Response to Disclosure as an Indicator of Competence to Stand Trial.

Ethics guidelines recommend that forensic mental health professionals begin in-person assessments by explaining the nature and purpose of the examination. To learn whether evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. This article explores how a forensic evaluee's disclosure response (DR) reveals substantive information relevant to the purposes of a forensic examination.

Trial 1 versus Trial 2 of the Test of Memory Malingering: Evaluating accuracy without a "gold standard".

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment than Trial 2, which is the source for inference recommended by the original instruction manual (Tombaugh, 1996). We used latent class modeling (LCM) implemented in a Bayesian framework to evaluate archival Trial 1 and Trial 2 data collected from 1,198 adults who had undergone outpatient forensic evaluations.

Using Dual Beta Distributions to Create "Proper" ROC Curves Based on Rating Category Data.

Background: Receiver operating characteristic (ROC) analysis helps investigators quantify and describe how well a diagnostic system discriminates between 2 mutually exclusive conditions. The conventional binormal (CvB) curve-fitting model usually produces ROCs that are improper in that they do not have the ever-decreasing slope required by signal detection theory. When data sets evaluated under the CvB model have hooks, the resulting ROCs can contain misleading information about the diagnostic performance of the method at low and high false positive rates.

A Bayesian approach to mixed group validation of performance validity tests.

Mental health professionals often use structured assessment tools to help detect individuals who are feigning or exaggerating symptoms. Yet estimating the accuracy of these tools is problematic because no "gold standard" establishes whether someone is malingering or not. Several investigators have recommended using mixed group validation (MGV) to estimate the accuracy of malingering measures, but simulation studies show that typical implementations of MGV may yield vague, biased, or logically impossible results.

From group data to useful probabilities: the relevance of actuarial risk assessment in individual instances.

Probability plays a ubiquitous role in decision-making through a process in which we use data from groups of past outcomes to make inferences about new situations. Yet in recent years, many forensic mental health professionals have become persuaded that overly wide confidence intervals render actuarial risk assessment instruments virtually useless in individual assessments. If this were true, the mathematical properties of probabilistic judgments would preclude forensic clinicians from applying group-based findings about risk to individuals.

Correlations of inflammatory gene pathways, corticolimbic functional activities, and aggression in pediatric bipolar disorder: a preliminary study.

The mechanisms underlying aggression in adolescents with bipolar disorder have been poorly understood. The present study has investigated the associations among TNF gene expressions, functional brain activations under the frustrative non-reward task, and aggression in adolescents with bipolar disorder. Baseline gene expressions and aggressive tendencies were measured with the RNA-sequencing and Brief Rating of Aggression by Children and Adolescents (BRACHA), respectively.

Constructing "proper" ROCs from ordinal response data using weighted power functions.

Background: Receiver operating characteristic (ROC) analysis is the standard method for describing the accuracy of diagnostic systems where the decision task involves distinguishing between 2 mutually exclusive possibilities. The popular binormal curve-fitting model usually produces ROCs that are improper in that they do not have the ever-decreasing slope required by signal detection theory. Not infrequently, binormal ROCs have visible hooks that falsely imply worse-than-chance diagnostic differentiation where the curve lies below the no-information diagonal.

The association between salivary hormone levels and children's inpatient aggression: a pilot study.

Aggression is a common management problem for child psychiatry hospital units. We describe an exploratory study with the primary objective of establishing the feasibility of linking salivary concentrations of three hormones (testosterone, dehydroepiandrosterone [DHEA], and cortisol) with aggression. Between May 2011 and November 2011, we recruited 17 psychiatrically hospitalized boys (age 7-9 years).

Evaluating risk assessments using receiver operating characteristic analysis: rationale, advantages, insights, and limitations.

The last two decades have witnessed major changes in the way that mental health professionals assess, describe, and think about persons' risk for future violence. Psychiatrists and psychologists have gone from believing that they could not predict violence to feeling certain they can assess violence risk with well-above-chance accuracy. Receiver operating characteristic (ROC) analysis has played a central role in changing this view.

Brief Rating of Aggression by Children and Adolescents (BRACHA): a reliability study.

The Brief Rating of Aggression by Children and Adolescents (BRACHA) is a 14-item instrument scored by emergency room staff members to assess aggression risk during an upcoming psychiatric hospitalization. In this study, we investigated the inter-rater reliability of the BRACHA 0.9, the latest version of the instrument.

