Marianne Kristiansson

Asperger's Syndrome in Forensic Settings

Researchers and clinicians have devoted increasing attention to Aspergers syndrome during the past two decades. Although Aspergers syndrome is a developmental disorder, professionals in a variety of settings have begun to consider the diagnosis among adults who manifest social and communication abnormalities. Case studies (e.g., Baron-Cohen, 1988; Kohn et al., 1998) and prevalence research (Scragg & Shah, 1994) from forensic settings indicate that a small subset of Aspergers syndrome patients come into contact with the legal system due to their social impairments and idiosyncratic interests. We provide case histories of individuals with Aspergers syndrome encountered in forensic contexts and discuss the implications of this disorder for forensic clinicians. Our six cases were notable for certain commonalties, including deficient empathy. The cases also revealed ways in which Aspergers patients tend to differ from most individuals in forensic settings.

Aggression, psychopathy and brain imaging — Review and future recommendations

Violent behavior appears to result from a complex web of interacting genetic as well as environmental factors. Psychopathy is a strong predictor for relapse in violent acts. The current review shed light on rapidly expanding knowledge in brain imaging related to violent behavior and psychopathy. A literature search was performed in PubMed, Cochrane and PsycInfo combining the key words: mentally disordered offender/aggression/violence/ crime/forensic psychiatry/brain imaging neuroimaging/fMRI/MRI/PET/SPECT/lack of empathy/psychopathy and antisocial personality disorder. The reviewed material, which consisted of 48 articles, indicates a rather strong consensus on the connection between dysfunctional parts of the frontal and temporal lobes and violent antisocial behavior and psychopathy. In future studies, it would be useful to focus on the limbic system and to investigate which parts of the frontal lobes and cerebral networks that are of interest in the psychopathic personality. Moreover, the reviewed material highlights some of the methodological difficulties in this area of research such as selection bias in the recruitment of patients, inadequate matching of control subjects, and sometimes incongruous results. In the future we hope that brain imaging can be used to map biological deviations in different offenders in order to try to learn more about the different mechanisms behind violent behaviors.

Cortical thickness alterations in social anxiety disorder

Social anxiety disorder (SAD) has been associated with aberrant processing of socio-emotional stimuli and failure to adaptively regulate emotion, corroborated by functional neuroimaging studies. However, only a few studies of structural brain abnormalities in SAD have been reported, and among these only one investigated cortical thickness. In the present study we used magnetic resonance imaging (MRI) in conjunction with an automated method to measure cortical thickness in patients with SAD (n=14) and healthy controls (n=12). Results showed significantly increased thickness of the left inferior temporal cortex in SAD patients relative to controls. Within the patient group, a negative association was found between social anxiety symptom severity and thickness of the right rostral anterior cingulate cortex. The observed alterations in brain structure may help explain previous findings of dysfunctional regulation and processing of emotion in SAD.

Changes in serum and cerebrospinal fluid cytokines in response to non-neurological surgery: an observational study

BackgroundSurgery launches an inflammatory reaction in the body, as seen through increased peripheral levels of cytokines and cortisol. However, less is known about perioperative inflammatory changes in the central nervous system (CNS).Our aim was to compare inflammatory markers in serum and cerebrospinal fluid (CSF) before and after surgery and evaluate their association with measures of blood–brain barrier (BBB) integrity.MethodsThirty-five patients undergoing knee arthroplastic surgery with spinal anesthesia had CSF and serum samples drawn before, after and on the morning following surgery. Cytokines and albumin in serum and CSF and cortisol in CSF were assessed at all three points.ResultsCytokines and cortisol were significantly increased in serum and CSF after surgery (Ps <0.01) and CSF increases were greater than in serum. Ten individuals had an increased cytokine response and significantly higher CSF/serum albumin ratios (Ps <0.01), five of whom had albumin ratios in the pathological range (>11.8). Serum and CSF levels of cytokines were unrelated, but there were strong correlations between CSF IL-2, IL-10 and IL-13, and albumin ratios (Ps <0.05) following surgery.ConclusionCytokine increases in the CNS were substantially greater than in serum, indicating that the CNS inflammatory system is activated during peripheral surgery and may be regulated separately from that in the peripheral body. CSF cytokine increase may indicate sensitivity to trauma and is linked to BBB macromolecular permeability.

Altered fusiform connectivity during processing of fearful faces in social anxiety disorder

Social anxiety disorder (SAD) has been associated with hyper-reactivity in limbic brain regions like the amygdala, both during symptom provocation and emotional face processing tasks. In this functional magnetic resonance imaging study we sought to examine brain regions implicated in emotional face processing, and the connectivity between them, in patients with SAD (n=14) compared with healthy controls (n=12). We furthermore aimed to relate brain reactivity and connectivity to self-reported social anxiety symptom severity. SAD patients exhibited hyper-reactivity in the bilateral fusiform gyrus in response to fearful faces, as well as greater connectivity between the fusiform gyrus and amygdala, and decreased connectivity between the fusiform gyrus and ventromedial prefrontal cortex. Within the SAD group, social anxiety severity correlated positively with amygdala reactivity to emotional faces, amygdala-fusiform connectivity and connectivity between the amygdala and superior temporal sulcus (STS). These findings point to a pivotal role for the fusiform gyrus in SAD neuropathology, and further suggest that altered amygdala-fusiform and amygdala-STS connectivity could underlie previous findings of aberrant socio-emotional information processing in this anxiety disorder.

