Incompetent to stand trial

BACKGROUND: Globally, crime is highly masculinised and research into female criminality is scarce. In South Africa, no research specifically investigating the characteristics of female observandi referred for non-violent crimes has been published. AIMS: The study aimed to describe the socio-demographic, clinical, and forensic correlates in women referred to Sterkfontein Hospital for forensic psychiatric observation following a non-violent criminal charge between 2010 and 2019...

New England Journal of Medicine, Volume 389, Issue 25, Page 2314-2317, December 2023.

Intellectual functioning impacts defendants' competence to stand trial, though research on this population remains limited. This study replicated and advanced prior work, focusing on defendants' demographic, clinical, cognitive, and criminal justice variables and their association with length of hospitalization and restoration determinations. Participants were 74 male and female criminal defendants in a midwestern state who were adjudicated incompetent to stand trial, had a diagnosis related to intellectual deficits, and completed competency restoration...

OBJECTIVE: Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis is a rare, recently discovered condition that typically presents initially with psychiatric disturbances followed by neurological and neuropsychological symptoms. Little is known about neuropsychological outcomes with this condition. This poster will expand our knowledge by presenting a monolingual Spanish male who emigrated to the US from Latin America and was arrested on multiple offenses during psychiatric symptom onset of anti-NMDAR encephalitis...

OBJECTIVE: Research has highlighted how key cognitive functions underlie abilities within the construct of Competency to Stand Trial (CST). This case study examines the impacts of Mild Neurocognitive Disorder and culture on a physician found incompetent to stand trial. METHOD: A 62-year-old African-born male physician charged with Health Fraud who was referred for an examination of his CST. His attorneys raised concerns about his rational understanding of the proceedings and his ability to collaborate constructively with them...

Criminal defendants found incompetent to stand trial (IST) may only be committed for competency restoration if their restoration success is considered likely and when this aim can be met within a "reasonable" period of time. In this study, we evaluated the predictive validity and test accuracy of standardized intelligence testing on the classification of nonrestorability in a sample of 293 male patients adjudicated IST and committed for inpatient restoration. At 90 days, 17.0% of cases with FSIQ scores within one standard deviation of the mean were unrestored, and nonrestoration rates increased with each additional FSIQ standard deviation decrement to 29...

Under United States law, criminal prosecution may not proceed against a defendant who is incompetent to participate in this process. The vast majority of defendants who are adjudicated incompetent to stand trial (IST) will subsequently regain sufficient capacities to be adjudicated competent to stand trial (CST). However, a small subgroup of defendants do not show sufficient improvement in clinical functioning and functional-legal capacities to regain CST. Under Jackson v. Indiana (1972), such individuals should be adjudicated unrestorably IST, with associated actions (e...

BACKGROUND: The Israel Mental Health Act of 1991 stipulates a process for court-ordered involuntary psychiatric hospitalization. As in many Western countries, this process is initiated when an individual is deemed "not criminally responsible by reason of mental disorder (NCR-MD)" or "incompetent to stand trial (IST)." A patient thus hospitalized may be discharged by the district psychiatric committee (DPC). The decision rendered by the DPC is guided by an amendment to the Mental Health Act that states that the length of the hospitalization should be in accordance with the maximum time of incarceration associated with the alleged crime...

BACKGROUND: Intrinsic atrioventricular (AV) conduction is used to optimize AV intervals with cardiac resynchronization therapy (CRT) in most device algorithms. Atrial pacing and heart rate affect conduction times, but little is known regarding differeces among chronotropic incompetent(CI) and competent(CC) patients to guide programming. METHODS: RAVE was a multicenter prospective trial of CRT patients. Heart rate was increased with incremental atrial pacing and with submaximal exercise...

OBJECTIVE: State of Washington v. Sisouvanh (2012) was the first case in which an appellate court asserted the need for cultural competence in competency-to-stand-trial evaluations. A court reiterated this need in State of Washington v. Ortiz-Abrego (2017). Research in forensic psychology seldom addressed cultural considerations in pretrial evaluations until this past decade, but the growing body of literature pales in comparison to the work found in clinical and counseling psychology...

