Neuropsychological assessment of aggressive offenders: a Delphi consensus study.

Objective: This study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression. Methods: An international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability. Results: The panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed. Conclusions: This research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify.

The Predictive Value of Early-Life Trauma, Psychopathy, and the Testosterone-Cortisol Ratio for Impulsive Aggression Problems in Veterans.

BACKGROUND: In this study, we examined whether early-life trauma, psychopathy, and the testosterone/cortisol ratio predicted impulsive aggression problems in veterans. METHOD: A sample of 49 male veterans with impulsive aggression problems and 51 nonaggressive veterans were included in the study. Logistic regression analysis was performed with early-life trauma, primary and secondary psychopathy, and testosterone/cortisol ratio as continuous predictor variables; impulsive aggression status was entered as a binary outcome measure. Correlation analyses were conducted to examine pairwise relations among the predictors. RESULTS: Results indicated that early-life trauma and secondary psychopathy, but not the testosterone/cortisol ratio or primary psychopathy, were significant predictors of impulsive aggression status. CONCLUSIONS: The current results indicate that early-life trauma and secondary psychopathy are risk factors for impulsive aggression problems among veterans. Future studies are needed to determine the exact causal relations among the variables examined here.

Fearful Faces do Not Lead to Faster Attentional Deployment in Individuals with Elevated Psychopathic Traits.

In the current study, a gaze-cueing experiment (similar to Dawel et al. 2015) was conducted in which the predictivity of a gaze-cue was manipulated (non-predictive vs highly predictive). This was done to assess the degree to which individuals with elevated psychopathic traits can use contextual information (i.e., the predictivity of the cue). Psychopathic traits were measured with the Self-Report Psychopathy Scale-Short Form (SRP-SF) in a mixed sample (undergraduate students and community members). Results showed no group difference in reaction times between high and non-predictive cueing blocks, suggesting that individuals with elevated psychopathic traits can indeed use contextual information when it is relevant. In addition, we observed that fearful facial expressions did not lead to a change in reaction times in individuals with elevated psychopathic traits, whereas individuals with low psychopathic traits showed speeded responses when confronted with a fearful face, compared to a neutral face. This suggests that fearful faces do not lead to faster attentional deployment in individuals with elevated psychopathic traits.

Visual attention in violent offenders: Susceptibility to distraction.

Impairments in executive functioning give rise to reduced control of behavior and impulses, and are therefore a risk factor for violence and criminal behavior. However, the contribution of specific underlying processes remains unclear. A crucial element of executive functioning, and essential for cognitive control and goal-directed behavior, is visual attention. To further elucidate the importance of attentional functioning in the general offender population, we employed an attentional capture task to measure visual attention. We expected offenders to have impaired visual attention, as revealed by increased attentional capture, compared to healthy controls. When comparing the performance of 62 offenders to 69 healthy community controls, we found our hypothesis to be partly confirmed. Offenders were more accurate overall, more accurate in the absence of distracting information, suggesting superior attention. In the presence of distracting information offenders were significantly less accurate compared to when no distracting information was present. Together, these findings indicate that violent offenders may have superior attention, yet worse control over attention. As such, violent offenders may have trouble adjusting to unexpected, irrelevant stimuli, which may relate to failures in self-regulation and inhibitory control.

Representational Uncertainty in the Brain During Threat Conditioning and the Link With Psychopathic Traits.

BACKGROUND: Psychopathy has repeatedly been linked to disturbed associative learning from aversive events (i.e., threat conditioning). Optimal threat conditioning requires the generation of internal representations of stimulus-outcome contingencies and the rate with which these may change. Because mental representations are imperfect, there will always be uncertainty about the accuracy of representations in the brain (i.e., representational uncertainty). However, it remains unclear 1) to what extent threat conditioning is susceptible to different types of uncertainty in representations about contingencies during the acquisition phase and 2) how representational uncertainty relates to psychopathic features. METHODS: A computational model was applied to functional neuroimaging data to estimate uncertainty in representations of contingencies (CoUn) and the rate of change of contingencies (RUn), respectively, from brain activation during the acquisition phase of threat conditioning in 132 adolescents at risk of developing antisocial personality profiles. Next, the associations between these two types of representational uncertainty and psychopathy-related dimensions were examined. RESULTS: The left and right amygdala activations were associated with CoUn, while the bilateral insula and the right amygdala were associated with RUn. Different patterns of relationships were found between psychopathic features and each type of uncertainty. Callous-unemotional traits and impulsive-irresponsible traits uniquely predicted increased CoUn, while only impulsive-irresponsible traits predicted increased RUn. CONCLUSIONS: The findings suggest that 1) the insula and amygdala differ in how these regions are affected by different types of representational uncertainty during threat conditioning and 2) CoUn and RUn have different patterns of relationships with psychopathy-related dimensions.

