1
Lecture Summaries: Forensic Diagnostics and Treatment
Lecture 1: Psychosis
1. What is the Forensic Mental Health Assessment (FMHA)?
How does it differ from a regular assessment?
o The goal of the assessment is the examination and presentation
of professional opinion with the highest possible psychological
certainty
o The three main questions we try to answer during the
assessment:
o 1. Competence to stand trail (or to even be interviewed)
o 2. Criminal Responsibility (establishing causality in a
forensic setting: did the disorder precede the criminal
offending; do they covary; is there no other plausible third-
variable explanation)
o 3. Other Claims
Personal Injury
Child Custody
2. What is tested as part of the FMHA?
o Cognitive Function:
o WAIS-IV (critical thinking, intelligence, impulse control)
o Neuropsychological Screening
o Korsakoff (memory loss and confabulation, assessed with
blood tests, MRIs…)
o Neuropsychological Dysfunction
Bourdon-Wiersma (used to assess a person's
concentration and vigilance)
Trail making Test (measures visual attention,
processing speed, and cognitive flexibility by
having participants connect a series of encircled
numbers and letters)
o Personality
o Minnesota Multiphasic Personality Inventoy-2 (MMPI-RF)
o Personality Assessment Inventory (PAI)
o PCL-R
o HEXACO, Big-5
o Trauma Testing
o PTSD Checklist from the DSM-5 (PCL-5)
o Trauma Symptom Inventory (TSI-2)
o Specific Forensic Tests
,2
o Violence Risk Assessment
o Malingering
SIMS: screens for exaggerated or feigned
psychiatric and cognitive symptoms
MENT (Memory and Effort Test): assessing memory
performance and effort to detect possible
insufficient effort or malingering
TOMM (Test of Memory Malingering): A visual
recognition memory test designed to detect
feigned memory impairment
MATE (Malingering Assessment Test of Executive
Functioning / MATE-EF): A test assessing executive
functioning with indicators for detecting
exaggerated or feigned cognitive deficits
o Criminal Responsibility (Rogers Criminal Responsibility
Assessment Scale (RCRAS))
3. What are the 6 Steps in Forensic Diagnostics?
o (1) Rule out Malingering/Factitious Disorder
o (2) Rule out Substance Aetiology
o (3) Rule out disorder due to medical condition
o (4) Determine specific primary disorders
o (5) Differentiating adjustment disorders from the residual other
(un) specified disorders)
o (6) Establish the boundary with no mental disorder (you must
clearly determine whether the person actually has a mental
disorder or whether their symptoms fall within the range of
normal behaviour)
4. How do you conduct Symptom Validity Assessments (SVA’s)?
Why is it important for forensic psychologist?
o Performance Validity Tests (PVTs):
o Structured tests that evaluate whether cognitive test
performance (memory, attention, executive function) is
credible.
Examples: TOMM, MENT, WMT, MSVT
o Symptom Validity Tests (SVTs)
o Questionnaires assessing whether reported
psychological symptoms are plausible or exaggerated.
Examples: SIMS, SIRS, M-FAST
o Consistency Checks & Behavioural Observation
,3
o compare test results with medical records, collateral
information, and real-world functioning
o Check for inconsistencies (e.g., severe reported memory
problems but intact functioning in daily life)
o Examine behaviour during the assessment (e.g.,
inconsistent effort, over-dramatized symptoms)
5. What are the statistics on Psychosis? What are common
myths?
o Only around 11% of homicide convictions in the UK were
mental health patients (and that can be ANY disorder, not
alone psychosis)
o Victim is most likely to be an acquaintance and less likely to be
unknown to the perpetrator than for homicides by non-patients
o Most patients had a history of alcohol or drug misuse;
homicide in the absence of comorbid substance misuse is
unusual
o Around half of patients were not receiving care as intended,
wither through loss of contact or non-adherence with drug
treatment
o Patients are also at high risk of being victims of homicide
o Psychotic disorders increased risk of violence from 49% to 68%
(modest risk factor)
o Substance abuse comorbidity plays an important role in
violence
o Although a significant risk factor, it only explains between 5-
40% of violent behaviour
o Social disorganization is high risk factor (e.g. being homeless,
drug-abuse, bad social circle…)
o Psychosis and violence are more weakly correlated in clinical,
than in community samples!
