Previous research demonstrates that expert witness education and experience have an influence on mock juror perceptions of credibility. However, whether this relationship extends to cases involving the insanity defense remains unclear, leaving an important gap in the literature given the high stakes of such trials. The current study used an experimental design to examine the impact of expert witness knowledge (high vs. low) on perceived credibility and subsequent NGRI endorsement. Participants (N = 425) read a case summary and the credentials and testimony of the expert witness, completed questionnaires, and reported the likelihood that they would endorse NGRI for the defendant. Results indicated that, regardless of expert witness testimony, prior attitudes about the insanity defense (IDA-R) predicted NGRI endorsement. Specifically, positive attitudes towards the insanity defense resulted in an increased likelihood of NGRI endorsement. These findings underscore that juror attitudes toward the insanity defense, rather than expert witness characteristics, may be the decisive factor shaping NGRI endorsement. This highlights the need for courts to consider such attitudes during jury selection in NGRI cases, paralleling the practice of death qualification in capital trials.

The insanity defense is intended to negate the culpability of defendants who cannot fairly be held responsible for behavior that was due to their mental illness. Does the calculus change when the defendant may have self-induced an impaired mental state by failing to take prescribed medication? That question was considered by the Georgia courts in the case of a woman with bipolar disorder whose reckless driving led to the death of a 5-year-old child. One of the few states to have addressed this issue, Georgia looked to the terms of its insanity defense statutes to come up with an answer.

Developmental factors in forensic assessments of children over the minimum age of criminal responsibility: A study of forensic reports in Norway 2013-2024.

We present the case of a 45-year-old woman who survived a suicide attempt with partial hanging and presented with electrocardiographic (ECG) abnormalities that mimicked acute coronary syndrome (ACS). She exhibited ST-segment abnormalities and QT interval prolongation, all of which resolved within 1 month. This case highlights the importance of recognizing stress-induced cardiomyopathy, such as Takotsubo cardiomyopathy, which can present with ECG changes similar to ACS, particularly in patients experiencing extreme emotional distress or suicide attempts.

IntroductionFeigning is defined as “to represent falsely; to imitate so as to deceive” (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). Malingering and dissimulation are subtypes of feigning: malingering involves intentionally producing symptoms for incentives (World Health Organization. ICD-11 2022), while dissimulation involves concealing symptoms to appear mentally well (Caruso et al. J Am Acad Psychiatry Law 2003; 31:444-50). The prevalence of feigning illness remains uncertain, and varies with context and incentives. Within the legal context, 17.5% feign incompetence to stand trial and 64.5% to plead not guilty by reason of insanity. Malingering has been reported in up to 56% of general offender samples (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). In the public setting, the malingering prevalence constituted 30% of disability evaluations, 29% of personal injury evaluations, 19% of criminal evaluations and 8% of medical cases (Mittenberg et al. J Clin Exp Neuropsychol). In 2006, malingering resulted in approximately $150 billion in annual expenses for the US insurance industry (Mason et al. Perspect Psychiatr Care 2014; 50: 51-7).ObjectivesTo explore the challenges in differentiating psychiatric illness from feigning.MethodsThis case involves analysing the patient’s history, collateral information, and diagnostic interviews to distinguish psychiatric pathology from feigned symptoms.ResultsA 31-year-old male with a history of paranoid schizophrenia, whose recent psychiatric admission was prompted by psychosis and charges of serious assault, property damage, and possession of a weapon. The admission raised suspicions of symptom feigning and patient wariness of the psychiatric stigma. Despite four years of engagement with mental health services (MHS), the patient disclosed shortly after admission that he had been feigning his symptoms to obtain an insanity plea, but now hopes to return to prison seeking a more favourable environment and the certainty of a confirmed guilty sentence. Collateral information from the community MHS and family members suggested underlying psychiatric concerns and manipulative tendencies of the patient, complicating the diagnosis and raising the possibility of dissimulation.ConclusionsThe case highlights the challenges of distinguishing genuine psychiatric illness from deceptive behaviour, emphasizing the importance of thorough history-taking, understanding symptom pathology, using diverse interview techniques, gathering collateral information, and conducting psychological assessments. Clinicians must carefully distinguish feigning from true pathology to provide accurate diagnoses, ensure proper treatment, reduce costs, and safeguard public safety.Disclosure of InterestNone Declared

