Abnormalities in emotion processing within cortical and subcortical regions in criminal psychopaths: evidence from a functional magnetic resonance imaging study using pictures with emotional content.

BACKGROUND: Neurobiology of psychopathy is important for our understanding of current neuropsychiatric questions. Despite a growing interest in biological research in psychopathy, its neural underpinning remains obscure. METHODS: We used functional magnetic resonance imaging to study the influence of affective contents on brain activation in psychopaths. Series containing positive and negative pictures from the International Affective Picture System were shown to six male psychopaths and six male control subjects while 100 whole-brain echo-planar-imaging measurements were acquired. Differences in brain activation were evaluated using BrainVoyager software 4.6. RESULTS: In psychopaths, increased activation through negative contents was found right-sided in prefrontal regions and amygdala. Activation was reduced right-sided in the subgenual cingulate and the temporal gyrus, and left-sided in the dorsal cingulate and the parahippocampal gyrus. Increased activation through positive contents was found left-sided in the orbitofrontal regions. Activation was reduced in right medial frontal and medial temporal regions. CONCLUSIONS: These findings underline the hypotheses that psychopathy is neurobiologically reflected by dysregulation and disturbed functional connectivity of emotion-related brain regions. These findings may be interpreted within a framework including prefrontal regions that provide top-down control to and regulate bottom-up signals from limbic areas. Because of the small sample size, the results of this study have to be regarded as preliminary.

Oxidative stress during treatment with first- and second-generation antipsychotics.

Neurotoxicity of first-generation antipsychotics (FGAs) may be involved in lipid peroxidation, which is the pathogenesis of extrapyramidal symptoms, including tardive dyskinesia (TD). Blood samples at day 0, 7, and 21 drawn from patients taking antipsychotics were analyzed for malondialdehyde (MDA) in plasma, a marker of lipid peroxidation, by high-performance liquid chromatography. Of 115 patients enrolled, 92 patients completed the study. Most MDA levels were within normal ranges (<1.0 micromol/liter). Malondialdehyde levels in patients receiving clozapine (p = 0.002), quetiapine (p = 0.003), amisulpride (p = 0.008), and risperidone (p = 0.008) were significantly lower than within the first generation antipsychotic group. The authors conclude that lipid peroxidation is significantly higher in treatment with FGAs.

[Attachment styles in German alcoholics with or without attention-deficit hyperactivity disorder (ADHD)]. / Bindungsstile bei deutschen Alkoholabhängigen mit und ohne Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS).

INTRODUCTION: Attachment theory yields empirical constructs for development of human self, personality and cognition. Insecure attachment strategies were associated with various psychiatric disorders. METHOD: We investigated distribution of attachment styles in 368 adult alcoholics of German descent with or without persistent symptoms of attention-deficit hyperactivity disorder (ADHD) and in 402 healthy individuals. RESULT: Insecure attachment styles were significantly overrepresented compared to healthy controls. The subgroup of alcoholics with ADHD showed significantly more frequent enmeshed (74.1 %), the subgroup of alcoholics without persistent ADH-associated symptoms showed more frequent dismissing (35 %) attachment strategies. CONCLUSION: In our sample, insecure attachment styles are associated with alcoholism. The subgroup of alcoholics with persistent ADHD shows a specific attachment behavior that could contribute to different therapy response or to early onset or severity of alcoholism.

[ADHD and alcohol dependence: a common genetic predisposition?]. / ADHS und Alkoholabhängigkeit: Gemeinsame genetische Grundlagen?

INTRODUCTION: Nearly 50 % of subjects with continuing symptoms of attention-deficit hyperactivity disorder (ADHD) in adulthood show a comorbid substance use disorder. Both, ADHD and alcohol dependence have a high genetic load and might even share overlapping sources of genetic liability. METHOD: We investigated phenotype and 5-HTT/5-HT2c allelic characteristics in 314 alcoholics of German descent. RESULT: 21 % of the alcoholics fulfilled DSM-IV-criteria of ADHD with ongoing symptoms in adulthood. There was no significant difference in 5-HTT- or 5-HT2c-allele distribution between alcoholics and matched controls or between alcoholics with or without ADHD. CONCLUSION: In our sample the functional relevant 5-HTT-promoter and the 5-HT2c-receptor Cys23Ser polymorphism do not contribute to the supposed common genetic predisposition of ADHD and alcohol dependence.

[Attention-deficit hyperactivity disorder and alcohol dependence: a risk constellation]. / Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) und Alkoholabhängigkeit: Eine Risikokonstellation.

INTRODUCTION: The estimated prevalence for attention-deficit hyperactivity disorder (ADHD) in adulthood is 2 - 6 %. Patients with a substance use disorder met the criteria for ADHD between 30 and 50 %. ADHD and conduct disorders are discussed to increase risk of developing substance abuse and increase severity of disorder. METHOD: We compared epidemiological and clinical characteristics and comorbidity in subgroups of 314 adult alcoholics of German descent with or without persistent symptoms of attention-deficit hyperactivity disorder (ADHD). Aim of the study was to identify specific pathophysiological mechanisms that could contribute to vulnerability, severity or complication of alcohol dependence. RESULTS: 21.3 % of the alcoholics fulfilled DSM-IV-criteria of ADHD with ongoing symptoms in adulthood and had a Wender-Utah-Rating-Scale score > 90. Subgroup of alcoholics with ADHD were significantly younger at age of onset of alcoholism (24 years versus 30 years), had a significantly higher daily alcohol intake (253 g versus 196 g EtOH), had significantly more social stress, lifetime experiences in court proceedings against them (11 versus 2 %) and suicidal ideation (25 versus 11 %). In the subgroup of alcoholics with ADHD 51 % fulfilled criteria of antisocial personality disorder. The early onset of alcoholism was most pronounced in this subgroup. CONCLUSION: In our sample, persistence of ADHD symptoms from childhood into adulthood and antisocial personality disorder contributes to vulnerability and morbidity of alcohol dependence with early onset and greater severity of disorder.