Lethal predators: psychopathic, sadistic, and sane.

The violent criminals defined in this article are a small, exceptionally dangerous group of offenders designated by the authors as "lethal predators." They have a history of sexual predation, have killed at least once, and are mentally abnormal but legally sane. They are highly likely to keep killing as long as they are free. Laws permitting civil commitment of dangerous and mentally abnormal sexual predators after they have completed criminal prison sentences have been upheld by the U.S. Supreme Court. Such laws can provide a legal means of keeping these highly dangerous killers confined so they cannot kill again.

Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging.

BACKGROUND: Psychopathy is a complex personality disorder of unknown etiology. Central to the disorder are anomalies or difficulties in affective processing. METHODS: Functional magnetic resonance imaging was used to elucidate the neurobiological correlates of these anomalies in criminal psychopaths during performance of an affective memory task. RESULTS: Compared with criminal nonpsychopaths and noncriminal control participants, criminal psychopaths showed significantly less affect-related activity in the amygdala/hippocampal formation, parahippocampal gyrus, ventral striatum, and in the anterior and posterior cingulate gyri. Psychopathic criminals also showed evidence of overactivation in the bilateral fronto-temporal cortex for processing affective stimuli. CONCLUSIONS: These data suggest that the affective abnormalities so often observed in psychopathic offenders may be linked to deficient or weakened input from limbic structures.

Psychopathy and the predictive validity of the PCL-R: an international perspective.

Its controversial past notwithstanding, psychopathy has emerged as one of the most important clinical constructs in the criminal justice and mental health systems. One reason for the surge in theoretical and applied interest in the disorder is the development and widespread adoption of reliable and valid methods for its measurement. The Hare PCL-R provides researchers and clinicians with a common metric for the assessment of psychopathy, and has led to a surge in replicable and meaningful findings relevant to the issue of risk for recidivism and violence, among other things. Most of the research thus far has been based on North American samples of offenders and forensic psychiatric patients. We summarize this research and compare it with findings from several other countries, including England and Sweden. We conclude that the ability of the PCL-R to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability, and that the PCL-R and its derivatives play a major role in the understanding and prediction of crime and violence.

An event-related potential investigation of response inhibition in schizophrenia and psychopathy.

BACKGROUND: Schizophrenia and psychopathy are both characterized by impulsive, poorly planned behavior. This behavior may originate from a weak or poorly coordinated response inhibition system. We tested the hypothesis that schizophrenia and psychopathy are associated with abnormal neural processing during the suppression of inappropriate responses. METHODS: The participants were schizophrenic patients, nonpsychotic psychopaths, and nonpsychotic, nonpsychopathic control subjects (defined by the Hare Psychopathy Checklist-Revised), all incarcerated in a maximum security psychiatric facility. We recorded behavioral responses and event-related potentials (ERPs) during a Go/No Go task. RESULTS: Schizophrenic patients made more errors of commission than did the nonpsychopathic offenders. As expected, the nonpsychopathic nonpsychotic participants showed greater frontal ERP negativity (N275) to the No Go stimuli than to the Go stimuli. This effect was small in the schizophrenic patients and absent in the psychopaths. For the nonpsychopaths, the P375 ERP component was larger on Go than on No Go trials, a difference that was absent in schizophrenic patients and in the opposite direction in psychopaths. CONCLUSIONS: These findings support the hypothesis that the neural processes involved in response inhibition are abnormal in both schizophrenia and psychopathy; however, the nature of these processes appears to be different in the two disorders.

Semantic and affective processing in psychopaths: an event-related potential (ERP) study.

We tested the hypothesis that psychopathy is associated with abnormal processing of semantic and affective verbal information. In Task 1, a lexical decision task, and in Task 2, a word identification task, participants responded faster to concrete than to abstract words. In Task 2, psychopaths made more errors identifying abstract words than concrete words. In Task 3, a word identification task, participants responded faster to positive than to negative words. In all three tasks, nonpsychopaths showed the expected event-related potential (ERP) differentiation between word stimuli, whereas psychopaths did not. In each task, the ERPs of the psychopaths included a large centrofrontal negative-going wave (N350); this wave was absent or very small in the nonpsychopaths. The interpretation and significance of these differences are discussed.

Psychopathy as a risk factor for violence.

As a result of Kansas v Hendricks, many sex offenders in the U.S. are likely to be civilly committed to mental institutions for indefinite periods, and many others with histories of violent offenses may also be so committed. It therefore becomes critical for mental health professionals to understand the risk factors for re-offending that put the public in jeopardy. The most reliable of these factors is psychopathy, which will here be defined, along with its differentiation from the more commonly diagnosed antisocial personality disorder. The assessment of psychopathy, its relationship to crime--especially, to violent crime, its (non-) responsiveness to the usual treatment, and an outline of a potentially more effective one, are presented. Finally, and particularly in view of its widely accepted validity, the potential for abuse of the PCL-R and :SV are noted.

