Psychopathic Patients Research Articles

Would you? Effects of oxytocin on moral choices in forensic psychopathic patients

Psychopaths are suggested to be more likely to favor utilitarian outcomes over non-utilitarian (i.e., deontological) choices. Here we re-test this hypothesis and investigate whether oxytocin, a hormone associated with empathy, can counter this utilitarian effect. Forensic psychopathic patients and non-psychopathic controls participated in a sacrificial moral decision-making paradigm. Psychopathic patients performed the task in a double-blind cross-over placebo-controlled oxytocin administration paradigm. We found no evidence for psychopathic patients to act more utilitarian (or sacrificial) or any effect of oxytocin administration. Psychopathic traits within the control group, particularly traits associated with lack of empathy and failure to consider consequences, were however associated with more utilitarian choices, but only when these actions were low in emotion. In contrast, psychopathy severity in psychopathic patients, particularly impulsivity-related traits, predicts deontological choices, but only in highly emotional actions. Thus, although psychopathic traits do predict utilitarianism when emotional investment is low, this is not the case in full-blown psychopathy. Instead, there is a link between impulsivity and deontological choices in psychopathic patients, but only when emotional investment is high, and self-interest is not at stake. These preliminary results are discussed to whether utilitarian outcomes align with the personal goals of psychopathic individuals.

Revealed masks: Facial mimicry after oxytocin administration in forensic psychopathic patients

Facial mimicry serves as an evolutionarily rooted important interpersonal communication process that touches on the concepts of socialization and empathy. Facial electromyography (EMG) of the corrugator muscle and the zygomaticus muscle was recorded while male forensic psychopathic patients and controls watched morphed angry or happy facial expressions. We tested the hypothesis that psychopathic patients would show weaker short latency facial mimicry (that is, within 600 ms after stimulus onset) than controls. Exclusively in the group of 20 psychopathic patients, we tested in a placebo-controlled crossover within-subject design the hypothesis that oxytocin would enhance short-latency facial mimicry. Compared with placebo, we found no oxytocin-related significant short-latency responses of the corrugator and the zygomaticus. However, compared with 19 normal controls, psychopathic patients in the placebo condition showed significantly weaker short-latency zygomaticus responses to happy faces, while there was a trend toward significantly weaker short-latency corrugator responses to angry faces. These results are consistent with a recent study of facial EMG responses in adolescents with psychopathic traits. We therefore posit a lifetime developmental deficit in psychopathy pertaining short-latency mimicry of emotional facial expressions. Ultimately, this deficit in mimicking angry and happy expressions may hinder the elicitation of empathy, which is known to be impaired in psychopathy.

Sniffing submissiveness? Oxytocin administration in severe psychopathy

Psychopathy is a personality disorder associated with criminal behavior and violent recidivism, and therefore a burden to society. Social dominance is one of the characteristics of psychopathy that might contribute to these problems. Nevertheless, only few studies have objectively measured the relationship between socially dominant behavior and psychopathy. Therefore, the current study assessed performance of 21 forensic PCL-R confirmed psychopathic patients and 24 normal controls on a gaze aversion task, in which slower gaze aversion from masked angry faces compared to masked happy faces is a measure of reactive dominance. Moreover, the current study assessed the potential beneficial effects of the neuropeptide oxytocin. The results showed that psychopaths were not more dominant on the gaze aversion task compared to normal controls. However, the severity of psychopathy was positively correlated with reactive dominance. Crucially, a single nasal spray administration of oxytocin abolished the connection between psychopathy and reactive dominance. This implies that socially dominant psychopaths might benefit from oxytocin administration.

