Through manual selection, we produced a base with 44 works considered fully relevant to forensic neuropsychology studies with this as the central topic — as opposed to legal studies or psychiatric studies that use the topic as a support strategy. A careful reading of these articles suggests groupings in four categories Table 1 :. The Neuropsychological Assessment for verification of cognitive damage in forensic psychiatric patients: the core interest in the studies is the verification of cognitive damage in forensic psychiatric patients; they concentrate on psychotic symptoms and are mostly transversal studies.
Neuropsychological Assessment for verification of simulation of cognitive damage: there was a consensus among researchers regarding this descriptor, given the high frequency of claims of psychic damage in legal contexts, whether criminal or civil. Among them, claims of memory loss are especially important. The Neuropsychological Assessment for verification of civil capacity, penal liability and risk of violence: based on the categories used for organizing this paper, there are a number of prominent studies that investigate the direct relationship between neuropsychological performance, civil capacity, penal liability and risk for violent behavior.
Finally, in terms of descriptions of methods, procedures, standards, validation of instruments, range and limits of Neuropsychological Assessment in the forensic field: forensic examiners in general agree that their contributions to the judicial process must be based on scientific principles, high ethical values and clinical skills for legal understanding. These are the objectives pursued in this category.
Neuropsychological Assessment for verification of cognitive damage in forensic psychiatric patients. Nestor et al. The results produced two different subgroups: one defined by higher incidence of psychosis and low level of psychopathy, and another defined by low incidence of psychosis and higher level of psychopathy, each one corresponding to distinct neuropsychological differences in intellectual abilities, learning difficulties and social intelligence. Despite the results, the authors highlight the need for studies with larger samples for better understanding and reliability of neuropsychological measures for this population.
Bentall and Taylor 20 , in a review of studies, investigated the implications of paranoid delusion in the neuropsychological context with forensic repercussions. For these authors, the conditions of paranoia have not been consistently associated with any specific neuropsychological abnormality. However, they highlighted three aspects of paranoid thinking that require better investigation. This would include the paranoia that produces motivations and anomalous perceptive experiences and distortion in reasoning.
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In a second case, there is association of paranoia with hearing impairment. And finally, there seems to be a strong association between negative paranoia and self-esteem. Reviewing studies by Naudts and Hodgins 21 shows that they considered neurobiological correlates and antisocial behavior in schizophrenia. Generally speaking, it was concluded that few studies have been conducted, and that the samples are not significant, which comprises the confirmation of hypotheses.
In analyzing the executive functions of 33 patients with a history of violence, and 49 nonviolent patients, Fullam and Dolan 22 , no significant differences between groups in neuropsychological task performance were found. However, they considered that the lower the IQ, the greater the association with violence. These authors also consider the association between neuropsychological deficits and violence in patients with schizophrenia to be limited and the results inconsistent.
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In another study, the histories of violence and neuropsychological aspects of individuals were investigated, from the first report of psychotic outbreak 7. The results show that The patients presented the lowest scores on neuropsychological variables work memory, executive functions and IQ. The authors considered that occasional health service interventions for patients from the first psychotic outbreak can reduce this occurrence, as well as recurrence of violent behavior. A second branch of studies regarding Neuropsychological Assessment for verification of cognitive damage in forensic psychiatric patients encompasses the consequences of PTSD and patients with brain lesions.
In this area, studies by Rosen and Powel 23 describe a case report on the use of the Symptoms Validation Test SVT to verify memory in post-traumatic patients. For these authors, as the literature states, people with organic brain dysfunction have problems with attention, executive function and social interaction. This procedure can be used as tool in the forensic field.
The results demonstrated that although these patients presented cognitive performances that are below average, when compared to people without organic dysfunction, the differences were are not as significant as expected.
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The authors also emphasize that the results suggest that these kinds of patients can benefit from neuropsychological rehabilitation programs. Examined through neuroimages, the tests and and psychological assessment of 15 patients, the results suggest that these patients, in fact, presented more difficulties in executive capacities. In addition, it is necessary to group these patients by kind of brain lesion, to better define interventional actions Bailie et al.
The main results demonstrate that Half the sample reported at least one neurological risk factor e. However, the neurological risk factors in a certain way do not influence performance on the self-reported test of neurological risks factors. These results corroborate the relevance of neuropsychological services in psychiatric hospitals as a means for intervention Neuropsychological Assessment for verification of simulation of cognitive damage.
The authors also emphasize the need for guidelines in future research on the topic, since growth in the forensic field was observed. Scott 30 emphasizes the need to master concepts, training and memory systems, in addition to the trigger causes of amnesia. The medical history and neuropsychological tests variation is crucial in this process Examining the authenticity of the claimed amnesia is a challenge for forensic experts and therefore, requires development of guidelines for standard proceedings assessment for these claims.
