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Research ArticleRegular Articles

Response to Disclosure as an Indicator of Competence to Stand Trial

Douglas Mossman, Rebecca M. Brown, Bridget A. Casey-Leavell, Christopher P. Marett and Elliot R. Lee
Journal of the American Academy of Psychiatry and the Law Online June 2018, 46 (2) 195-203; DOI: https://doi.org/10.29158/JAAPL.003747-18
Douglas Mossman
The coauthors are eternally grateful for their mentor and friend, Douglas Mossman, M.D., who passed away on January 4, 2018. Dr. Mossman was Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Drs. Brown, Casey-Leavell, and Marett are psychiatrists at Summit Behavioral Healthcare, Cincinnati, OH. Dr. Marett is also Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Lee is a Clinical Adjunct Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Rebecca M. Brown
The coauthors are eternally grateful for their mentor and friend, Douglas Mossman, M.D., who passed away on January 4, 2018. Dr. Mossman was Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Drs. Brown, Casey-Leavell, and Marett are psychiatrists at Summit Behavioral Healthcare, Cincinnati, OH. Dr. Marett is also Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Lee is a Clinical Adjunct Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Bridget A. Casey-Leavell
The coauthors are eternally grateful for their mentor and friend, Douglas Mossman, M.D., who passed away on January 4, 2018. Dr. Mossman was Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Drs. Brown, Casey-Leavell, and Marett are psychiatrists at Summit Behavioral Healthcare, Cincinnati, OH. Dr. Marett is also Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Lee is a Clinical Adjunct Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Christopher P. Marett
The coauthors are eternally grateful for their mentor and friend, Douglas Mossman, M.D., who passed away on January 4, 2018. Dr. Mossman was Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Drs. Brown, Casey-Leavell, and Marett are psychiatrists at Summit Behavioral Healthcare, Cincinnati, OH. Dr. Marett is also Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Lee is a Clinical Adjunct Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Elliot R. Lee
The coauthors are eternally grateful for their mentor and friend, Douglas Mossman, M.D., who passed away on January 4, 2018. Dr. Mossman was Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Drs. Brown, Casey-Leavell, and Marett are psychiatrists at Summit Behavioral Healthcare, Cincinnati, OH. Dr. Marett is also Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Lee is a Clinical Adjunct Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Article Figures & Data

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    Table 1

    Comparisons of Defendants Opined CST or IST

    CST (n = 126)IST (n = 129)p
    Age (mean ± SD)36.4 ± 12.542.3 ± 12.60.00024*
    Sex
        Men941070.14†
        Women3222
    Ethnicity
        African American70710.43‡
        White5452
        Other26
    Length of stay (mean ± SD)68.4 ± 69.596.9 ± 185.70.42*
    Education
        ≥12 Years54550.81§
        GED1721
        <12 Years, no GED5553
    Most serious charge
        Misdemeanor60770.071†
        Felony6652
    GCCT score (mean ± SD) (n = 177)88.7 ± 6.357.2 ± 17.5∼10−26*
    MacCAT-CA scores (mean ± SD)
        Understanding (n = 24)13.7 ± 3.68.3 ± 5.40.021*
        Reasoning (n = 23)14.2 ± 3.78.4 ± 5.50.012*
        Appreciation (n = 23)11.4 ± 2.76.0 ± 4.80.025*
    Diagnosis
        Schizophrenia2745∼10−5§
        Schizoaffective disorder2849
        Others7135
    Medications when evaluated
        Antipsychotics1041080.92†
        Mood stabilizers51560.73†
        Antidepressants34190.024†
        Others68700.92†
        None12140.89†
    Disclosure response
        DR = yes11960∼10−19‡
        DR = other741
        DR = no028
    • ↵* Mann-Whitney U test.

    • ↵† χ2 test, df = 1.

    • ↵‡ Fisher's exact test.

    • ↵§ χ2 test, df = 2.

    • View popup
    Table 2

    Examination Findings Construed as Diagnostic Tests of Incompetence to Stand Trial

    Type of FindingCategorySSLRAUC
    DiagnosisΣ+1.6 (1.3–2.1)0.64 (0.58–0.70)
    Σ−0.49 (0.35–0.67)
    GCCT score92–1000.045 (0.0076–0.15)0.95 (0.91–0.97)
    82–900.13 (0.065–0.23)
    72–801.5 (0.83–2.8)
    62–7055 (9.5–4300)
    ≤605000 (130–109)
    Disclosure responseDR = no106 (41–1014)0.73 (0.68–0.78)
    DR = other5.2 (2.5–12)
    DR = yes0.52 (0.42–0.63)
    • Data are median stratum–specific likelihood ratio (SSLR) and area under the ROC curve (AUC), with 95% confidence intervals. SSLRs and AUCs are rounded to two significant digits. Σ+, diagnosis of schizophrenia or schizoaffective disorder; Σ−, other diagnoses.

    • View popup
    Table 3

    Comparisons of Defendants According to Their DR

    DR = no (n = 28)DR = other (n = 48)DR = yes (n = 179)p
    Median age (IQR)43.0 (31.3–55.6)41.2 (31.6–53.3)36.1 (26.8–48.2)0.029*
    Sex
        Men23421360.30†
        Women5643
    Ethnicity
        African American2026950.14‡
        White61981
        Other233
    Median LOS (IQR)42 (21–51)40.5 (28–145)42 (29–117)0.50*
    Education
        ≥12 Years1116820.58§
        GED3728
        <12 years, no GED142569
    Most serious charge
        Misdemeanor1826930.60†
        Felony102286
    Median GCCT (IQR)54 (49–59)60 (42–69)86 (72–92)∼10−8*
    Examiner's diagnosis
        Schizophrenia915480.0039§
        Schizoaffective disorder121649
        Other psychoses377
        Bipolar disorder22460.0023‖
        Others2829
    • (n = 177). IQR, interquartile range; LOS, length of stay in days.

    • ↵* Kruskal-Wallis test, 2 df.

    • ↵† χ2 test, df = 2.

    • ↵‡ χ2 test, df = 2 (comparing African Americans and Caucasians).

    • ↵§ χ2 test, df = 4.

    • ↵‖ χ2 test, df = 1 (comparing bipolar disorder to all other diagnostic groups).

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Journal of the American Academy of Psychiatry and the Law Online: 46 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 46, Issue 2
1 Jun 2018
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Response to Disclosure as an Indicator of Competence to Stand Trial
Douglas Mossman, Rebecca M. Brown, Bridget A. Casey-Leavell, Christopher P. Marett, Elliot R. Lee
Journal of the American Academy of Psychiatry and the Law Online Jun 2018, 46 (2) 195-203; DOI: 10.29158/JAAPL.003747-18

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Response to Disclosure as an Indicator of Competence to Stand Trial
Douglas Mossman, Rebecca M. Brown, Bridget A. Casey-Leavell, Christopher P. Marett, Elliot R. Lee
Journal of the American Academy of Psychiatry and the Law Online Jun 2018, 46 (2) 195-203; DOI: 10.29158/JAAPL.003747-18
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