Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





Thomas Kucharski


Patricia Zapf

Committee Members

Patricia Zapf

Chitra Raghavan

Maureen Reardon

Warren Benton

Subject Categories

Clinical Psychology | Criminal Law | Psychology | Social and Behavioral Sciences


Delusional disorder, delusional ideation, competency to stand trial, psychotic disorders, competency restoration, fitness to proceed


Delusional disorder has long been recognized in the psychiatric nomenclature, however, low prevalence rates and prevailing clinical views about the seemingly refractory nature of delusional disorder have restricted data on clinical treatment outcomes for this illness. Similar perspectives have been noted in forensic settings where minimal data is available to guide standards of care for incompetent to stand trial (IST) delusional pretrial defendants. Rationale. While the factors explicated in Sell provide guidelines for the involuntary medication of defendants found IST, numerous questions are left unanswered regarding the restorability of pretrial delusional detainees. The proposed study investigated the competency restoration rates of defendants with delusional symptoms and, more broadly, using the Brief Psychiatric Rating Scale (BPRS) assessed how these symptoms impact competency related abilities. Method. Data were gathered from competency restoration reports at a federal medical center. A total of 232 cases were drawn with replacement from a five year span, and then coded for demographic, clinical, and psycholegal variables. Results. Nearly 60% of defendants suffered with one or more delusions, and the delusional ideation for those who met the BPRS threshold for a delusional disorder (DD) classification was more pervasive than for those in either the schizophrenia or mood with psychosis subgroups. Defendants in the DD subgroup were also more likely to refuse treatment. The logistic regression model showed adequate overall classification (63.4%) and one static variable, i.e., prior psychiatric treatment, reached statistical significance; indicating that those with such a history were less likely to be restored. Discussion. The high rates of treatment refusal for DD defendants meant that most of these defendants were opined IST after their first statutorily determined competency restoration period, however, this group was no less likely to be opined restorable by forensic examiners given an adequate trial of involuntary treatment with antipsychotic agents.