Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
Section of Criminology and Forensic Psychiatry, University of Bari, Interdisciplinary Department of Medicine, Bari, Italy.
Transl Psychiatry. 2022 Mar 22;12(1):115. doi: 10.1038/s41398-022-01871-8.
The insanity defense represents one of the most controversial and debated evaluations performed by forensic psychiatrists and psychologists. Despite the variation among different jurisdictions, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at the time of the crime. We developed the defendant's insanity assessment support scale (DIASS) based on a wide view of competent decision-making, which reflects core issues relevant to legal insanity in many jurisdictions. To assess the characteristics of the DIASS we asked 40 forensic experts (16% women; years of experience = 20.6 ± 12.9) to evaluate 10 real-life derived forensic cases with the DIASS; cases included defendants' psychiatric symptom severity, evaluated through the 24-itemBrief Psychiatric Rating Scale (BPRS). Exploratory factor analysis by principal axis factoring was conducted, which disclosed a two-factor solution explaining 57.6% of the total variance. The DIASS showed a good internal consistency (Cronbach's alpha = 0.86), and substantial inter-rater reliability (Cohen's kappa = 0.72). The capacities analyzed through the DIASS were mainly affected by mania/excitement and psychotic dimensions in nonresponsible and with substantially diminished responsibility defendants, while by hostility and negative symptoms in responsible defendants. The DIASS proved to be an effective psychometric tool to guide and structure insanity defense evaluations, in order to improve their consistency and reliability.
精神错乱辩护代表了法医精神病学家和心理学家进行的最具争议和争议的评估之一。尽管不同司法管辖区之间存在差异，但在西方国家，精神错乱的法律标准通常依赖于被告在犯罪时的认知和/或意志障碍。我们基于广泛的决策能力制定了被告的精神错乱评估支持量表 (DIASS)，该量表反映了许多司法管辖区中与法律精神错乱相关的核心问题。为了评估 DIASS 的特征，我们要求 40 名法医专家（16%为女性；经验年限=20.6±12.9）使用 DIASS 评估 10 个真实的法医案例；案例包括被告的精神病症状严重程度，通过 24 项简明精神病评定量表 (BPRS) 进行评估。通过主成分因子分析进行了探索性因素分析，揭示了一个解释总方差 57.6%的两因素解决方案。DIASS 表现出良好的内部一致性（Cronbach 的 alpha=0.86）和较高的评分者间可靠性（Cohen 的 kappa=0.72）。通过 DIASS 分析的能力主要受非责任和责任大大减轻的被告的躁狂/兴奋和精神病维度以及责任被告的敌对和消极症状的影响。DIASS 被证明是一种有效的心理计量工具，可以指导和构建精神错乱辩护评估，以提高其一致性和可靠性。
