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Neurochemistry and Neuroanatomy of APD

Neurochemistry and Neuroanatomy of APD. Background. Most research focused on behavioral disturbances APD Impulsive Aggression Criminality CD and ODD Externalizing disorders Novelty Seeking Sensation Seeking Little empirical attention to affective-interpersonal factor of psychopathy.

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Neurochemistry and Neuroanatomy of APD

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  1. Neurochemistry and Neuroanatomy of APD

  2. Background • Most research focused on behavioral disturbances • APD • Impulsive Aggression • Criminality • CD and ODD • Externalizing disorders • Novelty Seeking • Sensation Seeking • Little empirical attention to affective-interpersonal factor of psychopathy

  3. Neurochemical Disturbances • Monoamine neurotransmitters • Serotonin • Dopamine • Epinephrine and Norepinephrine • Hormones • Testosterone • Cortisol • Thyroid

  4. Serotonin • Lower levels of serotonin consistently associated with • Aggression • Criminal behavior • Suicidal behavior • Disturbances in serotonergic functioning early in life closely related to behaviors that progress to APD • Disruptive behavior disorders • Aggression • Family history of APD

  5. Serotonin deficits more fundamentally linked to Factor 2 features of psychopathy (impulsive-antisocial) • Serotonin levels • Low in spinal fluid • High in blood platelet cells • Specificity of site unclear but evidence points towards deficient serotonin precursor uptake or synthesis

  6. d-fenfluramine • Releases synaptic serotonin to activate postsynaptic serotonin receptors. The functional status of the serotonin is measured by levels of peripheral prolactin • Blunted prolactin response to fenfluramine • Convicted murderers w/APD • APD heroin users • Increased impulsive aggression • Children with aggressive and antisocial relatives

  7. Genetic polymorphisms • Variations in the DNA sequence coding • Dopamine • THP • Serotonin Transporter • MAO-A • Norepinephrine

  8. Hormones • Testosterone levels higher in violent people engaging in violent and aggressive behavior. Also related to hostility. • After age 25 • androgen levels decrease • violent crime rates decrease

  9. Dabbs & Morris (1990) • Studied 1,496 Vietnam Vets • Vets with high testosterone levels and low social integration (e.g., low SES, unmarried) most likely to be delinquent

  10. HPA Axis functioning • Low cortisol response related to violent offending, physically abusive behavior, aggressiveness, externalizing symptoms in childhood • Unclear whether this is a blunted basal output or a blunted cortisol response to stress

  11. Physiological Arousal • Antisocial personalities have lower resting heart rates (Raine, 1993) • Ortiz and Raine (2003) Meta-analysis • Anti-social behavior in children • 40 studies, n = 5,868, d = -.44 • Theories • reduced fear • autonomic underarousal

  12. Complications During Birth • Violent offenders more likely than nonviolent or non-criminals to have had a complicated birth • Likelihood of violence increases with complicated birth and • parental psychiatric illness or • minor physical anomalies

  13. Head Injuries • Study of death-row inmates (Lewis, 1986) • All 15 claimed a history of head injury • 12 of 15 showed neurological impairment • Study of 14 death-row juvenile offenders (Lewis et al., 1988) • All 14 had history of head injury • 8 of 14 severe enough to be hospitalized • Study of 16 death row inmates (Freedman & Hemenway, 2000) • 88% (14) had history of head injury • 88% had been physically or sexually abused • 88% had parents who abused drugs and alcohol

  14. Arthur ShawcrossGenesee River Killer • Killed 2 children, 11 prostitutes • Head injuries • 09 Hit in head with stone • 10 Hit head jumping into lake • 16 Hit in head with discuss • 17 Hit in head with sledge hammer • 23 Fell 40’ from ladder and hit his head, was unconscious

  15. David Berkowitz“Son of Sam” • Killed 6, started over a thousand fires • Head injuries • 7 Hit by a car, suffered head injuries • 7 Ran into a wall and suffered head injuries • 8 Hit in the head with a pipe, 4-inch gash in forehead