Top-down attention and selection history in psychopathy: Evidence from a community sample.

Psychopathy is a severe personality disorder, the core of which pertains to callousness, an entitled and grandiose interpersonal style often accompanied by impulsive and reckless endangerment of oneself and others. The response modulation theory of psychopathy states that psychopathic individuals have difficulty modulating top-down attention to incorporate bottom-up stimuli that may signal important information but are irrelevant to current goals. However, it remains unclear which particular aspects of attention are impaired in psychopathy. Here, we used 2 visual search tasks that selectively tap into bottom-up and top-down attention. In addition, we also looked at intertrial priming, which reflects a separate class of processes that influence attention (i.e., selection history). The research group consisted of 65 participants that were recruited from the community. Psychopathic traits were measured with the Psychopathic Personality Inventory (PPI; Uzieblo, Verschuere, & Crombez, 2007). We found that bottom-up attention was unrelated to psychopathic traits, whereas elevated psychopathic traits were related to deficits in the use of cues to facilitate top-down attention. Further, participants with elevated psychopathic traits were more strongly influenced by their previous response to the target. These results show that attentional deficits in psychopathy are largely confined to top-down attention and selection history.

Parsing fear: A reassessment of the evidence for fear deficits in psychopathy.

Psychopathy is a personality disorder characterized by interpersonal manipulation and callousness, and reckless and impulsive antisocial behavior. It is often seen as a disorder in which profound emotional disturbances lead to antisocial behavior. A lack of fear in particular has been proposed as an etiologically salient factor. In this review, we employ a conceptual model in which fear is parsed into separate subcomponents. Important historical conceptualizations of psychopathy, the neuroscientific and empirical evidence for fear deficits in psychopathy are compared against this model. The empirical evidence is also subjected to a meta-analysis. We conclude that most studies have used the term "fear" generically, amassing different methods and levels of measurement under the umbrella term "fear." Unlike earlier claims that psychopathy is related to general fearlessness, we show there is evidence that psychopathic individuals have deficits in threat detection and responsivity, but that the evidence for reduced subjective experience of fear in psychopathy is far less compelling. (PsycINFO Database Record

Reward can modulate attentional capture, independent of top-down set.

The traditional distinction between exogenous and endogenous attentional control has recently been enriched with an additional mode of control, termed "selection history." Recent findings have indicated, for instance, that previously rewarded or punished stimuli capture more attention than their physical attributes would predict. As such, the value that is associated with certain stimuli modulates attentional capture. This particular influence has also been shown for endogenous attention. Although recent leads have emerged, elucidating the influences of reward on exogenous and endogenous attention, it remains unclear to what extent exogenous attention is modulated by reward when endogenous attention is already deployed. We used a Posner cueing task in which exogenous and endogenous cues were presented to guide attention. Crucially, the exogenous cue also indicated the reward value. That is, the color of the exogenous cue indicated how much reward could be obtained on a given trial. The results showed main effects of endogenous and exogenous attention (i.e., speeded reaction times when either cue was valid, as compared to when it was invalid). Crucially, an interaction between exogenous cue validity and reward level was observed, indicating that reward-based associative-learning processes rapidly influence attentional capture, even when endogenous attention has been actively deployed.

A latent variable analysis of the Psychopathy Checklist-Revised and behavioral inhibition system/behavioral activation system factors in North American and Swedish offenders.

An influential neurobiological model of personality is the Reinforcement Sensitivity Theory, which postulates how basic motivational systems (behavioral activation system [BAS], behavioral inhibition system [BIS]) can help account for the development and expression of individual differences in personality. Earlier research has documented a link between psychopathic personality and the BIS/BAS scale (Carver & White, 1994), which was developed to measure the behavioral inhibition and activation systems. However, no studies have examined how latent BIS/BAS factors and the 4 empirically derived Psychopathy Checklist-Revised (PCL-R) psychopathy factors (Hare & Neumann, 2008) are associated across different cultures. In the current study, structural equation modeling was used to determine how the 4 PCL-R factors were able to predict BIS/BAS factors using 2 large independent samples of male offenders (North American N = 908; Swedish N = 242). The results were in line with theory and revealed a negative relationship between the PCL-R Affective factor and the BIS factor as well as positive relationships between the PCL-R Antisocial and Lifestyle factors with the BAS factor. Overall, the results of the current study provide evidence of cross-cultural generalizability for the associations between the PCL-R factors and the BIS-BAS factors. Taken together, the PCL-R psychopathy factors were able to account for meaningful variance in the BIS-BAS factors and further support a dimensional approach to understanding the psychopathy construct across cultures.