Clinical Appraisals of Individual Differences in Treatment Responsivity Among Patients With Psychopathy: A Consensual Qualitative Research Study

This study addressed which factors expert clinicians consider crucial in successful completion versus dropout in the mandatory forensic psychiatric treatment of psychopathic patients in the Netherlands. Eleven clinicians were interviewed about patient characteristics, treatment (provider) characteristics, and other factors they deemed associated with failure (transfer to another facility) or completion. The interviews were coded using the guidelines of Consensual Qualitative Research (CQR). Overall, extremely high scores on Psychopathy Checklist–Revised (PCL-R) Facets 1 (Deceitful Interpersonal Style) and 2 (Defective Affective Experience) were thought to impede treatment retention, particularly by its negative impact on motivation and therapeutic relationship. Older patients, those with a prosocial network, and/or patients with comorbid borderline traits appeared to fare better. Treatment success was deemed more likely when treatment goals and expectations are stipulated in a concrete fashion, when an extended and gradual resocialization trajectory is offered, and the treatment team is expert, cohesive, and stable.

A Psychopathic Analysis of Death Incidents Occurred in a Military Base in Korea: Implications for Prevention

이 연구의 목적은 군 내 사망사건을 사이코패스 특징과 연계 분석하여 병영 내에서 사이코패스들이 저지르는 범죄피해를 예방하기 위한 방안을 제시하고자 한다. 이를 위해 00사단 임00병장 총기 난사 사건, 00사단 윤00일병 사망사건을 감정⋅대인관계 측면, 행동 양식적 측면에서 사이코패스 성향을 분석하였다. 이 연구결과 예방대책으로는 첫째, 사이코 패스들의 조기식별과 격리를 위한 새로운 인성검사 진단기법이 개발되어야 한다. 둘째, 병영생활 전문상담관, 정신과 전문의 및 간부들에게 개발된 인성검사 진단기법 교육을 통해 사이코패스 식별능력을 길러줘야 한다. 셋째, 수사기관 헌병은 전문프로파일러를 양성하여 사건발생시 원인을 면밀하게 분석하여 국민들이 납득 할 수 있도록 해야 한다.The purpose of this research is to suggest alternatives to prevent a psychopathic crime in a military base by analyzing death incidents occurred in military bases in Korea. Based on the two cases on the “Goseong killing spree incident” and “death incident of Pvt. First Class Yoon”, this research analyzes their psychopathic features with emphasis on emotional, interpersonal, and behavioral perspectives. As the result of the research, some strategies to prevent a psychopathic crime are suggested. First, a new diagnostic test for early identification and isolation of psychopathic patients must be developed. Second, barracks counselors, military surgeons specialized in psychology, military school students, and field executives should have improved capabilities to discern psychopaths through a new method of personality test. Lastly, the military police in the investigation agency should train professional profilers who can accurately investigate a cause of incidents and provide a clear and reasonable explanation to the public.

Brain self-regulation in criminal psychopaths

Introduction: Psychopaths belong to a larger group of people with antisocial personality disorders and can be characterized by several symptoms: deficits in empathy, lack of remorse, impulsivity, aggressiveness and lack of behavioral control. Recent studies support the hypothesis that psychopathic offenders show structural and functional deficits in paralimbic and frontal areas associated with anticipatory planning, emotion regulation, empathy and behavioral inhibition and control. Additionally psychophysiological findings reveal differences in spontaneous brain activity as well as in event related potentials. Based on studies using feedback of slow cortical potentials (SCP-Feedback) in children with Attention Deficit-/Hyperactivity Disorder, we hypothesize that also psychopathic patients can gain volitional control of their brain activity and may profit from learned prefrontal control.

Using MMPI–2–RF Correlates to Elucidate the PCL–R and Its Four Facets in a Sample of Male Forensic Psychiatric Patients

ABSTRACTThis study documents the associations between the MMPI–2–RF (Ben-Porath & Tellegen, 2008) scale scores and the Psychopathy Checklist Revised (PCL–R; Hare, 2003) facet scores in a forensic psychiatric sample. Objectives were to determine how the MMPI–2–RF scales might enhance substantive understanding of the nature of the 4 PCL–R facets and to discern possible implications for the treatment of psychopathic patients. A sample of 127 male forensic psychiatric offenders admitted to a Dutch forensic psychiatric hospital completed the PCL–R and the MMPI–2. Exploratory stepwise regression analyses assessed the prediction of the PCL–R total and its facet scores from MMPI–2–RF scales at its 3 hierarchical levels. Conceptually meaningful results emerged at each level of the MMPI–2–RF hierarchy, including several consistent differences between predictor sets across the facets. Interestingly, ideas of persecution (RC6) was a specific predictor of PCL–R Facet 2, a facet noted for its association with treatment failure. Results are compared and contrasted to the extant body of empirical work to date, and some tentative clinical implications are offered.