6. Subtypes of Schizophrenia
o (1) Schizophrenia
o ≥6 months (with ≥1 month active symptoms)
o Core symptoms:
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic behaviour
Negative symptoms (flat affect, avolition, alogia,
anhedonia)
, 4
o Functioning: Significant decline in work, relationships, or
self-care
o Course: Chronic, often episodic; cognitive impairment
common
o (2) Schizophreniform Disorder
o 1–6 months
o Symptoms: Same symptom set as schizophrenia
o Difference: Functional decline may be absent or less
pronounced
o Outcome: ~⅓ recover fully; ~⅔ progress to
schizophrenia or schizoaffective disorder
o (3) Brief Psychotic Disorder
o Duration: 1 day–<1 month
o Symptoms
Sudden onset of one or more of: delusions,
hallucinations, disorganized speech, or
disorganized/catatonic behavior
Full return to premorbid functioning
o Triggers: Often stress-related (e.g., trauma, childbirth →
brief psychotic disorder postpartum)
o (4) Schizoaffective Disorder
o A major mood episode (depressive or manic)
o PLUS ≥2 weeks of psychosis with no mood
symptoms (this is the key feature!)
o Other periods have both psychosis and mood symptoms
together
o Course: More mood-driven than schizophrenia; better
functioning overall
o (5) Delusional Disorder
o One or more delusions for ≥1 month
o No other prominent psychotic symptoms
o Functioning typically intact; behaviour not obviously
bizarre
o Types:
Persecutory (Verfolungswahn)
Erotomaniac
Grandiose
Jealous
Somatic
Mixed
o Hallucinations: If present, are mild and related to
delusion (e.g., smelling “worms” in somatic delusion)
o (6) Substance/Medication induced Psychotic Disorder
Lecture Summaries: Forensic Diagnostics and Treatment
Lecture 1: Psychosis
1. What is the Forensic Mental Health Assessment (FMHA)?
How does it differ from a regular assessment?
o The goal of the assessment is the examination and presentation
of professional opinion with the highest possible psychological
certainty
o The three main questions we try to answer during the
assessment:
o 1. Competence to stand trail (or to even be interviewed)
o 2. Criminal Responsibility (establishing causality in a
forensic setting: did the disorder precede the criminal
offending; do they covary; is there no other plausible third-
variable explanation)
o 3. Other Claims
Personal Injury
Child Custody
2. What is tested as part of the FMHA?
o Cognitive Function:
o WAIS-IV (critical thinking, intelligence, impulse control)
o Neuropsychological Screening
o Korsakoff (memory loss and confabulation, assessed with
blood tests, MRIs…)
o Neuropsychological Dysfunction
Bourdon-Wiersma (used to assess a person's
concentration and vigilance)
Trail making Test (measures visual attention,
processing speed, and cognitive flexibility by
having participants connect a series of encircled
numbers and letters)
o Personality
o Minnesota Multiphasic Personality Inventoy-2 (MMPI-RF)
o Personality Assessment Inventory (PAI)
o PCL-R
o HEXACO, Big-5
o Trauma Testing
o PTSD Checklist from the DSM-5 (PCL-5)
o Trauma Symptom Inventory (TSI-2)
o Specific Forensic Tests
,2
o Violence Risk Assessment
o Malingering
SIMS: screens for exaggerated or feigned
psychiatric and cognitive symptoms
MENT (Memory and Effort Test): assessing memory
performance and effort to detect possible
insufficient effort or malingering
TOMM (Test of Memory Malingering): A visual
recognition memory test designed to detect
feigned memory impairment
MATE (Malingering Assessment Test of Executive
Functioning / MATE-EF): A test assessing executive
functioning with indicators for detecting
exaggerated or feigned cognitive deficits
o Criminal Responsibility (Rogers Criminal Responsibility
Assessment Scale (RCRAS))