Estimating the accuracy of neurocognitive effort measures in the absence of a "gold standard".

Psychologists frequently use symptom validity tests (SVTs) to help determine whether evaluees' test performance or reported symptoms accurately represent their true functioning and capability. Most studies evaluating the accuracy of SVTs have used either known-group comparisons or simulation designs, but these approaches have well-known limitations (potential misclassifications or lack of ecological validity). This study uses latent class modeling (LCM) implemented in a Bayesian framework to estimate SVT classification accuracy based on data obtained from real-life forensic evaluations.

Brief Rating of Aggression by Children and Adolescents (BRACHA): development of a tool for assessing risk of inpatients' aggressive behavior.

This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Version (BRACHA 0.8), an actuarial method of assessing the risk of aggressive behavior by hospitalized children and adolescents. Licensed psychiatric social workers used a 16-item questionnaire to assess all patients seen in the emergency department (ED) of a major urban children's hospital.

Quantifying the accuracy of forensic examiners in the absence of a "gold standard".

This study asked whether latent class modeling methods and multiple ratings of the same cases might permit quantification of the accuracy of forensic assessments. Five evaluators examined 156 redacted court reports concerning criminal defendants who had undergone hospitalization for evaluation or restoration of their adjudicative competence. Evaluators rated each defendant's Dusky-defined competence to stand trial on a five-point scale as well as each defendant's understanding of, appreciation of, and reasoning about criminal proceedings.

Let's think about human factors, not human failings.

Doctors typically think about medical errors as potential causes of malpractice litigation, as failures by individuals, and as evidence of personal incompetence that may deserve sanctions. Other professions take a different view: designing of safer systems, rather than criticism and punishment, is the way to prevent unintentional mishaps. In his article, Jeffrey Janofsky shows how psychiatrists can think about making care systems safer for patients.

Conceptualizing and characterizing accuracy in assessments of competence to stand trial.

This article describes a mathematical framework for conceptualizing the accuracy of forensic experts' opinions on competence to stand trial (CST) and explains how an expert's expressed opinion about CST can be decomposed into four elements: (1) contextual requirements of the defendant (determined partly by the defendant's past actions) that lie outside the defendant's future control; (2) personal attributes of the defendant that are relevant to competence; (3) the expert's intrinsic ability to distinguish competent from incompetent defendants; and (4) the expert's wish to favor or avoid certain types of outcomes (e.g., a preference to avoid seeing an incompetent defendant stand trial for a serious charge).

Analyzing the performance of risk assessment instruments: a response to Vrieze and Grove (2007).

In a recent article, Vrieze and Grove (Law Hum Behav, doi: 10.1007/s10979-007-9092-x , 2007) argue that, because of low recidivism base rates and limited predictive accuracy, an actuarial risk assessment instrument (ARAI) may produce decisions about sex offenders that are worse than simply predicting that no one will commit another sex offense. This article examines: (1) the construction and potential overfitting of ARAIs; (2) the meaning, value, and limitations of ROC areas; and (3) the relationship between the operating point that maximizes an ARAI's correct classifications and the legal criterion-"likely to reoffend"-used for sex offender designations.

Predicting restorability of incompetent criminal defendants.

U.S. courts frequently require forensic examiners to offer opinions concerning the likelihood that criminal defendants found incompetent to stand trial can have their competence "restored" through treatment.

AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial.

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations.

Another look at interpreting risk categories.

Several studies over the past decade have shown that simple rating scales can accurately rank sex offenders' long-term risk of recidivism. But when using these scales as prediction tools, evaluators often wish to translate categories of risk into probabilities of recidivism. D.

Tests of a symptom checklist to screen for comorbid psychiatric disorders in alcoholism.

In the treatment of substance use disorders, it is advantageous to identify patients with comorbid (nonsubstance) psychiatric disorders because treating comorbid disorders improves outcome. Because accurate psychiatric diagnosis is time-consuming, there is a need for strategies to screen for these comorbid conditions. This study used receiver operating characteristic analysis to investigate a symptom checklist (revised Symptom Checklist 90 [SCL-90-R]) as a screening instrument for comorbid conditions diagnosed using the Structured Clinical Interview for DSM-IV in 171 primarily military personnel with alcohol use disorders.