Experts Say Mentally Ill Defendants Often Regain Competence Through Medication

In February, a psychiatrist conducted three examinations of Nathan Trupp and concluded that the multiple-murder suspect was prone to hallucinations and bizarre rambling about Nazis conspiring against him.

Trupp’s frequent emotional outbursts during the examinations caused the psychiatrist, who routinely interviews people with psychotic disorders, to fear for his safety while with Trupp, a man authorities say has killed five people, including two Universal Studios security guards, because he believed that they were Nazis.

After the examinations, a Los Angeles Superior Court judge ruled Trupp mentally incompetent to stand trial and sent him to a hospital for the criminally insane.

Four months later, Trupp was studied by the same psychiatrist, who concluded that Trupp is sufficiently rational to aid his attorneys in his defense. And so last week the judge ruled Trupp competent to stand trial.

Trupp’s seemingly rapid transformation from delusional and dangerous to someone who can take part in making life-and-death decisions on his future is not extraordinary, psychiatrists and criminal justice experts say.

While at Patton State Hospital in San Bernardino County, the 42-year-old Trupp was treated with psychotropic drugs that authorities said have restored his competency.

“It’s not at all unusual,” Los Angeles County Deputy Dist. Atty. Linda B. Greenberg said of the changes in Trupp.

“We see amazing changes in people,” said Greenberg, who represented the state during Trupp’s competency hearings.

“In general, delusions are part of a chemical imbalance in the brain. When you supply the chemical, the delusions go into remission. Because they were able to give the right chemicals to him, he was brought back to competency.”

Authorities would not speak specifically about Trupp’s case or what drugs he is being treated with.

He is scheduled to be arraigned Wednesday on charges that he shot to death Jeren Beeks, 27, and Armando Torres, 18, two unarmed security guards at the main gate at Universal Studios on Dec. 1. The guards had turned Trupp away earlier after he asked to see actor Michael Landon.

Authorities said that two days before the slayings, Trupp shot three people to death at a bagel shop in Albuquerque, N. M., where he had been living, before taking a bus to Los Angeles to look for Landon.

Trupp, who has been hospitalized for mental illness at least twice since the early 1970s, was shot and captured by a sheriff’s deputy a few minutes after the shootings at Universal Studios. He repeatedly called out, “Help me! Kill me!” while paramedics treated him at the scene.

After his arrest, Trupp told investigators and court-appointed psychiatrists that he shot his victims and sought out Landon because he believed that they were Nazis conspiring against him, authorities said. A day before the shooting spree began in New Mexico, he told a taxi driver that he received messages from God.

During his court appearances before being ruled incompetent Feb. 16, Trupp at times appeared inattentive and skittish. “He looked scared. . . . He didn’t seem to be in touch with things around him,” Greenberg said.

After being treated at Patton and returned to court for a second competency hearing last week, Trupp sat calmly in the courtroom and appeared to pay careful attention to the proceedings. He answered questions from the judge and spoke calmly with his attorney. Afterward, Deputy Public Defender Philomene Swenson said, “I think he is rationally able to discuss things that he was too sick to discuss before.

“He is able to sit and carry on a conversation,” she said. “I believe he now understands the gravity” of the charges he faces.

Judge Florence Bernstein ruled him competent to understand the charges and participate in his defense and ordered the criminal trial to proceed.

Patton officials would not discuss Trupp. But Kaushal K. Sharma, a clinical associate professor at USC’s Institute of Psychiatry and Law who examined Trupp before both hearings, reported improvements in Trupp’s mental state at the second interview.

Sharma, who earlier had reported to the court that he feared for his safety while with Trupp, mentioned no safety concerns after the second session.

Sharma said in an interview last week that the changes in Trupp were the result of treatment with psychotropic drugs, also called “antipsychotic drugs.”

“I think the large portion of the improvement is due to medication,” Sharma said. “But it is conditional improvement, conditional on his continuing to take medication.”

Psychotropic drugs--Thorazine, Haldol, Prolixen and several others--are routinely prescribed in cases in which criminal defendants have exhibited psychotic behavior and are judged incompetent. The correct drug or combination of drugs and dosage can result in a rapid improvement in mental health, authorities say.

Experts said use of the drugs is an inexact science grounded in findings that human thought processes involve chemical reactions in the brain. Hallucinations, delusions, paranoid schizophrenia and other manifestations of mental illness are symptoms of chemical imbalances that can be treated with the antipsychotic drugs, along with therapy, Sharma said.

Paul Grossman, a UCLA psychiatry professor who runs a program at the Veterans Administration Hospital in Westwood that treats violent schizophrenics, explained that the drugs affect the way electrical impulses are transmitted in the brain. But how that in turn modifies behavior is unknown.

Psychiatrists prescribe different drugs, study their effects and fine-tune dosages until the mental illness is managed, he said.

“Probably after a couple weeks of antipsychotic medication, the hallucinations have gone away and the delusions have been resolved or the person does not feel compelled to act on them anymore,” Grossman said. “They remain at a sort of background level.”

“At times it is almost like trial and error,” Sharma said. “There is no one medication that can take care of all symptoms. Each human being is unique and each may respond more positively to a different chemical.”

Sharma, who conducts several competency examinations a day, said he usually sees defendants in criminal cases restored to competency three to five months after psychotropic treatment begins.

The improvements generally are more rapid if the defendant previously has used the medications, authorities said. Citing patient confidentiality laws, authorities would not say whether Trupp received psychotropic drugs while being treated for depression at a psychiatric hospital in Trenton, N. J., in 1987 and at a Baltimore institution in the early 1970s.

Authorities said that reaching a level of mental competency to stand trial does not mean a defendant has recovered from mental illness. “By and large, most of the people who are returned to criminal court are still mentally ill,” Sharma said.

Swenson, Trupp’s attorney, said Trupp is still mentally ill, though she would not say whether he will plead not guilty by reason of insanity.

(An insanity plea would hinge on Trupp’s mental health at the time of the slayings. The competency ruling last week dealt with his present mental health.)

Authorities compared mental patients who take psychotropic drugs to diabetics who must take insulin.

“It is not a cure; it is a treatment,” Greenberg said of the use of the drugs. “If you withhold the medication, the full-blown psychosis will come back.”

Bernstein ordered that Trupp be closely monitored to make sure he continues to take the medication that restored his competency. He has been transferred from Patton to the County Jail’s ward for the mentally ill.

“It is absolutely necessary that he keep up with the medication,” Sharma said. “Otherwise, he’ll be back to where he was four months ago.”