neurochemistry and neuroanatomy of apd
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Neurochemistry and Neuroanatomy of APD. Background. Most research focused on behavioral disturbances APD Impulsive Aggression Criminality CD and ODD Externalizing disorders Novelty Seeking Sensation Seeking Little empirical attention to affective-interpersonal factor of psychopathy .

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background
Background
  • Most research focused on behavioral disturbances
    • APD
    • Impulsive Aggression
    • Criminality
    • CD and ODD
    • Externalizing disorders
    • Novelty Seeking
    • Sensation Seeking
  • Little empirical attention to affective-interpersonal factor of psychopathy
neurochemical disturbances
Neurochemical Disturbances
  • Monoamine neurotransmitters
    • Serotonin
    • Dopamine
    • Epinephrine and Norepinephrine
  • Hormones
    • Testosterone
    • Cortisol
    • Thyroid
serotonin
Serotonin
  • Lower levels of serotonin consistently associated with
    • Aggression
    • Criminal behavior
    • Suicidal behavior
  • Disturbances in serotonergic functioning early in life closely related to behaviors that progress to APD
    • Disruptive behavior disorders
    • Aggression
    • Family history of APD
slide5
Serotonin deficits more fundamentally linked to Factor 2 features of psychopathy (impulsive-antisocial)
  • Serotonin levels
    • Low in spinal fluid
    • High in blood platelet cells
    • Specificity of site unclear but evidence points towards deficient serotonin precursor uptake or synthesis
slide7
d-fenfluramine
    • Releases synaptic serotonin to activate postsynaptic serotonin receptors. The functional status of the serotonin is measured by levels of peripheral prolactin
  • Blunted prolactin response to fenfluramine
    • Convicted murderers w/APD
    • APD heroin users
    • Increased impulsive aggression
    • Children with aggressive and antisocial relatives
genetic polymorphisms
Genetic polymorphisms
  • Variations in the DNA sequence coding
    • Dopamine
    • THP
    • Serotonin Transporter
    • MAO-A
    • Norepinephrine
hormones
Hormones
  • Testosterone levels higher in violent people engaging in violent and aggressive behavior. Also related to hostility.
  • After age 25
    • androgen levels decrease
    • violent crime rates decrease
dabbs morris 1990
Dabbs & Morris (1990)
  • Studied 1,496 Vietnam Vets
  • Vets with high testosterone levels and low social integration (e.g., low SES, unmarried) most likely to be delinquent
hpa axis functioning
HPA Axis functioning
  • Low cortisol response related to violent offending, physically abusive behavior, aggressiveness, externalizing symptoms in childhood
  • Unclear whether this is a blunted basal output or a blunted cortisol response to stress
physiological arousal
Physiological Arousal
  • Antisocial personalities have lower resting heart rates (Raine, 1993)
  • Ortiz and Raine (2003) Meta-analysis
    • Anti-social behavior in children
    • 40 studies, n = 5,868, d = -.44
  • Theories
    • reduced fear
    • autonomic underarousal
complications during birth
Complications During Birth
  • Violent offenders more likely than nonviolent or non-criminals to have had a complicated birth
  • Likelihood of violence increases with complicated birth and
    • parental psychiatric illness or
    • minor physical anomalies
head injuries
Head Injuries
  • Study of death-row inmates (Lewis, 1986)
    • All 15 claimed a history of head injury
    • 12 of 15 showed neurological impairment
  • Study of 14 death-row juvenile offenders (Lewis et al., 1988)
    • All 14 had history of head injury
    • 8 of 14 severe enough to be hospitalized
  • Study of 16 death row inmates (Freedman & Hemenway, 2000)
    • 88% (14) had history of head injury
    • 88% had been physically or sexually abused
    • 88% had parents who abused drugs and alcohol
arthur shawcross genesee river killer
Arthur ShawcrossGenesee River Killer
  • Killed 2 children, 11 prostitutes
  • Head injuries
    • 09 Hit in head with stone
    • 10 Hit head jumping into lake
    • 16 Hit in head with discuss
    • 17 Hit in head with sledge

hammer

    • 23 Fell 40’ from ladder and hit

his head, was unconscious

david berkowitz son of sam
David Berkowitz“Son of Sam”
  • Killed 6, started over a thousand fires
  • Head injuries
    • 7 Hit by a car, suffered head injuries
    • 7 Ran into a wall and suffered head injuries
    • 8 Hit in the head with a pipe, 4-inch gash in forehead
richard ramirez the night stalker
Richard Ramirez“The Night Stalker”
  • Killed 14
  • Head injuries
    • 02 Dresser fell on his head,

