Neuropsychology and Law Task 4 PDF

Problem 4: LG1: What is psychopathy? Are psychopaths born or bred? How can you determine if someone is a psychopath? Kiehl (2010): Inside the Mind of a Psychopath Psychopaths lack empathy, they lie and manipulate yet feel no compunction or regrets....

Problem 4: LG1: What is psychopathy? Are psychopaths born or bred? How can you determine if someone is a psychopath? Kiehl (2010): Inside the Mind of a Psychopath Psychopaths lack empathy, they lie and manipulate yet feel no compunction or regrets. However, they fake normal emotions. Often called mask of sanity They feel irritated when they don’t get their way and turn to risky behaviours for the flimsiest of reasons They offend earlier, more frequently and more violently than others Are four to eight times more likely to commit new crimes on release Correlation between how high people score PCL-R and how likely they are to violate parole Have trouble making appropriate moral value judgements and putting the brakes on their impulses. Hampered in how they respond to emotions, language and distractions, sometimes seen already by age 5 Have trouble detecting emotions, especially fear, in people’s voices (miss emotional nuances of language) and facial expressions Psychopaths have trouble shifting gears, even when their current strategy for obtaining their goal is failing Do not take in new information when their attention is otherwise engaged They have normal physiological reactions to unpleasant stimuli, except when their attention is directed elsewhere Paralimbic system Interconnected brain structures that are involved in emotion processing, goal seeking, motivation and self-control Psychopaths show a pronounced thinning of the paralimbic tissue, indicating that this part of the brain is underdeveloped A. Orbitofrontal Cortex: Involved in sophisticated decision-making tasks that involve sensitivity to risk, reward and punishment. a. People whose brains are damaged in this area develop problems with impulsivity and insight and lash out in response to perceived affronts B. Amygdala: Generates emotions such as fear C. Anterior Cingulate Cortex: Regulates emotional states and helps people control their impulses and monitor their behaviour for mistakes D. Insula: Recognizing violations of social norms, experiencing anger, fear, empathy and disgust. Also involved in pain perception a. Psychopaths can have unusually high disgust thresholds, tolerating repellent smells and images with equanimity Are psychopaths made or born? Probably both. 1. Genes account for 50% of the variability among those who exhibit adult antisocial traits 2. Environmental factors are just as important as biological inheritance a. There may be an early window for developing the social and cognitive skills that underlie what we call conscience Treatment: A new treatment for intractable juvenile offenders with psychopathic tendencies has had tremendous success. Intensive one-on-one therapy known as decompression aimed at ending the vicious cycle in which punishment for bad behaviour inspires more bad behaviour, which is in turn punished. Over time, the incarcerated youths in this program act out less frequently and become able to participate in standard rehabilitation services. LG2: Are psychopathic features linked to brain abnormalities? Hofhansel (2020): Morphology of the criminal brain: gray matter reductions are linked to antisocial behavior in offenders Individuals with high psychopathic traits, commit more violent crimes and have higher rates of criminal recidivism compared to non-psychopaths There is a strong association between violent criminal behaviour and psychopathy Psychopaths engage in both affective and impulsive antisocial behaviour, and aggression can be reactive-impulsive and proactive-instrumental. Distinct neural networks and brain regions that amplify these different behaviours are expected to be involved Several studies reported that a) Decreased Gray Matter Volume (GMV): is associated with increased aggressive behaviour in frontal, temporal, occipital and parietal lobe areas a. More specifically in the dorso and ventrolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, lateral and medial parts of the temporal lobe, the temporal poles, insula, postcentral gyrus, fusiform gyrus, superior and inferior parts of the parietal lobes and the cerebellum. b) Increased Gray Matter Volume (GMV): is associated with violent behaviour a. Especially in the striatum, thalamus and hypothalamus These results underline a two-fold problem: 1. Biomarkers for both psychopathic and aggressive behavior might be undistinguishable or have substantial overlap. 