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August 9, 2026Open Access

Thirty years of forensic psychiatric evaluations: Reflections on diagnostic consistency and expert opinion

NCNarjis Elisa CattaneoUniversity of Padua CCClara CestonaroUniversity of Padua RMRocco MiazziSapienza University of Rome

Key Points

This study aims to examine the challenges in achieving diagnostic consistency and objectivity in forensic psychiatric evaluations over 30 years.
The case study spans three decades of forensic assessments of a 63-year-old man detained for violence.
Multiple evaluations were conducted with varying outcomes regarding criminal responsibility and mental health diagnoses.
Diverse methodologies including psychological and neuroscientific assessments were applied over time.
Initial evaluations consistently found the subject not guilty by reason of insanity due to schizophrenia, with varying diagnoses over the years.
In 2022, a panel and a consultant reached differing conclusions on the subject's criminal responsibility, indicating methodological discrepancies.
New expert opinion in 2023 identified potential malingering, suggesting different assessments and implications for responsibility.

Abstract

Forensic psychiatry lacks objective biological markers and relies on clinical methodologies inherently influenced by the evaluator's cultural background and cognitive biases. This case study, spanning 30 years of clinical and forensic assessments, highlights the challenges associated with achieving diagnostic consistency and objectivity in expert opinions. A 63-year-old man, first detained at 19 for attempted robbery and homicide, underwent multiple forensic psychiatric evaluations from 1989 to 2025. Initial assessments consistently found him not guilty by reason of insanity due to a schizophrenic disorder associated with mild intellectual disability. Recurrent diagnoses included schizophrenic syndrome, paranoid schizophrenia and delusional disorder. Expert reports for the defense and court-appointed evaluations supported this view. In 2022, significant discrepancies emerged: a collegial panel concluded that the subject was partially criminally responsible, while the Public Prosecutor's consultant proposed a dissociative disorder characterized by exaggerated symptoms, judging the subject fully criminally responsible; in contrast, the defense reaffirmed the opinion of not guilty by reason of insanity. In 2023, a new expert opinion found full criminal responsibility suggesting malingering. A further evaluation is currently ongoing (as of 2025). Over the years, a wide range of professionals applied differing methodologies with psychometric and neuroscientific tools introduced only in the most recent phase. This case illustrates how, lacking shared standards, forensic psychiatric assessments may remain vulnerable to methodological variability and individual bias. Divergent conclusions on criminal responsibility suggest standardized and multidisciplinary approaches could improve reliability and scientific rigor in forensic evaluations, while remaining exploratory given the single-case nature of the report.

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