Decision-making ability, psychopathology, and brain connectivity.

Decision-making is a cognitive process of central importance for the quality of our lives. Here, we ask whether a common factor underpins our diverse decision-making abilities. We obtained 32 decision-making measures from 830 young people and identified a common factor that we call "decision acuity," which was distinct from IQ and reflected a generic decision-making ability. Decision acuity was decreased in those with aberrant thinking and low general social functioning. Crucially, decision acuity and IQ had dissociable brain signatures, in terms of their associated neural networks of resting-state functional connectivity. Decision acuity was reliably measured, and its relationship with functional connectivity was also stable when measured in the same individuals 18 months later. Thus, our behavioral and brain data identify a new cognitive construct that underpins decision-making ability across multiple domains. This construct may be important for understanding mental health, particularly regarding poor social function and aberrant thought patterns.

The predictive value of neurobiological measures for recidivism in delinquent male young adults.

Background: Neurobiological measures have been associated with delinquent behaviour, but little is known about the predictive power of these measures for criminal recidivism and whether they have incremental value over and above demographic and behavioural measures. This study examined whether selected measures of autonomic functioning, functional neuroimaging and electroencephalography predict overall and serious recidivism in a sample of 127 delinquent young adults. Methods: We assessed demographics; education and intelligence; previous delinquency and drug use; behavioural traits, including aggression and psychopathy; and neurobiological measures, including heart rate, heart rate variability, functional brain activity during an inhibition task and 2 electroencephalographic measures of error-processing. We tested longitudinal associations with recidivism using Cox proportional hazard models and predictive power using C-indexes. Results: Past offences, long-term cannabis use and reactive aggression were strongly associated with recidivism, as were resting heart rate and error-processing. In the predictive model, demographics, past delinquency, drug use and behavioural traits had moderate predictive power for overall and for serious recidivism (C-index over 30 months [fraction of pairs in the data, where the higher observed survival time was correctly predicted]: C30 = 0.68 and 0.75, respectively). Neurobiological measures significantly improved predictive power (C30 = 0.72 for overall recidivism and C30 = 0.80 for serious recidivism). Limitations: Findings cannot be generalized to females, and follow-up was limited to 4 years. Conclusion: Demographic and behavioural characteristics longitudinally predicted recidivism in delinquent male young adults, and neurobiological measures improved the models. This led to good predictive function, particularly for serious recidivism. Importantly, the most feasible measures (autonomic functioning and electroencephalography) proved to be useful neurobiological predictors.

Balancing the brain of offenders with psychopathy? Resting state EEG and electrodermal activity after a pilot study of brain self-regulation training.

Although investigation of the brains of criminals began quite early in the history of psychophysiological research, little is known about brain plasticity of offenders with psychopathy. Building on our preliminary study reporting successful brain self-regulation using slow cortical potential (SCP) neurofeedback in offenders with psychopathy, we investigated the central nervous and autonomic peripheral changes occurring after brain self-regulation in a group of severe male offenders with psychopathy. Regarding the central nervous system, an overall suppression of the psychopathic overrepresentation of slow frequency bands was found, such as delta and theta band activity, after EEG neurofeedback. In addition, an increase in alpha band activity could be observed after the SCP self-regulation training. Electrodermal activity adaptively changed according to the regulation task, and this flexibility improved over training time. The results of this study point towards a constructive learning process and plasticity in neural and peripheral measures of offenders with psychopathy.

Psychopathy is associated with fear-specific reductions in neural activity during affective perspective-taking.

Psychopathic individuals are notorious for their callous disregard for others' emotions. Prior research has linked psychopathy to deficits in affective mechanisms underlying empathy (e.g., affective sharing), yet research relating psychopathy to cognitive mechanisms underlying empathy (e.g., affective perspective-taking and Theory of Mind) requires further clarification. To elucidate the neurobiology of cognitive mechanisms of empathy in psychopathy, we administered an fMRI task and tested for global as well as emotion-specific deficits in affective perspective-taking. Adult male incarcerated offenders (N = 94) viewed images of two people interacting, with one individual's face obscured by a shape. Participants were cued to either identify the emotion of the obscured individual or identify the shape from one of two emotion or shape choices presented on each trial. Target emotions included anger, fear, happiness, sadness, and neutral. Contrary to predictions, psychopathy was unrelated to neural activity in the Affective Perspective-taking > Shape contrast. In line with predictions, psychopathy was negatively related to task accuracy during affective perspective-taking for fear, happiness, and sadness. Psychopathy was related to reduced hemodynamic activity exclusively during fear perspective-taking in several areas: left anterior insula extending into posterior orbitofrontal cortex, right precuneus, left superior parietal lobule, and left superior occipital cortex. Although much prior research has emphasized psychopathy-related abnormalities in affective mechanisms mediating empathy, current results add to growing evidence of psychopathy-related abnormalities in a cognitive mechanism related to empathy. These findings highlight brain regions that are hypoactive in psychopathy when explicitly processing another's fear.