Neural pathways involved in the processing of concrete and abstract words.

The purpose of this study was to delineate the neural pathways involved in processing concrete and abstract words using functional magnetic resonance imaging (fMRI). Word and pseudoword stimuli were presented visually, one at a time, and the participant was required to make a lexical decision. Lexical decision epochs alternated with a resting baseline. In each lexical decision epoch, the stimuli were either concrete words and pseudowords, or abstract words and pseudowords. Behavioral data indicated that, as with previous research, concrete word stimuli were processed more efficiently than abstract word stimuli. Analysis of the fMRI data indicated that processing of word stimuli, compared to the baseline condition, was associated with neural activation in the bilateral fusiform gyrus, anterior cingulate, left middle temporal gyrus, right posterior superior temporal gyrus, and left and right inferior frontal gyrus. A direct comparison between the abstract and concrete stimuli epochs yielded a significant area of activation in the right anterior temporal cortex. The results are consistent with recent positron emission tomography work showing right hemisphere activation during processing of abstract representations of language. The results are interpreted as support for a right hemisphere neural pathway in the processing of abstract word representations.

Reduced P300 responses in criminal psychopaths during a visual oddball task.

BACKGROUND: Clinicians have long recognized that psychopaths show deficits in cognitive function, but there have been few experimental studies exploring these deficits. We present here the first in a series of event-related potential (ERP) experiments designed to elucidate and characterize the neural correlates of cognitive processes of psychopaths. METHODS: We recorded ERPs from a topographic array from 11 psychopathic and 10 nonpsychopathic prison inmates, assessed with the Hare Psychopathy Checklist-Revised, during performance of a visual oddball task. ERPs to target (25% of trials) and nontarget (75% of trials) visual stimuli were analyzed. RESULTS: Consistent with previous research, there were no group differences in the latency or amplitude of the ERPs for the nontarget stimuli. For nonpsychopaths, the P300 amplitude was larger when elicited by the target stimuli than when elicited by the nontarget stimuli. In contrast, psychopaths failed to show reliable P300 amplitude differences between the target and nontarget conditions. Psychopaths had a smaller amplitude P300 to target stimuli than did nonpsychopaths. In addition, the amplitude of the P300 was less lateralized in psychopaths than in nonpsychopaths. Psychopaths also had a larger centrofrontal negative wave (N550) during the target condition than did nonpsychopaths. CONCLUSIONS: The results of this study indicate that there are substantial differences between psychopaths and others in the processing of even simple cognitive tasks and provide support for information processing models of psychopathy.

Functional magnetic resonance imaging: the basics of blood-oxygen-level dependent (BOLD) imaging.

There are 2 principal techniques of functional MRI (fMRI): the blood-oxygen-level dependent (BOLD) technique, which is the favoured method because no intravenous contrast medium is required, and the dynamic or exogenous technique. The BOLD technique takes advantage of the fact that the change from diamagnetic oxyhemoglobin to paramagnetic deoxyhemoglobin that takes place with brain activation results in decreased signal intensity on MRI. Commercially available scanners can be used to conduct single-slice BOLD fMRI experiments, but echo-planar hardware is needed for multislice wholebrain experiments. Sequence choices in BOLD fMRI include spin-echo and gradient-echo sequences, to which rapid acquisition with relaxation enhancement and echoplanar techniques may be applied. Optimal imaging parameters (echo time, slice thickness, field of view and flip angle) are important in maximizing signal-to-noise ratios. Various statistical techniques and software programs have been developed to interpret the large amounts of data gathered from BOLD fMRI experiments, which presents one of the biggest challenges in performing this technique with clinical MR units. Controversy exists regarding the effects of draining veins on cortical mapping, of inflow of blood into the imaging slice or volume, and of motion artifact. BOLD fMRI has demonstrated good correlation with positron emission tomography, magneto-encephalography and electrocorticographic recordings of motor responses. It has been used to study cortical activity of visual, motor, auditory and speech tasks as well as brain centres for smell, motor imagery, complex motion and memory. As such, it holds promise for the study of brain function, but must be subjected to larger studies comparing it with the gold standard of electrocorticographic mapping.

Acoustic distinctions in the speech of male psychopaths.