The present study was designed to examine the mental health challenges facing Ukrainian migrants exposed to the 2022 Russian invasion and who now reside in the United States, focusing on trauma, posttraumatic stress disorder, and emotional distress. Our study explored how anticipatory grief and perseverative worry intersect and contributed to migrants' emotional distress, which is further compounded by their ongoing emotional connection to Ukraine, where many relatives remain in danger. Using a general inductive approach, we analyzed data from interviews with eight Ukrainian war migrants in the U.S. interviews were conducted in Ukrainian or Russian and analyzed using Dedoose Version 9.2.005. The majority (five of eight) of participants discussed posttraumatic stress disorder symptoms and extreme emotional distress (six of eight) as a direct result of their exposure to war and violence, either firsthand or through loved ones. Participant statements suggested that emotional distress and strong emotional connection to Ukraine often co-occurred, with (a) 62.5% of individuals reporting both concerns for the safety of family members still in Ukraine, (b) material/emotional connections to Ukraine, and (c) 75% of participants indicating that their emotional distress was highly linked to trauma and posttraumatic stress disorder. Ukrainian migrants face a complex spectrum of trauma and emotional distress, influenced by their ongoing connection to a conflict zone and by constant worry for their families' safety. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The COVID-19 pandemic led to extreme social isolation and emotional distress. Technology-based contacts were used as substitutes for in-person interactions. Yet, studies suggest inequities in technology access and mixed perceptions regarding technological solutions to facilitate social interactions and deliver services among older adults. In this study, we explored and compared experiences with social isolation and adaptation to technology among low-income White and ethnically minoritized older adults. Analysis of semi-structured interviews embedded in a randomized controlled trial of a community-based peer support intervention delivered by telephone to low-income White and ethnically minoritized older adults with depression during the COVID-19 pandemic. Sixty-seven transcripts were analyzed using an inductive thematic approach. All participating older adults perceived the importance of adapting to technology and had a range of positive and negative views. However, ethnically minoritized and White older adults differed regarding their experiences of social disruptions in their social network. Ethnically minoritized older adults more often lacked skills and access to devices, relying on public resources for assistance with technology. Regardless of ethnic minority or income status, older adults generally perceived the quality of video-based social interactions as limited, leading to decreased engagement in social activities, although a subset acknowledged that the convenience facilitated engagement. For technological interventions to be feasible among underserved older adults, considerations of access to devices and technology skills will be needed. Further study is needed to understand the advantages and disadvantages of technology use for social engagement among low-income White and ethnically minoritized older adults.

The "Insanity Defence" within the framework of the Indian Legal System serves as a protective measure for individuals accused of criminal offenses, especially when they lack the mental capacity to understand the nature of their actions or differentiate between right and wrong. This defence aligns with the legal principle “Actus non facit reum nisi mens sit rea,” which emphasizes that for an action to be deemed unlawful, it must be accompanied by a guilty mind. Consequently, punishing individuals who are not accountable for their actions would contravene fundamental human rights enshrined in the Constitution of India. To delve deeper into the concept of the insanity defence, it's essential to trace its origins and development within English law and its subsequent impact on Indian legal statutes. It's crucial to understand that insanity defence isn't merely a matter of suffering from a mental illness; rather, it requires a demonstration that the accused lacked the mental capacity to comprehend the consequences of their actions. Thus, the burden of proof lies with the accused, who must provide compelling evidence to establish their state of insanity, akin to the standard of “preponderance of the evidence” often seen in civil cases. This paper seeks to analyze the intricacies of insanity within the legal framework and how it has evolved into a potential loophole within the current judicial system.

A series of pioneering studies from the late 1970s and early 1980s evidenced that the general public held grossly inaccurate estimations of the frequency and success of the insanity plea, as well as significantly negative attitudes towards the plea. Since the 1980s replications of these findings are nonexistent and, perhaps consequently, contemporary scholars continue to rely on the findings of these studies when discussing the general population's understanding of the insanity defence. We replicated several major research findings from this body of literature by conducting a cross-sectional, online-administered, self-report study of 257 adults aged 18-65 within the general US population by administering the same questions as found in previous studies, and additional questions. Results support each of our hypotheses; compared to the two past representative studies, participants in this study believed that the insanity plea was used less frequently, was less successful when employed, was not as abused or overused, and was more acceptable as a defence. Throughout the paper we conjecture why attitudes and estimations may have shifted over the past 40 years. We also explicate how our results can be useful to lawyers or psychologists; primarily by elucidating attitudes and knowledge of the plea among prospective jurors.