Temporal Discounting Impulsivity and Its Association with Conduct Disorder and Irritability.

Objectives: Temporal reward discounting impulsivity (TDI) reflects a propensity to choose smaller immediate rather than larger delayed rewards relative to age/IQ-matched peers. Previous work with adults has linked TDI to an increased risk for antisocial behavior but also psychopathology in general. However, little work has examined TDI in adolescents with conduct disorder (CD), or considered whether TDI might be associated dimensionally with traits associated with antisocial behavior, that is, impulsivity, irritability, and/or callous-unemotional traits. In this study TDI was investigated in a large adolescent group with varying levels of antisocial behavior. Methods: Participants consisted of 195 adolescents (67 with CD, 77 in a psychiatric comparison group and 51 typically developing adolescents). Participants performed a temporal discounting task and individual differences were measured through the Connors rating scale for attention-deficit/hyperactivity disorder (impulsivity), Affective Reactivity Index (irritability), and Inventory of Callous-Unemotional traits. Results: The adolescents with CD and those in the psychiatric comparison group showed significantly greater TDI than typically developing adolescents. However, these group differences were abolished when dimensional covariates were included. Irritability was significantly associated with TDI. Conclusions: We conclude that TDI reflects a transdiagnostic form of dysfunction that particularly manifests in adolescents with increased irritability.

Frontal alpha asymmetry and emotional processing in youth with psychopathic traits.

Emotional processing deficits are often considered central to psychopathy. There is evidence that those high in psychopathy pay less attention to emotional stimuli, and it is possible that these individuals experience diminished withdrawal motivation or heightened approach motivation in response to emotional stimuli. Studying emotional processing abnormalities, especially among youth, may be essential for better understanding psychopathy's development and for informing interventions. However, few studies on psychopathy have experimentally manipulated emotional processing, and despite the growing literature on neuroscience and psychopathy, there are aspects of neural activity that have yet to be investigated. The current study used a sample of 52 justice-involved youth to examine how psychopathy, as measured by the Proposed Specifiers for Conduct Disorder scale, relates to frontal alpha asymmetry (FAA), a neural correlate of approach and withdrawal motivation. Alpha asymmetry was first measured at rest and then while youth were asked to process emotional stimuli spontaneously as well as to increase and decrease their responses to emotional stimuli. Results indicated that total psychopathy was not related to FAA at rest or during task performance. However, youth higher in callous-unemotional traits demonstrated similar patterns of neural activity to youth lower in callous-unemotional traits when instructed to increase their response to emotional stimuli. These findings were not evident for grandiose-manipulative or daring-impulsive traits. These findings may indicate that youth high in callous-unemotional traits are capable of modulating their emotional responding, which could in turn have treatment implications for youth high in psychopathic traits.

The interplay of gaming disorder, gaming motivations, and the dark triad.

BACKGROUND AND AIMS: There is a considerable amount of research on the psychological antecedents and outcomes of gaming disorder. Although many studies have examined various personality traits or motivations as predictors in isolation, fewer studies have investigated the mediations between personality traits and motivations. Furthermore, the analyzed personality traits have been limited to a few core concepts, with the Big Five personality traits being a standard model in this context. However, more recently the dark triad of personality traits (Machiavellianism, narcissism, and psychopathy) has been found to be associated with various forms of problematic online behavior and usage, such as online gambling, yet little is known about gaming disorder. The current study examines the relationship of these dark personality traits to gaming disorder with three gaming motivations (achievement, social, and escapism) as mediators. METHOD: The study uses an online survey of 1,502 German digital game users. RESULTS: Results indicate a fully mediated association for narcissism via escapism and partial mediation associations for Machiavellianism and psychopathy. Direct effects on gaming disorder were observed for Machiavellianism and psychopathy. Indirect effects by psychopathy were observed via escapism and social motivation, by narcissism via escapism, and by Machiavellianism via social motivation. DISCUSSION AND CONCLUSIONS: These findings contribute to the theoretical understanding of the mediation of gaming motivations and the dark triad personality traits' importance for gaming disorder.

