{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T08:55:58Z","timestamp":1753520158590,"version":"3.37.3"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T00:00:00Z","timestamp":1647907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T00:00:00Z","timestamp":1647907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Transl Psychiatry"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The insanity defense represents one of the most controversial and debated evaluations performed by forensic psychiatrists and psychologists. Despite the variation among different jurisdictions, in Western countries, the legal standards for insanity often rely on the presence of cognitive and\/or volitional impairment of the defendant at the time of the crime. We developed the defendant\u2019s insanity assessment support scale (DIASS) based on a wide view of competent decision-making, which reflects core issues relevant to legal insanity in many jurisdictions. To assess the characteristics of the DIASS we asked 40 forensic experts (16% women; years of experience\u2009=\u200920.6\u2009\u00b1\u200912.9) to evaluate 10 real-life derived forensic cases with the DIASS; cases included defendants\u2019 psychiatric symptom severity, evaluated through the 24-itemBrief Psychiatric Rating Scale (BPRS). Exploratory factor analysis by principal axis factoring was conducted, which disclosed a two-factor solution explaining 57.6% of the total variance. The DIASS showed a good internal consistency (Cronbach\u2019s alpha\u2009=\u20090.86), and substantial inter-rater reliability (Cohen\u2019s kappa\u2009=\u20090.72). The capacities analyzed through the DIASS were mainly affected by mania\/excitement and psychotic dimensions in nonresponsible and with substantially diminished responsibility defendants, while by hostility and negative symptoms in responsible defendants. The DIASS proved to be an effective psychometric tool to guide and structure insanity defense evaluations, in order to improve their consistency and reliability.<\/jats:p>","DOI":"10.1038\/s41398-022-01871-8","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T18:21:08Z","timestamp":1647973268000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Validation of a new instrument to guide and support insanity evaluations: the defendant\u2019s insanity assessment support scale (DIASS)"],"prefix":"10.1038","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7998-2443","authenticated-orcid":false,"given":"Giovanna","family":"Parmigiani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4887-5108","authenticated-orcid":false,"given":"Gabriele","family":"Mandarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1031-0948","authenticated-orcid":false,"given":"Paolo","family":"Roma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Ferracuti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,3,22]]},"reference":[{"unstructured":"American Academy of Psychiatry and the Law (AAPL). AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense. J Am Acad Psychiatry Law. 2014;42:S3\u2013S76..","key":"1871_CR1"},{"unstructured":"Simon RJ, Ahn\u2010Redding H. The Insanity Defense, The World Over. Plymouth: Bowman & Littlefields; 2006.","key":"1871_CR2"},{"unstructured":"American Law Institute. Model Penal Code. Philadelphia: American Law Institute; 1962.","key":"1871_CR3"},{"key":"1871_CR4","first-page":"453","volume":"23","author":"JR Ciccone","year":"1995","unstructured":"Ciccone JR, Ferracuti S. Comparative Forensic Psychiatry: II. The Perizia and the Role of the Forensic Psychiatrist in the Italian Legal System. Bull Am Acad Psychiatr Law. 1995;23:453\u201366.","journal-title":"Bull Am Acad Psychiatr Law"},{"key":"1871_CR5","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1037\/lhb0000001","volume":"37","author":"WN Gowensmith","year":"2013","unstructured":"Gowensmith WN, Murrie DC, Boccaccini MT. How reliable are forensic evaluations of legal sanity? Law Hum Behav. 2013;37:98\u2013106.","journal-title":"Law Hum Behav"},{"key":"1871_CR6","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1037\/pas0000388","volume":"29","author":"LA Guarnera","year":"2017","unstructured":"Guarnera LA, Murrie DC. Field reliability of competency and sanity opinions: a systematic review and metaanalysis. Psychol Assess. 