The Role of Real-Time Computerized Neuropsychological Examination in Forensic Psychiatry Practice

Article excerpt

Abstract: Neuropsychological examination (NPE) is an important tool for evaluation of cognitive functioning in clinical and forensic situations. In forensic practice, NPE usually focuses on competency to stand trial, the mental state at the time of the offense, risk for future violence and malingering/aggravation issues. Real-time computerized NPE shows more accurate results than traditional pen-and-paper tests and provides quantitative data in a relatively standard format. It permits detection of any manipulation by the examinee in "real time." Therefore, it makes it possible not only to analyze the final results, but also to monitor closely the sequence of single acts of the assessment procedure. Thus, the computerized NPE attenuates possible examinee-related manipulations, which may distort the test results. The real-time NPE report of these elementary behavioral parameters can be used in the courts as acceptable evidence under cross-examination. This method leaves less room for bias; however, a cautious interpretation is always essential since the computerized data do not transform subjective methods into objective ones. Establishing a standard testing procedure and further utilization of real-time computerized tools could improve significantly the quality of NPE in forensic psychiatric practice.

Introduction

Forensic mental health assessment is a form of evaluation performed by psychiatrists to provide relevant clinical data to legal decision makers or to the litigants involved in civil or criminal proceedings (1). The forensic psychiatrist consults an attorney in order to educate and instruct the latter on the clinical issues that are involved. Psychiatrists in a forensic context may offer optional evidence that represents conclusions drawn from the facts in a case (2). For a comprehensive psychiatric evaluation the psychiatrist should assess all pathological factors that may be relevant for a particular forensic situation. During court testimony the psychiatrist should clearly define the competency of the defendant to stand trial and his mental state at the time of the offense. Psychiatrists generally base their expert conclusions on clinical interviews and on collateral sources. Psychological tests are an additional source of relevant information (3, 4). Since Jenkins vs. United States ( 1962), the courts have officially recognized psychologists as experts in forensic situations (5).

Forensic neuropsychological examination (NPE) is a new and rapidly growing subspecialty that applies neuropsychological principles and practices to matters that pertain to legal decision-making and provides the specific information regarding brainbehavior relationships (6). NPE is one of the major developments in the field of forensic psychiatry in recent years (7, 8).

The aim of this paper is to describe the current status of NPE in clinical forensic practice and to discuss the potential role of this instrument in improving detection of neurocognitive contributors to the complex phenomenon of criminal behavior.

What is neuropsychological examination (NPE)?

In a comprehensive evaluation of the mental status of a defendant, which includes clinical psychological analysis, it is essential to assess his cognitive abilities. Cognition is the mental processes of knowing, thinking, learning, judging, and problem solving. Such evaluation should be used not only to detect dementia or mental retardation, but also to evaluate a widespread spectrum of cognitive abilities, which may contribute to criminal behavior.

Neurocognitive deficits may be involved particularly in lower behavioral control and may reduce the ability to behave in a socially appropriate manner. There is a rapidly accumulating body of knowledge related to the neurobiology of impulsive, violent and criminal behaviors based on multidisciplinary neuropsychological and neuroimaging studies (913). Combining NPE and neuroimaging may clarify the neurobiological substrate of such social deviant behaviors. …