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.

The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed for criminal responsibility. We investigated the demographic, psychiatric, and criminological characteristics of women recommended as eligible or ineligible for the defence of Not Criminally Responsible (NCR) on account of mental disorder following a criminal responsibility assessment in Central Canada. Data were collected through retrospective chart reviews of court-ordered criminal responsibility assessments for 109 women referred for evaluations between 2003 and 2019. Accused were an average age of 34.55 years, predominately identified as Indigenous (37.7%) or Caucasian (20.8%), and had often been charged with assault (47.7%). Women identified in the reports as NCR-eligible were significantly more likely to be employed, experience delusions during the index offence, and have expert reports linking their mental health symptoms to NCR legal criteria. They were also significantly less likely to have a personality disorder, substance-related diagnosis, or have used substances during the index offence. Delusions during the index offence significantly predicted assessment recommendations when controlling for age at assessment order, current substance-related diagnosis, and whether the expert report linked mental health symptoms to NCR legal criteria. Findings indicate the key factors considered by forensic mental health professionals when conducting criminal responsibility assessments with women. Meaningful differences exist between women identified as NCR-eligible and ineligible, with findings illustrating who may be more likely to receive services within the Canadian forensic mental health system.

Behaviors that would otherwise be considered criminal acts, but occur in the context of a sleep disorder, pose challenges to the traditional application of legal principles of criminal responsibility. Determining the degree to which consciousness is present during such behaviors becomes a necessary step in assigning criminal culpability. Historically, legal defense theories of unconsciousness, automatism, and insanity have been raised to negate culpability for parasomnia related behaviors. Accordingly, proper assessment of sleep disorders in the context of criminal charges becomes critical in assisting the functions of the justice system. This article reviews principles related to the legal tradition, expert assessment, and elements of expert testimony related to criminal behaviors and sleep disorders.

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.

Empowerment not only benefits patients but also provides support and assistance to their family members, especially in cases when patients are subject to custodial protection sentences. The positive effects of empowerment on patients\' family members may be summarized into three main aspects, including: enhancing their engagement in healthcare, alleviating their anxiety, and enhancing their caregiving skills. With regard to enhancing engagement in healthcare, family members receive health education that provides an overview of the illness, treatment options, prognosis, and key nursing points and allows them to better understand the patient\'s condition and actively participate in decision-making. With regard to alleviating anxiety, patients under custodial protection sentences are involved in legal problems, which results in higher levels of stress for family members compared to their peers caring for general patients. Through emotional support and active listening, nurses provide opportunities for family members to express their concerns and offer comfort and encouragement, helping them cope with difficulties and pressures. With regard to enhancing caregiving skills, the purpose of custodial protection sentences is to prevent recidivism, and family members bear significant responsibility for caregiving after discharge. Nurses can share similar caregiving experiences from their ward, educate family members about observing symptoms, and provide guidance, thereby strengthening their caregiving capabilities. In addition, with regard to the disposition of patients, nurses assist family members to understand the medical process and provide necessary guidance, ensuring family members have a clear understanding and are respected during the preparations for discharge. Based on related theoretical frameworks and practical experiences, this research highlights the positive role of empowerment in enhancing the caregiving abilities and satisfaction of the family members of patients, particularly those subject to custodial protection sentences.
BACKGROUND: 監護處分之病人家屬賦能理論與實務.
賦能不僅對病人有益，同樣也可以對病人的家屬提供支持和幫助。賦能應用於監護處分之病人家屬可分為三個部分：增進家屬對於醫療的投入—透過衛教，提供疾病概述、治療選項、預後和護理重點，另外藉由整合病人家屬之不同意見，建立良好的合作關係，及時傳達病情變化和治療計畫，讓家屬更了解病情，並積極參與決策；緩解家屬的焦慮感—因為監護處分涉及司法案件，監護處分病人的家屬較一般病人的家屬面臨更多的壓力，透過護理師的情感支持和聆聽，讓家屬有機會表達他們的擔憂，可以讓病人家屬的情緒得到安慰甚至是鼓勵；提升家屬後續照護技巧—監護處分的目的是避免再犯，家屬在出院後須承擔許多照護上的責任，藉由護理師將病房中照顧經驗分享、發病徵兆的觀察等，教導家屬，可以使家屬更有能力照顧病人，並在轉銜上，協助家屬清楚流程並且得到尊重。本研究除整理理論外，亦介紹實務上經驗，分享賦能如何提升監護處分病人家屬的照護能力，並建議在監護處分病人的照顧上，值得善加運用。.

