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Diagnostic correlation between clinical and expert assessment in non-imputable individuals due to mental illness. Error of perception or diagnostic convenience
Abstract
The determination of non-imputability due to mental disorder represents a complex intersection between criminal justice and forensic psychiatry, which requires determining whether an individual was capable of understanding the wrongfulness of their conduct or acting in accordance with that understanding at the time of the crime. This essay analyzes the relevance of clinical diagnosis and forensic diagnosis in this process, highlighting their methodological differences, objectives, and contexts of application. It also addresses the factors that affect diagnostic concordance and the judicial implications of any discrepancy, highlighting the need for standardized and collaborative diagnostic approaches. Based on a theoretical and practical review, it examines various psychopathological profiles and their relationship with criminal behavior, ranging from psychotic and affective disorders to personality disorders. Finally, it discusses the challenges associated with symptom simulation and the structural problems of the Ecuadorian judicial system in the forensic approach to non-imputability.
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References
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16. Gangotena, F. S. S. (2022). Thoughts on prison system and increases in crime: The Ecuadorian Case. RFJ, 11, 98. Available in: https://heinonline.org/HOL/LandingPage?handle=hein.journals/revfj11&div=8&id=&page=
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18. Sindeev A. Legal, medical and epidemiological characteristics of those who are not imputable for mental disorders in the National Penitentiary Institute of Peru, 2014-2019. Span J Penitentiary Health. 2021;23(2):49-59. Available in: https://scielo.isciii.es/pdf/sanipe/v23n2/2013-6463-sanipe-23-02-49.pdf
19. Condo JEG, Román CEO, Tello VIP. Diagnóstico Pericial y Diagnóstico Hospitalario Asignado a Personas Inimputables Internadas por Orden Judicial, Periodo 2013-2022. Revista Cubana de Educacion Medica Superior. 2023;42(special 2):221-36. Available in: https://www.researchgate.net/publication/376616081_Diagnostico_Pericial_y_Diagnostico_Hospitalario_Asignado_a_Personas_Inimputables_Internadas_por_Orden_Judicial_Periodo_2013-2022
20. Figueroa Benalcázar KS. Inimputability for mental disorders, an approach from Neurolaw and volitional capacity [Doctoral dissertation]. Pontificia Universidad Católica del Ecuador Ibarra; 2023. Available in: https://www.pucesi.edu.ec/webs2/
21. Moreno-Zambrano D, Wong-Ayoub JA, Arevalo-Mora M, San Andrés-Suárez I, Santana D. Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendations. Rev Ecuat Neurol. 2023;32(2). Available in: https://revecuatneurol.com/wp-content/uploads/2023/10/2631-2581-rneuro-32-02-00055.pdf
22. Asamblea Nacional del Ecuador. Código Orgánico Integral Penal. Febrero de 2021. Available in: https://www.defensa.gob.ec/wp-content/uploads/downloads/2021/03/COIP_act_feb-2021.pdf
23. Fox B, Miley LN, Kortright KE, Wetsman RJ. Assessing the effect of mental health courts on adult and juvenile recidivism: a meta-analysis. Am J Crim Justice. 2021;46(4):644-64. Available in: https://doi.org/10.1007/s12103-021-09629-6
24. Tremlin RC, Beazley P. A systematic review of offender mental health stigma: Commonality, psychometric measures and differential diagnosis. Psychol Crime Law. 2024;30(2):125-49. Available in: https://doi.org/10.1080/1068316X.2022.2072842
25. Ministry of Public Health. Report on the evaluation of the 2014-2017 MH plan of Ecuador. Department of provision of health services. 2022. Available in: https://www.salud.gob.ec/wp-content/uploads/2022/11/Informe-Evaluacion-Plan-Salud-Mental_2014-2017_24_08_2022_Final1-signed.pdf
26. Fish FJ, Casey P, Kelly B. Fish's clinical psychopathology: signs and symptoms in psychiatry. Cambridge University Press; 2024. Available in: https://archive.org/details/epdf.pub_fishs-clinical-psychopathology-3rd-edition/page/n3/mode/2up