2. There is evidence that both, increases and decreases of regional brain volumes have been linked with psychopathy and aggression Behavioral studies have distinctively analyzed the sub-features that individually contribute to psychopathy and aggression separately and further, focused on their dimensional character. AIM: Identify brain structure characteristics of psychopathic and aggressive behavior An experiment was set up to focus in particular on the link of sub-factors contributing to these two constructs with brain morphology A violent cohort was recruited was assessed in both, psychopathy as well as trait aggression and respective sub- factors of the two constructs were independently examined. They also had a non-criminal control group Hypotheses: 1. Authorst would find GMV reductions in offenders compared to a respective control group in prefrontal, temporal and parietal regions 2. It was expected that specific components of aggressive and psychopathic behavior would be associated with distinguishing brain morphology characteristics a. First Dimension of Psychopathy: Is defined by instrumental, proactive aggression and emotional detachment, that could previously be linked to lack of empathy and guilt in addition to low reactivity to stress and punishment i. They expected to find structural alterations in brain regions involved in affective components of moral decision making, such as the amygdala, but also in orbitofrontal, anterior cingulate, insula and temporal cortices b. Second Dimension of Psychopathy: Is reactive aggression and impulsive–antisocial behavior that is highly associated with the inability of offenders to control their behavior and modulate the intensity of their negative responses. i. Negative correlations of reactive aggression and GMV in ventromedial prefrontal, temporal and the temporo-parietal junction regions involved in behavioral control, response inhibition and cognitive components of empathy were to be expected Methods: Participants: 67 male violent offenders were recruited from three different parole offices in Aachen. A male control group without any criminal background was recruited by public advertisement. Neuropsychological assessments and psychiatric screenings were performed with all participants Participants were excluded a) If they had an acute mood, psychotic or anxiety disorder, b) If any type of opiates had been taken in the past 12 months c) If they exceeded the age range of 18-55 years, and if they held any contradictions for MRI measurement 27 criminal offenders and 28 controls were left eligible for participation in this study. All criminal offenders were convicted for at least one violent crime, such as armed robbery (in 13 cases), assault (eight cases), burglary (two cases), sexual offence (two cases) or manslaughter (two cases) Neuropsychological Testing: Performed with several tests A. Verbal Crystalized Intelligence Test (WTS): estimated the IQ of participants B. Aggression Questionnaire (AQ) and Reactive-Proactive Aggression Questionnaire (RPQ): measured trait aggression C. Psychopathy Checklist–Revised (PCL-R): was used to obtain psychopathy scores of criminal offenders a. The score ranges from 0 to 40 and reflects the dimension of the participants’ psychopathic traits b. Psychopathic behaviour is divided in two dimensions  i. Factor 1: interpersonal and affective aspect issues, now divided in 1. Facet 1 (Interpersonal Problems): glibness, superficial charm, grandiose self-worth and pathological lying 2. Facet 2 (Specifically Affective Traits): lack of remorse, responsibility or guilt, shallow effect and callousness ii. Factor 2: antisocial deviant behaviour, now divided in 1. Facet 3 (Lifestyle): stimulation seeking behaviour, impulsivity and lack of realistic goals 2. Facet 4 (Antisocial Sub-Scale): Poor behavioural control, revocation of conditional release, juvenile delinquency and criminal versatility MRI Data Acquisition: Collected using a 3-Tesla PRISMA MR scanner MRI Data Preprocessing: A voxel-based morphometry (VBM) analysis was performed using the CAT12 toolbox Standard processing involved four steps: 1. Tissue Segmentation: Classification of grey matter, white matter and cerebrospinal fluid of the individual raw T1 images 2. Standard Tissue Probability Maps (TPM): All images were affine registered to standard tissue probability maps by correcting individual head positions and orientations and were translated into Montreal Neurologic Institute (MNI) space. 3. Normalization: Corrected for volume changes of the segmented images by applying linear deformation 4. Smoothing: Modulated grey matter images were smoothed with a Gaussian kernel of 8 mm full width at half maximum (FWHM) Results: The group of violent offenders had less years of education and lower levels of verbal intelligence compared to the control group. Higher levels of anger, physical, reactive and proactive aggression were observed in the criminal cohort. No significant group differences were found for age, verbal aggression and hostility.  