2017;29:795\u2013818.","journal-title":"Psychol Assess"},{"key":"1871_CR7","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/BF01056164","volume":"13","author":"JC Beckham","year":"1989","unstructured":"Beckham JC, Annis LV, Gustafsont DJ. Decision making and examiner bias in forensic expert recommendations for not guilty by reason of insanity. Law Hum Behav. 1989;13:79\u201387.","journal-title":"Law Hum Behav"},{"key":"1871_CR8","first-page":"482","volume":"34","author":"FM Dattilio","year":"2006","unstructured":"Dattilio FM, Commons ML, Adams KM, Gutheil TG, Sadoff RL. A pilot rasch scaling of lawyers\u2019 perceptions of expert bias. J Am Acad Psychiatry Law. 2006;34:482\u201391.","journal-title":"J Am Acad Psychiatry Law"},{"key":"1871_CR9","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/0160-2527(86)90084-1","volume":"8","author":"RJ Homant","year":"1986","unstructured":"Homant RJ, Kennedy DB. Judgment of legal insanity as a function of attitude toward the insanity defense. Int J Law Psychiatry. 1986;8:67\u201381.","journal-title":"Int J Law Psychiatry"},{"key":"1871_CR10","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1177\/0956797613481812","volume":"24","author":"DC Murrie","year":"2013","unstructured":"Murrie DC, Boccaccini MT, Guarnera LA, Rufino KA. Are forensic experts biased by the side that retained them? Psychol Sci. 2013;24:1889\u201397.","journal-title":"Psychol Sci"},{"key":"1871_CR11","first-page":"70","volume":"32","author":"ML Commons","year":"2004","unstructured":"Commons ML, Miller PM, Gutheil TG. Expert witness perceptions of bias in experts. J Am Acad Psychiatry Law. 2004;32:70\u201375.","journal-title":"J Am Acad Psychiatry Law"},{"key":"1871_CR12","doi-asserted-by":"publisher","first-page":"597918","DOI":"10.3389\/fpsyt.2021.597918","volume":"12","author":"C Scarpazza","year":"2021","unstructured":"Scarpazza C, Miolla A, Zampieri I, Melis G, Sartori G, Ferracuti S, et al. Translational application of a neuro-scientific multi-modal approach into forensic psychiatric evaluation: why and how? Front Psychiatry. 2021;12:597918.","journal-title":"Front Psychiatry"},{"key":"1871_CR13","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.ijlp.2014.02.034","volume":"37","author":"A Kalis","year":"2014","unstructured":"Kalis A, Meynen G. Mental disorder and legal responsibility: the relevance of stages of decision making. Int J Law Psychiatry. 2014;37:601\u20138.","journal-title":"Int J Law Psychiatry"},{"key":"1871_CR14","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s11019-010-9250-7","volume":"13","author":"G Meynen","year":"2010","unstructured":"Meynen G. Free will and psychiatric assessments of criminal responsibility: a parallel with informed consent. Med Health Care Philos. 2010;13:313\u201320.","journal-title":"Med Health Care Philos"},{"key":"1871_CR15","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s11017-010-9158-5","volume":"31","author":"G Meynen","year":"2010","unstructured":"Meynen G. Free will and mental disorder: exploring the relationship. Theor Med Bioeth. 2010;31:429\u201343.","journal-title":"Theor Med Bioeth"},{"key":"1871_CR16","first-page":"231","volume":"39","author":"G Meynen","year":"2011","unstructured":"Meynen G. Autonomy, criminal responsibility, and competence. J Am Acad Psychiatry Law. 2011;39:231\u20136.","journal-title":"J Am Acad Psychiatry Law"},{"key":"1871_CR17","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.ijlp.2012.04.011","volume":"35","author":"G Meynen","year":"2012","unstructured":"Meynen G. An ethical framework for assessments of criminal responsibility: applying Susan Wolf\u2019s account of sanity to forensic psychiatry. Int J Law Psychiatry. 2012;35:298\u2013304.","journal-title":"Int J Law Psychiatry"},{"key":"1871_CR18","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ijlp.2013.01.001","volume":"36","author":"G Meynen","year":"2013","unstructured":"Meynen G. A neurolaw perspective on psychiatric assessments of criminal responsibility: decision-making, mental disorder, and the brain. Int J Law Psychiatry. 2013;36:93\u20139.","journal-title":"Int J Law Psychiatry"},{"doi-asserted-by":"crossref","unstructured":"Meynen G. Legal insanity: Explorations in psychiatry, law, and ethics. Springer; 2016.","key":"1871_CR19","DOI":"10.1007\/978-3-319-44721-6"},{"key":"1871_CR20","first-page":"9","volume":"52","author":"G Parmigiani","year":"2017","unstructured":"Parmigiani G, Mandarelli G, Meynen G, Tarsitani L, Biondi M, Ferracuti S. Free will, neuroscience, and choice: towards a decisional capacity model for insanity defense evaluations. Riv Psichiatr. 