This study sought to delineate the neuropsychological processes that undergird the psycho-legal concept of competency to stand trial (CST). Accordingly, we retrospectively examined the relationship between clinical judgments of competence or incompetence of defendants committed to a maximum-security psychiatric facility and neuropsychological measures of cognitive and social intelligence and declarative memory. Results indicated that both groups (competent and incompetent) showed similar levels of depressed cognitive intelligence with Wechsler full-scale IQ levels falling in the upper end of the borderline range...

OBJECTIVE: The aim of this study was to assess factors associated with SARS-CoV-2 (COVID-19) vaccination in patients in 2 inpatient forensic psychiatric hospitals. METHODS: This was a retrospective chart review evaluating factors associated with COVID-19 vaccination for patients residing in two inpatient forensic psychiatric hospitals between January 1, 2021 and February 28, 2022. Data was collected through electronic medical records utilizing MetaCare Enterprise™ and secure facility computer drives, individual patient paper charts, and Missouri's vaccination records database, ShowMeVax...

Introduction: A defendant who is deemed incompetent to stand trial may go through competency restoration consisting of mental health treatment and legal education. Antipsychotics are often used in treatment; however, there is little data examining their role. Methods: This retrospective study included subjects opined competent to stand trial from July 2016 to February 2020 and prescribed an antipsychotic. The primary outcome was difference in time to competency between antipsychotics...

Referrals for competency restoration increased in the past decade, with the majority of incompetent to stand trial (IST) patients having schizophrenia; 25 percent of schizophrenia patients are treatment resistant. Clozapine is superior to other antipsychotics for treatment resistance but remains underutilized, particularly in forensic settings. Despite the impact of treatment resistance on the legal system, the literature on clozapine for IST patients is limited to two papers comprising 26 patients. A retrospective chart review was conducted of all IST admissions to a California hospital for 2014 to -2018, examining clinical and forensic outcomes in those newly started on clozapine and discharged...

This study aimed to provide a descriptive analysis of the geriatric forensic population referred to a Regional Forensic Psychiatric Service by the court for evaluation (as inpatient, outpatient, or while incarcerated) in New Zealand, over a 7-year period. Data were collected retrospectively from forensic hospital records, including court-ordered reports for those aged 60 and older. Two-fifths (42%) of the 97 referred study subjects were diagnosed with some form of cognitive impairment such as dementia. The majority had a prior history of offending...

Forensic systems have seen an increase in the number of defendants in need of competency restoration services. Traditionally, competency restoration services have occurred at state psychiatric hospitals. Unfortunately, the waitlists for hospital competency restoration are extensive and result in many defendants waiting in jail for more than 4 months for an inpatient bed. These waitlists have led to lawsuits forcing states to provide adequate treatment and evaluation services to mentally ill adults languishing in jails...

Over the past several years, individuals with serious mental illness (SMI) have become involved with the legal system at an increasing rate. State psychiatric hospitals and community mental health programs have seen a high number of referrals and admissions at a time when resources and staffing have been challenges. Individuals with SMI continue to be highly represented among those incarcerated in jails and prisons, often for minor charges. This article serves as an introduction to a special section of Psychological Services on innovations in assessment and treatment of legally involved patients in state hospitals and community mental health settings...

In the United States, criminal proceedings must be halted or suspended if a defendant is determined to be incompetent to stand trial. Competency to stand trial (CST) is one of the most notable intersections between psychiatry and criminal law, and evaluating defendants for CST is a key role for many forensic psychiatrists and other mental health professionals. Despite the significance of CST evaluations in U.S. criminal justice, the number of CST evaluations conducted across the country each year remains largely unknown...

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS...

Over 50,000 defendants are referred for competency to stand trial evaluations each year in the United States (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, New York, NY: The Guildford Press; 2018). Approximately 20% of those individuals are found by courts to be incompetent and are referred for "restoration" or remediation (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, 4th edn. New York, NY: The Guildford Press; 2018; Bull Am Acad Psychiatry Law...