received 30 stitches,

almost died

    • 06 Hit by a swing, knocked

unconscious, caused a

deep gash

    • 11 Diagnosed with epilepsy
robert garrow
Robert Garrow
  • Killed 7 people
  • Head Injuries
    • 2 years old: Mother splits his head open with a crowbar during a beating
    • 5 years old: Knocked unconscious when mother hits him in the head with a piece of wood
    • 6 Years old: Beaten unconscious by his father
    • 36: Receives head injury in auto accident
raymond fernandez
Raymond Fernandez
  • Killed 17 people in the late 1940s
  • History
    • Normal, friendly personality prior to injury
    • Hit on head with a steel hatch cover
    • In coma for a week
    • Complete personality change
    • Killed 17 women over next few years
    • Executed in Sing Sing in 1951
brain damage
Brain Damage
  • 57% of violent criminals
    • 94% for homicide
    • 78% for rape
    • 61% for habitual aggression
    • 49% for pedophiles
  • 15% of criminals committing single violent act
  • 3% of the general population
  • Damage is typically in the prefrontal area
prefrontal cortex
Prefrontal Cortex
  • Frontal Lobe: Orbitofrontal Cortex (OF)
    • poor impulse control
    • explosive, aggressive outbursts
    • lack of interpersonal sensitivity
  • Frontal Lobe: Ventromedial (vm) Prefrontal
    • judgment, awareness of socially appropriate conduct, assessing consequences
prefrontal cortex23
Prefrontal Cortex
  • Antisocial/Violent Behavior
    • Reduced activation related to impulsive aggressive acts
  • Psychopaths
    • Increased activation during emotionally challenging tasks
corpus callosum
Corpus Callosum
  • Structural abnormalities
    • Social, autonomic, and emotional impairment
    • “faulty wiring”
amygdala
Amygdala
  • Arousal
  • Controls Autonomic Responses Associated with Fear
  • Emotional Responses
hippocampus
Hippocampus
  • Hippocampal impairments
    • Affect dysregulation
    • Poor contextual fear conditioning
psychopathic traits
Psychopathic Traits
  • Enlarged corpus callosum
  • Reduced posterior hippocampus volume
  • Exaggerated right > left anterior hippocampus asymmetry
  • Reduced prefrontal gray volume
psychopaths
Psychopaths
  • Increased prefrontal white matter in deceitful/cunning/manipulative behavior
  • Reduced amygdala volume in violent offenders with high psychopathy scores
  • Reduced prefrontal gray volume with psychopathy factors
apd violent behavior
APD – Violent Behavior
  • Reduced prefrontal gray matter
  • Reduced temporal lobe volume
  • Reduced posterior hippocampal volumes
  • Increased collosal volume
  • No amygdala differences
messina et al 2003
Messina et al (2003)
  • Background
    • Literature unclear whether ASPD is predictive of substance abuse treatment responsivity
  • Hypotheses for ASPD patients
    • CBT, CM, & CBT + CM > MM
    • CBT < CM < CBT + CM
    • CM effects decrease significantly during post-treatment
procedure
Procedure
  • 120 MM patients randomly assigned to CBT, CM, CBT + CM, or MM
  • 16 weeks of treatment
  • Outcome measures
    • Urine samples
    • Attendance
results in treatment
Results In-Treatment
  • ASPD significantly and positively related to treatment responsivity
  • All conditions better than control for ASPD, but not for non-ASPD
  • ASPD patients in CM condition significantly more likely to be abstinent during treatment than CBT condition. No diff between CM and CBT + CM.
  • ASPD CM > non-ASPD CM
results post treatment
Results Post-Treatment
  • ASPD CM - highest level of abstinence
  • ASPD: CM, CBT, & CBT + CM > MM
  • Non ASPD: No between group differences
digiuseppe
Digiuseppe
  • Proposed components of effective tx for anger management:
    • Therapeutic alliance
    • Motivation for change
    • Manage physiological arousal
    • Cognitive change
    • Behavior change
    • Relapse Prevention
slide38
Secondary targets
    • Manage impulsive behavaiors
    • Forgiveness
    • Systemic interventions
    • Rebuilding relationships
    • Environmental supports
    • Treatment manuals
treatment for psychopathy
Treatment for Psychopathy
  • Therapeutic Communities
    • Lower recidivism for non-psychopaths and higher recidivism for psychopaths (violent)
    • Did the new skills actually aide the psychopaths in manipulating others?
  • CBT
    • Inconclusive
    • In one study psychopaths rated as showing the most improvement after tx were the most likely to re-offend. Why?
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