Saint Elizabeths Hospital, Department of Behavioral Health, Washington, DC, USA.
Forensic Services Division, Department of Behavioral Health, Washington, DC, USA.
J Forensic Sci. 2021 May;66(3):982-991. doi: 10.1111/1556-4029.14669. Epub 2021 Feb 19.
Few studies on adjudicative competence explore the relationship between diagnosis, treatment, and restorability. Most focus on demographics and major psychiatric diagnosis with very few exploring the diagnoses common to the forensic population (i.e., personality disorders and substance abuse). Our study of 365 defendants who were incompetent to stand trial at a state psychiatric facility indicates that non-restored defendants have a greater likelihood of cognitive disorders, misdemeanor charges, and histories of prior hospitalization, and less likelihood of personality disorders. In addition, the odds of having a substance use disorder and being medication non-adherent was greater among restored defendants. The mean length of time to restoration (LOR) of 56 days was significantly different from the mean length of time to adjudication (LOA) for those not restored (88 days). This study supports prior literature on restorability while distinguishing those treated for psychosis from those treated for substance use and personality disorder. In its novel focus on medication adherence, the study expands the remediable factors available to clinical and forensic professionals and supports interventions that improve treatment and shorten the time to restoration.
很少有研究探讨裁决能力与诊断、治疗和可恢复性之间的关系。大多数研究都集中在人口统计学和主要精神科诊断上，很少有研究探讨法医学领域常见的诊断（即人格障碍和药物滥用）。我们对在州立精神病院被判定无能力接受审判的 365 名被告进行了研究，结果表明，无法恢复的被告更有可能患有认知障碍、轻罪指控和先前住院治疗的病史，而患有人格障碍的可能性较小。此外，在已恢复的被告中，患有物质使用障碍和不遵医嘱的可能性更大。56 天的恢复平均时间（LOR）与未恢复的被告（88 天）的判决平均时间（LOA）有显著差异。这项研究支持了先前关于可恢复性的文献，同时将接受精神病治疗的人与接受药物滥用和人格障碍治疗的人区分开来。该研究在关注药物依从性方面具有新颖性，扩大了临床和法医专业人员可利用的补救因素，并支持改善治疗和缩短恢复时间的干预措施。