Affective touch modulates the rubber hand illusion.

INTRODUCTION: Humans experience touch as pleasant when this occurs with a certain velocity (1-10cm/s). Affective, pleasant touch is thought to be mediated by a distinct neural pathway consisting of un-myelinated tactile afferents (C tactile fibers) that respond to stroking with a low velocity on the hairy skin. As pleasant touch provides additional information on bodily signals we hypothesized that, compared to regular touch, pleasant touch would have a stronger effect on body ownership as measured through induction of the rubber hand illusion (RHI). METHODS: Two experiments involving the RHI were conducted. In the first experiment, the effects of stroking velocity (3cm/s and 30cm/s) and stroking material (soft/rough) on the RHI were tested. In the second experiment, the effect of an additional stroking velocity (0.3cm/s) and side of stimulation (hairy and glabrous) was examined. RESULTS: The first experiment showed that low velocity stroking in combination with a soft material was not only regarded as most pleasant but also resulted in an enhanced RHI on proprioceptive drift and temperature measurements. In the second experiment, we confirmed that stroking with a velocity of 3cm/s resulted in a larger RHI in terms of proprioceptive drift. In addition, compared to regular touch, pleasant touch of the hairy skin resulted in a larger proprioceptive drift, while similar stroking on the glabrous side of the skin did not induce a stronger effect of RHI on proprioceptive drift. CONCLUSION: Our data suggest that pleasant touch modulates the body representation which is consistently reflected in a larger proprioceptive drift. Our data also suggest that C tactile fibers are likely to be involved in the modulation of body ownership.

Determining optimal rTMS parameters through changes in cortical inhibition.

OBJECTIVES: Evidence shows that repetitive transcranial magnetic stimulation (rTMS) changes cortical inhibition (CI) and excitability and that these changes may relate to its therapeutic effects. This study aimed to investigate the effects of differing durations or 'doses' of rTMS on cortical inhibition and excitability in healthy subjects. METHODS: Four different experiments were conducted: 1 session of 1200 pulses of 1 or 20 Hz active or sham rTMS; 10 sessions of 1 or 20 Hz active or sham rTMS, 1200 pulses/session; 1 session of 3600 pulses of 1 or 20 Hz active or sham rTMS; 1 session of 6000 pulses of 20 Hz active or sham rTMS. Measures of cortical inhibition and excitability included short-interval intracortical inhibition, long interval cortical inhibition, cortical silent period (CSP), motor evoked potential amplitude, resting motor threshold and intracortical facilitation. RESULTS: Only 6000 pulses of 20 Hz rTMS lead to a significant lengthening of the CSP and therefore potentiation of CI. There were no changes to excitability measures. CONCLUSION: Only high frequency rTMS potentiated CI. Longer treatment durations are required to produce such changes. SIGNIFICANCE: Studies investigating the therapeutic effects of rTMS may benefit from extended dosing with increased number of pulses per session. CSP lengthening may be used to guide treatment response.

Abnormal interhemispheric connectivity in male psychopathic offenders.

BACKGROUND: Psychopathic offenders inevitably violate interpersonal norms and frequently resort to aggressive and criminal behaviour. The affective and cognitive deficits underlying these behaviours have been linked to abnormalities in functional interhemispheric connectivity. However, direct neurophysiological evidence for dysfunctional connectivity in psychopathic offenders is lacking. METHODS: We used transcranial magnetic stimulation combined with electroencephalography to examine interhemispheric connectivity in the dorsolateral and motor cortex in a sample of psychopathic offenders and healthy controls. We also measured intracortical inhibition and facilitation over the left and right motor cortex to investigate the effects of local cortical processes on interhemispheric connectivity. RESULTS: We enrolled 17 psychopathic offenders and 14 controls in our study. Global abnormalities in right to left functional connectivity were observed in psychopathic offenders compared with controls. Furthermore, in contrast to controls, psychopathic offenders showed increased intracortical inhibition in the right, but not the left, hemisphere. LIMITATIONS: The relatively small sample size limited the sensitivity to show that the abnormalities in interhemispheric connectivity were specifically related to the dorsolateral prefrontal cortex in psychopathic offenders. CONCLUSION: To our knowledge, this study provides the first neurophysiological evidence for abnormal interhemispheric connectivity in psychopathic offenders and may further our understanding of the disruptive antisocial behaviour of these offenders.

