Kenny Richey may find it hard to adjust to the outside world including finding it difficult to rebuild relationships, a forensic psychologist has warned.
Richey greets a reporter after his Putnam County Courthouse release
Ian Stephen said readjusting to normal life would not be easy for Richey, 43, who has spent 20 years on death row in the US.
He will also face major stresses and challenges as he tries to adapt to a world which has changed dramatically.
Mr Stephen said Richey will be hit by a barrage of stimuli after his captivity.
And once the initial elation dies down, other problems are likely to emerge, such as depression and stress.
The Scot will also face the challenge of adjusting to a world which has gone through a technological revolution in the past two decades.
Mobile phones, iPods and the internet were the stuff of fantasy when he was jailed in 1987.
He is also returning to a country which has undergone major changes since he left in 1982, with devolution and the regeneration of many Scottish cities.
Mr Stephen, a committee member of the Miscarriages of Justice Organisation in Scotland, said: "It will be a strange world for him as he was staying in America and Scotland is a different place now than it was 20 years ago.
"He is re-emerging into a country he just doesn't know and it takes a long time to adapt."
Richey will need intensive support, with counselling and practical help if he is to adapt, Mr Stephen said.
Kenny Richey winks to the world's media as he leaves jail
But although his family will be important to his integration into society, Mr Stephen warned that it might be difficult for Richey to rebuild relationships with his mother Eileen and other relations.
He said: "He will find it difficult to co-habit with family and people who are friends.
"His mother will have unreal expectations of how things are going to be and he may also have unreal expectations."
Mr Stephen added: "He will suffer from stimulus overload. Many prisoners coming out after a long time find the noise of socialising outside, with too many people crushing in on them, hard to cope with.
"We find that prisoners coming out of miscarriages of justice initially go through a euphoria stage of coming out, then they hit the stage where all the negative impact hits them, such as post-traumatic stress disorder and feeling very angry over what has happened to them."
He said many prisoners built up tension and anger from their time in jail, and found the outside world a very threatening place rather than a welcoming place.
Even the relief of coming off death row after so long could unleash pent-up tension and anxiety.
He said that prisoners whose convictions are a miscarriage of justice are even more vulnerable to problems because they do not go through pre-release programmes like other prisoners coming to the end of a sentence.