2017;52:9\u201315.","journal-title":"Riv Psichiatr"},{"key":"1871_CR21","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-019-0628-x","volume":"9","author":"G Parmigiani","year":"2019","unstructured":"Parmigiani G, Mandarelli G, Meynen G, Carabellese F, Ferracuti S. Translating clinical findings to the legal norm: the Defendant\u2019s Insanity Assessment Support Scale (DIASS). Transl Psychiatry. 2019;9:278.","journal-title":"Transl Psychiatry"},{"key":"1871_CR22","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/BF01044698","volume":"8","author":"C Slobogin","year":"1984","unstructured":"Slobogin C, Melton GB, Showalter CR. The feasibility of a brief evaluation of mental state at the time of the offense. Law Hum Behav. 1984;8:305\u201320.","journal-title":"Law Hum Behav"},{"key":"1871_CR23","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1002\/1097-4679(198107)37:3<683::AID-JCLP2270370343>3.0.CO;2-F","volume":"37","author":"R Rogers","year":"1981","unstructured":"Rogers R, Dolmetsch R, Cavanaugh JL. An empirical approach to insanity evaluations. J Clin Psychol. 1981;37:683\u20137.","journal-title":"J Clin Psychol"},{"key":"1871_CR24","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/BF01044697","volume":"8","author":"R Rogers","year":"1984","unstructured":"Rogers R, Wasyliw OE, Cavanaugh JL. Evaluating insanity. A study of construct validity. Law Hum Behav. 1984;8:293\u2013303.","journal-title":"Law Hum Behav"},{"key":"1871_CR25","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.forsciint.2013.12.018","volume":"236","author":"W Cai","year":"2014","unstructured":"Cai W, Zhang Q, Huang F, Guan W, Tang T, Liu C. The reliability and validity of the rating scale of criminal responsibility for mentally disordered offenders. Forensic Sci Int. 2014;236:146\u201350.","journal-title":"Forensic Sci Int"},{"key":"1871_CR26","doi-asserted-by":"publisher","first-page":"579243","DOI":"10.3389\/fpsyt.2020.579243","volume":"11","author":"LF Meyer","year":"2020","unstructured":"Meyer LF, Leal CCS, Omena AAS, Mecler K, Valenca AM. Criminal Responsibility Scale: development and validation of a psychometric tool structured in clinical vignettes for criminal responsibility assessments in Brazil. Front Psychiatry. 2020;11:579243.","journal-title":"Front Psychiatry"},{"key":"1871_CR27","first-page":"227","volume":"3","author":"J Ventura","year":"1993","unstructured":"Ventura J, Lukoff D, Nuechterlein KH, Liberman RP, Green M, Shaner A. Appendix 1: brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0) scales, anchor points and administration manual. Int J Methods Psychiatr Res. 1993;3:227\u201343.","journal-title":"Int J Methods Psychiatr Res"},{"key":"1871_CR28","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.ijlp.2018.12.006","volume":"62","author":"G Mandarelli","year":"2019","unstructured":"Mandarelli G, Parmigiani G, Trobia F, Tessari G, Roma P, Biondi M, et al. The Admission Experience Survey Italian Version (I-AES): a factor analytic study on a sample of 156 acute psychiatric in-patients. Int J Law Psychiatry. 2019;62:111\u20136.","journal-title":"Int J Law Psychiatry"},{"key":"1871_CR29","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.psychres.2019.02.055","volume":"279","author":"L Tarsitani","year":"2019","unstructured":"Tarsitani L, Ferracuti S, Carabellese F, Catanesi R, Biondi M, Quartesan R, et al. Brief Psychiatric Rating Scale-Expanded (BPRS-E) factor analysis in involuntarily hospitalized psychiatric patients. Psychiatry Res. 2019;279:380\u20131.","journal-title":"Psychiatry Res"},{"key":"1871_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/001316446002000104","volume":"20","author":"J Cohen","year":"1960","unstructured":"Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:1.","journal-title":"Educ Psychol Meas"},{"key":"1871_CR31","doi-asserted-by":"publisher","first-page":"363","DOI":"10.2307\/2529786","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33:363\u201374.","journal-title":"Biometrics."