Risk-taking and fairness among cocaine-dependent patients in dual diagnoses: Schizophrenia and Anti-Social Personality Disorder.

This study reports experimental results from a clinical sample of patients with a cocaine-related disorder and dual diagnosis: Schizophrenia and Anti-Social Personality Disorder. Both types of patients as well as a non-clinical group of students performed two incentivized decision-making tasks. In the first part of the experiment, they performed a lottery-choice task in order to elicit their degree of risk aversion. In the second part, they decided in two modified dictator games aimed at eliciting their aversion to advantageous and disadvantageous inequality. It is found that the Anti-Social Personality Disorder group exhibits no significant differences from the non-clinical sample in either task. However, compared with the students' sample, subjects from the group with schizophrenia show more risk aversion and exhibit more aversion towards disadvantageous inequality.

The role of monoamine oxidase A in the neurobiology of aggressive, antisocial, and violent behavior: A tale of mice and men.

Over the past two decades, research has revealed that genetic factors shape the propensity for aggressive, antisocial, and violent behavior. The best-documented gene implicated in aggression is MAOA (Monoamine oxidase A), which encodes the key enzyme for the degradation of serotonin and catecholamines. Congenital MAOA deficiency, as well as low-activity MAOA variants, has been associated with a higher risk for antisocial behavior (ASB) and violence, particularly in males with a history of child maltreatment. Indeed, the interplay between low MAOA genetic variants and early-life adversity is the best-documented gene × environment (G × E) interaction in the pathophysiology of aggression and ASB. Additional evidence indicates that low MAOA activity in the brain is strongly associated with a higher propensity for aggression; furthermore, MAOA inhibition may be one of the primary mechanisms whereby prenatal smoke exposure increases the risk of ASB. Complementary to these lines of evidence, mouse models of Maoa deficiency and G × E interactions exhibit striking similarities with clinical phenotypes, proving to be valuable tools to investigate the neurobiological mechanisms underlying antisocial and aggressive behavior. Here, we provide a comprehensive overview of the current state of the knowledge on the involvement of MAOA in aggression, as defined by preclinical and clinical evidence. In particular, we show how the convergence of human and animal research is proving helpful to our understanding of how MAOA influences antisocial and violent behavior and how it may assist in the development of preventative and therapeutic strategies for aggressive manifestations.

Biocognitive Classification of Antisocial Individuals Without Explanatory Reductionism.

Effective and specifically targeted social and therapeutic responses for antisocial personality disorders and psychopathy are scarce. Some authors maintain that this scarcity should be overcome by revising current syndrome-based classifications of these conditions and devising better biocognitive classifications of antisocial individuals. The inspiration for the latter classifications has been embedded in the Research Domain Criteria (RDoC) approach. RDoC-type approaches to psychiatric research aim at transforming diagnosis, provide valid measures of disorders, aid clinical practice, and improve health outcomes by integrating the data on the genetic, neural, cognitive, and affective systems underlying psychiatric conditions. In the first part of the article, we discuss the benefits of such approaches compared with the dominant syndrome-based approaches and review recent attempts at building biocognitive classifications of antisocial individuals. Other researchers, however, have objected that biocognitive approaches in psychiatry are committed to an untenable form of explanatory reductionism. Explanatory reductionism is the view that psychological disorders can be exclusively categorized and explained in terms of their biological causes. In the second part of the article, we argue that RDoC-like approaches need not be associated with explanatory reductionism. Moreover, we argue how this is the case for a specific biocognitive approach to classifying antisocial individuals.

GRM8 genotype is associated with externalizing disorders and greater inter-trial variability in brain activation during a response inhibition task.