3. What are the 6 Steps in Forensic Diagnostics?
o (1) Rule out Malingering/Factitious Disorder
o (2) Rule out Substance Aetiology
o (3) Rule out disorder due to medical condition
o (4) Determine specific primary disorders
o (5) Differentiating adjustment disorders from the residual other
(un) specified disorders)
o (6) Establish the boundary with no mental disorder (you must
clearly determine whether the person actually has a mental
disorder or whether their symptoms fall within the range of
normal behaviour)
4. How do you conduct Symptom Validity Assessments (SVA’s)?
Why is it important for forensic psychologist?
o Performance Validity Tests (PVTs):
o Structured tests that evaluate whether cognitive test
performance (memory, attention, executive function) is
credible.
Examples: TOMM, MENT, WMT, MSVT
o Symptom Validity Tests (SVTs)
o Questionnaires assessing whether reported
psychological symptoms are plausible or exaggerated.
Examples: SIMS, SIRS, M-FAST
o Consistency Checks & Behavioural Observation
,3
o compare test results with medical records, collateral
information, and real-world functioning
o Check for inconsistencies (e.g., severe reported memory
problems but intact functioning in daily life)
o Examine behaviour during the assessment (e.g.,
inconsistent effort, over-dramatized symptoms)
5. What are the statistics on Psychosis? What are common
myths?
o Only around 11% of homicide convictions in the UK were
mental health patients (and that can be ANY disorder, not
alone psychosis)
o Victim is most likely to be an acquaintance and less likely to be
unknown to the perpetrator than for homicides by non-patients
o Most patients had a history of alcohol or drug misuse;
homicide in the absence of comorbid substance misuse is
unusual
o Around half of patients were not receiving care as intended,
wither through loss of contact or non-adherence with drug
treatment
o Patients are also at high risk of being victims of homicide
o Psychotic disorders increased risk of violence from 49% to 68%
(modest risk factor)
o Substance abuse comorbidity plays an important role in
violence
o Although a significant risk factor, it only explains between 5-
40% of violent behaviour
o Social disorganization is high risk factor (e.g. being homeless,
drug-abuse, bad social circle…)
o Psychosis and violence are more weakly correlated in clinical,
than in community samples!
6. Subtypes of Schizophrenia
o (1) Schizophrenia
o ≥6 months (with ≥1 month active symptoms)
o Core symptoms:
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic behaviour
Negative symptoms (flat affect, avolition, alogia,
anhedonia)
, 4
o Functioning: Significant decline in work, relationships, or
self-care
o Course: Chronic, often episodic; cognitive impairment
common
o (2) Schizophreniform Disorder
o 1–6 months
o Symptoms: Same symptom set as schizophrenia
o Difference: Functional decline may be absent or less
pronounced
o Outcome: ~⅓ recover fully; ~⅔ progress to
schizophrenia or schizoaffective disorder
o (3) Brief Psychotic Disorder
o Duration: 1 day–<1 month
o Symptoms
Sudden onset of one or more of: delusions,
hallucinations, disorganized speech, or
disorganized/catatonic behavior
Full return to premorbid functioning
o Triggers: Often stress-related (e.g., trauma, childbirth →
brief psychotic disorder postpartum)
o (4) Schizoaffective Disorder
o A major mood episode (depressive or manic)
o PLUS ≥2 weeks of psychosis with no mood
symptoms (this is the key feature!)
o Other periods have both psychosis and mood symptoms
together
o Course: More mood-driven than schizophrenia; better
functioning overall
o (5) Delusional Disorder
o One or more delusions for ≥1 month
o No other prominent psychotic symptoms
o Functioning typically intact; behaviour not obviously
bizarre
o Types:
Persecutory (Verfolungswahn)
Erotomaniac
Grandiose
Jealous
Somatic
Mixed
o Hallucinations: If present, are mild and related to
delusion (e.g., smelling “worms” in somatic delusion)
o (6) Substance/Medication induced Psychotic Disorder
