Journal of Forensic Medicine

Journal of Forensic Medicine

   

Analysis of the Reasons for the Inconsistent Opinions on the Mental Disability Assessments

Chen-huai-yu ZHU1(), Jie-yu WANG1, Ying LIU1, Bi-yu WANG2, Zhi-jun HUANG2, Yang YU1, Yan-ni ZENG1,3,4(), Yan-wei SHI1,2,3,4()   

  1. 1.Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
    2.Forensic Medicine Center, Sun Yat-sen University, Guangzhou 510080, China
    3.Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Guangzhou 510080, China
    4.Guangdong Province Key Laboratory of Brain Function and Disease, Guangzhou 510080, China
  • Received:2024-10-21
  • Contact: Yan-ni ZENG, Yan-wei SHI

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Abstract:

Objective To analyze the factors contributing to inconsistent opinions on assessments of mental disability degrees caused by traumatic brain injury （TBI）. Methods A retrospective analysis was conducted on 50 cases of re-assessment of mental disability caused by TBI at Sun Yat-sen University Forensic Medicine Center from 2018 to 2019.General demographic information of the assessed individuals, TBI conditions, and initial and re-assessment opinions were collected. Descriptive statistics, Spearman’s correlation test, unpaired t test, binary logistic regression and multinomial logistic regression were used to analyze the differences in mental disorder diagnosis and disability degrees between initial and re-assessment. The reasons for inconsistent opinions were analyzed. The analysis results were plotted using R 4.3.1. Results The inconsistency rate for two mental disability assessment opinions was 70.0% （including only mental diagnosis were inconsistent, only disability degrees were inconsistent and both inconsistent）. In the initial assessment reports, 64% of the cases lacked brain imaging data of the past three months, which significantly affected the degree difference between these two assessments. The differences of the location of cerebral malacia foci were significantly correlated with the responses during assessment, memory, intelligence, emotional activities, willpower and self-awareness. There were significant differences between the two assessments in the degree of impairment to some mental symptoms and the ability of activities related to daily life. Conclusion The reasons for the inconsistent opinions on the two assessments may be: （1） depending on different brain imaging information （including whether there is brain imaging information in the recent three months, and the location of cerebral malacia foci）; （2） examiners have different understandings of the degree of damage caused by mental disorders; （3） examiner’s identification of the degree of impairment in living ability varies.

Key words: forensic psychiatry, cerebral injury, mental disability, reappraisal, imageological examination, evaluation of activities of daily living

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