Jürgen L. Müller

Disturbed Prefrontal and Temporal Brain Function During Emotion and Cognition Interaction in Criminal Psychopathy

Impaired emotional responsiveness has been revealed as a hallmark of psychopathy. In spite of an increasing database on emotion processing, studies on cognitive function and in particular on the impact of emotion on cognition in psychopathy are rare. We used pictures from the International Affective Picture Set (IAPS) and a Simon Paradigm to address emotion-cognition interaction while functional and structural imaging data were obtained in 12 healthy controls and 10 psychopaths. We found an impaired emotion-cognition interaction in psychopaths that correlated with a changed prefrontal and temporal brain activation. With regard to the temporal cortex, it is shown that structure and function of the right superior temporal gyrus is disturbed in psychopathy, supporting a neurobiological approach to psychopathy, in which structure and function of the right STG may be important.

The Role of Testosterone in Sexuality and Paraphilia—A Neurobiological Approach. Part II: Testosterone and Paraphilia

INTRODUCTION Antiandrogen therapy has been used for 30 years to treat paraphilic patients and sexual offenders. Yet the therapeutic success of antiandrogens is uncertain. Furthermore, there is still a lack of comprehensive knowledge about the effects of androgen-lowering therapy in paraphilic patients. AIM We discuss endocrinological, neurobiological, and therapeutic aspects of paraphilia with the aim of integrating these on the basis of the current neurobiological and clinical knowledge on testosterone that was set out in Part I of this review. METHODS Our review of the human literature comprises the current knowledge about the neurobiology of paraphilia and the known endocrinological, pathophysiological, and genetic aspects of this disorder. The role of testosterone is discussed. A survey of antiandrogen therapy and its outcome in paraphilic patients and sex offenders is provided. RESULTS Although not all data are consistent, current imaging research suggests that structural and functional changes in pedophilia appear for the most part in brain regions also involved in sexual functions. Not exclusively testosterone but also some other endocrinological and neurochemical parameters could be disturbed in pedophilic patients and child molesters; these include changes in hypothalamic-pituitary function, prolactin levels, and dopaminergic or serotonergic functions. There appears to be a sex-steroid-related genetic influence on antisocial traits, externalizing behavior, and sexual behavior. Most of the studies in which antiandrogen therapy in paraphilic patients and sex offenders have been examined were case reports, or observational or open-label studies, and many did not include adequate control groups. Only a few placebo-controlled double-blind studies have been published with inconsistent results concerning treatment effects. Outcome measures differ between the studies and do not seem ideally suited to their purpose. CONCLUSIONS On the basis of the current knowledge about testosterone and its effects on brain and behavior as described in Part I, and of available results on the relationship between testosterone and paraphilia as well as antiandrogen therapy, we present from a neurobiological perspective an extended scientific proposal for design features to investigate the effects of antiandrogen treatment in large clinical trials.

Motor-induced brain activation in cortical, subcortical and cerebellar regions in schizophrenic inpatients. A whole brain fMRI fingertapping study

Motor symptoms including neurological soft signs have been found to be more prevalent in schizophrenic patients. In addition, catatonic symptoms and neuroleptic treatment as well may influence cortical and subcortical motor organization in schizophrenia. The results of previous neuroimaging studies exploring motor function in patients with schizophrenia are inhomogenous reporting on a decreased activity in cortical motor regions in some studies and normal activity in others. Using fMRI, we studied 40 subjects performing a unilateral self-paced fingertapping task. Analyzing a general linear model of four groups, we compared patients with schizophrenia according to DSM-IV treated with olanzapine (OL; 10) or haloperidol (HA; 10) to healthy controls (HC; 10) and untreated patients (UN; 10). Brainvoyager software was used for data analyzing. In all groups, the contralateral motor cortex was significantly activated. Significant activation of the ipsilateral cerebellum was found in the UN group, the control group and the OL group. The contralateral basal ganglia were activated in UN and in controls. Motor-induced cortical and subcortical brain activation in HC was significantly higher than in patients with schizophrenia. UN with schizophrenia showed a significant overactivation than the other groups. In conclusion, we revealed a diminished activation in the patient group treated with neuroleptic drugs. This study outlines the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.

