Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel.

This Article analyzes the 2021 judgment of the Supreme Court of Pakistan in the case of Mst. Safia Bano v. Home Department, Government of Punjab. The case has garnered significant local and international attention due to the Court\'s ruling that a death sentence may not be carried out on a defendant who has a mental illness. Setting the case against the backdrop of Pakistan\'s Islamic and colonial contexts, this article argues that the Supreme Court has reshaped the insanity defense in Pakistani law by placing the determination of a defendant\'s mental state mainly in the hands of medical professionals. However, the Court\'s reliance on medical professionals and the subsequent downplaying of the \"moral capacity\" element of the insanity defense-a determination of law made by courts-has created an obstacle for courts to punish offenders more stringently in future cases due to the popular belief that mental health professionals are ill-equipped to answer broader questions of justice for victims and society. The article recommends that this issue can be remedied by establishing an objective legal test for insanity that considers Islamic law, Pakistani precedent, and advances in medical science.

There are some distinct methodological challenges, and possible pitfalls, for neuroethics when it evaluates neuroscientific results and links them to issues such as moral or legal responsibility. Some problems emerge in determining the requirements for responsibility. We will show how philosophical proposals in this area need to interact with legal doctrine and practice. Problems can occur when inferring normative implications from neuroscientific results. Other problems arise when it is not recognized that data about brain anatomy or physiology are relevant to the ascription of responsibility only when they are significantly correlated with the psychological capacities contemplated by the legal formulations of responsibility. We will demonstrate this by considering two significant cases concerning psychopathy. Some paradigms that aim at measuring higher-order capacities, such as moral understanding, have limited validity. More robust paradigms for the study of learning in restricted controlled conditions, on the other hand, have limited ecological validity across individuals and context to be of any use for the law.

The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.

Bipolar disorder is a chronic, relapsing illness characterised by recurrent episodes of manic or depressive symptoms, with intervening periods that are relatively (but not fully) symptom-free. Studies have found higher rates of psychiatric disorders in homicide offenders than in the general population. The insanity defence is a legal construct that, under some circumstances, excuses defendants with mental illness from legal responsibility for criminal behaviour. Here we report two cases of family murder by the mother of the family caused by bipolar disease. The role of the forensic psychiatrist in diagnosing insanity during the commission of a crime is very important as these patients should be diagnosed, treated as soon as possible, and monitored. Public education through social media should be considered to reduce crimes in societies. Diagnosing insanity during the commission of a crime is very important and requires high precision forensic psychiatry. Public education through social media should be considered to reduce crimes in societies.

Psychiatric symptoms resulting from Multiple Sclerosis (MS) itself or its treatment are well known. However, the relationship between psychotic episodes and Multiple Sclerosis remains debated. In this paper, we present the case of a woman who developed a chronic psychotic disorder a few months after the onset of MS. We describe the process which led us to make the diagnosis of Psychotic Disorder due to Medical Condition (Multiple Sclerosis). Because her criminal charges brought significant attention to her case, we also address the difficulty in treating a neurological condition with psychiatric features within the forensic context. Moreover, one of the main concerns of the patient was that Lyme Disease was the correct diagnosis as opposed to MS. We also report the difficulty of treating and initiating successful follow-up for a patient whose paranoia is enabled by the opinions of certain health advocacy groups.

In Portugal the expert whose report supports the criminal defence of not guilty by reason of insanity (NGRI) must also consider the defendant\'s dangerousness. Nevertheless, the concept of dangerousness has received little attention in the Portuguese critical literature. Moreover, there is concern that the concept is often used improperly. We endeavoured to evaluate a sample of Portuguese forensic reports in order to discuss: 1) the prevalence of defendants who were considered guilty, NGRI, and dangerous; 2) which treatments were proposed; and 3) the frequency of technical errors found. We analysed 124 case folders from the year 2006, from both mainland Portugal and the archipelagos of Madeira and the Azores, which included an evaluation of dangerousness of the defendants. These 124 cases were analysed using frequencies, correlations and multiple logistic regressions. The majority of the defendants were male and single. Thirty-nine percent (39%) were considered NGRI. A total of 34% of the defendants were considered dangerous or no dangerousness could be excluded. In 66% of cases treatment was recommended but in only 9% was admission to a forensic hospital recommended. Technical errors in the forensic reports, both of format and content, were identified in 26% of the 124 cases, the incidence of errors being high in reports from certain institutions. The majority of the forensic reports did not discuss the educational background of the defendants or their criminal history/records. We conclude that the experience of the expert is crucial in producing an appropriate report. The establishment of uniform criteria for the preparation of forensic reports and enhanced training of psychiatrists in forensic psychiatry should be considered as possible strategies to improve the accuracy of forensic reporting, particularly when assessing dangerousness.

Evaluations of legal sanity are some of the most complex and consequential mental health evaluations that forensic clinicians perform for the courts. Thus, there is strong reason to monitor the wide-scale process and conclusions of sanity evaluations. In this study, we review 1,111 court-ordered sanity evaluation reports submitted by 74 evaluators in Virginia from the first year after the state initiated an oversight system that allowed for such comprehensive review. Overall, the base rate of insanity findings was 16.9%, although base rates of insanity findings among individual evaluators varied from 0% to 50%. Similarly, most evaluators cited the cognitive (rather than volitional) criteria of the insanity defense as the basis for their insanity findings, although evaluators varied in their patterns of citing these underlying insanity criteria. Our review revealed other trends in practice, such as the rarity of psychological testing (2% of cases) and the frequency of conveying conclusions in \"ultimate issue\" format (76%). Overall, findings reveal that a majority of reports seem reasonably consistent with practice guidelines, but also reveal some idiosyncratic practices or patterns that suggest there is opportunity for improvement.

The role of experts and their presentation of testimony in insanity cases remain controversial. In order to decrease possible expert bias associated with this testimony, a number of different alternatives to adversarial presentation have been suggested. Two such alternatives are the use of court-appointed experts and the use of concurrent testimony (or \"hot-tubbing\"), in which opposing experts provide testimony concurrently and converse with each other directly. An experiment using a sample of venire jurors (n = 150) tested the effect of these alternatives. Results indicate that participants\' pre-existing attitudes towards the insanity defense had significant effects on their comprehension of expert testimony, their evaluations of the two opposing experts, and their eventual verdicts, over and above the presentation format (i.e., concurrent vs. traditional testimony) or the use of court-appointed experts (vs. traditional adversarial experts). When concurrent testimony was presented, defense-favoring experts were perceived by jurors as more credible than their traditional counterparts, though comprehension of the testimony did not increase; nor did the presentation format or the affiliation of the experts affect verdicts. The legal and policy implications of the incorporation of the hot-tubbing procedure to US courts are discussed.

This project began as an attempt to develop systematic, measurable indicators of bias in written forensic mental health evaluations focused on the issue of insanity. Although forensic clinicians observed in this study did vary systematically in their report-writing behaviors on several of the indicators of interest, the data are most useful in demonstrating how and why bias is hard to ferret out. Naturalistic data were used in this project (i.e., 122 real forensic insanity reports), which in some ways is a strength. However, given the nature of bias and the problem of inferring whether a particular judgment is biased, naturalistic data also made arriving at conclusions about bias difficult. This paper describes the nature of bias - including why it is a special problem in insanity evaluations - and why it is hard to study and document. It details the efforts made in an attempt to find systematic indicators of potential bias, and how this effort was successful in part, but also how and why it failed. The lessons these efforts yield for future research are described. We close with a discussion of the limitations of this study and future directions for work in this area.