Insanity defense and social dangerousness: A comparative study between China and Italy.

Insanity defense for all? The Arab minority in Israel's psychiatric and legal systems.

Aims: Temporal Lobe Epilepsy (TLE) is the most common symptomatic cause ofpartial epilepsy worldwide. It can present with vague symptoms including affectivedisturbances, personality changes, sensory disturbances, altered consciousness etc., whichcan confound diagnosis. Overt focal or tonic-clonic seizures are present in only 60%patients. It manifests with psychotic symptoms in around 5%. This case report describeshow undiagnosed TLE with psychotic symptoms led to grave consequences.Methods: We present a 52-year-old male who was found to have killed hisfather and was subsequently diagnosed with TLE. This diagnosis was later found to bedirectly implicated in the act. When arrested on suspicion of homicide he presented withseveral psychotic symptoms and severe agitation in custody. He was then detained under theMental Health Act to a high secure psychiatric hospital. He had no formal psychiatric ormedical diagnosis prior to his arrest but it was noted that he had presented on multipleoccasions to secondary neurology and psychiatric services over the preceding 10 years withvague but consistent symptoms which were labelled as night terrors. These includedclouding of consciousness, affective disturbance, night terrors, suicidal ideation, andisolated aggressive outbursts. Following his hospital admission, he was assessed byneurologists and was diagnosed of TLE after his EEG clearly demonstrated abnormalities inline with the diagnosis. The gentleman’s psychiatric symptoms resolved entirely when hewas treated adequately for TLE with an anti-epileptic (lamotrigine). At trial, he wasfound not guilty of murder by reason of insanity and received a hospital order withrestrictions.Results: TLE is a treatable neurological disorder but is associated with arisk of heightened violence especially if misdiagnosed. In this patient, repeatedopportunities were missed in diagnosing and treating TLE in a timely manner. Potentialdifferentials that can confound TLE diagnosis include night terrors, functional psychosis,anxiety disorders, affective disorders, substance misuse etc.Conclusion: TLE can have far-reaching and life-altering consequences. Toobviate these, it is recommended that repeated presentations with unexplained neurologicaland psychiatric symptoms in outpatient or emergency settings should trigger robustassessments and multi-specialty liaison. It would be beneficial to develop a protocol totrigger a thorough evaluation of suspected TLE cases with a lower threshold to investigatethem than what is currently practised. This could involve earlier and wider utilisation ofelectro-encephalogram (EEG) (ambulatory or residential).

Generative artificial intelligence (AI), with its increasing ubiquity and power, will likely transform forensic psychiatry, sparking both advances and new challenges for the field. A possible consequence of the technology is that it will be used to assist malingerers in learning about and feigning psychiatric symptoms. In this study, the AI chatbot ChatGPT was asked to provide information about the insanity defense and psychosis and to use this information to assist the user in simulating a psychotic illness to avoid legal consequences. We found that ChatGPT 3.5 demonstrated a relatively nuanced understanding of typical symptoms of psychosis and that it could translate that knowledge into practical guidance on how to exploit the mental health system for secondary gain. Our findings suggest that, although significant limitations exist with the technology in its current form, forensic psychiatrists should be prepared for its increasing sophistication and the potential consequences in malingering assessments.