Disentangling attentional deficits in psychopathy using visual search: Failures in the use of contextual information

Psychopathic patients show a lack of affective reactivity in threatening situations. Previous research has shown that this lack of affective reactivity can be explained by diminished processing of goal-irrelevant information once psychopathic individuals initiate goal-directed behavior. Although the response modulation theory of psychopathy has claimed that this is caused by deficits in top-down–bottom-up integration of information, it is currently unclear whether it is predominantly bottom-up or top-down attention that is affected. To investigate which aspect of attention is causing these deficits, we administered three visual search tasks in which top-down attention was required to find the target (i.e., search for a specific feature) in the presence or absence of bottom-up and top-down cues. The research group consisted of 30 violent offenders, with varying degrees of psychopathy. Dimensional analyses showed no relationship between psychopathy and deficits in processing bottom-up cues but a strong correlation with deficits in processing top-down cues and core psychopathic personality traits. The current study corroborates the notion that psychopathic traits are associated with response modulation problems, and adds that this is predominantly related to deficits in top-down incorporation of contextual information. Interestingly, this failure of top-down incorporation was observed even when top-down cues were beneficial for current goals.

Clinicians’ emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation.

The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed.

Long-term patterns in interpersonal behaviour amongst psychopathic patients in secure inpatient treatment: A follow-up study.

Psychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., ) found that higher levels of psychopathy led to a specific interpersonal 'trajectory' amongst patients in a secure psychiatric treatment programme during the first 9 months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33 months of treatment. It was found that the more psychopathic patients' increased dominance returned to baseline levels by 33 months, as did the less psychopathic patients' increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent.

Psychopathy - The Polygrapher's Viewpoint

This work examines characteristics of psychopathic patients, the methods of evaluation and recent concepts for validating polygraphs, and important polygraph studies in psychopathic subjects. The purpose of the study is to review what kind of results can be expected from polygraph analyses in respect to psychopathic patients.

Treating the untreatable: A single case study of a psychopathic inpatient treated with Schema Therapy.

From its first conceptualization in modern psychiatry, psychopathy has been considered difficult if not impossible to treat. Schema Therapy (ST) is a psychotherapeutic approach that has shown efficacy in patients with borderline personality disorder. ST has recently been adapted for personality disordered forensic patients, including patients with high levels of psychopathy. The present case study examined the process of individual ST, combined with movement therapy and milieu therapy by the nursing staff, with a forensic inpatient with psychopathic features (Psychopathy Checklist-Revised total score = 28.4). The patient had been sentenced to a mandatory treatment order in relation to a sexual assault. We assessed change using independent assessments of psychopathic traits, cognitive schemas, and risk-related behaviors over the 4-year treatment period and a 3-year follow-up. We also assessed the quality of the working alliance. Reliable change analyses showed significant improvements in psychopathic traits, cognitive schemas, and risk-related outcomes. At 3 years posttreatment, the patient was living independently outside of the forensic institution without judicial supervision and he had not reoffended. While many questions remain about the effectiveness of psychotherapeutic treatment for psychopathic patients, our study challenges the view that they are untreatable.

