Commentary: sex offenders and insanity.

Sex offenders with a psychotic illness present challenges in the determination of criminal responsibility, risk assessment, and psychiatric treatment. Novak et al. present data that raise concerns regarding how forensic psychiatrists could conclude sex offenders were not responsible for their offenses in the absence of clear evidence of psychotic symptoms at the time of assessment and/or offense. They also highlight issues of risk assessment and management of psychotic sex offenders that have not been adequately studied. We require further research of psychotic sex offenders to be able to offer scientifically supported opinions on risk assessment to courts and decision-makers.