Table 1: Sample characteristics and group comparisons Correlational analyses between aggression and psychopathy subscales yielded throughout positive associations The strongest effects were observed by correlating antisocial behaviour (PLC-R facet 4) with physical (AQ) and reactive aggression (RPQ) Table 2: Correlation of trait aggression and psychopathy in offenders MRI Data Results: a. correlation of Trait aggression and psychopathy with gmv in offenders Model 1: Whole brain multiple regression analyses in the offender group were performed with each sum- and sub-scale of the psychopathy and aggression tests separately. Revealed significant negative correlations of both constructs with GMV Model 2: Results of analyses including all sub-scales into statistical design  Table 3: Negative correlations of grey matter volume (GMV) with aggression and psychopathy in offenders Global psychopathy (PCL-R sum score) was negatively linked with GMV in prefrontal regions Determined by the negative correlation of the second factor of the PCL-R (impulsive–antisocial behavior) and more specifically with the fourth facet (antisocial behavior) of the scale. Antisocial behavior correlated negatively with GMV in the right middle and superior temporal gyrus, right superior frontal and left inferior parietal regions Only one sub-scale of the trait aggression scales correlated significantly with the offenders GMV. RPQ reactive aggression was negatively linked with GMV in the right middle and superior temporal gyrus No other sub-scales of the AQ, RPQ and PCL-R correlated significantly with the GMV of offenders. Figure 1: Negative correlations of grey matter volume (GMV) with aggression and psychopathy in offenders A: Negative correlations resulting from whole brain multiple regression analyses with a cluster-defining threshold of p < 0.05 of GMV with antisocial behaviour (PCL-R), reactive aggression (RPQ) in offenders , implementing total intracranial volume (TIV) and age as covariates b. overlap in comparisons of grey matter volume One region in the right temporal cortex emerged in two in separate analyses. To identify the overlap, the results from the regression analyses of RPQ reactive aggression x GMV and PCL-R antisocial behaviour (facet 4) x GMV were transformed into one unified MNI space and the MANGO function “create logical overlays” was used One cluster (952 mm3) in the right middle temporal gyrus was found to be negatively correlated with both measures B: Illustration of cluster emerging from the overlap of both results (RPQ reactive aggression × GMV and PCL-R antisocial behavior (facet 4) × GMV) comprising the right middle temporal gyrus. Group comparisons of grey matter volume No significant group difference in a voxel-by-voxel whole brain group comparison using TIV, IQ and age as control variables could be found However, a stronger trend could be determined in the total GMV Discussion In a cohort of 27 male criminal offenders less gray matter was found in the superior frontal gyrus with increasing psychopathy. This result was exclusively borne by the antisocial behavior facet of psychopathy, after no other sub-scales of the PCL-R could be significantly linked to brain structure specifics. Antisocial behavior of the offenders was associated with volume reductions in right superior frontal gyrus, right middle and superior temporal regions, and in left inferior parietal lobe. Particularly to highlight are the strongly pronounced effects in the right temporal lobe, which also became evident by a correlational analysis of offenders’ brain structure with reactive aggression. Also, no differences in gray matter volume between offenders and controls could be found. An inverse correlation between global psychopathy and grey matter volume was found. The higher the PCL-R sum scores of the offenders were, the less GMV was found in the superior parts of the prefrontal cortex. This links global psychopathy with particular prefrontal gray matter volume reductions, albeit positive correlations between PCL-R sum scores and prefrontal volumes were also reported  With increasing PCL-R facet 4 scores, i.e. severity of antisocial behaviour, greater volume reductions were found in the right superior frontal gyrus, the right middle and superior temporal regions and the left inferior parietal lobe. Premise: morphological alterations are not equivalent to the functionality of the particular brain regions. With increasing antisocial behavior tissue volumes are reduced in regions belonging to a fronto-temporo-parietal network, suggests a link between cognitive control and antisocial behavior. This network is associated with high cognitive functioning, intelligence and mental flexibility o Disturbances have been reported in patients with impulsive–compulsive behavior and antisocial personality disorder or psychopathy Theory of Mind: A prerequisite for all social behavior is a person’s ability to make assumptions about internal and mental states of another person, to predict others feelings, intentions, ideas and opinions. These social skills are often impaired in psychopathic or aggressive populations Has two dimensions 1. Cognitive ToM: understanding others’ beliefs, intentions and motivations 2. Affective