Michael Brook

Emotion processing in Psychopathy Checklist — assessed psychopathy: A review of the literature

Deficient emotional experience is recognized as one of the central features of psychopathy and an impressive body of empirical findings regarding emotion processing in psychopathy has amassed over the past several decades, resulting in two broad theoretical perspectives. The general emotional deficit perspective postulates a globally reduced capacity for emotional experience and processing across the emotional spectrum. In contrast, according to the specific emotional deficit perspective, psychopathy is associated with abnormal experience of only specific types of emotion; several distinct hypotheses have been proposed under this latter perspective. We systematically and critically review findings from peer-reviewed research of emotion processing in psychopathy in relation to the two theoretical perspectives. In general, findings suggest that, compared to controls, psychopaths exhibit behavioral, psychophysiologic, and regional brain activation anomalies when processing emotion, but their ratings of self-arousal and stimulus valence/intensity do not differ from controls. However, when behavioral findings are examined separately by emotion type, the overall pattern of findings is not clearly consistent with any of the dominant theoretical perspectives of emotion processing in psychopathy. We summarize the current state of the field, including consistencies and inconsistencies in the literature, offer alternative explanations for the findings, and outline directions for future research.

Neuropsychological and Intellectual Differences Between Types of Murderers Affective/Impulsive Versus Predatory/ Instrumental (Premeditated) Homicide

The notion that affective/impulsive violence and predatory/instrumental violence constitute distinct behavioral phenotypes has been supported in the forensic literature. Prior research suggests that offenders committing affective/impulsive homicide exhibit differing patterns of anomalous regional brain activation and decreased executive functions relative to predatory/instrumental homicide offenders. However, no prior research has examined the extent to which murderers who kill impulsively versus those who kill as the result of the execution of a premeditated strategic plan differ with regard to other neuropsychological functions and intelligence. Based on established criteria, we classified 77 murderers into affective/impulsive and predatory/instrumental groups, and compared their performance on standardized measures of intelligence and neuropsychological functioning. Results revealed significant differences between the affective/impulsive group (mean Full Scale IQ = 79) and the predatory/instrumental group (mean Full Scale IQ = 93) on indices of intelligence, memory, attention, and executive functioning. Most differences remained significant after controlling for relevant background factors.

PSYCHOPATHIC PERSONALITY TRAITS IN MIDDLE-AGED MALE TWINS: A BEHAVIOR GENETIC INVESTIGATION

Psychopathic personality is characterized by interpersonal dominance, impulsivity, sensation seeking, poor planning, and aggressiveness. Studies have shown that the Multidimensional Personality Questionnaire (MPQ) can be used to estimate scores on the fearless-dominant (FD) and the impulsive-antisocial (IA) dimensions of the Psychopathic Personality Inventory (PPI), the best validated self-report measure of psychopathic personality traits. Prior behavior genetic studies reported roughly equal genetic and nonshared environmental influences for both FD and IA, which remained stable from adolescence to young adulthood. However, no prior studies address genetic and environmental influences on these dimensions beyond early adulthood. We utilized the classic twin method to examine genetic and environmental influences on variance in FD and IA in a sample of middle-aged male twins. Biometric modeling indicated that the variance in both factors is best explained by additive genetic and nonshared environmental influences. FD showed roughly equal contributions from genetic and environmental factors, whereas IA showed greater contributions from environmental than genetic factors. Additionally, the small phenotypic correlation between FD and IA was explained entirely by nonshared environmental factors.

Domestic Homicide: Neuropsychological Profiles of Murderers Who Kill Family Members and Intimate Partners

Domestic homicide is the most extreme form of domestic violence and one of the most common types of homicide. The objective was to examine differences between spontaneous domestic homicide and nondomestic homicide offenders regarding demographics, psychiatric history, crime characteristics, and neuropsychological status, utilizing neuropsychological test data from forensic examinations of 153 murderers. Using standard crime classification criteria, 33% committed spontaneous domestic homicides (SDH) and 61% committed nondomestic homicides (NDH). SDH offenders were more likely to manifest psychotic disorders, but less likely to be diagnosed with antisocial personality disorder or to have prior felony convictions. SDH offenders manifested significantly worse neuropsychological impairments than NDH offenders. The mean number of victims was lower for the SDH than the NDH group and only 14% of SDH offenders used a firearm, whereas 59% of NDH offenders used a firearm. These findings corroborate the notion that spontaneous domestic homicide may represent a discernible criminological phenotype.

