Despite the popularity of structural neuroimaging techniques in twenty-first-century research, its results have had limited translational impact in real-world settings, where inferences need to be made at the individual level. Structural neuroimaging methods are now introduced frequently to aid in assessing defendants for insanity in criminal forensic evaluations, with the aim of providing \"convergence\" of evidence on the mens rea of the defendant. This approach may provide pivotal support for judges\' decisions. Although neuroimaging aims to reduce uncertainty and controversies in legal settings and to increase the objectivity of criminal rulings, the application of structural neuroimaging in forensic settings is hampered by cognitive biases in the evaluation of evidence that lead to misinterpretation of the imaging results. It is thus increasingly important to have clear guidelines on the correct ways to apply and interpret neuroimaging evidence. In the current paper, we review the literature concerning structural neuroimaging in court settings with the aim of identifying rules for its correct application and interpretation. These rules, which aim to decrease the risk of biases, focus on the importance of (i) descriptive diagnoses, (ii) anatomo-clinical correlation, (iii) brain plasticity and (iv) avoiding logical fallacies, such as reverse inference. In addition, through the analysis of real forensic cases, we describe errors frequently observed due to incorrect interpretations of imaging. Clear guidelines for both the correct circumstances for introducing neuroimaging and its eventual interpretation are defined.

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The AAPL Practice Guidelines for the Forensic Evaluation of Psychiatric Disability reminds treating psychiatrists as well as forensic examiners of the potential for role conflicts and of numerous factors related to handling of treatment records. This commentary suggests ways of more completely avoiding role conflicts, including those related to payment, and elaborates on implementation of requirements of the HIPAA Privacy Rules applicable to independent examination by third parties.

The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts\' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist\'s opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist\'s analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law\'s interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.

The author assesses the accuracy of both the public\'s opinion and researchers\' conclusions regarding the method of adjudication of insanity cases and investigates the impact of the various types of reforms enacted in the 1980s on the degree to which insanity cases are contested. Data from seven states are analyzed. The public\'s view that insanity cases are typically resolved by a jury trial is inaccurate. Only 14.4 percent of the 7,299 insanity cases involved a jury trial. Likewise, scholars\' views that most cases are resolved through plea-bargained insanity acquittals are inaccurate. Only 42.9 percent of all insanity cases are plea bargains, and 87.9 percent of all plea bargains are to a conviction. Jury trials are most likely to occur when the case involves a violent crime such as murder and the defendant has not been diagnosed with a major mental illness. Public fears that defendants easily \"fool\" juries into an inappropriate insanity acquittal are also unfounded. Only 16.1 percent of all jury trials result in an insanity acquittal. In three states, the figure is 10 percent or less. Contrary to the conclusions drawn by some scholars, this author finds that several types of reforms enacted in the 1980s affected the processing of insanity cases.

The insanity defense reflects the moral judgment that some criminal defendants do not deserve criminal sanctions because of mental incapacity. This Note examines the alternative formulations, such as guilty but mentally ill and diminished responsibility, that some states have enacted in the face of growing controversy over the insanity defense. It observes that the alternatives, if used in lieu of the insanity defense, distort the criminal law and do not comport with the legal doctrine of responsibility, which eschews punishing mentally ill defendants. The Note concludes that the insanity defense should not be abolished unless the moral consensus changes regarding the criminal responsibility of mentally ill defendants.

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This paper examines three categories of mentally abnormal offenders who are held under Lieutenant Governor\'s Warrants. It explores the psychiatric-legal issues in cases of pre-trial (not fit to stand trial) and post-trial (not guilty by reason of insanity) L.G.W.\'s. An attempt is made to provide a structure for such psychiatric-legal evaluations. Clinical guidelines are offered about the objectives, the assumptions and the criteria which form the basis of such evaluations. Suggestions are made for collection of relevant data which should inform psychiatric and legal judgement-making in this area. The role of the psychotropic medication in N.G.I. cases is discussed. It is recommended that whenever medically feasible, a controlled drug-free trial should be carried out in N.G.I. cases prior to their final release, in order to unambiguously establish their need for medication.