Diagnostic Accuracy of Eye Movements in Assessing Pedophilia

INTRODUCTION Given that recurrent sexual interest in prepubescent children is one of the strongest single predictors for pedosexual offense recidivism, valid and reliable diagnosis of pedophilia is of particular importance. Nevertheless, current assessment methods still fail to fulfill psychometric quality criteria. AIMS The aim of the study was to evaluate the diagnostic accuracy of eye-movement parameters in regard to pedophilic sexual preferences. METHOD Eye movements were measured while 22 pedophiles (according to ICD-10 F65.4 diagnosis), 8 non-pedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult. Fixation latency was assessed as a parameter for automatic attentional processes and relative fixation time to account for controlled attentional processes. MAIN OUTCOME MEASURES Receiver operating characteristic (ROC) analyses, which are based on calculated age-preference indices, were carried out to determine the classifier performance. Cross-validation using the leave-one-out method was used to test the validity of classifiers. RESULTS Pedophiles showed significantly shorter fixation latencies and significantly longer relative fixation times for child stimuli than either of the control groups. Classifier performance analysis revealed an area under the curve (AUC) = 0.902 for fixation latency and an AUC = 0.828 for relative fixation time. The eye-tracking method based on fixation latency discriminated between pedophiles and non-pedophiles with a sensitivity of 86.4% and a specificity of 90.0%. Cross-validation demonstrated good validity of eye-movement parameters. CONCLUSIONS Despite some methodological limitations, measuring eye movements seems to be a promising approach to assess deviant pedophilic interests. Eye movements, which represent automatic attentional processes, demonstrated high diagnostic accuracy.

Subcortical overactivation in untreated schizophrenic patients: A functional magnetic resonance image finger‐tapping study

Abstract Functional magnetic resonance imaging (fMRI) is a well established, non‐invasive technique for mapping the working brain. Yet imaging of subcortical regions has proven to be difficult. We studied 40 subjects performing an unilateral self‐paced finger‐tapping task. Patients with schizophrenia according to DSM‐IV treated with olanzapine (n = 10) or haloperidol (n = 10) were compared to healthy controls (n = 10) and untreated patients (n = 10). Brainvoyager software was used for data‐analyzing. All subjects showed highly significant activation in the contralateral sensorimotor area, the supplementary motor area and the ipsilateral cerebellum. In every investigated subject contralateral subcortical regions were also significantly activated (P < 0.001). Activation in ipsilateral pallidum was significantly higher in untreated patients compared with the other groups indicating an increase in subcortical coactivation. In addition, significant correlations were revealed within groups. This study emphasizes the possibility of investigating subcortical brain activation in patients with schizophrenia. The results of the present study outline the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.

Eye movements in pedophiles: automatic and controlled attentional processes while viewing prepubescent stimuli.

Recent theories in sexuality highlight the importance of automatic and controlled attentional processes in viewing sexually relevant stimuli. The model of Spiering and Everaerd (2007) assumes that sexually relevant features of a stimulus are preattentively selected and automatically induce focal attention to these sexually relevant aspects. Whether this assumption proves true for pedophiles is unknown. It is aim of this study to test this assumption empirically for people suffering from pedophilic interests. Twenty-two pedophiles, 8 nonpedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult while eye movements were measured. Entry time was assessed as a measure of automatic attentional processes and relative fixation time in order to assess controlled attentional processes. Pedophiles demonstrated significantly shorter entry time to child stimuli than to adult stimuli. The opposite was the case for nonpedophiles, as they showed longer relative fixation time for adult stimuli, and, against all expectations, pedophiles also demonstrated longer relative fixation time for adult stimuli. The results confirmed the hypothesis that pedophiles automatically selected sexually relevant stimuli (children). Contrary to all expectations, this automatic selection did not trigger the focal attention to these sexually relevant pictures. Furthermore, pedophiles were first and longest attracted by faces and pubic regions of children; nonpedophiles were first and longest attracted by faces and breasts of adults. The results demonstrated, for the first time, that the face and pubic region are the most attracting regions in children for pedophiles.