27. Organización Mundial de la Salud. Clasificación Internacional de Enfermedades, 11.ª edición (CIE-11). Ginebra: OMS; 2021 [citado 2025 jul 21]. Disponible en: https://icd.who.int/es
28. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Publishing; 2013 [citado 2025 jul 21]. Disponible en: https://www.psychiatry.org/psychiatrists/practice/dsm
29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text rev. (DSM-5-TR). Arlington (VA): American Psychiatric Publishing; 2022 [citado 2025 jul 21]. Disponible en: https://www.psychiatry.org/psychiatrists/practice/dsm
2. Guashpa M. La inimputabilidad de las personas con síntomas de trastorno mental y adopción [Tesis de maestría]. Quito: Universidad Central del Ecuador; 2020. Available in: http://www.dspace.uce.edu.ec/handle/25000/24405
3. American Psychiatric Association. Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-5. Edición Revisada. Editorial Médica Panamericana; 2022. Available in: https://www.federaciocatalanatdah.org/wp-content/uploads/2018/12/dsm5-manualdiagnsticoyestadisticodelostrastornosmentales-161006005112.pdf
4. Howitt D. Introduction to Forensic and Criminal Psychology. 7th ed. Pearson; 2022. Available in: Introduction to Forensic and Criminal Psychology (pearson.com)
5. Peña M, Toledo N. Problemas del proceso de peritaje psicológico de una persona adulta para determinar su internamiento en el área de inimputables en las instituciones de salud mental en el Ecuador [Tesis de grado]. Universidad Politécnica Salesiana; 2022. Available in: https://dspace.ups.edu.ec/handle/123456789/21608
6. Velsor SF, Rogers R, Donnelly JW, et al. Assestment of Factitious Psychological Presentations (FPP): an Ovrelooked Response Style in Forensic Practice. Psychol Inj Law. 2021; 14:201-12. Available in: https://doi.org/10.1007/s12207-021-09413-1
7. Instituto Nacional de Estadísticas y Censo (INEC). Encuesta de estratificación del nivel económico, 2024. Available in: https://www.ecuadorencifras.gob.ec/encuesta-de-estratificacion-del-nivel-socioeconomico/
8. World Health Organization. Global health estimates: Leading causes of DALYs. The Global Health Observatory. [citado 2024 Feb 21]. Available in: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys
9. U.S. Department of State. 2023 Country Reports on Human Rights Practices: Ecuador [Internet]. 2023 [citado 2023-07-27]. Disponible en: https://www.state.gov/reports/2023-country-reports-on-human-rights-practices/ecuador/
10. The Organized Crime Index. Criminality in Ecuador [Internet]. [citado 2024 Jul 4]. Available in: https://ocindex.net/
11. Sindeev A. Características epidemiológicas y médico-legales de los inimputables por trastornos mentales en el Instituto Nacional Penitenciario del Perú, 2014-2019. Rev Esp Sanid Penit. 2021;23(2):49-59. Available in: https://scielo.isciii.es/pdf/sanipe/v23n2/es_2013-6463-sanipe-23-02-49.pdf
12. World Health Organization, Regional Office for Europe. Health in prisons European database (HIPED) (BY-NC-SA 3.0 IGO) [dataset] [Internet]. 2023. Available in: https://www.who.int/data/region/europe/health-in-prisons-european-database-(hiped)#:~:text=The%20WHO%20Prison%20Health%20Framework,HIPEDS%20round%2C%20conducted%20in%202021
13. Patiño WVR, Román CEO, Tello VIP. Factores Psicosociales de Riesgo y Delitos Asociados en Inimputables con Esquizofrenia. Guayaquil-Ecuador 2013-2022. Rev cubana Educ Sup. 2023;42(especial 2). Available in: https://revistas.uh.cu/rces/article/view/8311
14. Whiting D, Gulati G, Geddes JR, Fazel S. Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: a systematic review and meta-analysis. JAMA Psychiatry. 2021;79(2):120-32. Available in: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2787197
15. Mascialino G, Carrington SJ, Coral-Almeida M, Álvarez-Mejía D, Torres-Tapia ME, Rodríguez-Lorenzana A. Burden of disease, incidence, and spatial distribution of Schizophrenia in Ecuador from 2011 to 2021 using hospital discharge records. 2023. Available in: https://doi.org/10.21203/rs.3.rs-3754263/v1