ToM: understanding others feelings, empathy On the one hand, emotionally detached psychopaths (PCL-R factor 1) showed less empathy (affective ToM), while no deficits in tasks assessing cognitive ToM were observed Low levels of cognitive ToM were linked with high reactive aggression and high affective ToM levels could be associated with proactive aggression in children A negative link between antisocial behavior with tissue volume in regions overlapping with the cognitive ToM network was found Such as dorsomedial parts of the prefrontal cortex (i.e. the superior frontal gyrus), the tempo-parietal junction (i.e. inferior parietal regions) as well as in the middle temporal gyrus. The fronto-temporo-parietal network is further involved in information processing, and in particular in attention A well-established theory of social interaction deficits postulates that psychopaths have difficulties to continuously update incoming situational information when once being engaged into goal-oriented behavior Response Set Modulatiuon Hypothesis: suggests that psychopaths often involuntarily neglect especially affective information (“bottle neck theory”), particularly if they are not relevant for the targeted outcome of the situation. These disruptions in selective attention processes might originate in corrupted top-down inhibitory quality of cortical regions on limbic neural activity. Interestingly we find GMV reductions in those cortical regions relevant for selective attention with increasing antisocial behavior. Hence we conclude, that problems in attention setting, shifting and updating might be linked with the antisocial behavior facet of the PCL-R. There is a relationship between temporal grey matter reduction has been associated with impulsive aggressive behaviour  Diseases accompanied by aggressive symptoms involve neurodegenerations or dysfunctions of particularly temporal regions. Group Comparisons Strong trends but no significant group differences in GMV were found in a whole brain analysis after controlling for TIV, age and IQ. Comparisons with other studies are impeded by two major aspects. 1. Most of the reported studies analyzed regional gray matter volumes (ROI) rather than applied a whole brain approach which might results in diminished comparability of the results. 2. Null-results might be related to the characteristics of our cohorts. a. Although all offenders were convicted for at least one violent crime and displayed significantly higher levels of trait aggression compared to the controls, test scores of the PCL-R, AQ and RPQ did not reach the top percentile of the scales normatives. Limitations: a) Differences between the offender and control groups, as offenders had significantly lower verbal IQ, fewer years of education, and a higher prevalence of substance use disorders. a. Despite efforts to match the control group on these variables, an ideal non-criminal control group was not achieved, leaving potential influences on brain morphology unaccounted for. b. However, the main findings were based on correlational analysis within the offender group, which was fairly homogeneous in terms of IQ and substance use disorders. b) Psychopathy was only assessed in offenders using the PCL-R, as this instrument is designed for forensic populations and not suitable for community samples. c) Lastly, the small sample size (27 participants per group) is a limitation, although it still offered substantial statistical power Conclusion: Psychopathy (antisocial traits) is associated with grey matter volume (GMV) reductions in brain regions related to social information processing and cognitive functioning Such as the prefrontal, temporal, and parietal regions. Different components of psychopathic or aggressive behaviour correlate differently with whole-brain GMV. Antisocial behaviour and reactive aggression were significantly associated with GMV reductions, while traits like emotional detachment and proactive aggression showed no such association. Indicates that specific sub-factors of psychopathic and aggressive behaviour have a greater influence on brain structure.  Ling (2018): The Neuroscience of Psychopathy and Forensic Implications Aim: Reviewing brain imaging findings (MRI) on psychopathy of forensic and community samples and their relevance to the criminal justice system § Children exhibiting disruptive behaviour disorders (e.g. conduct disorders), and callous-unemotional traits (e.g. lacking guilt, remorse, empathy) o Aggressive, socioemotionally impaired and exhibit stable trajectories of antisocial behaviour § Adult psychopathy Neural correlates of psychopathy: a. Prefrontal Cortex (PFC): Contributes to behavioural disinhibition and poor representation of expected values. Damage to this region can result in pseudopsychopathic personality and behavioural changes structure: Grey Matter: Psychopathy has been associated with reduced PFC volume and thickness § PFC grey matter volume has been negatively associated