On the relative importance of "psychopathic" personality and alcoholism on neuropsychological measures of frontal lobe dysfunction

Cool and hot executive function impairments in violent offenders with antisocial personality disorder with and without psychopathy

BACKGROUND

Impairments in executive function characterize offenders with antisocial personality disorder (ASPD) and offenders with psychopathy. However, the extent to which those impairments are associated with ASPD, psychopathy, or both is unknown.

METHODS

The present study examined 17 violent offenders with ASPD and psychopathy (ASPD+P), 28 violent offenders with ASPD without psychopathy (ASPD-P), and 21 healthy non-offenders on tasks assessing cool (verbal working memory and alteration of motor responses to spatial locations) and hot (reversal learning, decision-making under risk, and stimulus-reinforcement-based decision-making) executive function.

RESULTS

In comparison to healthy non-offenders, violent offenders with ASPD+P and those with ASPD-P showed similar impairments in verbal working memory and adaptive decision-making. They failed to learn from punishment cues, to change their behaviour in the face of changing contingencies, and made poorer quality decisions despite longer periods of deliberation. Intriguingly, the two groups of offenders did not differ significantly from the non-offenders in terms of their alteration of motor responses to spatial locations and their levels of risk-taking, indicated by betting, and impulsivity, measured as delay aversion. The performance of the two groups of offenders on the measures of cool and hot executive function did not differ, indicating shared deficits.

CONCLUSIONS

These documented impairments may help to explain the persistence of antisocial behaviours despite the known risks of the negative consequences of such behaviours.

The neuropsychology of prefrontal function in antisocial personality disordered offenders with varying degrees of psychopathy

BACKGROUND

Despite methodological differences between studies, it has been suggested that psychopathy may be associated with a ventromedial prefrontal cortex (VMPFC) deficit and antisocial personality disorder (ASPD), as classified in the DSM-IV, with a broader range of deficits in dorsolateral prefrontal cortex (DLPFC) and VMPFC function.

METHOD

Ninety-six male offenders with ASPD who were assessed using the psychopathy checklist: screening version (PCL:SV) and 49 male right-handed healthy controls (HCs), matched for age and IQ, completed a neuropsychological test battery.

RESULTS

Offenders with ASPD displayed subtle impairments on executive function tasks of planning ability and set shifting and behavioural inhibition compared to HCs. However, among the offenders with ASPD there was no significant association between executive function impairment and scores on the measure of psychopathy.

CONCLUSIONS

Psychopathic traits in offenders with ASPD are not associated with greater executive function impairment.

Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account

This paper reviews the role of orbitofrontal cortex (OFC) lesions in antisocial behaviors and the adequacy of a strict OFC account of antisocial disorders where there is no evidence of lesion. Neurocognitive accounts of antisocial behaviors are extended beyond the OFC. Several methodological shortcomings specific to this neuroscience approach to antisocial behavior are identified. A developmental approach is advocated to chart the developmental sequences of impaired brain development and of the various comorbid states typically seen in antisocial disorders.

Executive and nonexecutive neuropsychological functioning in antisocial personality disorder

OBJECTIVE

To examine the relationships between antisocial personality disorder and executive abilities as well as antisocial personality disorder with other domains of cognitive functioning.

BACKGROUND

Previous research has suggested that antisocial personality disorder is associated with impaired executive functioning. However, methodological limitations of past research have resulted in inconsistent findings.

METHODS

Executive functioning and other cognitive abilities were compared in four demographically matched groups of middle-aged community dwelling male veterans (N = 336). The groups were: (A). those with active antisocial personality disorder psychopathology; (B). those with a lifetime prevalence of antisocial personality disorder but inactive antisocial personality disorder psychopathology; (C). a nonantisocial personality disorder psychiatrically matched control group; and (D). a normal control group.

RESULTS

Multivariate analysis of variance revealed that the four groups were not statistically significantly different on measures of executive functioning or other cognitive abilities.

