioning.SCHIZOPHRENIA295.xxSchizophrenia:delusions,hallucinations,ordisorganizedspeechorbehavior295.40Schizophreniform:twosuchepisodesinlessthansixmonths295.70Schizoaffective:schizophreniawithdepressionorbipolar297.1  Delusionaldisorder:sufferingfromaplausibledelusionformorethanamonth   298.8  BriefPsychoticEpisode:sufferingfromadelusionforlessthanamonth   MOODDISORDERS  depression=atleastfiveofthefollowing:feelsdepressed,lossofinterest,weightlossorgain,insomniaorhypersomnia,increasedordecreasedactivity,fatigue,guiltorsenseofworthlessness,unabletoconcentrateormakedecisions.  mania=inflatedselfesteemorgrandiose,decreasedsleep,moretalkativeorpressuredspeech,flightofideasorracingthoughts,distractability,increasedactivity,increasedactivitieswithrisks.296.xxBipolarI:manicanddepressedatleastfourtimeswithinayear296.89BipolarII:manicanddepressedatleastoncewithinayear301.13Cyclothymic:generallylessseveremanicphases300.4  Dysthymic:longtermlowgradedepression  311  DepressiveNOS(nototherwisespecified)  ANXIETYDISORDERS300.01Panicattacks300.02Generalanxiety:foratleastsixmonths300.21Panicattackswithagoraphobia300.22Agoraphobia=fearofcrowds300.23Socialphobia=socialanxietysettings300.29Specificphobia=anobjecttriggerspanic300.3  Obsessivecompulsive=recurrentthoughtoractivity &"" 308.3  Acutestress:forlessthanamonth '## 309.81PostTraumaticStressSyndrome:(A)witnessesorexperiencedaneventconcerning(athreatof)greatinjuryordeathandwithfear,helplessness,orhorror;and(B)thetraumaticeventisreexperiencedbyrecurrentrecollectionordreams,actingorfeelingasifitisrecurring,distressedfromcuessymbolizingtheeventortrauma;and(C)avoidstimuliofthe +'' trauma;and(D)arousalwithinsomnia,irratability,hypervigilance,oreasilystartled.IMPULSEDISORDERS=failuretoresisttemptationorimpulsewhichisharmful312.30ImpulseControlNOS312.32Kleptomania312.33PyromaniaV71.01AntisocialbehaviorSUBSTANCEABUSE  Dependence,abuse,intoxication,orwithdrawal  Dualdiagnosis:substanceabuseandanotherdisorder,usuallyschizophreniaormood291,303Alcohol292.xxAmphetamine,cannabis,cocaine,hallucinogen,nicotine,_opioid_,PCP,sedative.304.80PolysubstancedependenceSEXUALDISORDERS302.9  ParaphiliaNOS=recurrentandintensefantasies,urges,orbehaviorsformorethan  sixmonthsinvolving_nonconsensual_Ԁsex302.2  Pedophilia  ADJUSTMENTDISORDER309.9  AdjustmentdisorderNOS:stressorscausedistressorfunctionalimpairment  309.0  withdepressedmood  309.24withanxiety309.28withanxietyanddepressedmood309.3  withconductdisturbance=violatesrules  FACTITIOUS,_SOMATOFORM_ԀDISORDERS  300.xx_Somatization_,conversion,hypochondria:psychosomaticsymptomscausingsignificantimpairmentwithnoapparentadvantagetothepatient  300.16Factitiousdisorder:feignedpsychosomaticsymptomswithnoapparentadvantagetothepatient  V65.2Malingering:feignedpsychosomaticsymptomstogainanapparentadvantage  V15.81NoncompliancewithtreatmentATTENTIONDEFICITDISORDER  Symptomsarisebeforetheageof7,symptomsexistatschoolandathome,andtheyimpairfunctioning.  314.00Attentiondeficitdisorder.Atleastsixofthefollowingformorethansixmonths:notdevotecloseattentiontodetail,frequentdifficultysustainingattention,doesnot +'' seemstolistenwhenspokento,doesnotfollowinstructionsorfinishtasks,difficultyorganizingtasks,avoidsordislikestasksinvolvingsustainedeffort,losesthingsnecessarytocompletetasks,easilydistracted,forgetful.  