  16. Richard Ramirez“The Night Stalker” • Killed 14 • Head injuries • 02 Dresser fell on his head, received 30 stitches, almost died • 06 Hit by a swing, knocked unconscious, caused a deep gash • 11 Diagnosed with epilepsy

  17. Robert Garrow • Killed 7 people • Head Injuries • 2 years old: Mother splits his head open with a crowbar during a beating • 5 years old: Knocked unconscious when mother hits him in the head with a piece of wood • 6 Years old: Beaten unconscious by his father • 36: Receives head injury in auto accident

  18. Raymond Fernandez • Killed 17 people in the late 1940s • History • Normal, friendly personality prior to injury • Hit on head with a steel hatch cover • In coma for a week • Complete personality change • Killed 17 women over next few years • Executed in Sing Sing in 1951

  19. Brain Abnormalities

  20. Brain Damage • 57% of violent criminals • 94% for homicide • 78% for rape • 61% for habitual aggression • 49% for pedophiles • 15% of criminals committing single violent act • 3% of the general population • Damage is typically in the prefrontal area

  21. Prefrontal Cortex • Frontal Lobe: Orbitofrontal Cortex (OF) • poor impulse control • explosive, aggressive outbursts • lack of interpersonal sensitivity • Frontal Lobe: Ventromedial (vm) Prefrontal • judgment, awareness of socially appropriate conduct, assessing consequences

  22. Prefrontal Cortex • Antisocial/Violent Behavior • Reduced activation related to impulsive aggressive acts • Psychopaths • Increased activation during emotionally challenging tasks

  23. Corpus Callosum • Structural abnormalities • Social, autonomic, and emotional impairment • “faulty wiring”

  24. Amygdala • Arousal • Controls Autonomic Responses Associated with Fear • Emotional Responses

  25. Hippocampus • Hippocampal impairments • Affect dysregulation • Poor contextual fear conditioning

  26. Psychopathic Traits • Enlarged corpus callosum • Reduced posterior hippocampus volume • Exaggerated right > left anterior hippocampus asymmetry • Reduced prefrontal gray volume

  27. Psychopaths • Increased prefrontal white matter in deceitful/cunning/manipulative behavior • Reduced amygdala volume in violent offenders with high psychopathy scores • Reduced prefrontal gray volume with psychopathy factors

  28. APD – Violent Behavior • Reduced prefrontal gray matter • Reduced temporal lobe volume • Reduced posterior hippocampal volumes • Increased collosal volume • No amygdala differences

  29. Treatment

  30. Messina et al (2003) • Background • Literature unclear whether ASPD is predictive of substance abuse treatment responsivity • Hypotheses for ASPD patients • CBT, CM, & CBT + CM > MM • CBT < CM < CBT + CM • CM effects decrease significantly during post-treatment

  31. Procedure • 120 MM patients randomly assigned to CBT, CM, CBT + CM, or MM • 16 weeks of treatment • Outcome measures • Urine samples • Attendance

  32. Results In-Treatment • ASPD significantly and positively related to treatment responsivity • All conditions better than control for ASPD, but not for non-ASPD • ASPD patients in CM condition significantly more likely to be abstinent during treatment than CBT condition. No diff between CM and CBT + CM. • ASPD CM > non-ASPD CM

  33. Results Post-Treatment • ASPD CM - highest level of abstinence • ASPD: CM, CBT, & CBT + CM > MM • Non ASPD: No between group differences

  34. Digiuseppe • Proposed components of effective tx for anger management: • Therapeutic alliance • Motivation for change • Manage physiological arousal • Cognitive change • Behavior change • Relapse Prevention

  35. Secondary targets • Manage impulsive behavaiors • Forgiveness • Systemic interventions • Rebuilding relationships • Environmental supports • Treatment manuals

  36. Treatment for Psychopathy • Therapeutic Communities • Lower recidivism for non-psychopaths and higher recidivism for psychopaths (violent) • Did the new skills actually aide the psychopaths in manipulating others? • CBT • Inconclusive • In one study psychopaths rated as showing the most improvement after tx were the most likely to re-offend. Why?

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