Mirrored or identical — Is the role of visual perception underestimated in the mental rotation process of 3D-objects?: A combined fMRI-eye tracking-study

The mental-rotation task is a well known research paradigm to examine cognitive processes of mental imaging and mental manipulation (Shepard & Metzler, 1971). So far, research has been focused on stimulus orientation which indicates the necessary amount of mental rotation. But little attention has been paid to stimulus parity, specifically if and how identical and mirror-reversed stimuli are processed differently. We wanted to fill this gap by combining performance, eye-tracking, and neurofunctional measures using pairwise presented three-dimensional Shepard-Metzler stimuli in a self-paced event-related fMRI design. Based on our results we tried to reason at which stage of the mental-rotation process the treatment of mirrored and identical stimuli begins to diverge. As a common finding, response times for tasks with mirrored stimuli were longer compared to tasks with identical stimuli reflecting their higher cognitive demand. Moreover, we observed smaller saccade amplitudes for mirrored than for identical stimuli suggesting a smaller functional field of view during stimulus perception. The eye-movement results were complemented by our neurofunctional findings. Here, the processing of mirrored stimuli led to less activation in parts of the early visual cortex that respond to the visual periphery than the processing of identical figures. This activation difference remained after eye-movement-associated activations had been excluded. We explain our findings by stimulus-parity-induced differences in saliency maps built up to enhance perception. Thus, the treatment of mirrored and identical stimuli begins to diverge very early in the mental-rotation process and is associated with differences in visual processing.

[Pedophilia: etiology, diagnostics and therapy].

Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented.

Virtual Viewing Time: The Relationship between Presence and Sexual Interest in Androphilic and Gynephilic Men

Virtual Reality (VR) has successfully been used in the research of human behavior for more than twenty years. The main advantage of VR is its capability to induce a high sense of presence. This results in emotions and behavior which are very close to those shown in real situations. In the context of sex research, only a few studies have used high-immersive VR so far. The ones that did can be found mostly in the field of forensic psychology. Nevertheless, the relationship between presence and sexual interest still remains unclear. The present study is the first to examine the advantages of high-immersive VR in comparison to a conventional standard desktop system regarding their capability to measure sexual interest. 25 gynephilic and 20 androphilic healthy men underwent three experimental conditions, which differed in their ability to induce a sense of presence. In each condition, participants were asked to rate ten male and ten female virtual human characters regarding their sexual attractiveness. Without their knowledge, the subjects’ viewing time was assessed throughout the rating. Subjects were then asked to rate the sense of presence they had experienced as well as their perceived realism of the characters. Results suggested that stereoscopic viewing can significantly enhance the subjective sexual attractiveness of sexually relevant characters. Furthermore, in all three conditions participants looked significantly longer at sexually relevant virtual characters than at sexually non-relevant ones. The high immersion condition provided the best discriminant validity. From a statistical point of view, however, the sense of presence had no significant influence on the discriminant validity of the viewing time task. The study showed that high-immersive virtual environments enhance realism ratings as well as ratings of sexual attractiveness of three-dimensional human stimuli in comparison to standard desktop systems. Results also show that viewing time seems to be influenced neither by sexual attractiveness nor by realism of stimuli. This indicates how important task specific mechanisms of the viewing time effect are.