Aims: Temporal Lobe Epilepsy (TLE) is the most common symptomatic cause of partial epilepsy worldwide. It can present with vague symptoms including affective disturbances, personality changes, sensory disturbances, altered consciousness etc., which can confound diagnosis. Overt focal or tonic-clonic seizures are present in only 60% patients. It manifests with psychotic symptoms in around 5%. This case report describes how undiagnosed TLE with psychotic symptoms led to grave consequences.Methods: We present a 52-year-old male who was found to have killed his father and was subsequently diagnosed with TLE. This diagnosis was later found to be directly implicated in the act. When arrested on suspicion of homicide he presented with several psychotic symptoms and severe agitation in custody. He was then detained under the Mental Health Act to a high secure psychiatric hospital. He had no formal psychiatric or medical diagnosis prior to his arrest but it was noted that he had presented on multiple occasions to secondary neurology and psychiatric services over the preceding 10 years with vague but consistent symptoms which were labelled as night terrors. These included clouding of consciousness, affective disturbance, night terrors, suicidal ideation, and isolated aggressive outbursts. Following his hospital admission, he was assessed by neurologists and was diagnosed of TLE after his EEG clearly demonstrated abnormalities in line with the diagnosis. The gentleman’s psychiatric symptoms resolved entirely when he was treated adequately for TLE with an anti-epileptic (lamotrigine). At trial, he was found not guilty of murder by reason of insanity and received a hospital order with restrictions.Results: TLE is a treatable neurological disorder but is associated with a risk of heightened violence especially if misdiagnosed. In this patient, repeated opportunities were missed in diagnosing and treating TLE in a timely manner. Potential differentials that can confound TLE diagnosis include night terrors, functional psychosis, anxiety disorders, affective disorders, substance misuse etc.Conclusion: TLE can have far-reaching and life-altering consequences. To obviate these, it is recommended that repeated presentations with unexplained neurological and psychiatric symptoms in outpatient or emergency settings should trigger robust assessments and multi-specialty liaison. It would be beneficial to develop a protocol to trigger a thorough evaluation of suspected TLE cases with a lower threshold to investigate them than what is currently practised. This could involve earlier and wider utilisation of electro-encephalogram (EEG) (ambulatory or residential).

Aims: Long-acting buprenorphine has been explored in context of its use in opioid dependence, however its potential for managing self-harm behaviour is limited. Self-harming behaviour often signals extreme emotional distress. This case report brings an insight into the effectiveness of injectable buprenorphine in a person with extreme self-harm behaviour.Methods: Miss SD, 30-year-old single, unemployed woman, with history of emotional abuse, sexually abused by father from the age 6–8 and mother having difficulties with alcohol abuse. She has been involved with Psychiatric services from the age of 13 and had several Psychiatric hospital admissions, transfer to low secure Forensic unit and step down to supported accommodation. Having difficulties with self-harming behaviours, suicidal thoughts or attempts and aggression towards staff. Self-harm behaviour included cutting, overdoses, ligatures; to an extent she needed multiple surgical interventions for cutting, inserting glass and glueing the genitalia multiple times, along with glueing nose and lips.Over the course her diagnoses included EUPD, PTSD, Depressive disorder, transient Psychotic episodes, alcohol dependence and polysubstance misuse.Due to escalating behaviour she was trialled on injectable buprenorphine as off-licence use for self-harming behaviour. We have compared the data of 2 years on injectable buprenorphine to history prior to that.Initiation on buprenorphine treatment had a dramatic improvement in Miss SD given the number of incidents of both alcohol use and self-harm.Results: Buprenorphine treatment had a greater reduction in self-harming behaviour in Miss SD. There have been only 1–2 episodes of self-harm per year since she started on buprenorphine i.e, in last 2 years, when compared with the several episodes a week. In addition the number of hospital admissions reduced to 2 brief admissions, compared with several admissions including long stay in Low Secure Unit.Recurrent self-harm can have an endogenous opioid response, and in the long term the pattern is similar to addiction.Buprenorphine is a partial μ-opioid receptor agonist and a potent kappa antagonist, and treatment with long-acting opioid antagonist could block the reward of enhanced endogenous opioids caused by self-harming behaviours and subsequently lead to their extinction.Conclusion: A retrospective case study of Miss SD since the initiation of buprenorphine suggests this may be an alternative therapeutic option to treat people with significant Self-harming behaviour with functional impairment. In addition it is much safer as it causes less respiratory depression than other opioids.The evidence is promising, however more research is needed to review the effectiveness, establish efficacy, and safety.