I know how you feel: the warm-altruistic personality profile and the empathic brain.

The ability to empathize with other people is a critical component of human social relationships. Empathic processing varies across the human population, however it is currently unclear how personality traits are associated with empathic processing. This study was designed to test the hypothesis that specific personality traits are associated with behavioral and biological indicators of improved empathy. Extraversion and Agreeableness are personality traits designed to measure individual differences in social-cognitive functioning, however each trait-dimension includes elements that represent interpersonal social functioning and elements that do not represent interpersonal social functioning. We tested the prediction that interpersonal elements of Extraversion (Warmth) and Agreeableness (Altruism) are associated with empathy and non-interpersonal elements of Extraversion and Agreeableness are not associated with empathy. We quantified empathic processing behaviorally (empathic accuracy task using video vignettes) and within the brain (fMRI and an emotional perspective taking task) in 50 healthy subjects. Converging evidence shows that highly warm and altruistic people are well skilled in recognizing the emotional states of other people and exhibit greater activity in brain regions important for empathy (temporoparietal junction and medial prefrontal cortex) during emotional perspective taking. A mediation analysis further supported the association between warm-altruistic personality and empathic processing; indicating that one reason why highly warm-altruistic individuals may be skilled empathizers is that they engage the temporoparietal junction and medial prefrontal cortex more. Together, these findings advance the way the behavioral and neural basis of empathy is understood and demonstrates the efficacy of personality scales to measure individual differences in interpersonal social function.

Murder and psychosis: Neuropsychological profiles of homicide offenders with schizophrenia

BACKGROUND Neurocognitive dysfunction, a core feature of schizophrenia, is thought to contribute to the impulsive violent aggression manifested by some individuals with schizophrenia, but not enough is known about how homicidal individuals with schizophrenia perform on neuropsychological measures. AIMS The primary aim of our study was to describe the neuropsychological profiles of homicide offenders with schizophrenia. Supplementary analyses compared the criminal, psychiatric and neuropsychological features of schizophrenic homicide offenders with and without God/Satan/demon-themed psychotic symptoms. METHODS Twenty-five men and women diagnosed with schizophrenia who had killed another person - 21 convicted of first-degree murder and 4 found not guilty by reason of insanity - completed neuropsychological testing during forensic evaluations. RESULTS The sample was characterised by extensive neurocognitive impairments, involving executive dysfunction (60%), memory dysfunction (68%) and attentional dysfunction (50%), although those with God/Satan/demon-themed psychotic symptoms performed better than those with nonreligious psychotic content. CONCLUSIONS Our findings indicate that impaired cognition may play an important role in the commission of homicide by individuals with schizophrenia. A subgroup with God/Satan/demon delusions seem sufficiently less impaired that they might be able to engage in metacognitive treatment approaches, aimed at changing their relationship to their psychotic symptoms, thus reducing the perception of power and omnipotence of hallucinated voices and increasing their safety. Copyright

Neuropsychological assessment in a case of adult-onset hemophagocytic lymphohistiocytosis (HLH).