White matter deficits in psychopathic offenders and correlation with factor structure.

Psychopathic offenders show a persistent pattern of emotional unresponsivity to the often horrendous crimes they perpetrate. Recent studies have related psychopathy to alterations in white matter. Therefore, diffusion tensor imaging followed by tract-based spatial statistics (TBSS) analysis in 11 psychopathic offenders matched to 11 healthy controls was completed. Fractional anisotropy was calculated within each voxel and comparisons were made between groups using a permutation test. Any clusters of white matter voxels different between groups were submitted to probabilistic tractography. Significant differences in fractional anisotropy were found between psychopathic offenders and healthy controls in three main white matter clusters. These three clusters represented two major networks: an amygdalo-prefrontal network, and a striato-thalamo-frontal network. The interpersonal/affective component of the PCL-R correlated with white matter deficits in the orbitofrontal cortex and frontal pole whereas the antisocial component correlated with deficits in the striato-thalamo-frontal network. In addition to replicating earlier work concerning disruption of an amygdala-prefrontal network, we show for the first time that white matter integrity in a striato-thalamo-frontal network is disrupted in psychopathic offenders. The novelty of our findings lies in the two dissociable white matter networks that map directly onto the two major factors of psychopathy.

The EEG correlates of the TMS-induced EMG silent period in humans.

Application of magnetic or electrical stimulation to the motor cortex can result in a period of electromyography (EMG) silence in a tonically active peripheral muscle. This period of EMG silence is referred to as the silent period (SP). The duration of SP shows intersubject variability and reflects the integrity of cortical and corticospinal pathways. A non-invasive technique for assessing the duration of SP is the combination of Transcranial Magnetic Stimulation (TMS) with EMG. Utilizing TMS-EMG, several studies have reported on the shortening or lengthening of SP in neuropsychiatric disorders such as schizophrenia, bipolar disorder, depression, obsessive compulsive disorder, epilepsy, Parkinson's disease, and stroke. However, cortical, corticospinal and peripheral components are difficult to disentangle from EMG alone. Here, we use the multimodal neuroimaging technique of TMS-EMG combined with concurrent electroencephalography (EEG) recording to further examine the cortical origin of SP and the cortical oscillatory activity that underlies SP genesis. We demonstrate that the duration of SP is related to the temporal characteristics of the cortical reactivity and the power of delta to alpha oscillations in both local and remote areas ipsilateral and contralateral to the stimulation site, and beta oscillations locally. We illustrate that, compared to EMG, the EEG indices of the SP provide additional information about the brain dynamics and propose that the EEG measures of SP may be used in future clinical and research investigations to more precisely delineate the mechanisms underlying inhibitory impairments.

Inhibitory deficits in the dorsolateral prefrontal cortex in psychopathic offenders.

Often typified as cunning social predators, psychopathic offenders show a persistent pattern of impulsive and reckless behavior, the pathophysiology of which has been related to dysfunction in the dorsolateral prefrontal cortex (DLPFC). That is, the DLPFC is important for the regulatory control of impulses and emotion as well as working memory and psychopathic offenders show impairments in all three dimensions. In the present study, we used combined transcranial magnetic stimulation and electroencephalography to compare the physiology of the DLPFC in 13 psychopathic offenders and 15 healthy subjects vis à vis excitability and inhibition. In addition, working memory performance was measured through the letter-number sequencing test. Results showed that compared to healthy subjects, psychopathic offenders had inhibition not excitability deficits in the DLPFC that was accompanied by deficits in working memory performance. In healthy controls and psychopathic offenders working memory performance correlated with the extent of inhibition over the DLPFC. Taken together, these findings suggest that psychopathic offenders suffer from dysfunctional inhibitory neurotransmission in the DLPFC and impaired working memory which may account for the behavioral impairments associated with this disorder.

Corticospinal state variability and hemispheric asymmetries in motivational tendencies.

This transcranial magnetic stimulation (TMS) study examined interrelations between asymmetrical hemispheric differences in the degree of variability of corticospinal excitability levels and motivational tendencies. The relative standard deviation in motor evoked potentials (MEP) to single pulse TMS over the left and right primary motor cortex, and approach- and avoidance-related motivational tendencies were investigated in sixty right-handed healthy volunteers. Results showed that subjects exhibited significantly higher state variability in the left as compared to the right frontal cortex and subjects displayed a dominant pattern of approach versus avoidance related motivational tendencies. Differences in left-right corticospinal state variability and approach-avoidance related motivation were significantly correlated and are consistent with the frontal lateralization model of motivational direction. This study demonstrates that MEP variability may provide an additional means for studying non-stationary properties of corticospinal excitability in relation to hemispheric asymmetries and motivational tendencies.