314.01Attentiondeficitandhyperactivitydisorder.Inaddition,atleastsixofthefollowing:fidgetsorsquirmsinaseat,leavesdeskinappropriatelyinclass,runsandclimbsexcessivelyandwheninappropriate,difficultyplayingquietly,alwaysmoving,talksexcessively,blurtsoutanswersbeforequestionsarecompleted,difficultywaitingturns,interrupts.CONDUCTDISORDER312.8xConductdisorder:aggressive,harmful,damaging,deceitfulorthieving,orseriousviolationofrules.313.81_Oppositional_ԀdefiantMENTALRETARDATION318.2  Profoundretardation:IQ<25  318.1  Severeretardation:IQ2040  318.0Moderateretardation:IQ3555317  Mildretardation:IQ5070  ABUSEORNEGLECT995.52victimofchildneglect995.53victimofmolestation995.54victimofchildabuse AxisII     Personalitydisorder=Astable,inflexiblebehaviorpatterndeviatingfromculturalexpectationscausingadistortedperceptionofselforothers,abnormalrangeofemotion,impairedanddistressedinterpersonalfunctioning,orpoorimpulsecontrol.Theyareenduring,inflexibleandpervasive,startinginearlyadulthood.ECCENTRICFEATURES(relatedtoschizophreniaormooddisorders)  301.00Paranoid_PD_Ԁ=Pervasivedistrustandsuspicion,andatleastfourofthefollowing:feelsexploited,doubtsothers'loyalties,willnotconfideinothers,readshiddenmeaningsintobenignremarks,holdsgrudges,perceivesattacksonreputation,doubtsothers'fidelity.  301.20Schizoid_PD_Ԁ=Detachedandrestrictedemotion,andatleastfourofthefollowing:nodesireforcloserelationships,solitary,nosexualinterest,nopleasurefromactivities,noclosefriends,indifferenttopraiseorcriticism. +''   301.22Schizotypal_PD_Ԁ=Poorinterpersonalskills,distortedperception,eccentricbehavior,nocloserelationships,andatleastfiveofthefollowing:nondelusionalideasofreference,oddormagicalbeliefs,unusualperception,oddthinkingandspeech,paranoid,constrictedaffect,oddbehaviororappearance,noclosefriends,socialanxiety.DRAMATICOREMOTIONALFEATURES(relatedtodepressionoranxiety)  301.7 ` Antisocial_PD_*=Violatesother'srightswhenatleast15yearsold,andat   leastthreeofthefollowing:nonconformitytolawsorsocialnorms,deceitful,impulsive,irritableandaggressive,disregardofsafety,irresponsibleatworkorwithmoney,lackofremorse.  301.81Narcissistic_PD_*=Needsadmirationandlacksempathy,andatleastfiveofthefollowing:grandioseorsenseofsuperiority,fantasiesofpowerorbeautyorideallove,believesheorsheisspecialandshouldassociateonlywithhighstatuspeople,requiresexcessiveadmiration,asenseofentitlement,exploitive,lacksempathy,enviousofothersandabeliefthatothersareenvious,arrogant.  301.83Borderline_PD_Ԁ(borderlinedepressedorbipolar)=Unstablerelationshipsorselfimage,andatleastfiveofthefollowing:franticavoidanceofabandonment,unstableandintenserelationshipswithidealizationanddepersonalizationoftheotherperson,unstableselfimage,impulsive,suicidalandselfmutilatingbehavior,reactivemoodorunstableaffect,chronicfeelingofemptiness,inappropriateanger,paranoid.  301.50Histrionic_PD_Ԁ=Emotionalandattentionseeking,andatleastfiveofthefollowing:aneedtobethecenterofattention,seductiveorprovocativebehavior,shiftingandshallowemotions,physicalappearancemadetodrawattention,impressionistic,theatrical,suggestible,viewsrelationshipsasmoreintimatethanisrealistic.  *PsychopathicinSVPcases(Hare)isacombinationofantisocialandnarcissisticpersonalitytraits.ANXIOUSORFEARFULFEATURES(relatedtoanxietydisorders)  301.82_Avoidant_Ԁ_PD_Ԁ=Inhibitedorhypersensitive,andatleastfourofthefollowing:avoidsinterpersonalactivity,doesnotriskbeingdisliked,restraintinintimaterelationships,preoccupiedwithpotentialcriticism,inhibitedinnewsituations,viewsselfassociallyinept,reluctancetotakerisks.  301.6 ` Dependent_PD_Ԁ=Submissive,clingy,inneedofbeingtakencareof,andat $  leastfiveofthefollowing:indecisive,letsothersassumeresponsibilityformajorareasone'slife,notdisagreeable,lacksinitiative,helplesswhenalone,excessiveefforttoreceivenurture,constantneedforrelationships,excessivefearofbeinglefttocareforoneselfalone.  301.4 ` Obsessivecompulsive_PD_Ԁ=Preoccupiedwithorderliness,perfection,control, ($$ orinflexibleandclosed,andatleastfourofthefollowing:irrationalpreoccupationwithdetailsororganization,perfectionismthwartscompletionoftasks,excessivedevotiontowork,overlymoral,difficultythrowingthingsout,reluctanttodelegate,miserlyspending, +'' rigidandstubborn.MISCELLANEOUS301.9  PersonalityDisorderNOS  301.9  Depressive_PD_  301.9  Passiveaggressive_PD_   V62.89Borderlineretardation:IQ7184 AxisIII      Generalmedicalconditions(_GMC_)=Medicalproblemsofthepatient.Canincludemedicationinducedailments,suchasthefollowing:332.1  _Neuroleptic_ԄinducedParkinsonism   333.xxothermedicationinducedproblemswithmuscletone995.2  adversereactiontomedication   AxisIV     _Psychosocial_Ԁandenvironmentalproblems(PEP)=Thesourcesofthepatient'spsychologicalstressorsortheabsenceofexpectedsupport.Generally,thedoctorfocusesonthefollowing:primarysupportgroup(family)socialenvironmenteducationoccupationorvocationhousingeconomichealthcareaccesslegalotherstressors AxisV  %!!   GlobalAssessmentofFunctioning(_GAF_)scale=Ascalefrom1to100onhowwellthepatientisfunctioning.90+  superiorfunctioning,nopsychologicalsymptoms *&& 80  goodfunctioninginallareas,doesnotrequiringcounseling +'' 70  nomorethanslightimpairment,transientandexpectedimpairmentfromstressors  60  somedifficultybutgenerallyfunctionswell,occasionalcounselinghelpful  50  moderatedifficultyandinterferencewithfunctioning,needscounseling  40  seriousimpairmentandavoidanceorpanic  30  majorimpairment,poorjudgment,needsconstantsupervision,inpatienttreatment  20  unabletofunction,delusionalorimpairedreality   10  unabletofunction,sometimesadangertoselforothers,mustcommit   1  persistentlynonfunctional,requireslongtermcommitment   0  inadequateinformation    Observations/MenaltalS tatus  Evaluations s / tatu      Observationsofcertainfeaturesconcerningthepatientarefrequentlyrecordedinpsychologicalreportsbecausetheymightindicatecertaindisorders.  Inappropriatedressordemeanormightrevealanxietyordisorganizedthought.  Posture,facialreaction,andgroomingcanindicatethepatient'smotivationandselfperception. `     Eyecontact:wanderingeyesmightsuggest_distractability_,hallucinations,cognitivedeficitsormania;avoidingeyecontactmightsuggestanxiety,constanteyecontactmightsuggestsuspicionorparanoia  Orientation(time,place,andpurpose)andwhethermemoryisdistortedcanindicateschizophreniaorhallucinations  Speech:subduedtonecanindicatedepressionoranxiety;hoarseorpressuredspeechcanindicatemania;monotonecanindicateschizophrenia;risingpitchcanindicateanxiety;dropinpitchcanindicatesadnessordepression;excessivemodulationcanindicatemaniaor_somatoform_Ԁdisorder.  