We present a case of an individual diagnosed with hemophagocytic lymphohistiocytosis (HLH), an extremely rare and commonly fatal disorder characterized by rapid dysregulation of immune system processes. Typical age of onset is in childhood, with adult-onset occurring less frequently. The pathophysiology of this condition is characterized by a hyperinflammatory response with infiltration of visceral organs, lymph nodes, bone marrow, and the central nervous system. The clinical presentation has been documented in the extant medical literature. However, there appear to be no published reports of neuropsychological functioning in HLH patients. The patient we present here is a 28-year-old woman with 16 years of education who developed HLH subsequent to systemic lupus erythematosus flare-up. She was initially comatose for 3 weeks. Acute MRI reported multiple subcortical abnormalities, including the brainstem. The patient underwent chemotherapy, immunosuppresant, and steroid treatments. She underwent a neuropsychological evaluation at 2.5 and 7 months post initial presentation. Preliminary neuropsychological evaluation found impairments in motor abilities and aspects of executive functions. Subsequent evaluation showed improved executive function and relative sparing of higher-order cognitive abilities, but continued impairment on motor tests. To our knowledge this is the first study to report neuropsychological data for an adult diagnosed with HLH.

Socio-neuro risk factors for suicidal behavior in criminal offenders with psychotic disorders

Abstract Relative to the general population, individuals with psychotic disorders have a higher risk of suicide. Suicide risk is also elevated in criminal offenders. Thus, psychotic-disordered individuals with antisocial tendencies may form an especially high-risk group. We built upon prior risk analyses by examining whether neurobehavioral correlates of social cognition were associated with suicidal behavior in criminal offenders with psychotic disorders. We assessed empathic accuracy and brain structure in four groups: (i) incarcerated offenders with psychotic disorders and past suicide attempts, (ii) incarcerated offenders with psychotic disorders and no suicide attempts, (iii) incarcerated offenders without psychotic disorders and (iv) community non-offenders without psychotic disorders. Established suicide risk variables were examined along with empathic accuracy and gray matter in brain regions implicated in social cognition. Relative to the other groups, offenders with psychotic disorders and suicide attempts had lower empathic accuracy and smaller temporal pole volumes. Empathic accuracy and temporal pole volumes were significantly associated with suicide attempts independent of other risk variables. The results indicate that brain and behavioral correlates of social cognition may add incremental value to models of suicide risk.

Predictors of Decertification From Involuntary Hospitalization for Patients With Bipolar Disorder

OBJECTIVE This study examined predictors of decertification (release from involuntary hospitalization after legal hearing) among inpatients with bipolar disorder. METHODS Records from 1992 to 1997 were examined retrospectively for 50 decertified and 48 certified patients with bipolar disorder. The relationship between demographic and clinical variables and decertification was examined using logistic regression analyses. RESULTS In the overall multiple logistic regression model, participants were significantly more likely to be decertified if they used a mood stabilizer before the decertification hearing (odds ratio [OR]=6.73, 95% confidence interval [CI]=1.78-25.50) or if they had a comorbid substance use disorder (OR=3.45, CI=1.15-10.34). The odds of decertification increased with the number of prior hospitalizations (OR=3.92, CI=1.73-8.87) and decreased with the length of prior hospitalization (OR=.72 per week, CI=.49-1.04) and number of emergency room visits before admission (OR=.46, CI=.28-.74). CONCLUSIONS Predictors of decertification in bipolar disorder require further research to guide future efforts to improve inpatient treatment outcomes.

Neuropsychological and Criminological Features of Female Homicide Offenders

Few studies have examined life history and cognitive characteristics unique to female homicide offenders. Understanding these characteristics could aid in risk assessment for extreme violence in this group of offenders. The current study utilized t‐tests or chi‐square tests to compare 27 female and 81 male homicide offenders on psychiatric, neurologic, criminal, and cognitive characteristics. Additionally, we explored the role of abuse history in female offenders through Kruskal–Wallis or Fishers exact tests. Results indicate that in comparison with male counterparts, females are more likely to have history of mood disorder, borderline personality disorder, and abuse. Cognitively, female homicide offenders exhibit circumscribed cognitive impairment in verbal abilities and perform similarly to male homicide offenders across most cognitive tasks. Within the female offender group, history of sexual abuse is associated with higher rates of impulsive homicide and poorer verbal abilities. These findings provide preliminary evidence for distinct factors associated with homicide in women.