Psychotic patients' awareness of mental illness: Implications for legal defense proceedings

This study examined the relationship between psychotic patients' insight into their mental illness and current symptoms, competency to stand trial, and willingness to use the insanity defense. Inpatients with psychotic disorders were grouped by whether they exhibited insight into their mental status (n=18) or denied being mentally ill (n=13). The majority of all patients, regardless of insight status, failed at least one item on a 16-item competency exam. However, the majority of insightful subjects (77%) were willing to consider using the insanity defense, while only a minority (31%) of the non-insightful subjects were willing to consider such a defense. Using the Brief Psychiatric Rating Scale (BPRS), univariate analyses indicated that the insightful subjects manifested significantly more Anxiety-Depression and less Thought Disturbance than the non-insightful subjects. Although there was no relationship between insight and performance on the competency exam, there were significant inverse correlations between competency scores and ratings on the BPRS symptom factors.