The following case report illustrates the value of neuropsychological expertise in disentangling the effects of brain injury and malingering when evaluating competency to stand trial (CST). A 58-year-old Caucasian male, charged with first-degree murder, sustained a self-inflicted gunshot wound to the head, with significant frontal lobe damage. He underwent multiple examinations of CST as well as competency restoration and cognitive remediation attempts. Initial neuropsychological evaluation revealed profound aphasia and neurocognitive dysfunction, with adequate performance validity; however, subsequent exams suggested nonneurological speech changes and symptom exaggeration, with no benefit from education efforts. The defendant was ultimately found competent to stand trial. This case study is a useful example for practicing forensic clinicians, as it involves both unequivocally severe brain injury and unequivocal response bias. It also raises technical and conceptual issues regarding malingering assessment in general and the revision of the Slick criteria for malingering specifically (e.g., the concept of “secondary malingering”).

以下案例报告说明了神经心理学专业知识在评估立竿见影（CST）能力时，在理清脑部损伤和犯罪行为方面的价值。一名58岁的白人男子被控以一级谋杀罪，头部头部遭受枪击伤，额叶明显受损。他接受了CST的多项检查，以及能力恢复和认知补救尝试。初步的神经心理学评估显示严重的失语症和神经认知功能障碍，并具有足够的表现效度。然而，随后的检查显示非神经语言改变和症状夸大，而没有从教育工作中受益。最终发现被告有资格接受审判。此案例研究是练习法医的有用例子，因为它涉及明确的严重脑损伤和明确的反应偏差。它还提出了有关总体恶意攻击评估以及专门针对恶意攻击的Slick标准进行修订的技术和概念问题（例如，“次级恶意攻击”的概念）。