Epilepsy may be associated with automatisms that are classed as \'insane \'as they are deemed to have originated within the mind. \'Sane automatism\' is said to occur from external factors, such as physical trauma, while \'insane automatism\' is said to be innate to the individual experiencing them. To claim automatism within the context of a criminal matter requires a detailed evaluation of the behavior demonstrated and a questioning of the volitional and purposeful nature of this behavior. It is insufficient to rely upon past behavior in association with these seizures to justify the defense of automatism within a specific event. Epilepsy is often considered to be associated with an increase in violence. Proper epidemiological research, both in long-term, large population control studies and hospital-based studies, has suggested that epilepsy, per se, is not associated with an increase in violence when compared to the population at large and controlled for other familial and environmental factors.

Persons with neuropsychiatric disorders present specific and unique challenges for forensic experts and defense attorneys in the criminal justice system. This article reviews two potential criminal defenses: legal insanity and the various legal standards or tests of criminal responsibility that are used in jurisdictions throughout the United States (i.e., the M\'Naghten standard and the American Law Institute\'s Model Penal Code), and the partial legal defense of diminished capacity (lacking the mental state necessary to be found guilty of a specific intent crime). The process of evaluating criminal responsibility or diminished capacity is also presented with a specific emphasis on common issues that arise in evaluating defendants with Intellectual Developmental Disorder (Intellectual Disability), Parasomnias, Seizure Disorders, and Neurocognitive Disorders.

Extraneous neuroscience information improves ratings of scientific explanations, and affects mock juror decisions in many studies, but others have yielded little to no effect. To establish the magnitude of this effect, we conducted a random-effects meta-analysis using 60 experiments from 28 publications. We found a mild but highly significant effect, with substantial heterogeneity. Planned subgroup analyses revealed that within-subjects studies, where people can compare the same material with and without neuroscience, and those using text, have stronger effects than between-subjects designs, and studies using brain image stimuli. We serendipitously found that effect sizes were stronger on outcomes of evaluating satisfaction or metacomprehension, compared with jury verdicts or assessments of convincingness. In conclusion, there is more than one type of neuroscience explanations effect. Irrelevant neuroscience does have a seductive allure, especially on self-appraised satisfaction and understanding, and when presented as text.

The procedures and outcomes of conditional release of insanity acquittees is a relatively neglected area of forensic psychiatric research. The release procedures vary in individual states, resulting in a wide range of approaches, from the careful selection of appropriate patients and strict monitoring in the community, to literally no mechanism for ensuring the future safety of such individuals. In North Carolina there are institutional barriers which even hinder research on the outcomes of such cases. Haroon and colleagues report on the post-release outcomes of insanity acquittees in North Carolina from 1996 to 2020. The findings of the researchers are analyzed in light of the lack of a formal post-release monitoring system in their state, contrasted with outcomes in states where a strict monitoring program is in place. Commentary is provided on the study findings, including associations between demographic, psychiatric, and criminological characteristics of insanity acquittees and release outcomes, as well as an apparent systemic bias against minority acquittees in the insanity commitment and release process in North Carolina. Further research on this important topic, from additional state jurisdictions, is recommended.

COVID-19 strongly affected referral of individuals from Oregon\'s courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days. An inevitable judicial process intensified in the U.S. District Court of Oregon after OSH requested a COVID-related modification of the seven-day limit. This commentary demonstrates more clearly than in the past that there is a negative correlation between civil commitment and competency restoration as components of an interrelated system. After updating the situation in Oregon, this article ends with suggested interventions to improve Oregon\'s civil and criminal commitment processes, hoping for better care of patients and improved administration of justice.