16. Gangotena, F. S. S. (2022). Thoughts on prison system and increases in crime: The Ecuadorian Case. RFJ, 11, 98. Available in: https://heinonline.org/HOL/LandingPage?handle=hein.journals/revfj11&div=8&id=&page=
17. Mercurio EN, Sheinbaum Lerner D. Unfitness to stand trial and the social model of disability: challenges for Latin American criminal justice. Curr Issues Crim Justice. 2024;1-17. Available in: https://doi.org/10.1080/10345329.2023.2297479
18. Sindeev A. Legal, medical and epidemiological characteristics of those who are not imputable for mental disorders in the National Penitentiary Institute of Peru, 2014-2019. Span J Penitentiary Health. 2021;23(2):49-59. Available in: https://scielo.isciii.es/pdf/sanipe/v23n2/2013-6463-sanipe-23-02-49.pdf
19. Condo JEG, Román CEO, Tello VIP. Diagnóstico Pericial y Diagnóstico Hospitalario Asignado a Personas Inimputables Internadas por Orden Judicial, Periodo 2013-2022. Revista Cubana de Educacion Medica Superior. 2023;42(special 2):221-36. Available in: https://www.researchgate.net/publication/376616081_Diagnostico_Pericial_y_Diagnostico_Hospitalario_Asignado_a_Personas_Inimputables_Internadas_por_Orden_Judicial_Periodo_2013-2022
20. Figueroa Benalcázar KS. Inimputability for mental disorders, an approach from Neurolaw and volitional capacity [Doctoral dissertation]. Pontificia Universidad Católica del Ecuador Ibarra; 2023. Available in: https://www.pucesi.edu.ec/webs2/
21. Moreno-Zambrano D, Wong-Ayoub JA, Arevalo-Mora M, San Andrés-Suárez I, Santana D. Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendations. Rev Ecuat Neurol. 2023;32(2). Available in: https://revecuatneurol.com/wp-content/uploads/2023/10/2631-2581-rneuro-32-02-00055.pdf
22. Asamblea Nacional del Ecuador. Código Orgánico Integral Penal. Febrero de 2021. Available in: https://www.defensa.gob.ec/wp-content/uploads/downloads/2021/03/COIP_act_feb-2021.pdf
23. Fox B, Miley LN, Kortright KE, Wetsman RJ. Assessing the effect of mental health courts on adult and juvenile recidivism: a meta-analysis. Am J Crim Justice. 2021;46(4):644-64. Available in: https://doi.org/10.1007/s12103-021-09629-6
24. Tremlin RC, Beazley P. A systematic review of offender mental health stigma: Commonality, psychometric measures and differential diagnosis. Psychol Crime Law. 2024;30(2):125-49. Available in: https://doi.org/10.1080/1068316X.2022.2072842
25. Ministry of Public Health. Report on the evaluation of the 2014-2017 MH plan of Ecuador. Department of provision of health services. 2022. Available in: https://www.salud.gob.ec/wp-content/uploads/2022/11/Informe-Evaluacion-Plan-Salud-Mental_2014-2017_24_08_2022_Final1-signed.pdf
26. Fish FJ, Casey P, Kelly B. Fish's clinical psychopathology: signs and symptoms in psychiatry. Cambridge University Press; 2024. Available in: https://archive.org/details/epdf.pub_fishs-clinical-psychopathology-3rd-edition/page/n3/mode/2up
27. Organización Mundial de la Salud. Clasificación Internacional de Enfermedades, 11.ª edición (CIE-11). Ginebra: OMS; 2021 [citado 2025 jul 21]. Disponible en: https://icd.who.int/es
28. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Publishing; 2013 [citado 2025 jul 21]. Disponible en: https://www.psychiatry.org/psychiatrists/practice/dsm
29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text rev. (DSM-5-TR). Arlington (VA): American Psychiatric Publishing; 2022 [citado 2025 jul 21]. Disponible en: https://www.psychiatry.org/psychiatrists/practice/dsm
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Figueira JAV. Diagnostic correlation between clinical and expert assessment in non-imputable individuals due to mental illness. Error of perception or diagnostic convenience. Rev. Hosp. Psiq. Habana [Internet]. 2025 Jul. 29 [cited 2025 Aug. 17];22. Available from: https://revhph.sld.cu/index.php/hph/article/view/845
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Copyright (c) 2025 Jose Alejandro Valdevila Figueira
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