Thinking:longpausescanindicatedepression;shortpausescanindicatemania;variedpausescanindicateschizophrenia;fragmentedspeechortheuseofspecialtermscanindicateschizophrenia.  Insight:full(describessymptomsasaresultfromadisorder),partial(knowsthereareproblemsbutlacksawarenessofthedisorder),none(deniessufferingfrommentalproblems).  Judgment=theabilitytochooseappropriategoalsandselectsociallyacceptableobjectivesinordertoreachthegoals.   ($$ ScoresBasedontheBellCurve   <( ,XX" Xp XX<CUMULATIVE " STANDARD h WECHSLER  WECHSLER  TSCORES   PERCENTAGE " DEVIATION h IQTEST  SUBSETS  0.1   `  " 3   h 55    1 p   20 x    2.3   `  " 2   h 70    4 p   30   15.9   `  " 1   h 85    7 p   40   50   `  " 0   h 100    10 p   50   84.1   `  " +1   h 115    13 p   60 x    97.7   `  " +2   h 130    16 p   70   99.9   " +3   h 145    19 p   80   )#)S#   MEDICATIONS     _Antipsychotics_/_Neuroleptics_/_Psychotropics_   0  Treatsschizophrenia(psychosis,delusions);sometimestreatsdepression,mania,bipolar,anxiety,nausea. (#(# 0  Sideeffects:_extrapyramidal_Ԁeffects(spasms,tardive_diskenesia_,stiffness),endocrineeffects(weightgain,diabetes,impotenceinmen,_menstral_Ԁ_irregularaties_Ԁinwomen),sedation,mentaldullness( _Thorazine_Ԁhaze),_muscarinic_Ԁeffects(drymouth,constipation,blurredvision). (#(# _PHENOTHIAZINES_Ԁ(includes_TRICYCLICS_)_8P_chlorpromazine(_Thorazine_) P _promazine_Ԁ(_Sparine_)_triflupromazine_Ԁ(_Vesprin_)_acetophphenazine_Ԁ(Tindal)_fluphenazine_Ԁ(_Prolixin_,_Decanoate_,_Permitil_,_Modecate_)  P _perphenazine_Ԁ(_Trilafon_)_prochlorperazine_Ԁ(_Compazine_)_trifluoperazine_Ԁ(_Stelazine_)_mesoridazine_Ԁ(_Serentil_) $P"# _thioridazine_Ԁ(_Mellaril_)_butoperazine_Ԁ(_Repoise_)_PHENYLBUTYLPIPERADINES_  Lesssedativebutharsher_extrapyramidal_Ԁeffects._haloperidol_Ԁ(_Haldol_)_pimozide_Ԁ(_Orap_) +P)* Ї_THIOXANTHENES_  Lesssedativebutharsher_extrapyramidal_Ԁeffects._thioxanthene_Ԁ(_Navane_)_flupenthixol_Ԁ(_Fluanxol_)_DIHYDROINDOLONES__molindone_Ԁ(_Moban_)_ATYPICALS_Ԁ(includes_DIBENZEPINES_)0  Newerdrugsgenerallywithlessseveresideeffects. (#(# _clozapine_Ԁ(_Clozaril_)[canreducethewhitebloodcellcount]_loxapine_Ԁ(_Loxitane_,_Daxoline_)_olanzapine_Ԁ(_Zyprexa_)_quetiapine_Ԁ(_Seroquel_)_risperidone_Ԁ(_Risperdal_)[generallylessseveresideeffectsthanother_atypicals_]_ziprasidone_Ԁ(_Geodon_)_aripiprazole_Ԁ(_Abilify_) Antidepressants     Treatsdepression,bipolar,_dysthymia_,anxiety,smalldosesof_tricyclics_Ԁformigraines.  Sideeffects:_tricyclics_Ԁand_tetracyclics_Ԁhavethesameeffectsas_antipsychotics_._TRICYCLICS__amitriptyline_Ԁ(_Elavil_,_Endep_)_clomipramine_Ԁ(_Anafranil_)_doxepin_Ԁ(_Sinequan_,_Adapin_)_imipramine_Ԁ(_Tofranil_,_Janimine_)_trimipramine_Ԁ(_Surmontil_,_Rhotrimine_)_amoxapine_Ԁ(_Asendin_)_desipramine_Ԁ(_Norpramin_,_Pertofrane_)_notriptyline_Ԁ(_Aventyl_,_Pulvules_,_Pamelor_)_protriptyline_Ԁ(_Vivactil_,_Triptil_)_TETRACYCLICS__maprotroline_Ԁ(_Ludiomil_)_mirtazapine_Ԁ(_Remeron_)_PHENETHYLAMINES__venlafaxine_Ԁ(_Effexor_) +'' Ї_TRIAZOLOPYRIDINES__trazodone_Ԁ(_Desyrel_)_AMINOKETONES_  Alsotreatsnicotineaddiction  Sideeffect:greaterriskofseizures_bupropion_Ԁ(_Wellbutrin_,_Zyban_)SELECTIVESEROTONIN_REUPTAKE_ԀINHIBITORS(_SSRI_)0  Newerdrugswithlesssideeffectsbutcanincreasesuicidalandhomicidaltendencieswhenthemedicationisstartedorended. (#(# _fluoxetine_Ԁ(Prozac)_paroxetine_Ԁ(_Paxil_)_sertraline_Ԁ(_Zoloft_)_fluvoxamine_Ԁ(_Luvox_)_citalopram_Ԁ(_Celexa_)_MONOAMINE_Ԁ_OXIDASE_ԀINHIBITORS(_MAOI_)0  Awiderangeofsideeffectsincludinghighbloodpressure,reducedperformanceofthekidneys,lowerbloodflowtothebrainandsometimescoma.Thedruginteractswithawidevarietyofmedicationsandfoods. (#(# _isocarboxazid_Ԁ(_Marplan_)_phenelzine_Ԁ(_Nardil_)_tranylcypromine_Ԁ(_Parnate_)MISCELLANEOUS_nefazodone_Ԁ(_Serzone_) _Antianxiety_/_Anxiolytics_/Depressants      Treatsanxiety,panicdisorders,phobias,insomnia.  