Mental Health Symptoms and their Relationship to Specific Deficits in Competency to Proceed to Trial Evaluations

Jeremy G. Gay, Laurie Lynn Ragatz, Michael J Vitacco

Research output: Contribution to journalArticle

4 Scopus citations


This study examined clinical, legal and social variables, and their relationship to forensic evaluators’ opinions of competency to stand trial on each of the three Dusky prongs (factual understanding of court proceedings, rational understanding of court proceedings and ability to assist one's counsel). Information was extracted from 257 competency to proceed to trial evaluations conducted between 2010 and 2013. Psychotic symptoms, intellectual disabilities and impairment in mental status (e.g., lack of orientation to person, place, time and/or situation) predicted opinions of not competent to stand trial across the Dusky competency prongs. However, the prongs were differentially related to mental health issues. Impaired mental status was associated with impairment on all three competency prongs. Delusions were associated with impaired rational understanding and impaired ability to assist one’s counsel. Finally, thought derailment and a diagnosis of mental retardation were associated with impaired factual understanding of court proceedings.

Original languageEnglish (US)
Pages (from-to)780-791
Number of pages12
JournalPsychiatry, Psychology and Law
Issue number5
StatePublished - Sep 3 2015



  • Dusky standard
  • competency to stand trial
  • restoration of competency

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Psychology (miscellaneous)
  • Psychiatry and Mental health
  • Law

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