Personality goes a long a way: an interhemispheric connectivity study.

Throughout the development of psychology the delineation of personality has played a central role. Together with the NEO-PI-R, a questionnaire derived from the Five Factor Model of Personality, and recent advances in research technology it is now possible to investigate the relationship between personality features and neurophysiological brain processes. The NEO-FFI, the short version of the NEO-PI-R, reliably measures five main personality traits: Neuroticism, Extraversion, Openness to experience, Agreeableness, and Conscientiousness. As behavior and some psychiatric disorders have been related to interhemispheric connectivity, the present study used the combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to measure frontal interhemispheric connectivity and its association with personality as indexed by the NEO-FFI. Results demonstrated that prefrontal interhemispheric connectivity between the left and right dorsolateral prefrontal cortex correlates with Agreeableness in healthy subjects. This is the first study to relate personality features to interhemispheric connectivity through TMS-EEG and suggests that Agreeableness relates to the effectiveness of prefrontal communication between hemispheres.

Alcohol breaks down interhemispheric inhibition in females but not in males: alcohol and frontal connectivity.

INTRODUCTION: Alcohol has renowned behavioral disinhibitory properties which are suggested to involve reductions in frontal lobe functioning as a result of diminished interhemispheric connectivity. METHODS: To examine sex differences in frontal interhemispheric connectivity in response to alcohol, 12 female and ten male healthy volunteers received a single administration of 0.5 per thousand alcohol in a placebo-controlled counterbalanced crossover design. Paired-pulse transcranial magnetic stimulation was applied to measure transcallosal inhibition (TCI) between the left and right primary motor cortex (M1). RESULTS: Results showed significant reductions in TCI after alcohol administration in female participants exclusively. DISCUSSION: These findings provide the first evidence that moderate doses of alcohol differentially affect frontal interhemispheric connectivity in males and females. The present data may shed new light on the physiological mechanisms underlying sex differences in the susceptibility to alcohol.

High-frequency repetitive transcranial magnetic stimulation to the cerebellum and implicit processing of happy facial expressions.

BACKGROUND: Previous research has demonstrated that the cerebellum is involved in emotive and cognitive processes. Furthermore, recent findings suggest high-frequency repetitive transcranial magnetic stimulation (rTMS) to the cerebellum has mood-improving properties. We sought to further explore the effects of cerebellar high-frequency rTMS on implicit processing of emotional stimuli and mood. METHODS: In a double-blind, crossover study, 15 healthy volunteers received 15 minutes of 20 Hz (5 s on, 5 s off) rTMS over the medial cerebellum, occipital cortex or sham in a randomized counterbalanced order on 3 consecutive days. A masked emotional faces response task measured implicit emotional processing of happy, fearful and neutral facial expressions. We used positive and negative affect scales to evaluate rTMS-related changes in mood. RESULTS: High-frequency rTMS over the cerebellum was associated with significant increases in masked emotional responses to happy facial expressions only. We observed no changes in consciously experienced mood. LIMITATIONS: Although the sham rTMS served as our baseline measurement, additional pre-rTMS data showing that reaction time increases immediately after cerebellar rTMS would have made our results more compelling. CONCLUSION: The results replicate and extend previous findings by establishing a direct relation between the cerebellum and emotive information-processing. The parallel between the present effects of high-frequency cerebellar rTMS and short-term antidepressant therapy regarding the change in implicit processing of positive stimuli in the absence of mood changes is notable and warrants further research.

The role of the cerebellum in the pathophysiology and treatment of neuropsychiatric disorders: a review.

The cerebellum has traditionally been looked upon as a brain area primarily involved in motor behaviour. The last decade has however heralded the cerebellum as a brain region of renewed interest for neuropsychiatric disorders. This renewed interest is fuelled by new insights obtained from neuroanatomical research, modern functional neuroimaging and transcranial magnetic stimulation studies. In this review, evidence in support of cerebellar involvement in neuropsychiatric disorders will be presented. In addition, transcranial magnetic stimulation will be introduced as a novel way to study cerebellar contributions to the pathophysiology of psychiatric disorders. In conclusion, a new functional concept of the cerebellum as more than simply a brain area regulating motor control appears mandatory and the involvement of the cerebellum should be considered when studying the neurological basis of neuropsychiatric disorders.