Deceptive behaviour and instrumental violence among psychopathic and non-psychopathic violent forensic psychiatric patients

Deceptive behaviour and instrumental violence are well-known psychopathic features and as such play important roles in the assessment of psychopathy. This study examined first, the nature of the violence committed by offenders that have been admitted to forensic psychiatric care and whether scores on the Psychopathy Checklist: Screening Version (PCL:SV), Part 1, were associated with the instrumentality of violence. Second, we examined the proneness of offenders to re-frame the instrumentality in their past violent crimes, and whether this was associated with scores on the PCL:SV. The results show that the PCL:SV, Part 1 (interpersonal/affective features), was positively related to the officially coded instrumentality of the violent crimes. As expected, this association disappeared when the instrumentality was self-reported. However, the majority of the patients tended to exaggerate the reactivity of their violent crimes when it was self-reported, indicating that most offenders, independently of level of psychopathy, used deception when questioned about the characteristics of their past violent crimes. The reasons for, and implications of, the use of deception are discussed.

High and abnormal forms of aggression in rats with extremes in trait anxiety – Involvement of the dopamine system in the nucleus accumbens

A better neurobiological understanding of high and abnormal aggression based on adequate animal models is essential for novel therapy and prevention. Selective breeding of rats for extremes in anxiety-related behavior resulted in two behavioral phenotypes with high and abnormal forms of aggression. Rats bred for low anxiety-related behavior (LAB) consistently show highest levels of aggression and little social investigation in the resident-intruder (RI) test, compared with non-selected low-aggressive (NAB) rats. High anxiety-related (HAB) rats also show higher levels of aggression than NAB rats, but to a lesser extent than LAB rats. Accordingly, extremes in inborn anxiety in both directions are linked to an increased aggression level. Further, both LAB and HAB, but not NAB males, display abnormal aggression (attacks towards vulnerable body parts, females or narcotized males), which is particularly prominent in LABs. Also, only in LAB rats, the nucleus accumbens (NAc) was found to be strongly activated in response to the RI test as reflected by increased c-fos and zif268 mRNA expression, and higher local dopamine release compared with NAB males, without differences in local dopamine receptor binding. Consequently, local pharmacological manipulation by infusion of an anesthetic (lidocaine, 20 μg/μl) or a dopamine D2 (haloperidol, 10 ng/μl), but not D1 (SCH-23390 10 ng/μl), receptor antagonist significantly reduced high aggression in LAB rats. Thus, LAB rats are an adequate model to study high and abnormal aggression. In LAB males, this is likely to be linked to hyper-activation of the reward system, as found in psychopathic patients. Specifically, activation of the accumbal dopamine system is likely to underlie the high aggression observed in LAB rats.

Patterns and changes in psychopathic interpersonal behaviour in forensic inpatient treatment

ABSTRACTPsychopathy is a vital construct in the treatment of mentally disordered offenders, and it is arguable that at the heart of psychopathy is a deviant interpersonal style. The present study analysed the changes in perceived dominance and warmth (as rated by staff using the Chart of Interpersonal Reactions in Closed Living Environments) of 34 male psychopathic patients admitted to the Dangerous and Severe Personality Disorder Service of a high‐security hospital in the UK. Results showed that the level and direction of change in dominance and warmth were dependent on the level of psychopathy; patients with a higher level of psychopathy increased significantly in dominance but did not decrease in warmth, whereas patients with a lower level of psychopathy decreased significantly in warmth but did not increase in dominance. These results are discussed in terms of possible implications for the treatment and management of patients with varying levels of psychopathy. Copyright © 2011 John Wiley & Sons, Ltd.

Cortical Correlates of Impaired Self-Regulation in Personality Disordered Patients with Traits of Psychopathy

Psychopathic personality disordered patients would, by virtue of a failure to self-regulate, be expected to show diminished amplitudes of feedback-related brain potentials. Among a sample of personality disordered patients detained at different levels of security, those who met a Psychopathy Checklist (PCL) criterion of 25 or above were identified (N = 27). Their event-related brain potentials (ERPs), together with those of their nonpsychopathic counterparts (N = 22) and healthy male controls (N = 20), were measured while they performed a visual Go/No Go task, with feedback given for correct and incorrect performance. Psychopathic patients showed a significantly reduced amplitude of an early frontal negative ERP component maximally evoked by negative feedback, and a high rate of errors of commission. Findings are consistent with the idea that psychopathic patients' unsuccessful attempts to self-regulate reflect a cognitive deficit characterised by a failure to attend and respond to a mismatch between expected and obtained outcomes.