Sideeffects:sedation,poorsleepinghabits,addiction._Buspirone_Ԁisnotsedating.BENZODIAZEPINESdiazepam(Valium)_clonazepam_Ԁ(_Klonopin_)others(_Librium_,_Ativan_,_Xanax_,_Dalmane_,_Restoril_,Halcion)_BUSPIRONE_Ԁ(_BuSpar_) +'' _TRICYCLIC_ԀANTIDEPRESSANTS  Seeabove._amitriptyline_Ԁ(_Elavil_,_Endep_)others  BETA_BLOCKERS_  Beta_blockers_Ԁinhibittheeffectsofadrenaline(alsoknownasepinephrine).0  Treatshypertension,angina,arrhythmia,migraines,insomnia,_extrapyramidal_disorders,anxietyandpanicattacks. (#(#   Sideeffects:potentialheartproblems,asthma,_hypotension_,temporarysterility._propranolol_Ԁ(_Inderal_)_nadolol_Ԁ(_Corgard_)others  _Anticonvulsants_/_Antiepileptics_     Treatssevereanxiety,seizures,Parkinson's,_extrapyramidal_Ԁdisorders,mania.BENZODIAZEPINES  Sideeffects:seeabove.diazepam(Valium)_clonazepam_Ԁ(_Klonopin_)BARBITURATESamobarbital(Amytal)_pentobarbital_Ԁ(Nembutal)phenobarbital(_Sulfoton_)secobarbital(Seconal)_HYDANTOINS_  Sideeffects:interfereswithawiderangeofdrugs._phenytoin_Ԁ(Dilantin)_mephenytoin_Ԁ(_Mesantoin_)_ethotoin_Ԁ(_Peganone_)_fosphenytoin_Ԁ(_Cerebyx_)MISCELLANEOUS_valporic_Ԁacid(_Depakote_,_Valproate_)  Sideeffect:seeabove.Itsbenefitisthatitisnotsedating._carbamazepine_Ԁ(_Tegretol_,_Epitol_) +''   Sideeffect:higherriskofanemia,bonemarrowdeficiency._primidone_Ԁ(_Mysoline_,_Myidone_)  Metabolizesintophenobarbital.  ANTICHOLINERGICS  Sideeffect:fastheartbeatandarrhythmia,ulcers,glaucoma,psychosisinelderly._trihexphenidyl_Ԁ(_Artane_)_benztropine_Ԁ_mesylate_Ԁ(_Cogentin_)ANTIHISTAMINES0  Inadditiontoallergies,olderantihistaminestreatnausea,motionsickness,anxiety,_extrapyramidal_Ԁeffectsandinsomniabecauseofthesideeffectofcausingdrowsiness. (#(# _diphenyldramine_Ԁ(_Benadryl_,_Excedrin_ԀPM,_Nytol_)_promethazine_Ԁ(_Phenegran_)_hyrdroxyzine_Ԁ(_Atarax_,_Vistaril_) _Antimania_     Treatsmania,bipolar.lithium(_Carbolith_,_Cibalith_,_Lithane_)0  Sideeffect:Canimpairskidneyfunction,highbloodpressure,diabetes.Inrarecases,itcausesirreversiblebraindamage.Thepatientneedsconstantmonitoringbecausethetherapeuticdoseisclosetoatoxiclevel.Theconcentrationoflithiumchangesbroadlywithnormalchangesinbodychemistrythroughouttheday.Signsoftoxicityincludedrowsinessandconfusion. (#(# _valporic_Ԁacid(_Depakote_,_Valproate_)0  Sideeffects:Higherriskofliverfailure,pancreasfailure,ovariancysts,_spina_Ԁbifidainchildren. (#(# _carbamazepine_Ԁ(_Tegretol_,_Epitol_)  Sideeffect:higherriskofanemia,bonemarrowdeficiency. Stimulants  $  0  Treatsattentiondeficitdisorder/hyperactivity,_narcolepsy_,obesity,dementia,fatigue,depression,psychosis. (#(# 0  Sideeffects:hyperactivity,hypertension,insomnia,addiction,psychosis,depression,thinningofthebone,anxiety,addiction. (#(# AMPHETAMINES +'' amphetamine(_Adderall_,_Benzadrine_,_Biphetamine_)dextroamphetamine(_Dexadrine_)methamphetamine(_Desoxyn_)_methylphenidate_Ԁ(_Ritalin_)