The role of real-time computerized neuropsychological examination in forensic psychiatry practice

Neuropsychological examination (NPE) is an important tool for evaluation of cognitive functioning in clinical and forensic situations. In forensic practice, NPE usually focuses on competency to stand trial, the mental state at the time of the offense, risk for future violence and malingering/aggravation issues. Real-time computerized NPE shows more accurate results than traditional pen-and-paper tests and provides quantitative data in a relatively standard format. It permits detection of any manipulation by the examinee in "real time." Therefore, it makes it possible not only to analyze the final results, but also to monitor closely the sequence of single acts of the assessment procedure. Thus, the computerized NPE attenuates possible examinee-related manipulations, which may distort the test results. The real-time NPE report of these elementary behavioral parameters can be used in the courts as acceptable evidence under cross-examination. This method leaves less room for bias; however, a cautious interpretation is always essential since the computerized data do not transform subjective methods into objective ones. Establishing a standard testing procedure and further utilization of real-time computerized tools could improve significantly the quality of NPE in forensic psychiatric practice.