The Foundations and Practice of Neuropsychological Diagnostics in the Context of Forensic Psychiatric Examination

Abstract

Background: cognitive impairments are comorbid for most mental disorders and can be important in assessing the ability of a subject to understand and control their actions in legally significant situations. The aim of review: аnalysis of neurobiological correlates and cognitive impairments in individuals suffering from mental disorders — organic personality disorder, schizophrenia, borderline personality disorder, in the context of forensic psychiatric examination. Material and methods: using keywords: “cognitive impairments in schizophrenia”, “cognitive impairments in organic personality disorders”, “cognitive impairments in personality disorders”, “MRI in schizophrenia”, “MRI in organic personality disorder”, “MRI in personality disorder”, “forensic neuropsychology”, “schizophrenia and criminal actions”, “organic personality disorders and criminal actions”, “personality disorders and criminal actions” the search and analysis of scientific publications was carried out in PubMed, Scopus, and RSCI databases over the past 5 years. Conclusion: schizophrenia shows deviations in the functioning of frontal and temporal lobes characterized by cognitive impairments: executive functions, attention, auditory-verbal memory, psychomotor slowness, inconsistent behavior, and deficits in volitional efforts. Borderline personality disorder is associated with reduced volume of the anterior cingulate gyrus, hippocampus, amygdala, and prefrontal cortex, dysfunctional interaction between limbic and prefrontal areas resulting in difficulties in emotion identification and impulsivity. Individuals with a history of traumatic brain injury (TBI) and secondary personality disorders exhibit diffuse gray matter damage affecting frontal, temporal, and parietal regions, emphasizing dysfunction of limbic-reticular complex structures with cognitive impairments including decreased thinking speed, attention stability, executive functions, auditory-verbal memory, visual-spatial memory, visual-motor coordination, and decreased impulse control. Individuals with mental disorders who commit criminal acts often exhibit deficiencies in frontal lobes and associated disturbances in executive components of mental activity, particularly cognitive flexibility and planning. Neuropsychological methods for studying cognitive functions can be used to obtain additional information in forensic psychiatric examinations.