Swain, E; (2012) Schizophrenia, insight and fitness to plead in court and stand trial. Doctoral thesis , UCL (University College London).

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Abstract

Part one of this thesis is a literature review concerning the relationship between insight and neuropsychological function among individuals with a diagnosis of schizophrenia. It comprises of two sections summarising: 1) the relationship between insight and executive function; and 2) the relationship between insight and general cognitive function. The review concludes with a discussion on the findings, limitations, areas for future research and the clinical implications. Part two is an empirical investigation into the impact of having a diagnosis of schizophrenia on fitness to plead in court and stand trial. The research compared how individuals with a diagnosis of schizophrenia performed on a novel ecologically valid measure of fitness to plead (FTP) compared to a healthy control sample. The research also investigated whether performance on the FTP test was associated with intellectual ability, memory, executive function and psychiatric symptoms. The results, limitations, recommendations and clinical implications are discussed. Part three is a critical appraisal of the empirical investigation described in part two. It highlighted two main concerns that arose over the course of the research: 1) the construct of fitness to plead and its impact upon the development of standardised measures, particularly in relation to the novel FTP test that was used in this study; and 2) the challenges of assessing fitness to plead in individuals with a diagnosis of schizophrenia and whether the FTP test is applicable across the spectrum of schizophrenia.

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