This procedure will certainly contribute to more reliable and valid assessment for forensic experts, which will result in fewer contestations of their results in a legal context It is understood that the development of studies in this field is necessary when we consider, for example, cases of supposed intellectual disability, as highlighted by Musso et al.
Neuropsychological Assessment for verification of civil capacity, penal liability and risk of violence. In terms of risk of violence, two articles 1 , 33 highlight the relationship between neurocognitive functions and risk of violence, as well as recidivism. The first issex offenders 34 - The second group involves criminals in a general way, e. Denney and Wynkoop 3 and Heilbronner et al. These authors write from the perspective that the professional body in the field of neuropsychology has mostly clinical experience, with little experience in criminal matters.
Regarding studies related to civil matters, the articles describe protocols for assessment of verbal function 43 and assessment of damage after traumatic brain injury 44 , and presentation of case reports about civil capacity assessment in elderly people Descriptions of methods, procedures, standards, validation of instruments, range and limits of Neuropsychological Assessment in the forensic field. In this context, the neuropsychological exam is an important tool for cognitive function assessment in clinical and forensic situations 9 , According to Archer et al.
An article by Hom 4 calls attention to these observations, emphasizing that the main responsibility of the forensic neuropsychologist is to provide information based on neuropsychological principles that are scientifically validated, relevant to the forensic issue, and not just related to whether the patient has a dysfunction, but if the results of dysfunction have causal relation within the legal issue.
Essig et al. Therefore, we conducted a review of the literature guided by two-phase analysis. Based on mapping the progression of the field of forensic neuropsychology Phase 1 , it can be seen that this area is growing, both in the consolidation of professional practice and in the context of the search. As previously stated, this pattern is typical in fields that are still maturing — which reinforces the perspective that ad-hoc tools are still being refined.
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However, in all the articles analyzed there are no doubts about the definition and process of the application, as described below. Forensic neuropsychology is the application of neuropsychological science and methods to the legal system. A forensic neuropsychological examination is performed by a neuropsychologist who is hired as an independent contractor by a third party, such as an attorney, insurance company, or the courts, to make a determination regarding neuropsychological functioning.
Given the recognized growth of neuropsychological assessment in the forensic field, mainly in relation to expert testimony, we held the hypothesis that a considerable number of articles dealing with description and standardization of this practice existed when we organized this review. In our view, this aspect presents itself as essential in regards to neuropsychological assessment interface and the forensic field. Authors like Archer et al. According to these authors, when this happens, there is frequent risk of contesting, with claims of inappropriate use of techniques and psychological tests.
Therefore, we understand the need for standardization of procedures for investigating cognitive functions, for documentation of production arising from this assessment report and for answers to questions prepared by professionals in the judiciary. When we refer to training in forensic neuropsychology, this also does not exist. In regards to example 3, use of inappropriate techniques and neuropsychological tests that do not meet or answer the courts, are in fact more common than one might expect One limitation of this review is the narrowness of its scope, since only forensic neuropsychology studies were considered.
However, the objective was precisely this, to assess the specific issues regarding the field. In conclusion, two aspects are relevant in this review. The first refers to the growth in the use of neuropsychological assessment as a diagnostic resource in the forensic context. The second is related to the need for development of uniformity in the process and resources used in this field, since there is no regulatory procedures and standardization of instruments in the legal system.
There are many examples of the interplay between neuropsychology and legal decisions. An example is the increasing life expectancy around the world, and with it major changes in the capacity of the elderly in daily activities; neuropsychological assessment certainly will meet the need to quantify this and many other requests. In a general way, forensic experts agree that their contributions to the legal process must be based on scientific principles, ethical values, combined with clinical and judgment skills. Therefore, broader research in this area is needed, as well as the establishment of centers for development of forensic neuropsychologists.
Neuropsychological and diagnostic differences between recidivistically violent not criminally responsible and mentally ill prisoners. Int J Law Psychiatry.
Principles of forensic mental health assessment: implications for neuropsychological assessment in forensic contexts. Denney R, Wynkoop T.
Clinical neuropsychology in the criminal forensic setting. J Head Trauma Rehabil. Hom J. Forensic neuropsychology: are we there yet? Arch Clin Neuropsychol. Larrabee GJ. Forensic Neuropsychology: A Scientific Approach. New York: Oxford University Press; Heilbronner RL. A status report on the practice of forensic neuropsychology. Clin Neuropsychol. Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis. Early Interv Psychiatry. Official position of the American Academy of Clinical Neuropsychology on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts.
Ruff R. Best practice guidelines for forensic neuropsychological examinations of patients with traumatic brain injury. Forensic neuropsychological evaluations in an academic medical center. Bush SS. Independent and court-ordered forensic neuropsychological examinations: official statement of the National Academy of Neuropsychology.
Treats to the validity of forensic neuropsychological data: ethical considerations.
J Forensic Neuropsychol. Neuropsychological Assessment.