},{"key":"1871_CR32","doi-asserted-by":"publisher","first-page":"6223","DOI":"10.1073\/pnas.1219302110","volume":"110","author":"E Aharoni","year":"2013","unstructured":"Aharoni E, Vincent GM, Harenski CL, Calhoun VD, Sinnott-Armstrong W, Gazzaniga MS, et al. Neuroprediction of future rearrest. Proc Natl Acad Sci USA. 2013;110:6223\u20138.","journal-title":"Proc Natl Acad Sci USA"},{"key":"1871_CR33","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1177\/1524838005275089","volume":"6","author":"JL Bufkin","year":"2005","unstructured":"Bufkin JL, Luttrell VR. Neuroimaging studies of aggressive and violent behavior: current findings and implications for criminology and criminal justice. Trauma Violence Abus. 2005;6:176\u201391.","journal-title":"Trauma Violence Abus"},{"key":"1871_CR34","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1126\/science.289.5479.591","volume":"289","author":"RJ Davidson","year":"2000","unstructured":"Davidson RJ. Dysfunction in the neural circuitry of emotion regulation\u2014a possible prelude to violence. Science. 2000;289:591\u20134.","journal-title":"Science."},{"key":"1871_CR35","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.ijlp.2009.04.005","volume":"32","author":"P Pietrini","year":"2009","unstructured":"Pietrini P, Bambini V. Homo ferox: The contribution of functional brain studies to understanding the neural bases of aggressive and criminal behavior. Int J Law Psychiatry. 2009;32:259\u201365.","journal-title":"Int J Law Psychiatry"},{"key":"1871_CR36","doi-asserted-by":"publisher","first-page":"160","DOI":"10.3389\/fnbeh.2010.00160","volume":"4","author":"D Rigoni","year":"2010","unstructured":"Rigoni D, Pellegrini S, Mariotti V, Cozza A, Mechelli A, Ferrara SD, et al. How neuroscience and behavioral genetics improve psychiatric assessment: report on a violent murder case. Front Behav Neurosci. 2010;4:160.","journal-title":"Front Behav Neurosci"},{"key":"1871_CR37","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1098\/rstb.2004.1547","volume":"359","author":"RM Sapolsky","year":"2004","unstructured":"Sapolsky RM. The frontal cortex and the criminal justice system. Philos Trans R Soc Lond B Biol Sci. 2004;359:1787\u201396.","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"1871_CR38","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1007\/s00415-016-8143-y","volume":"263","author":"G Sartori","year":"2016","unstructured":"Sartori G, Scarpazza C, Codognotto S, Pietrini P. An unusual case of acquired pedophilic behavior following compression of orbitofrontal cortex and hypothalamus by a Clivus Chordoma. J Neurol. 2016;263:1454\u20135.","journal-title":"J Neurol"},{"key":"1871_CR39","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-018-0274-8","volume":"8","author":"C Scarpazza","year":"2018","unstructured":"Scarpazza C, Ferracuti S, Miolla A, Sartori G. The charm of structural neuroimaging in insanity evaluations: guidelines to avoid misinterpretation of the findings. Transl Psychiatry. 2018;8:227.","journal-title":"Transl Psychiatry"},{"key":"1871_CR40","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1002\/bsl.2343","volume":"36","author":"LE Kois","year":"2018","unstructured":"Kois LE, Chauhan P. Criminal responsibility: meta\u2010analysis and study space. Behav Sci Law. 2018;36:276\u2013302.","journal-title":"Behav Sci Law"},{"key":"1871_CR41","doi-asserted-by":"publisher","first-page":"101503","DOI":"10.1016\/j.ijlp.2019.101503","volume":"66","author":"G Mandarelli","year":"2019","unstructured":"Mandarelli G, Carabellese F, Felthous AR, Parmigiani G, Del Casale A, Catanesi R, et al. The factors associated with forensic psychiatrists\u2019 decisions in criminal responsibility and social dangerousness evaluations. Int J Law Psychiatry. 2019;66:101503.","journal-title":"Int J Law Psychiatry."}],"container-title":["Translational Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41398-022-01871-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41398-022-01871-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41398-022-01871-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T19:17:35Z","timestamp":1669231055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41398-022-01871-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,22]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["1871"],"URL":"https:\/\/doi.org\/10.1038\/s41398-022-01871-8","relation":{},"ISSN":["2158-3188"],"issn-type":[{"type":"electronic","value":"2158-3188"}],"subject":[],"published":{"date-parts":[[2022,3,22]]},"assertion":[{"value":"22 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"115"}}