Validation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test in a Swedish sample of suspected offenders with signs of mental health problems: Results from the Mental Disorder, Substance Abuse and Crime study

Substance abuse is common among offenders. One method widely used for the detection of substance abuse is screening. This study explored the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) screening tools in relation to (a) substance abuse and dependency diagnoses and (b) three problem severity domains of the sixth version of the Addiction Severity Index in a sample of 181 suspected offenders with signs of mental health problems. The screening tools showed moderate to high accuracy for identification of dependency diagnoses. The AUDIT was associated with alcohol problem severity, whereas the DUDIT was associated with drug and legal problem severity. Administering the screening tools in the current population yields valid results. However, the suggested cutoff scores should be applied with caution due to the discrepancy between present and previous findings.

Women who kill: a comparison of the psychosocial background of female and male perpetrators.

The purpose of this study was to compare the psychosocial background of female and male perpetrators convicted of homicide in Sweden between 1995-2001. All women (n=43) who were convicted for lethal violence during the period and a corresponding number of randomly chosen men (n=43) were examined. In total, information about 86 individuals was collected retrospectively. Areas of interest were psychosocial variables during childhood and at the time of the current crime. Results showed that both female and male perpetrators were psychosocially encumbered already at an early age. Homicidal women had more severe childhood circumstances, but less aggressive childhood behaviour than did their male counterparts. At the time of the crime, women had a more ordered social situation, had more often been exposed to violence and searched for help than had the men. These gender differences suggest that specific actions are needed for preventing womens homicidal behaviour.

Classifying social anxiety disorder using multivoxel pattern analyses of brain function and structure

Highlights • Social anxiety disorder (SAD) is a common and disabling psychiatric disorder.• Support vector machines (SVM) were trained to separate SAD from controls.• Neural face processing in the fear network separated SAD patients from controls.• Gray matter volume alterations over the whole brain separated SAD from controls.• SVM classifiers may be useful for identifying imaging biomarkers of SAD.

Field Reliability of the Psychopathy Checklist-Revised Among Life Sentenced Prisoners in Sweden

Although typically described as reliable and valid, the Psychopathy Checklist-Revised (PCL-R) has come under some criticism by researchers in the last half-decade due to evidence of poor interrater reliability and adversarial allegiance being reported in applied settings in North America. This study examines the field reliability of the PCL-R using a naturalistic test-retest design among a sample of Swedish life sentenced prisoners (N = 27) who had repeatedly been assessed as part of their application to receive a reduced prison term. The prisoners, who were assessed by a team of forensic evaluators retained by an independent government authority, had spent on average 14 years in prison with a mean time from Assessment 1 to Assessment 2 of 2.33 years. The overall reliability of the PCL-R (ICC(A1)) was .70 for the total score and .62 and .76 for Factor 1 and 2 scores, respectively. Facet 1-3 scores ranged from .54 to .60, whereas Facet 4 was much higher (.90). Reliability of individual items was quite variable, ranging from .23 to .80. In terms of potential causes of unreliability, both high and low PCL-R scores at the initial assessment tended to regress toward the mean at the time of the second evaluation. Our results are in line with previous research demonstrating concerns regarding the reliability of the PCL-R within judicial settings, even among independent evaluation teams not retained by a particular side in a case. Collectively, these findings question whether the interpersonal (Facet 1) and affective (Facet 2) features tapped by the PCL-R are reliable enough to justify their use in legal proceedings.

Offender Characteristics in Lethal Violence With Special Reference to Antisocial and Autistic Personality Traits

The objective of the study is to assess the relationships between personality traits, lifetime psychosocial functioning, and crime scene behavior. Thirty-five male offenders referred for forensic psychiatric assessment in Sweden (1996-2001) and assigned a main diagnosis of either antisocial personality disorder (APD) or autism spectrum disorder (AUT) were retrospectively studied. APD were subcategorized into impulsive (APDi) and controlled (APDc). Those in the AUT group were less intoxicated at the time of the crime and did not often use knives or guns compared to the APD group. Males in the APDi group were older and had a higher proportion of abuse of alcohol and drugs in biological parents, physical abuse during childhood, psychiatric contacts, and suicide attempts compared to the APDc group. In the APDi group, knives were used in the homicide compared to the use of guns in the APDc group. The results suggest differences in psychosocial functioning and crime scene characteristics related to personality traits.