OBJECTIVE: The present investigation tested the association of a novel measure of brain activation recorded during a simple motor inhibition task with a GRM8 genetic locus implicated in risk for substance dependence. METHODS: 122 European-American adults were genotyped at rs1361995 and evaluated against DSM-IV criteria for Alcohol Dependence, Cocaine Dependence, Conduct Disorder, and Antisocial Personality Disorder. Also, their brain activity was recorded in response to rare, so-called "No-Go" stimuli presented during a continuous performance test. Brain activity was quantified with two indices: (1) the amplitude of the No-Go P300 electroencephalographic response averaged across trials; and (2) the inter-trial variability of the response. RESULTS: The absence of the minor allele at the candidate locus was associated with all of the evaluated diagnoses. In comparison to minor allele carriers, major allele homozygotes also demonstrated increased inter-trial variability in No-Go P300 response amplitude but no difference in average amplitude. CONCLUSIONS: GRM8 genotype is associated with Alcohol and Cocaine Dependence as well as personality risk factors for dependence. The association may be mediated through an inherited instability in brain function that affects cognitive control. SIGNIFICANCE: The present study focuses on a metric and brain mechanism not typically considered or theorized in studies of patients with substance use disorders.

Sex Differences in QEEG in Psychopath Offenders.

Introduction. Functional brain differences related to sex in psychopathic behavior represent an important field of neuroscience research; there are few studies on this area, mainly in offender samples. Objective. The aim of this study was to investigate the presence of electrophysiological differences between male and female psychopath offenders; specifically, we wanted to assess whether the results in quantitative EEG, low-resolution electromagnetic tomography (LORETA), and changes in synchronous brain activity could be related to sex influence. Sample and Methods. The study included 31 male and 12 female psychopath offenders, according to the Hare Psychopathy Checklist-Revised criteria from 2 prisons located in Havana City. The EEG visual inspection characteristics and the use of frequency domain quantitative analysis techniques are described. Results. The resting EEG visual analyses revealed a high percentage of EEG abnormalities in both studied groups. Significant statistical differences between the mean parameters of cross spectral measures between psychopathic offender groups were found in the beta band at bilateral frontal derivation and centroparietal areas. LORETA showed differences especially in the paralimbic and parieto-occipital areas Synchronization likelihood revealed a significant group effect in the 26 to 30 Hz band. These results indicate that combining quantitative EEG, LORETA analysis, and synchronization likelihood may improve the neurofunctional differentiation between psychopath offenders of both sexes.

Electrocortical measures of performance monitoring from go/no-go and flanker tasks: Differential relations with trait dimensions of the triarchic model of psychopathy.

This study examined associations of performance-monitoring event-related potentials (ERPs) from go/no-go and flanker tasks with one another, and with psychopathy-related traits of disinhibition, meanness, and boldness. A task-dependent relationship was evident between the error-related negativity (ERN) and trait disinhibition, with high-disinhibited participants showing reduced no-go ERN but not flanker ERN. Disinhibition was also inversely related to variants of the P3 and the error positivity (Pe) from these two tasks. A factor analysis of the ERPs revealed two distinct factors, one reflecting shared variance among the P3 and Pe measures from the two tasks, and the other covariance among the N2 and ERN measures. Scores on the P3/Pe factor, but not the N2/ERN factor, were inversely related to disinhibition, and accounted for associations of this trait with variants of the P3 and Pe across tasks. The implication is that high trait disinhibition relates mainly to reductions in brain responses associated with later elaborative stages in the processing of motivationally significant events across different tasks. Importantly, no-go ERN predicted disinhibition scores beyond N2/ERN factor scores, indicating that high disinhibition is not generally related to diminished early preresponse conflict and error processing, but rather to processing impairments in conditions calling for inhibition of prepotent response tendencies.

The neurophysiological correlates of the triarchic model of psychopathy: An approach to the basic mechanisms of threat conditioning and inhibitory control.

The psychopathic traits boldness, meanness, and disinhibition are theorized to be underlined by trait fearlessness and externalizing vulnerability as etiologic neurobiological processes. However, little is known about the neurophysiological correlates of these traits. In this work, we explored how the three traits are associated with event-related potential (ERP) components targeted at the etiological processes in a partial delayed threat conditioning task and in a go/no-go task. Fifty community-dwelling volunteers (25 women), without history of neurological or psychiatric conditions, were recruited and assessed for psychopathic traits using the triarchic psychopathy measure. Participants performed a threat conditioning task, and a go/no-go task while undergoing an electroencephalography recording. Results from the threat conditioning task showed that boldness was significantly associated with reduced late positive potential. Concerning the go/no-go task, disinhibition was significantly associated with reduced error-related negativity ERP component. Overall, distinct psychopathic traits were found to be associated with distinct neurophysiological correlates of threat conditioning and response inhibition. This is consistent with models of psychopathy entailing trait fearlessness and externalizing proneness, and related brain mechanisms, as distinct processes underlying the expression of psychopathic traits.