A key feature of psychopathy is the ability to deceive, manipulate, and con the unwary, while seeming to be perfectly sincere. Is this impression of sincerity achieved solely through body gestures and facial expression, or is there also something different about the voice quality of psychopaths? We analyzed the acoustic characteristics of speech in 20 male offenders (10 psychopaths and 10 nonpsychopaths), assessed with the Psychopathy Checklist--Revised (Hare, 1991). We used a computer program developed by Alpert, Merewether, Homel, Martz, and Lomask (1986) to measure variations in amplitude and prosody. Results indicated that psychopaths spoke more quietly than controls and did not differentiate, in voice emphasis, between neutral and affective words. These findings are consistent with the developing view that psychopaths are insensitive to the emotional connotations of language. In addition, their vocal characteristics may be part of a self-presentation mode designed to manipulate and control interpersonal interactions.

Assessment of psychopathy as a function of age.

The assessment of psychopathy was examined as a function of age in 889 male prison inmates between the ages of 16 and 69. Ratings of psychopathy were made with the Psychopathy Checklist (PCL), which measures 2 correlated factors. Factor 1 describes a cluster of affective-interpersonal traits central to psychopathy. Factor 2 describes traits and behaviors associated with an unstable, unsocialized lifestyle, or social deviance. Cross-sectional analyses revealed that mean scores on Factor 1 were stable across the age-span; mean scores on Factor 2 declined with age. The prevalence of antisocial personality disorder, and, to a lesser extent of PCL-defined psychopathy, also declined with age. The results are consistent with a conceptualization of psychopathy as encompassing 2 correlated but distinct constructs. They also suggest that age-related differences in traits related to impulsivity, social deviance, and antisocial behavior are not necessarily paralleled by differences in the egocentric, manipulative, and callous traits fundamental to psychopathy.

Single-trial processing of event-related potentials using outlier information.

A new approach to extracting single-trial event-related information is described in this paper. This approach, called the outlier processing method (OPM), is based on the concept that event-related information is contained in EEG time-series outliers. In particular, the OPM has been effective in extracting motor-related information from single-trial EEG. An investigation into the viability of the OPM was carried out on single-trial EEG data from four subjects. The EEG was collected under two conditions: an active task in which the subject performed a skilled thumb movement and an idle task in which the subject remained alert but did not carry out any motor activity. The results of this investigation demonstrated that consistent single-trial motor related information can be successfully extracted using the OPM.

Psychopathy and the DSM-IV criteria for antisocial personality disorder.

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.

Abnormal processing of affective words by psychopaths.

We tested the hypothesis that psychopathy is associated with abnormal processing of affective verbal material. Criminal psychopaths and nonpsychopaths, defined by the Psychopathy Checklist, performed a lexical decision task ("Is it a word or not?") while we recorded reaction time and event-related potentials in response to letter-strings consisting of affective and neutral words and pronounceable nonwords. On the assumption that they do not make efficient use of affective information, our primary prediction was that psychopaths would show less behavioral and event-related potential differentiation between affective and neutral words than would nonpsychopaths. The results were in accordance with this prediction. The lexical decisions of nonpsychopaths were significantly faster, and relevant event-related potential components were significantly larger, to affective words than to neutral words. In sharp contrast, psychopaths failed to show reaction time facilitation or larger amplitude event-related potentials to affective words. We suggest that psychopaths extract less information from affective words than do other individuals. Possible implications of these and related findings for understanding the behavior of psychopaths are discussed.

Performance of criminal psychopaths on selected neuropsychological tests.

Screening batteries of standard neuropsychological tests were administered to 2 different samples (Ns = 90 and 167) of male prison inmates. Scores on the revised Psychopathy Checklist were used to divide inmates in each sample into high, moderate, and low psychopathy groups. There were no group differences in test performance in either of the samples, even when the effects of self-reported psychopathology and substance abuse were taken into account. The overall prevalence of both test-specific and global neuropsychological impairment was low and did not vary significantly across the 3 groups. The results provide no support for traditional brain-damage explanations of psychopathy.

The contingent negative variation in psychopaths.

There have been persistent claims that the contingent negative variation (CNV) is absent or greatly attenuated in psychopaths. However, these claims are based on a few studies with serious methodological and diagnostic problems. The present study attempted to avoid these problems. The subjects were male prison inmates divided into psychopaths and nonpsychopaths on the basis of scores on the Psychopathy Checklist. CNV was recorded while the subject performed a forewarned reaction time task with a relatively long interval (6 s) between the warning stimulus and the imperative stimulus. Motivation to perform well was ensured by having reaction times to the imperative stimulus determine how much money would be won or lost on a given trial. The early CNV of psychopaths was significantly larger than was that of the nonpsychopaths. There were no group differences in the late CNV or in reaction time. To the extent that the early CNV reflects processing of the warning stimulus and attention to task demands, the results are consistent with the hypothesis that psychopaths are proficient at focusing attention on events that interest them.