Legal Admissibility of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR).

The Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR) was developed to assess competence to stand trial in defendants with Intellectual Disability. Although it remains the only validated instrument for this population, previous research has suggested it is rarely used by forensic examiners, a finding our survey of legal cases confirms. Initial validation studies provided some support for the instrument's reliability and validity. However, in both these and subsequent studies, there were significant limitations with respect to the size and representativeness of study samples, and therefore the associated interpretation of scores, such that questions remain as to whether the tool adequately assesses competence to stand trial in this population. In this paper, we review the research on the CAST-MR, discuss the strengths and limitations of the instrument, and debate its legal admissibility.

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Recent research has suggested nationwide increases in the rates of referral for competence to stand trial (CST) evaluations across the United States. Many of these evaluations are for defendants charged only with misdemeanor offenses and for whom diversion programs are most appropriate. The present study was designed to analyze the characteristics of, and re-arrest outcomes for, defendants charged with misdemeanors ordered to undergo CST evaluations in a large metropolitan area. Overall, there was a high base rate of incompetent to stand trial (IST) opinions (over 70% of defendants) in this sample, with the greatest impairments in rational understanding and ability to assist counsel. Defendants opined IST were more likely to have a psychotic disorder, a history of psychiatric hospitalization, and greater abnormalities in thought content relative to their competent counterparts. Of concern, defendants opined IST, and especially those referred for crisis evaluations upon dismissal of the charges, were significantly more likely to be re-arrested than their counterparts. These data support the criminalization hypothesis, suggesting that criminal justice involvement for this subset of defendants inappropriately reflects psychiatric instability, supporting the need for more options for inpatient and outpatient treatment to effectively intervene in this process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preliminary examination of an insanity defense typology: Prevalence rates and correlates.

The present investigation was designed to systematically examine the insanity defense typology proposed by Brown (2018) using a large sample of cases wherein there was support for the insanity defense. A total of 187 court-ordered cases in which an insanity defense was supported were categorized based on the typology. The sample comprised of mostly single, middle-aged males who had been charged with a felony and diagnosed with a psychotic disorder. About half the sample was ultimately adjudicated not guilty by reason of insanity by the court. About two-thirds of the cases were categorized into one of the seven insanity defense subtypes using a coding scheme developed by the author of the typology. Inter-rater agreement occurred 82% of the time. The most frequent subtype was Paranoid Self-Defense, followed by "But It's Mine" and Paranoid Protection of Others. There were few differences among these subtypes based on demographic, clinical, offense, and outcome variables, except for presence of a primary psychotic disorder and offense type. Implications and ideas for future research are discussed.

Insanity defense typology.

Much has been written about how to conduct insanity defense evaluations, as well as how to operationalize the legal definitions of insanity. However, the insanity defense has never been categorized by a typology. This article describes a typology of six subtypes of the insanity defense: paranoid self-defense, "but it's mine," erotomanic stalking, deific decree, disorganized, and false report. Knowledge of these subtypes, while not all inclusive, can inform insanity defense evaluations, guide training, and potentially increase the reliability of forensic evaluators' opinions. In addition, such subtypes can generate future research regarding prevalence, interrater reliability, and associated features of the different subtypes.

Use of the Personality Assessment Inventory in Fitness-for-Duty Evaluations of Physicians.

This study provides normative data regarding the use of the Personality Assessment Inventory (PAI) in physician fitness-for-duty evaluations. Information was derived from a sample of 371 physicians who took the PAI as part of a comprehensive fitness-for-duty evaluation. A multidisciplinary evaluation team, not blinded to psychological testing results, recommended whether or not each physician was fit to practice, allowing for the differentiation of results by this finding. The majority of PAI protocols were valid and interpretively useful. Descriptive statistics are presented for validity, clinical, treatment, interpersonal, and subscale scores. Mean differences for those found fit versus unfit to practice are also presented. Significant elevations for clinical scales are rare in physicians referred for fitness-for-duty evaluations. Although mean differences were small between the fit and unfit groups, there were significant mean differences found. Guidance is offered for interpreting the PAI in this population.

Suicidal behavior among physicians referred for fitness-for-duty evaluation.

OBJECTIVE: We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not. METHOD: Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample. RESULTS: Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05). CONCLUSION: Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.