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J Forensic Sci. 2014 Jul;59(4):1008-15. doi: 10.1111/1556-4029.12429. Epub 2014 May 13.

Mental illness and legal fitness (competence) to stand trial in New York State: expert opinion and criminal defendants' psychiatric symptoms.

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University of Arkansas School of Law & University of Arkansas for Medical Sciences, 118 West Spring Street, Fayetteville, AR, 72701.


Fitness to Stand Trial is a critical concept in the adjudication of justice-involved persons. A retrospective study was conducted to examine criminal defendants' specific psychiatric symptoms and those symptoms' associations with expert opinions on Competence to Stand Trial. One hundred charts were reviewed: 50 Cases (opined as Not Fit) were compared against 50 Controls (opined as Fit) with respect to ratings on the Brief Psychiatric Rating Scale (BPRS). A significance level of 0.001 was selected a priori. Statistically significant differences were found in seven of the eighteen BPRS symptom constructs (with the highest differences in Conceptual Disorganization and Unusual Thought Content) and two of the four BPRS higher-order syndrome factors (Thinking Disorder and Hostile-Suspiciousness). Consistent with previous reports, psychotic symptoms are found in this study to be inversely associated with Fitness. Validity, reliability, and limitations of this study, as well as directions for future research, are discussed herein.


Brief Psychiatric Rating Scale; Brief Psychotic Disorder; Competence to Stand Trial; Delusional Disorder; Fitness to Stand Trial; Psychotic Disorder Not Otherwise Specified; Schizoaffective Disorder; Schizophrenia; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophreniform Disorder; behavioral science; criminal justice; criminal law; expert opinion; expert witness; forensic science; justice-involved persons; mental defect; mental disease; mental disease or defect; psychiatry; psychology; psychosis; psychotic disorders

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