Carl E. Fulwiler

Premorbid Risk Factors for Violence in Adult Mental Illness

The role of premorbid factors in the violence associated with adult mental illness has received little attention. We previously found that the premorbid onset of substance abuse in early adolescence or childhood was a more powerful predictor of violence in adult patients with chronic mental illness than comorbid substance abuse. In the present study, we retrospectively assessed patients with chronic mental illness for a history of childhood conduct disorder. Consecutive referrals to a community treatment team were evaluated with a standardized protocol that included questions about violent behavior. Patients who met DSM-IV criteria for a primary diagnosis of major axis I disorder (N = 64) were assessed for behavior prior to age 15 with a checklist for DSM-IV criteria of conduct disorder using self-report data, supplemented by collateral information from charts and relatives when possible. About half of the sample had a history of committing violent acts in the community, and 26% met criteria for childhood conduct disorder. The odds of violence in adulthood was 10-fold higher for subjects with a history of childhood conduct disorder. Not surprisingly, there was considerable overlap between conduct disorder and early-onset substance abuse. About half of the patients with a history of substance abuse prior to age 15 also had a history of conduct disorder. However, these two premorbid conditions appear to be at least partially independent in predicting adult violence in this population.

Amygdala-Orbitofrontal Resting State Functional Connectivity is Associated with Trait Anger

&NA; An important distinction in research on the neural mechanisms of emotion regulation involves the relatively limited duration of emotional states versus emotional traits that are defined as the stable tendency to experience particular emotions in daily life. Neuroimaging investigations of the regulation of anger states point to the involvement of reciprocal changes in the prefrontal cortex and amygdala activity, but the neural substrate of trait anger has received less attention. We used resting‐state functional MRI to determine whether the variation in the strength of functional connectivity between the amygdala and the orbitofrontal cortex is associated with trait anger. Sixteen healthy men completed the Spielberger State‐Trait Anger Expression Inventory. Correlational analysis for resting‐state functional connectivity (RSFC) was carried out with the left and the right amygdala as separate seed regions. Anger measures were correlated to RSFC involving the right and the left amygdala on a voxel‐by‐voxel basis across all individuals. We found that Trait Anger was inversely associated with the strength of RSFC between the amygdala and the contralateral middle orbitofrontal cortex. The association was stronger for the right amygdala–left orbitofrontal connection. Anger Control, the tendency to try to control expressions of anger, showed the opposite pattern of being positively correlated with amygdala–orbitofrontal connectivity. The present study provides evidence that RSFC in a corticolimbic circuit might subserve stable differences in anger regulation. Our findings also suggest that RSFC may prove valuable as a trait marker for disorders characterized by emotional dysregulation such as depression, anxiety, and personality disorders.

Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework.

The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy.

Hemispheric connectivity and the visual-spatial divergent-thinking component of creativity

BACKGROUND/HYPOTHESIS Divergent thinking is an important measurable component of creativity. This study tested the postulate that divergent thinking depends on large distributed inter- and intra-hemispheric networks. Although preliminary evidence supports increased brain connectivity during divergent thinking, the neural correlates of this characteristic have not been entirely specified. It was predicted that visuospatial divergent thinking would correlate with right hemisphere white matter volume (WMV) and with the size of the corpus callosum (CC). METHODS Volumetric magnetic resonance imaging (MRI) analyses and the Torrance Tests of Creative Thinking (TTCT) were completed among 21 normal right-handed adult males. RESULTS TTCT scores correlated negatively with the size of the CC and were not correlated with right or, incidentally, left WMV. CONCLUSIONS Although these results were not predicted, perhaps, as suggested by Bogen and Bogen (1988), decreased callosal connectivity enhances hemispheric specialization, which benefits the incubation of ideas that are critical for the divergent-thinking component of creativity, and it is the momentary inhibition of this hemispheric independence that accounts for the illumination that is part of the innovative stage of creativity. Alternatively, decreased CC size may reflect more selective developmental pruning, thereby facilitating efficient functional connectivity.

Prefrontal regional correlates of self-control in male psychiatric patients: Impulsivity facets and aggression

Investigating the organization of trait aggression and impulsivity in the prefrontal cortex (PFC) advances our understanding of the neuropsychobiology of self-control. While the orbital aspect of the PFC (OFC) has received attention, there is reason to believe the lateral aspect is also relevant. In the current study using magnetic resonance imaging, gray matter volumes in lateral PFC (LPFC) were derived in a heterogeneous male psychiatric sample (N=36) in which OFC volumes had previously been reported. In an analysis using self-report measures of trait impulsivity and aggression, the left LPFC accounted for significant variance in attentional aspects of impulsivity (13%) and aggression (10%) but not motor aspects of impulsivity, as hypothesized. The OFC was associated with motor impulsivity (left-20%; right-14%) and was also more robustly associated with aggression (left-36%; right-16%). A social/emotional information processing model was explored, based upon whether the LPFC or the OFC depended upon one another for their association to trait aggression and impulsivity. It was demonstrated that association of the LPFC to both aggression and attentional impulsivity depended upon the OFC, while the converse was not supported. The LPFC appears relevant to the higher-order aspects of a cortical self-control network, and that relevance is dependent upon the robust contribution of the OFC.

