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 l.jpg
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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Neurochemical Disturbances

  • Monoamine neurotransmitters

    • Serotonin

    • Dopamine

    • Epinephrine and Norepinephrine

  • Hormones

    • Testosterone

    • Cortisol

    • Thyroid


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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


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  • d features of psychopathy (impulsive-antisocial)-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


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Genetic polymorphisms features of psychopathy (impulsive-antisocial)

  • Variations in the DNA sequence coding

    • Dopamine

    • THP

    • Serotonin Transporter

    • MAO-A

    • Norepinephrine


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Hormones features of psychopathy (impulsive-antisocial)

  • 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


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Dabbs & Morris (1990) features of psychopathy (impulsive-antisocial)

  • Studied 1,496 Vietnam Vets

  • Vets with high testosterone levels and low social integration (e.g., low SES, unmarried) most likely to be delinquent


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HPA Axis functioning features of psychopathy (impulsive-antisocial)

  • 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


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Physiological Arousal features of psychopathy (impulsive-antisocial)

  • 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


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Complications During Birth features of psychopathy (impulsive-antisocial)

  • 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


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Head Injuries features of psychopathy (impulsive-antisocial)

  • 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


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Arthur Shawcross features of psychopathy (impulsive-antisocial)Genesee 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


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David Berkowitz features of psychopathy (impulsive-antisocial)“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


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Richard Ramirez features of psychopathy (impulsive-antisocial)“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


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Robert Garrow features of psychopathy (impulsive-antisocial)

  • 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


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Raymond Fernandez features of psychopathy (impulsive-antisocial)

  • 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


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Brain Abnormalities features of psychopathy (impulsive-antisocial)


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Brain Damage features of psychopathy (impulsive-antisocial)

  • 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


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Prefrontal Cortex features of psychopathy (impulsive-antisocial)

  • 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


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Prefrontal Cortex features of psychopathy (impulsive-antisocial)

  • Antisocial/Violent Behavior

    • Reduced activation related to impulsive aggressive acts

  • Psychopaths

    • Increased activation during emotionally challenging tasks


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Corpus Callosum features of psychopathy (impulsive-antisocial)

  • Structural abnormalities

    • Social, autonomic, and emotional impairment

    • “faulty wiring”


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Amygdala features of psychopathy (impulsive-antisocial)

  • Arousal

  • Controls Autonomic Responses Associated with Fear

  • Emotional Responses


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Hippocampus features of psychopathy (impulsive-antisocial)

  • Hippocampal impairments

    • Affect dysregulation

    • Poor contextual fear conditioning


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Psychopathic Traits features of psychopathy (impulsive-antisocial)

  • Enlarged corpus callosum

  • Reduced posterior hippocampus volume

  • Exaggerated right > left anterior hippocampus asymmetry

  • Reduced prefrontal gray volume


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Psychopaths features of psychopathy (impulsive-antisocial)

  • 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


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APD – Violent Behavior features of psychopathy (impulsive-antisocial)

  • Reduced prefrontal gray matter

  • Reduced temporal lobe volume

  • Reduced posterior hippocampal volumes

  • Increased collosal volume

  • No amygdala differences


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Treatment features of psychopathy (impulsive-antisocial)


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Messina et al (2003) features of psychopathy (impulsive-antisocial)

  • 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


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Procedure features of psychopathy (impulsive-antisocial)

  • 120 MM patients randomly assigned to CBT, CM, CBT + CM, or MM

  • 16 weeks of treatment

  • Outcome measures

    • Urine samples

    • Attendance


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Results In-Treatment features of psychopathy (impulsive-antisocial)

  • 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


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Results Post-Treatment features of psychopathy (impulsive-antisocial)

  • ASPD CM - highest level of abstinence

  • ASPD: CM, CBT, & CBT + CM > MM

  • Non ASPD: No between group differences


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Digiuseppe features of psychopathy (impulsive-antisocial)

  • Proposed components of effective tx for anger management:

    • Therapeutic alliance

    • Motivation for change

    • Manage physiological arousal

    • Cognitive change

    • Behavior change

    • Relapse Prevention


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  • Secondary targets features of psychopathy (impulsive-antisocial)

    • Manage impulsive behavaiors

    • Forgiveness

    • Systemic interventions

    • Rebuilding relationships

    • Environmental supports

    • Treatment manuals


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Treatment for Psychopathy features of psychopathy (impulsive-antisocial)

  • 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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