Eye contact during live social interaction in incarcerated psychopathic offenders.

Psychopathy is characterized by a lack of empathy, callousness, and a range of severe antisocial behaviors. A deficit to accurately process social cues, which has been widely documented in psychopathic populations, is assumed to underlie their pathological development. Impaired attention to socially salient cues, such as the eyes of an interaction partner, is a possible mechanism compromising the development of social cognition. Preliminary evidence from static facial stimuli suggests that psychopathy is indeed linked to reduced eye gaze. However, no study to date has investigated whether these mechanisms apply to naturalistic interactions. This study is the first to examine patterns of visual attention during live social interactions and their association with symptom clusters of psychopathy. Eye contact was assessed in a sample of incarcerated offenders (N = 30) during semistructured face-to-face interactions with a mobile eye-tracking headset and analyzed using a novel automated areas of interest (e.g., eye region) labeling technique. The interactions included an exchange on neutral predetermined topics and included a condition in which the participants were active (talking) and passive (listening). The data reveal that across both listening and talking conditions higher affective psychopathy is a significant predictor of reduced eye contact (listening: r = -.39; talking: r = -.43). The present findings are in line with previous research suggesting impaired attention to social cues in psychopathy. This study is the first to document these deficits in naturalistic, live social interaction and therefore provides important evidence for their relevance to real-life behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

He had it Comin': ERPs Reveal a Facilitation for the Processing of Misfortunes to Antisocial Characters.

Human sociality and prosociality rely on social and moral feelings of empathy, compassion, envy, schadenfreude, as well as on the preference for prosocial over antisocial others. We examined the neural underpinnings of the processing of lexical input designed to tap into these type of social feelings. Brainwave responses from 20 participants were measured as they read sentences comprising a randomly delivered ending outcome (fortunate or unfortunate) to social agents previously profiled as prosocial or antisocial individuals. Fortunate outcomes delivered to prosocial and antisocial agents aimed to tap into empathy and envy/annoying feelings, respectively, whereas unfortunate ones into compassion for prosocial agents and schadenfreude for antisocial ones. ERP modulations in early attention-capture (100-200 ms), semantic fit (400 ms), and late reanalysis processes (600 ms) were analyzed. According to the functional interpretation of each of these event-related electrophysiological effects, we conclude that: 1) a higher capture of attention is initially obtained in response to any type of outcome delivered to a prosocial versus an antisocial agent (frontal P2); 2) a facilitated semantic processing occurs for unfortunate outcomes delivered to antisocial agents (N400); and 3) regardless of the protagonist's social profile, an increased later reevaluation for overall unfortunate versus fortunate outcomes takes place (Late Positive Potential). Thus, neural online measures capture a stepwise unfolding impact of social factors during language comprehension, which include a facilitated processing of misfortunes when they happen to occur to antisocial peers (i.e., schadenfreude).

Heterogeneity of adaptive features among psychopathy variants.

Psychopathic personality traits can be conceptualized as a complex network of adaptive and maladaptive traits. Although general positive adjustment has been related to primary psychopathy and increased emotional stability, no study focused on the distribution of specific adaptive traits through psychopathy variants. Participants were 2,291 French college students who completed self-report questionnaires. A cluster analysis, based on a 4-factor model of psychopathy (Antagonism, Narcissism, Disinhibition, and Emotional Stability), was performed on a subsample with increased psychopathic traits (n = 378) and yielded 3 distinct groups: a primary psychopathy cluster, a secondary psychopathy cluster, and an emotionally stable-low antagonism cluster. The primary psychopathy cluster displayed the highest scores of Leadership, Logical Thinking, Focus, Management, and Money Smart, whereas the emotionally stable-low antagonism cluster had the highest scores of Composure and Extraversion. Conversely, the secondary psychopathy cluster exhibited reduced adaptive psychopathic traits. These results suggest that adaptive psychopathic traits are inconsistently distributed between psychopathy subtypes. Interaction effects between main factors of psychopathy are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Amygdala functioning during threat acquisition and extinction differentiates antisocial subtypes.