with total PCL-R scores as well as Factor 1 (Interpersonal-Affective) and Factor 2 (Lifestyle-Antisocial) OFC grey matter reductions are associated with psychopathy in incarcerated and community samples with high levels of psychopathy White Matter: Reductions in white matter have also been found to be associated with psychopathy. § Reduced fractional anisotropy (FA), a measure of white matter integrity, in the uncinated fasciculus (UF; white matter tract connecting the PFC with subcortical structures) in psychopathic individuals compared to non- psychiatric controls § This was true also for psychiatric controls with a history of drug abuse and institutionalization. Moreover, this result was found to be specific to the VMPFC/OFC – amygdala network, with no differences in the inferior longitudinal fasciculus or inferior fronto-occipital fasciculus tracts. § Psychopathic individuals had reduced integrity in the right UF. Present also reduced cortical thickness § There is evidence of reduced cortical thickness in the right OFC compared to non-psychopathic adult males after controlling for age, gender, and substance abuse § Reduced cortical thickness in the OFC and temporal regions has been associated with incresed response preservation in psychopathic individuals  o Inappropriate repetition of a particular response despite negative feedback There is evidence of increased OFC grey matter volumes in conduct-disordered males with callous-unemotional traits § CU traits may have a suppressor effect that could explain null or inconsistent findings within youth Function: Ventromedial Prefrontal Cortex/Orbitofrontal Cortex (VMPFC/OFC): Involved in linking potential decision outcomes with associated emotion based upon previous experiences of reward or punishment § It represents the value of goal-directed outcomes and options and regulating negative affect by exerting top- down inhibition of amygdala activity Patients with VMPFC lesions or damage who have exhibited psychopathic-like features (Phineas Gage) because of the disruption of decision-making processes Reduced functional connectivity between the VMPFC and the amygdala during rest have been found in psychopathic adults There is reduced PFC activation in psychopaths during fear conditioning tasks, while observing pain and distress cues expressed by others compared to antisocial individuals o This also happens during the perception of fear, sadness, happiness and pain expressions compared to non-psychopathic controls Psychopathic youth demonstrate abnormal PFC functioning. Children with psychopathic traits demonstrated increased VMPFC activity during punished reversal errors while healthy children and children with ADHD exhibited decreased BOLD responses compared to correct rewarded responses o The lack of typical reduction in VMPFC activity has been interpreted as impairments in appropriate processing of reinforcement expectation violations. Demonstrate reduced OFC activity to early stimulus-reinforcement exposure and rewards in a passive avoidance task b. Amygdala: Is considered the center for a range of affective processes such as empathy and fear conditioning, as well as emotion and affect recognition. Dysfunction can disrupt the ability to form stimulus- reinforcement associations, which can result in the inability or impaired ability to anticipate negative consequences associated with socially unacceptable behavior. o Can also contribute to pervasive emotion recognition deficits structure: Reduced amygdala volume has been found in psychopathic adults (in forensic and community samples), with bilateral reductions in the basolateral, lateral, cortical, and central nuclei of the amygdala Some studies have found amygdala gray matter concentration to be positively associated with conduct disorder but negatively associated with callous–unemotional traits function: Amygdala dysfunction is thought to be most relevant to the development of callous and unemotional traits and instrumental antisocial behavior No limbic activity in response to negative words compared to neutral words o This amygdala dysfunction is thought to contribute to poor affective processing and recognition but not prosopagnosia Have deficits in recognizing any type of emotion Psychopathy scores are negatively correlated with amygdala activation in incarcerated male youth when viewing unpleasant images with and without moral transgressions Youth with conduct disorder exhibit reduced amygdala activation for affective relative to cognitive theory of mind judgments Conduct disordered youth with callous–unemotional traits show reduced amygdala responses when performing tasks that engage either empathic responding or threat assessment This is not observed in conduct disordered youth alone c. striatum: Implicated in interpersonal-affective and impulsive-antisocial features of psychopathy, and has been associated with reward- seeking and impulsive behavior A. Ventral Striatum (nucleus accumbens) B. Dorsal Striatum (caudate, putamen, and globus pallidus), structure: Evidence of increased striatal volume in psychopathic individuals. A 9.6% increase in striatal volume was found in psychopathic individuals compared to controls matched for age, sex, ethnicity, and substance dependence Is associated with psychipathy severity in community and forensic samples Conduct disordered youth typically exhibit reduced striatal volumes  However, other studies found that putamen enlargements were correlated with increased psychopathic traits in a sample of adolescents. function: PCL-R Factor 2 (Lifestyle-Antisocial) scores to be associated with aberrant connectivity between the striatum and other brain areas, including the dorsolateral PFC and the ventral midbrain. Impulsive-antisocial features of psychopathy have been associated with amphetamine-induced dopamine release in the ventral striatum during anticipation of a monetary reward In contrast, reduced ventral striatal activity was found in psychopathic offenders in response to negatively- valenced stimuli compared to non-psychopathic offenders and non-criminal controls Psychopathic youth may also have difficulties in processing the omission of reward, which could result in difficulties in shifting behaviour when environmental contingencies change Forensic implications: Presenting a neural basis for such impairments could affect the criminal justice experience of psychopathic offenders. Although neuroscience should not be used as an excuse for criminal behavior it might provide explanations and provide guidance for better policies and sanctions. prediction: Scores on clinical and self-report psychopathy assessments have been used to predict both violent and non-violent criminal behaviour and recidivism Some evidence demonstrated that low anterior cingulate cortex (ACC) activity, a prefrontal-limbic area (involved in functions such as error detection/correction and performance monitoring) increased the likelihood of rearrest for adult offenders o Reduced amygdala volumes are associated with a threefold increase in violence three years post- scanning interventions: Most effective way to address the societal impact of psychopathy is through prevention during prenatal and early childhood periods, as these are crucial times for neurodevelopment. Early intervention, such as promoting proper prenatal care, nutrition, emotional intelligence, and strong parent–child bonds, can help prevent the development of psychopathic traits. While treatment for individuals with established psychopathic traits is challenging, intensive programs combining cognitive–behavioral therapy, family therapy, and pharmacological treatments have shown some effectiveness, especially in youth. Biological interventions, such as brain stimulation techniques, which have shown potential in altering emotional processing, impulsivity, and aggression, but ethical concerns remain. Tailoring treatments based on individual biological characteristics, like brain structure and function, may improve the effectiveness of interventions for psychopathic individuals.  Sanctions and risk assessments: Traditional harsh sanctions may be ineffective for psychopathic individuals Due to deficits in brain regions like the prefrontal cortex (PFC), amygdala, and striatum, which affect their ability to learn from outcomes and understand moral responsibility. There is debate over whether psychopathic offenders should be held fully responsible for their actions, with some arguing for alternative punishments, while others believe they should be held accountable within the traditional criminal justice system. Perceptions of psychopathy often result in harsher sentencing, as these individuals are seen as more dangerous and unresponsive to treatment. Neuroscientific evidence can act as a "double-edged sword" in court, either mitigating sanctions by showing reduced culpability due to brain abnormalities or leading to harsher sentences if viewed as evidence of inherent danger. Presenting neuroscientific evidence, particularly when linked to a biomechanical cause, can result in more lenient sentencing and greater sympathy for defendants Limitations: a) Neuroimaging studies are often correlational and cannot establish causality, typically involve small sample sizes, and have limitations in spatial and temporal resolution. b) Different methods of brain segmentation in structural MRI can lead to varying results, and functional imaging relies on inferences that may not always be accurate, emphasizing the need for replication and the use of supplementary methods. c) Psychopathy research also faces challenges, including inconsistent findings due to differences in measurement methods (categorical vs. dimensional, self-report vs. clinician-rated) and variations in subgroups of psychopathic individuals. d) Additional factors, such as substance use, may contribute to these inconsistencies. These limitations underline the complexity of interpreting and generalizing