Conceptualizing Psychopathy: A Psychodynamic Approach

Drawing from analytic theory and clinical conceptualization, three major types of psychopathy are detailed: Superego deficit, aggression driven, and sadism. The types of psychopathy are discussed in terms of their overlap with personality disorders. The range of sadism is charted from the enjoyment of inflicting pleasure to the borderline manifestations in compulsive reenactments in psychopathic patients. Two categories of antisocial behavior— low social intelligence and poor impulse control—are elaborated clinically as inconsistent with the psychodynamic formulation of characterological psychopathy. The divergence between psychodynamic and behavioral approaches to antisocial behavior is discussed, and unresolved enigmas in the formulation of psychopathy are outlined.

Change during forensic treatment in psychopathic versus nonpsychopathic offenders

Psychopathy in forensic psychiatric patients and other criminal offenders is associated with higher criminal recidivism rates. Moreover, many forensic mental health professionals believe that psychopaths are not amenable to treatment. The present study examines whether patients with psychopathy demonstrate change during forensic psychiatric treatment. Seventy-four personality disordered offenders who had been convicted for serious violence were rated on the the Hare Psychopathy Checklist-Revised and assessed repeatedly on risk-related behaviors during 20-months of inpatient forensic treatment. Group- and individual-level analyses showed no significant differences between psychopathic and non-psychopathic patients on adaptive social behavior, communication skills, insight, attribution of responsibility, and self-regulation strategies. However, a subgroup of psychopaths (22%) deteriorated during treatment with regard to physical aggression, whereas none of the non-psychopathic patients did (p < 0.01). Our findings demonstrate that, contrary to clinical lore, treatment does not make a majority of psychopaths worse, but there are significant differences between psychopaths and non-psychopaths in treatment responsiveness.

„Theory of mind“ und ihre neuronalen Korrelate bei forensisch relevanten Störungen

Theory of mind (ToM), the ability to recognize mental states of others, and empathy are crucial cognitive-emotional processes for appropriate social interactions. Deficits in these processes can lead to maladjusted social behavior or even to aggressive or criminal behavior. ToM and empathy deficits have been found in different forensically relevant disorders, such as schizophrenia, pedophilia but especially in autism and psychopathy according to Hare. Most notably, autistic and psychopathic patients differ in their type of deficits and in their neuronal correlates. While autistic individuals lack the ability to take the perspective of others, psychopaths lack empathy. The aim of this article is to provide a better understanding of the pathophysiology of ToM and empathy deficits in forensically relevant disorders by reviewing and discussing the findings of neuroimaging and lesion studies and to highlight crucial implications for neuropsychotherapy according to Grawe.

In psychopathic patients emotion attribution modulates activity in outcome-related brain areas

The understanding that other people's emotional states depend on the fulfilment of their intention is fundamentally important for responding adequately to others. Psychopathic patients show severe deficits in responding adequately to other people's emotion. The present study explored whether these impairments are associated with deficits in the ability to infer others' emotional states. Using functional magnetic resonance imaging (fMRI), identical cartoon stories, depicting a subject whose intention was fulfilled or not fulfilled, were presented to 14 psychopathic patients and 14 non-psychopathic patients. The participants should indicate the protagonist's emotional state. Additionally, a non-mentalizing control condition was presented. The two groups showed no behavioural differences. But in non-psychopathic patients emotion attribution was associated with increased activity of the mirror neuron system, the bilateral supramarginal gyrus and the superior frontal gyrus. In contrast psychopathic patients showed increased activation of regions associated with outcome monitoring and attention, such as the orbitofrontal cortex, the medial frontal cortex and temporo-parietal areas. The results emphasize that although psychopathic patients show no deficits in reasoning about other people's emotion if an explicit evaluation is demanded, they use divergent neural processing strategies that are related to more rational, outcome-oriented processes.