In theory, Japan’s two-pronged insanity defence offers a defence to a wider range of offenders, considering the narrow nature of the wrongness limb. However, the assessment of the volitional prong presents a significant challenge in murder trials. This assessment appears to rely more on the defendant’s general circumstances and the nature of the crime rather than the mental disorder. There seems to be a disregard for the influence of mental disorders, and the courts seem to emphasise defendants’ free will and alternative options. The ambiguity of the guidelines affords broad discretion to judges, as a result of which mentally disordered offenders are often sentenced to death. Drawing on case examples and legal guidelines, this article provides an overview of the assessment of the volitional prong in Japan, exploring its evaluation in conjunction with mental disorders and demonstrating the need for a clear and consistent approach to prevent the execution of mentally disordered offenders.

Overview of forensic outpatients on the Medical Treatment and Supervision Act in Japan.

The formulation of a scientific opinion on whether the individual who committed a crime should be held responsible for his/her actions or should be considered not responsible by reason of insanity is very difficult. Indeed, forensic psychopathological decision on insanity is highly prone to errors and is affected by human cognitive biases, resulting in low inter-rater reliability. In this context, artificial intelligence can be extremely useful to improve the inter-subjectivity of insanity evaluation. In this paper, we discuss the possible applications of artificial intelligence in this field as well as the challenges and pitfalls that hamper the effective implementation of AI in insanity evaluation. In particular, thus far, it is possible to apply only supervised algorithms without knowing which is the ground truth and which data should be used to train and test the algorithms. In addition, it is not known which percentage of accuracy of the algorithms is sufficient to support partial or total insanity, nor which are the boundaries between sanity and partial or total insanity. Finally, ethical aspects have not been sufficiently investigated. We conclude that these pitfalls should be resolved before AI can be safely and reliably applied in criminal trials.

School Distress refers to a child or young person's (CYP) difficulty attending school due to the extreme emotional distress associated with school attendance. Limited research exists on the impact of School Distress on the parents/carers supporting these CYP. Using a case-control, concurrent embedded mixed-method design, we explored this lived experience. 947 parents of CYP with School Distress completed a bespoke on line questionnaire, alongside two control parent groups (n=149, n=25) and one professional group (n=19). Findings revealed a devastating impact on the mental health of parents, with parents displaying significantly heightened daily anxiety and significantly lower mood during, but not before, their children's school attendance difficulties. In addition, parents with children experiencing School Distress reported significantly higher negative emotion states and significantly lower positive emotion states. Parents also reported overwhelmingly negative treatment from professionals, including being disbelieved or blamed for their child's difficulties, threatened with fines and court action, and disempowered by the actions of professionals surrounding their child. Significant, deleterious impacts were also evident across all aspects of their lives, including their careers, finances, and other children. Perhaps unsurprisingly, half of these parents reported developing a new mental health condition since their child's difficulties began, with the experience itself rated as the second most threatening potential life event, superseded only by the death of a first-degree relative (including a child or spouse). On the other hand, professionals working with CYP with School Distress did not experience these deleterious mental health or wider life consequences. Despite understanding how threatening the experience is for parents, they were often quick to blame parents for their children's difficulties. Professionals, like parents, expressed frustration with the lack of help available for these CYP and their families. This study highlights a bleak, adversarial, and lonely picture for parents of CYP struggling to attend school. More specifically, the findings depict a system rife with parental blame; a system that appears to isolate parents through hostile, threatening, and punitive actions. A wider lack of societal understanding of the experience of School Distress further compounds this dearth of support for parents, placing parental mental health in further peril.

Abstract This article critically examines the proposed use of the psychiatric distinction between delusions and extreme overvalued beliefs as a tool for distinguishing criminal insanity from (mere) violent extremism. The analysis contrasts this distinction with a wholly normative one that we designed to better fulfill the same purpose. This normative distinction, based on concepts from John Rawls’ political philosophy, highlights and depends upon a host of political considerations relevant to the ideals of the criminal justice system and the rights and freedoms fundamental to the political systems in which it is situated. These considerations challenge the psychiatric distinction between delusions and extreme overvalued beliefs, suggesting that criminal responsibility cannot be adequately explained or justified by psychiatric factors alone. The article further explores the case of criminal accountability for psychopaths and concludes that neither the psychiatric diagnosis of psychopathy nor the empirical findings that one may lack the capacity for empathy is determinative in such cases. Evaluations of criminal responsibility involve a host of other moral and political considerations, and the weight one gives to those considerations ultimately provides the basis for a legitimate determination of responsibility within the criminal law.