Impulsive-aggressive traits, serotonin function, and alcohol-enhanced aggression

Although alcohol consumption is involved in most acts of violence, most people do not become violent when they drink. Individuals also respond differently to alcohol on laboratory measures of aggression. The objective of this study was to determine whether individual differences in the effects of alcohol on a laboratory measure of aggression are related to specific personality traits and/or serotonin function, as measured by prolactin response to pharmacochallenge. Psychometric scales for impulsiveness, aggression, and anger, as well as a probe for suspiciousness, were administered to 10 healthy male social drinkers. Trait serotonin function was determined by citalopram challenge. The effect of alcohol on the Point Subtraction Aggression Paradigm was determined by comparing aggression scores with and without 1 g/kg alcohol. Impulsivity scores were significantly correlated with the change in aggressive responding after alcohol. Aggression, anger, and suspiciousness scores were not. Prolactin response did not predict the effect of alcohol on aggressive responding. The results suggest that trait impulsiveness may mediate the effects of alcohol on aggression in normal males.

Recidivism Among Released State Prison Inmates Who Received Mental Health Treatment While Incarcerated

This study assesses the likelihood of rearrest among a cohort of all adults (N = 1,438) released from the Massachusetts state prison system who received mental health services while they were incarcerated. All individuals were followed for 24 months. The analysis focused on four classes of variables: demographic characteristics, clinical history, criminal justice history, and postrelease supervision. These analyses showed that criminal history factors—a juvenile record and a history of multiple previous incarcerations—were significant risk factors, but that clinical factors, including a history of substance abuse, were not. Overall, the models developed here look much like the ones that would be observed in the general offender population. The implications of these findings for criminal justice and mental health policy are discussed.

Predictors of Accessing Substance Abuse Services Among Individuals with Mental Disorders Released from Correctional Custody

Objective: In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within 2 years of correctional release. Methods: Using merged administrative data on all ex-inmates with open mental health cases released from the Massachusetts Department of Corrections and two county houses of corrections from 2007 to 2009 (N = 2,280) and substance abuse treatment outcome data through 2011, we analyze the influence of demographics, behavioral and mental disorders, and criminal justice variables on entry into substance abuse treatment within 24 months post-release. We also describe primary drug use and services utilized for all the ex-inmates who accessed substance abuse services (n = 1,383). Regression techniques were used to analyze the probability of utilizing substance abuse treatment services by various demographic, behavioral, and criminal involvement characteristics. Results: The prevalence of a history of substance use disorders is high in this population (69%, n = 1,285). Subsequently, at 24 months post release, 61% (n = 1,383) of ex-inmates with open mental health cases utilized substance abuse treatment services. This group was disproportionately female and White, with a preincarceration history of substance abuse and an increased number of previous incarcerations, and was more likely released under correctional supervision. Conclusions: Substance abuse is a chronic relapsing disorder and dual diagnosis is common among individuals with mental disorders involved with the criminal justice system. Their service needs and contacts across substance abuse, mental health, and criminal justice systems highlight individuals caught up in the institutional circuit. Study results point to the need for expanded and targeted dual diagnosis treatment approaches and relapse prevention for ex-inmates with mental disorders post correctional release.

Neural correlates of impulsivity factors in psychiatric patients and healthy volunteers: a voxel-based morphometry study

According to bottom-up/top-down models, impulsivity facets are represented across the cerebral cortex and subcortex. Hypothesized gray matter correlates of motor, attentional and non-planning impulsivity were examined in groups of 35 psychiatric patients characterized by self-control problems and 18 healthy volunteers. Among patients, a positive correlation was found between motor impulsivity and the right cerebellum, and a negative correlation emerged between attentional impulsivity and the left lateral orbitofrontal cortex (OFC). Among controls, attentional and motor impulsivity correlated negatively with the left superior temporal gyrus, while non-planning impulsivity correlated positively with the left OFC and lateral frontopolar cortex. Follow-up analyses revealed convergence in correlation patterns from patients to controls, but not vice versa. That pattern suggested broader neural representation of the trait in the healthy controls, who were less impulsive than the psychiatric patients.

Brain Dysfunction and Community Violence in Patients With Major Mental Illness

The objective of this study is to determine whether violence in psychiatric patients is associated with brain dysfunction independent of substance abuse. Psychiatric inpatients with a history of violent behavior in the community were compared to nonviolent inpatients on several variables related to brain dysfunction. The two groups were similar in terms of demographics and psychiatric diagnosis. No significant differences were found in neuropsychological function, but violent patients were significantly more likely to have co-occurring substance abuse and nearly 4 times more likely to have a history of closed-head injury. Logistic regression revealed that the association between violence and head injury can be explained by comorbid substance abuse.