الفهرس 
History & development of the insanity pleaOnly 14 pages are availabe for public view
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Abstract
In many countries, there continues to be conflicting opinions and mechanisms regarding the appropriateness of treatment and/or punishment for mentally ill individuals who commit crimes. Court referrals of defendants claiming criminal irresponsibility on the basis of the insanity defense have been recently on the rise to the extent that many psychiatrists and judges feel that the insanity defense has been misused.
Insanity standards evolved over time. The oldest standard was called the wild beast test which states that “A man must be totally deprived of his understanding and memory, so as not to know what he is doing, no more than an infant, a brute, or a wild beast.” Another test, the irresistible impulse test states that “If some controlling disease was the acting power within the person which he could not resist, then he will not be held responsible.”
As for the most famous of insanity standard; The M’Naghten rule, it states that “A defendant is considered not criminally responsible if he has a mental disease or defect at the time of the act which caused him not to know the nature and quality or the wrongfulness of the act.”
In addition, the Durham Rule states that “The accused is not criminally responsible if his unlawful act is the product of a mental disease or defect”. This rule is rarely used nowadays. The Model Penal Code of the American Law Institute holds that “A person is not responsible for criminal conduct if at the time of such conduct, as a result of mental disease or defect, he lacks substantial capacity to appreciate the wrongfulness of his conduct (cognitive arm) or to conform his conduct to the requirements of the law (volitional arm).
In the same vein, the Egyptian law states that “a person who committed a crime is not criminally responsible if he was suffering a mental or psychiatric disorder to the degree of complete loss of awareness or choice, or if he was under the effect of a drug if he had taken it involuntarily (obliged) or unknowingly. If he partially lost awareness or choice he is still considered criminally responsible, but this will be taken into consideration when a sentence is defined.”
In Egypt when a defendant pleads not guilty by reason of insanity (NGRI), the defendant is referred to mental health hospital forensic psychiatry unit. In each court referral, a committee of three psychiatrists is set up by the National Mental Health Commission, to investigate and assess the mental state and criminal responsibility of the defendant & to provide a medico legal report to the court. A psychiatrist is often consulted as an expert witness in insanity cases, but the ultimate legal judgment of the defendant’s sanity is determined by the judge, not by a psychiatrist.
As for findings of the current study, the success rate of insanity pleas in this study was slightly higher than the worldwide success rate. Successful insanity pleas were related to higher mean age of the defendants, unemployment and less serious crimes. Moreover, defendants found not responsible were more likely to exhibit a psychotic disorder rather than a non psychotic psychiatric disorder. Delusions were the most commonly occurring psychiatric symptom. Quite often the defendants had past psychiatric history.
The medico legal reports examined in the study; were scrutinized to highlight some pitfalls and recommend ways to amend it. The greatest flaw of the reports was that the committee failed to give a clear explanation to the relation between the diagnoses reached and the defendants’ losing awareness and choice in many reports. No causal link was illustrated between psychiatric symptoms exhibited by the defendant and the crime committed.