findings in neuroscientific and psychopathy research. LG3: Can psychopaths be cured? What treatments are there to cure psychopathy? Kiehl (2011): The Criminal Psychopath: History, Neuroscience, Treatment and Economics The best current estimate is that just less than 1% of all noninstitutionalized males age 18 and over are psychopaths Approximately 1,150,000 adult males who would meet the criteria for psychopathy in the United States today And of the approximately 6,720,000 adult males that are in prison, jail, parole, or probation, 16%, or 1,075,000, are psychopaths Thus, approximately 93% of adult male psychopaths in the United States are in prison, jail, parole, or probation. Psychopaths are much more likely than non-psychopaths to be imprisoned for committing violent crimes They are also more likely to finagle an early release using the deceptive skills that are part of their pathologic toolbox, and then, once released, are much more likely to recidivate, and to recidivate violently. The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not formally recognize psychopathy, but uses instead the largely subsuming diagnosis of antisocial personality disorder (ASPD). Psychopathy Checklist (PCL): Combine affective criteria (Factor 1) and socially deviant criteria (Factor 2) Comprises detailed rules for measuring those criteria to create a diagnostic score that has proven valifity and high interrater reliability Figure 1: Relationship between Psychopathy Factors and ASPD, at least in incarcerated populations ASPD fails to capture the affective traits but does a good job of capturing antisocial traits ASPD-targeted treatment will do a good job of reaching prisoners with deviance trait disorders However, ASPD-targeted treatment will not be targeted at all because up to 85% of all prisoners suffer from ASPD. Figure 2: Depicts the comorbidity of substance abuse and psychopathy for incarcerated populations Psychopaths with drug and alcohol problems make up a little less than half of all the incarcerated psychopaths. About 10% of all of the drug treatment efforts in prison are potentially wasted at the outset (on half of the 20% who are psychopaths), unless treaters consider the influence of psychopathy on treatment. Legal Insanity: Terms as ‘mental disease or defect’ do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct. It is arguable that those who lack that moral core might , at the extreme, be no more responsible for their immorality than those who lack the cognitive ability to perceive the world with sufficient accuracy to allow their reason to guide them through it However, the law still excuses harmful acts if the defendant’s ability to perceive the world is so disabled that it renders his rationality useless to him. Arguably, psychopaths are rational since they consider only their self-interests But do they perceive the world with sufficient accuracy to be held responsible for their highly rational manipulations of it? Counterarguments:  a) Malingering: Whenever the criminal law recognizes exceptions to blameworthiness it can count on people faking the excusing conditions. a. This has forced the law to recognize only a few narrow exceptions to responsibility. Only when the clinical sciences can speak with at least some degree of reliability about the excusing conditions. b. If psychiatry will still not recognize psychopathy as a formal diagnosis apart from ASPD, you can be sure the law will not recognize it as an excuse b) M’Naghten Rules: Psychopaths are not deluded at all about the external world, and they certainly do not lack free will, their will is in fact too free. a. Nor can we say that the psychopath should be excused because his defective moral compass rendered his crimes irresistible to him in the sense of the controversial “irresistible impulse” formulation of insanity i. Psychopaths seem perfectly capable of resisting self-harming actions that do not require an understanding of the social network ii. Impulsiveness is a part of psychopathy, but it’s more their lack of empathy that drives them to commit crimes c) Lack of Empathy is Hard to Excuse: How can the system morally punish those of us who on occasion breach the social contract, but forgive a whole category of criminals who breach it all the time for their own gain? a. The system can much better tolerate some moral slippage with an incorrigible 1% of the population than suffer the significant strategic costs a psychopathy defense would cause in the other 99% of cases. Psychopaths disproportionally recidivate and disproportionately commit sex crimes Habitual criminal laws, indetermine sentencing for sex offenders, registration of sex offenders, and special laws on violent sexual predators Table 1: Hare’s Criteria The items corresponding to the early two-factor conceptualization of psychopathy, Subsequent three-factor model, and current four-factor model are listed. The two-factor model labels are Interpersonal-Affective (Factor 1) and Social Deviance (Factor 2); The three-factor model labels are Arrogant and Deceitful Interpersonal Style (Factor 1); Deficient Affective Experience (Factor 2), and Impulsive and Irresponsible Behavioral Style (Factor 3) The four-factor model labels are Interpersonal (Factor 1), Affective (Factor 2), Lifestyle (Factor 3), and Antisocial (Factor 4). Items indicated with “--” did not load on any factor. The Hare instrument requires the clinician to give a score on each of these criteria of 0 (item does not fit), 1 (item fits somewhat) or 2 (item definitely fits).  