Extensive work implicates abnormal amygdala response during threatening stimuli in youth with antisocial behaviour. However, no research has examined whether youth identified in Primary and Secondary psychopathy subtypes would show differences in amygdala activity in response to threat acquisition and extinction. Latent profile analysis (LPA) was used to identify distinct antisocial groups based on participants' scores on callous-unemotional (CU) traits, anxiety, and familial abuse in a sample of 136 high-risk adolescents (mean age = 17.7, SD = 1.6; 86% male). Functional MRI was then used to assess amygdala activation patterns during a classical differential delay threat-conditioning task. In addition to the Primary and Secondary subtypes, we identified groups mainly high on anxiety and others who were mainly high on abuse. Participants in the Primary group showed lower right amygdala activity in response to neutral male faces compared to the low, Anxious, and Secondary groups, whereas participants in the group with history of abuse exhibited higher right amygdala activity during threat acquisition compared to the rest of the groups. During threat extinction, the Primary group showed lower right amygdala activity compared to the Secondary and abuse groups. This is the first study to reveal amygdala activation in identified psychopathy-related variants during threat conditioning. We found that stratifying the sample based on the identified variants revealed amygdala functioning patterns that furthered our understanding of emotion-based deficits among high-risk adolescents.

Aberrant personality tendencies and academic success throughout engineering education.

OBJECTIVE: In a longitudinal field study, we investigated the predictive associations between six aberrant personality tendencies (schizotypal, avoidant, borderline, antisocial, narcissistic, obsessive-compulsive) and academic success of science, technology, engineering, and mathematics students. METHOD: Bachelor students of Industrial Engineering at a Dutch technical university (N = 432, Mage  = 18.45; 87.3% male) filled out the NEO-PI-R and aberrant tendencies were operationalized by the five-factor model (FFM) compound technique. Indicators of academic achievement (grades) and persistence (credit points earned per year, re-enrollment, study duration) were made available by the academic office. RESULTS: Validities across the 3 years of the study program consistently support the role of two aberrant tendencies: Individuals with high antisocial tendency reached lower academic achievement, took longer to finish their study, and had a higher risk of dropout. The obsessive-compulsive tendency was associated with higher grade-point average, faster study progress, and higher retention rates and effects were still visible while controlling for known predictors (high school grades, Conscientiousness). Contrary to our expectations, we found no evidence for inverted U-shaped relationships. CONCLUSIONS: We used the compound technique for aberrant tendencies based on the FFM in the academic context and our findings support the importance of personality-based psychopathological tendencies for academic success.

Abnormalities of the late positive potential during emotional processing in individuals with psychopathic traits: a meta-analysis.

BACKGROUND: Individuals with psychopathic traits display deficits in emotional processing. A key event-related potential component involved in emotional processing is the late positive potential (LPP). In healthy controls, LPP amplitude is greater in response to negative stimuli than to positive or neutral stimuli. In the current study, we aimed to compare LPP amplitudes between individuals with psychopathic traits and control subjects when presented with negative, positive or neutral stimuli. We hypothesized that LPP amplitude evoked by emotional stimuli would be reduced in individuals with psychopathic traits compared to healthy controls. METHODS: After a systematic review of the literature, we conducted a meta-analysis to compare LPP amplitude elicited by emotional stimuli in individuals with psychopathic traits and healthy controls. RESULTS: Individuals with psychopathic traits showed significantly reduced LPP amplitude evoked by negative stimuli (mean effect size = -0.47; 95% CI -0.60 to -0.33; p < 0.005) compared to healthy controls. No significant differences between groups were observed for the processing of positive (mean effect size = -0.15; 95% CI -0.42 to 0.12; p = 0.28) and neutral stimuli (mean effect size = -0.12; 95% CI 0.31 to 0.07; p = 0.21). CONCLUSIONS: Measured by LPP amplitude, individuals with psychopathic traits displayed abnormalities in the processing of emotional stimuli with negative valence whereas processing of stimuli with positive and neutral valence was unchanged as compared with healthy controls.