Psychopathology and Competence to Stand Trial

Abstract

This study incorporated multiple indices of competence as well as diagnostic and symptom ratings to determine the symptoms and diagnostic categories associated with incompetence to stand trial and whether these correlates differ as a function of the defendant's diagnosis. One hundred thirty-eight pretrial criminal defendants evaluated for competence were rated by at least one of eight clinicians for (a) overall degree of competence (on a 0-10 rating scale), (b) whether they were able to understand the charges against them and/or assist in their defense, (c) the severity of several psychiatric symptoms, and (d) clinical diagnosis. Interrater reliability estimates for competence and most symptom ratings were quite high, whereas reliability of diagnostic classification, ratings of depression, and estimated overall intelligence were modest. A stepwise discriminant analysis predicting competence for defendants with a psychotic disorder diagnosis generated a model that contained only two variables—thought disorder symptoms and delusional beliefs—whereas a model predicting competence findings for nonpsychotic defendants contained four variables: disorientation, hallucinations, history of prior clinic findings of incompetence, and manic symptoms.