Hare himself defined psychopathy as a score of 30 or more , which will exclude most individuals with ASPD unless the subject also exhibits a number of interpersonal and affective traits. Typical group studies break down the Hare scores into the low (20 and below), moderate (21–29) and high (30 and above) ranges. Studies also examine whether the different models of psychopathy are related to forensic issues (that is, risk assessment) and neurobiology. Critics: There is skepticism about the clinical reliability of diagnosing and scoring the affective factors Controversy about whether psychopathy is a mental condition or merely a forensic wolf in psychiatric clothing. Concerns about the predictive ability of the PCL-R in youth and therefore about the propriety of the criminal justice system branding people, especially juveniles, as psychopaths. Impact on the criminal justice system: Prevalence: Psychopaths make up roughly 1% of the general male adult population Between 15% and 25% of the males incarcerated in North American prison systems. Psychopaths are 15 to 25 times more likely to commit crimes that land them in prison than non-psychopaths. Psychopathy is highly correlated to being in prison Violent Offending: 62% of the general male prison population is made up of violent offenders, but 78% of imprisoned psychopaths are there because of a violent offense There is few decrease in criminal activity as one get’s older in violent psychopaths Recidivism: Figure 3: Psychopaths are much more likely to recidivate than non- psychopaths After 9 months, more than half of the high psychopaths had not only been rearrested but reconvicted After 3 years, high psychopathy scores bottomed out approximately an 80% recidivism rate  Figure 4: Violent recidivism After the first year after release a whopping 25% of all individuals scoring high in psychopathy were rearrested for a new violent offense After seven years only 25% had not been rearrested for a new violent offense. By the study’s 20-year end, individuals high in psychopathy had a violent recidivism rate of 90%, compared with 40% for individuals scoring low in psychopathy Figure 5: Violent sexual recidivism 75% of all individuals with both a high Hare score and a positive sexual deviance response—defined as a positive penile pleithismograph response to depictions of children, rape cues, or nonsexual violence— committed a new sexually violent crime within 10 years Figure 6: Youth who have both callous-unemotional traits and impulsive traits are at a higher risk for being convicted of a new violent crime. Neuroscience of psychopathy There is abnormal brain function in psychopaths, namely, decresed neural activity in the paralimbic regions of the brain Figure 8: Psychopaths showed decreased activation in the right posterior temporal cortex and increased activation in the amygdala  Figure 9: TOP: Shows neural areas in which criminal psychoapths showed less activity Posterior cingulate, causal and rostral anterior cingulate and ventral striatum Right amygdala-hippocampus BOTTOM: Shows neural areas with greater affect-related activity Bilateral inferior frontal gyrus Psychopaths showed reduced activity in paralimbic regions— amygdala, anterior and posterior cingulate Showed increased activity in the lateral frontal cortex, an area typically associated with cognition, not emotion. Figure 10: Decreased activity in the regions of the brain involved in inhibition overlap the paralimbic regions, primarily the anterior and posterior cingulate. Treatment Caldwell’s Program: Programs for treating juveline psychopaths offenders showing some results Intense, requiring several hours per day Long lasting (a minimum of six months and sometimes even exceeding one year), one on one Focused on the slow and methodical rebuilding of the social connections that are absent in psychopaths. 70% of the control group receiving no treatment was rearrested at least once in the two years, 20% of the group getting traditional group therapy treatment and only 10% of the group getting treatment Figure 11: Recidivism showed a significant decrese for those who got Caldwell’s treatment (56% vs 78%) and this included the category of violent recidivism Treatment has been demonstrated to be ighly effective in reducing both institutional misconduct and recidivism, but only if it was lengthy and only for juveniles scoring in the low to moderate ranges of the PCL-YV (≤ 31)