Factors underlying clinicians' judgements of patient insight and confidence in using clinical judgement in psycho-legal settings

Psychiatr Psychol Law. 2020 Feb 13;27(1):95-109. doi: 10.1080/13218719.2019.1687046. eCollection 2020.


This study investigates the factors that clinicians use to make clinical judgements of insight and their confidence in using clinical judgement across three clinical and forensic assessment domains. The 12 participating clinicians rated 30 DVD vignettes of psychiatric patients with a psychotic disorder. Qualitative analyses revealed eight themes that align closely with the dimensions of insight reported in the literature. However, it is unclear how clinicians weigh each dimension. The clinicians were more confident in making a judgement on insight for treatment planning than for involuntary treatment or fitness to stand trial evaluations. They wanted more information when making a judgement in the forensic domains, recognising the greater consequences for the patients and the greater level of scrutiny of their judgements in legal settings compared to clinical settings. The data obtained suggest that both clinical and forensic assessment of insight would benefit from empirically derived structured professional judgement (SPJ) tools.

Keywords: clinical judgement; confidence; decision-making; insight; involuntary treatment; psycho-legal; psychoses; schizophrenia; treatment compliance.