title: [Differences in psychiatric expertise of responsibility: Assessment and initial hypotheses through a review of literature].
abstract: BACKGROUND
  Forensic psychiatric assessment regarding liability ensures a balance between justice and psychiatry. In France, criminal assessment is not contradictory. The psychiatric expert is commissioned by judges to determine whether or not the accused has a mental disorder and specify whether it affects discernment and control of actions at the time of offense. Its mission focuses on the mental element required to constitute an offense, and is structured around Article 122-1 of the Criminal Code. This article, composed of two paragraphs, distinguishes the framework of the abolition of discernment — a cause of non-imputability and therefore of a statement of lack of criminal responsibility due to mental disorder — and the framework of the alteration of discernment. Nowadays expertise seems to meet discomfort, with criticism focusing on possible differences among psychiatric experts, without specific studies having been conducted to confirm it.
  
  
  OBJECTIVE
  Our objective was to identify the main points of disagreement between psychiatric experts and to propose explicative hypotheses.
  
  
  METHODS
  For this, we carried out a literature review on PubMed, Science Direct and Cairn, and studied the report of the 2007 public hearing on forensic psychiatric assessment with contributions from different authors. The keywords were: forensic psychiatry, psychiatric court report, psychiatric expertise, differences among experts, legal responsibility, and discernment. We defined differences as disagreements between experts, or as a mismatch in conclusions and approaches of experts.
  
  
  RESULTS
  The differences among experts concerned mainly forensic interpretation, i.e. the discussion of the relationship between pathology and offense, particularly in contexts that involve a larger forensic discussion, including interruption of medication, use of drugs, association with antisocial personality, premeditation, denial of facts, especially when the accused suffers from a mental illness (especially schizophrenia). For a finding of abolition of discernment, an expert must consider two requirements, one temporal (the mental disease must be active during offense) and the other causal that involves seeking a direct and exclusive relationship between the offence and the mental state, according to expert jurisprudence. Some experts do not comply with these two requirements or this jurisprudence, whence differences. There were also diagnostic differences and disputes relating to the concept of "alteration of discernment". Disagreements appeared to be related primarily to personal ideologies or different schools of thought that influenced interpretations and conclusions of experts, e.g. accountability as a therapeutic response for the psychotic person. Then, the lack of clarity of expert mission regarding necessary causal relationship — between any disease and crime — to demonstrate to conclude an abolition of discernment, could also contribute to differences. Moreover, time available to achieve the mission is too short and the expert would not devote enough time to an expert examination, which could lead to less good expertise and differences; especially as observed clinical examination in expertise is sometimes difficult, misleading, due to pathological reticence of accused mentally ill but also sometimes due to possible simulations. Finally, the low quality of some expert reports — due in part to the less well-trained experts, but also the particular conditions of achievement of expertise, especially in prisons — were mentioned by some authors as causes of differences.
  
  
  CONCLUSIONS
  It appears from this review of literature that differences mainly concern forensic interpretation and are mainly explained by ideologies. This synthesis is a preliminary work prior to a study among psychiatric experts.
authors: Pôle psychiatrie centre, CHU Conception, AP-HM, Secteur 13G04, 147, boulevard Baille, 13005 Marseille, France. Electronic address: Jokthan.Guivarch@ap-hm.fr.
authors: J
authors: J
authors: Guivarch
authors: Service de médecine légale et droit de la santé, CHU Timone, Aix Marseille université, CNRS, EFS, ADES UMR 7268, 13916, 13385 Marseille cedex 5, France.
authors: M-D
authors: MD
authors: Piercecchi-Marti
authors: AP-HM, CHU Sainte Marguerite, CRIR AVS PACA, 270, boulevard de Sainte-Marguerite, 13274 Marseille cedex 9, France.
authors: D
authors: D
authors: Glezer
authors: Pôle psychiatrie centre, CHU Conception, AP-HM, Secteur 13G04, 147, boulevard Baille, 13005 Marseille, France.
authors: J-M
authors: JM
authors: Chabannes
mesh_terms: D034462:Dissent and Disputes; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005602:France; D006801:Humans; D007298:Insanity Defense; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D015588:Observer Variation
keywords: Article 122-1 du code pénal; Criminal insanity; Differences among experts; Discernement et contrôle des actes; Divergences entre experts; Expertise psychiatrique pénale; Forensic interpretation; Forensic psychiatry; Interprétation médicolégale; Psychiatric expertise