Commentary: A road map for research in restoration of competency to stand trial

Dr. Bertman and coauthors should be recognized and complimented for their tremendous effort in completing a research protocol in a hard-to-study population. Strengths of this research include the use of a validated CST assessment instrument, ongoing measurements of psychiatric status with the BPRS, and the attempt to exclude malingerers through the use of the APS scale of the GCCT-MSH. Future researchers in this area should consider the use of structured diagnostic instruments, a careful assessment of possible mild MR, usefulness of obtaining a Certificate of Confidentiality from NIH, description of legal charges facing the defendant, and the use of additional CST instruments for evaluating not only the defendant's factual understanding of the charges, but also his or her rational understanding and ability to consult with counsel. The challenges of conducting research in pretrial defendants are substantial. Bertman et al. offer a beginning road map for CST research that highlights useful directions and the inherent difficulty of such work.