Personality Disorders and '~estoration to Sanity'

Historically, the use of the insanity defense has been limited although not exclusively to those with a psychotic mental disorder at the time of the crime. Occasionally, an insanity acquittee may primarily suffer from a personality disorder at the time of commitment to the psychiatric hospital. Such examples can include someone with a personality disorder who malingers psychosis and legal insanity or who at the time of the crime may have been suffering from a drug-induced or brief reactive psychosis. One such case will be presented as well as dilemmas created for the clinician and forensic evaluator. In addition, pertinent medical and psycho-logical literature and legal case precedents will be discussed. Finally, a proposed guideline for the treatment and evaluation of the personality-disordered insanity acquittee will be offered, focusing specifically on the aspects of the personality disorder that contribute to the individual's dangerousness. There are numerous individuals in this country who have been found "not guilty by reason of insanity " (NGRI) and are undergoing psychiatric treatment in state hospitals or as outpatients. The goal of such treatment is to treat the individuals ' mental illness in order for them to be safely returned to society. By law, this occurs when the individual is no longer mentally ill or dangerous and therefore has been "restored to sanity." For numerous reasons that will be dis-cussed later, the majority of NGRI ac-quittees suffer from major mental dis-orders such as psychotic or mood disor-Dr. Osran is assistant professor of psychiatry, Medica