Anwendung virtueller Realitäten in der forensischen Psychiatrie

BACKGROUND For more than 20 years virtual realities (VR) have been successfully used in the assessment and treatment of psychiatric disorders. The most important advantages of VR are the high ecological validity of virtual environments, the entire controllability of virtual stimuli in the virtual environment and the capability to induce the sensation of being in the virtual environment instead of the physical environment. VRs provide the opportunity to face the user with stimuli and situations which are not available or too risky in reality. Despite these advantages VR-based applications have not yet been applied in forensic psychiatry. OBJECTIVES AND METHODS On the basis of an overview of the recent state-of-the-art in VR-based applications in general psychiatry, the article demonstrates the advantages and possibilities of VR-based applications in forensic psychiatry. RESULTS AND CONCLUSIONS Up to now only preliminary studies regarding the VR-based assessment of pedophilic interests exist. These studies demonstrate the potential of ecologically valid VR-based applications for the assessment of forensically relevant disorders. One of the most important advantages is the possibility of VR to assess the behavior of forensic inpatients in crime-related situations without endangering others. This provides completely new possibilities not only regarding the assessment but also for the treatment of forensic inpatients. Before utilizing these possibilities in the clinical practice exhaustive research and development will be necessary. Given the high potential of VR-based applications, this effort would be worth it.ZusammenfassungHintergrundVirtuelle Realitäten (VR) werden seit mehr als 20 Jahren erfolgreich in der Diagnostik und Behandlung psychischer Störungen eingesetzt. Die Vorteile von VR liegen dabei in der hohen ökologischen Validität virtueller Umgebungen, in der vollständigen Kontrolle der virtuellen Reize und der Fähigkeit, beim Patienten das Gefühl zu erzeugen, tatsächlich in der virtuellen Realität zu sein. VR erlaubt die Konfrontation mit Reizen und Situationen, die in der Realität nicht zugänglich oder zu gefährlich sind. Trotz dieser Vorteile werden VR-gestützte Verfahren bis jetzt noch nicht in der forensischen Psychiatrie eingesetzt.Fragestellung, Material und MethodenAnhand eines Überblickes über den aktuellen Forschungsstand VR-gestützter Anwendungen in der Allgemeinpsychiatrie werden die Vorteile und Möglichkeiten VR-gestützter Verfahren für die forensische Psychiatrie dargestellt.Ergebnisse und SchlussfolgerungenZum gegenwärtigen Zeitpunkt existieren lediglich erste Studien zu VR-gestützter Diagnostik devianter sexueller Interessen. Diese Studien verdeutlichen das hohe Potenzial ökologisch valider virtueller Umgebungen für die Erfassung forensisch-relevanter Symptomgruppen. Einer der größten Vorteile VR-gestützter Verfahren für die forensische Psychiatrie liegt in der erstmaligen Möglichkeit, psychisch kranke Straftäter in deliktrelevanten Risikosituationen ohne Gefährdung Dritter zu beobachten. Dies eröffnet nicht nur aus diagnostischer und prognostischer, sondern auch aus therapeutischer Sicht neue Möglichkeiten. Bevor diese Möglichkeiten im klinischen Alltag ausgeschöpft werden können, ist noch eine umfangreiche Entwicklungs- und Forschungsarbeit notwendig. Angesichts des Potenzials VR-gestützter Verfahren für die forensische Psychiatrie erscheint diese Forschungsarbeit jedoch lohnenswert.SummaryBackgroundFor more than 20 years virtual realities (VR) have been successfully used in the assessment and treatment of psychiatric disorders. The most important advantages of VR are the high ecological validity of virtual environments, the entire controllability of virtual stimuli in the virtual environment and the capability to induce the sensation of being in the virtual environment instead of the physical environment. VRs provide the opportunity to face the user with stimuli and situations which are not available or too risky in reality. Despite these advantages VR-based applications have not yet been applied in forensic psychiatry.Objectives and methodsOn the basis of an overview of the recent state-of-the-art in VR-based applications in general psychiatry, the article demonstrates the advantages and possibilities of VR-based applications in forensic psychiatry.Results and conclusionsUp to now only preliminary studies regarding the VR-based assessment of pedophilic interests exist. These studies demonstrate the potential of ecologically valid VR-based applications for the assessment of forensically relevant disorders. One of the most important advantages is the possibility of VR to assess the behavior of forensic inpatients in crime-related situations without endangering others. This provides completely new possibilities not only regarding the assessment but also for the treatment of forensic inpatients. Before utilizing these possibilities in the clinical practice exhaustive research and development will be necessary. Given the high potential of VR-based applications, this effort would be worth it.