Decision making of forensic psychiatric inpatients deemed incompetent to stand trial

Abstract

This study examined decision making and its correlates among forensic psychiatric inpatients deemed incompetent to stand trial (IST). This study utilized archival data (n = 41; Mean Age = 44.27, SD = 15.89, 79.1% Male; 34.1% Caucasian). Decision making was measured using the Iowa Gambling Task (IGT), which is purported to simulate real-life decision making. Correlates included cognitive functioning, psychiatric symptom severity, and impulsivity. Participants selected more frequently from disadvantageous decks, which yield larger immediate monetary gains with a larger long-term monetary losses (Mean NET = −9.51, SD = 26.70), but avoided decks yielding frequent monetary losses (Mean GLF = 10.10, SD = 26.70). Consistently, participants selected most frequently from a deck yielding the most immediate monetary gains and the least frequent monetary losses compared to other decks (ps < 0.05). Based upon their selections, participants lost a significant amount of money (M = −$1,493.22, SD = $1,182.26). IGT outcomes were differentially associated with cognitive functioning (rs = −0.26 to 0.47), psychiatric symptom severity (rs = −0.41 to 0.37), and impulsivity (rs = −0.47 to 0.28; all ps = 0.003–0.98). Findings can guide future research, as well as guide competency restoration and decision-making interventions, for this population.

Keywords:

• Forensic psychiatric inpatients
• decision making
• Iowa Gambling Task
• severe mental illness
• Schizophrenia spectrum disorder

Acknowledgements

We thank Michael W. Barsom, MD, for his support of the research program at Patton State Hospital.

Disclosure statement

The findings and conclusions in this article are those of the authors and do not necessarily represent the view or opinions of the California Department of State Hospitals or the California Health and Human Services Agency.