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Cited by 19Clinical Reasoning and Diagnostic SkillsHealthcare Decision-Making and RestraintsPsychopathy, Forensic Psychiatry, Sexual Offending

Clinical reasoning in forensic psychiatry: concepts, processes, and pitfalls

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Raharjanti, Natalia Widiasih, Wiguna, Tjhin, Purwadianto, Agus, Soemantri, Diantha, Bardosono, Saptawati, Poerwandari, Elizabeth Kristi, Mahajudin, Marlina S., Ramadianto, Adhitya Sigit +7 more·2021·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2021.691377PMC PMC8374734
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Abstract

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.

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  • The inclusion of the Burden_Score aligns with literature advocating for holistic, multi-dimensional indicators in forensic psychiatry.

    “Importantly, the inclusion of the Burden_Score also aligns with literature advocating for holistic, multi-dimensional indicators in forensic psychiatry (Raharjanti et al., 2021).”

    From A hybrid fuzzy logic–Random Forest model to predict psychiatric treatment order outcomes: an interpretable tool for legal decision support (2025) · cites this paper as Raharjanti et al., 2021

    The Background describes forensic psychiatric analysis as integrating information across psychiatry, psychology, medicine, and law. Clinical Reasoning in Forensic Assessments also says an evaluee’s developmental history, social context, and chain of events must be considered. These passages support a broad, multidimensional approach to assessment, but they do not advocate multidimensional indicators or address a Burden_Score specifically (page numbers unavailable in our copy). (LLM, conf=0.83)

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Authors
Raharjanti, N. W., Wiguna, T., Purwadianto, A., Soemantri, D., Bardosono, S., Poerwandari, E. K., Mahajudin, M. S., Ramadianto, A. S., Alfonso, C. A., Findyartini, A., Nugrahadi, N. R., Lazuardi, M. Q., Subroto, P. A. M., Saroso, O. J. D. A., & Levania, M. K.
Affiliations
  • University of Indonesia (ID)
  • Universitas Airlangga (ID)
Corresponding author
Raharjanti, Natalia Widiasih
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2021-08-05
Volume
12
Pages
691377-691377
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2021.691377
PMC
PMC8374734
OpenAlex
W3187815284
Cited by
19
References
4
Citations by year
2026: 8 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 2
FWCI
0.40
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Universitas Indonesia (RST/HKP.05.00/2020, 00/2020)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
clinical reasoning, forensic psychiatry, hypothetico-deductive method, dual-process theory, cognitive biases, situated cognition, debiasing strategies, mental capacity assessment

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