CONCLUSIONS

Those with antisocial personality disorder perform at comparable levels to psychiatric and normal controls with respect to executive functioning and other domains of cognitive ability (i.e., language, memory, visuospatial, and motor abilities). An incidental finding was that, over time, the antisocial personality disorder groups improved more than control groups on a measure of general intellectual aptitude.

Autonomic stress reactivity and executive functions in successful and unsuccessful criminal psychopaths from the community

A significant gap in the psychopathy literature is the lack of studies comparing "successful," nonconvicted psychopaths with "unsuccessful," convicted psychopaths. This study tested the hypothesis that successful psychopaths show increased autonomic stress reactivity and better neuropsychological function compared with unsuccessful psychopaths. A total of 26 controls, 16 unsuccessful psychopaths, and 13 successful psychopaths were assessed on psychophysiological measures recorded during an emotional manipulation, the Wisconsin Card Sorting Test (WCST), Wechsler Memory Scale--Revised subtests, and childhood stressors. Compared with controls, unsuccessful psychopaths showed reduced cardiovascular stress reactivity. In contrast, successful psychopaths showed heightened reactivity, better WCST performance, and more parental absence than unsuccessful psychopaths and controls. The implications of these findings and the generalizability of existing psychopathy research are discussed.

A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function

Previous narrative reviews of the relation between antisocial behavior (ASB) and neuropsychological tests of executive functioning (EF) have raised numerous methodological concerns and produced equivocal conclusions. By using meta-analytic procedures, this study attempts to remedy many of these concerns and quantifies the relation between ASB and performance on six reasonably well validated measures of EF. Thirty-nine studies yielding a total of 4,589 participants were included in the analysis. Overall, antisocial groups performed .62 standard deviations worse on EF tests than comparison groups; this effect size is in the medium to large range. Significant variation within this effect size estimate was found, some of which was accounted for by differences in the operationalizations of ASB (e.g., psychopathy vs. criminality) and measures of EF. Evidence for the specificity of EF deficits relative to deficits on other neuropsychological tasks was inconsistent. Unresolved conceptual problems regarding the association between ASB and EF tests, including the problem of localizing EF tests to specific brain regions, are discussed.

Executive cognitive functioning in alcohol use disorders

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.

Ventral frontal deficits in psychopathy: neuropsychological test findings

The hypothesis of prefrontal dysfunction in psychopathy has been pursued for many years, without convincing results. It is proposed here that this approach in previous studies was far too global. The present investigation was carried out in order to test a more specific hypothesis of orbitofrontal and/or frontal ventromedial deficits in psychopathy. Psychopathic criminals were compared to non-psychopathic criminals with measures related to orbitofrontal or frontal ventromedial functioning, as well as with control measures more associated with frontodorsolateral and posterorolandic functions. All subjects provided urine samples for drug assay. It was found that, while the two groups performed similarly on all the control measures, including the drug tests, the psychopaths were significantly impaired on all the orbitofrontal-ventromedial tasks. The psychopaths were significantly impulsive on several tests as well as significantly dysosmic [corrected]. The latter finding is particularly important in the sense that it cannot readily be explained socioculturally, thus presenting a new and convincing argument for brain-based etiology of this disorder. The results are discussed in relation to other psychiatric disorders characterized by impulse dyscontrol as well as in relation to other putative neurobiological etiological factors in psychopathy.

Psychopathy--a neurobiological perspective

BACKGROUND

Diagnostic and conceptual issues relating to psychopathy are widely debated, but advances in our understanding of the aetiology are limited.

METHOD

A PSYCHLIT computerised database search of publications covering five decades was supplemented by tracing back through references from existing review work.

RESULTS

Over 200 articles were extracted, and 95 were selected for review.

CONCLUSIONS

It is timely to evaluate the rôle of brain dysfunction. Biological determinants are under-researched and the lack of consistency in operational definitions in published research precludes anything more than tentative conclusions about the genetic, biochemical or electrophysiological correlates of psychopathy and antisocial behaviour. A multi-modal research programme is required in the search for a comprehensive model of psychopathy that can guide both research efforts and clinical interventions.

Cognitive functioning, family history of alcoholism, and antisocial behavior in female polydrug abusers

Family history of alcoholism and antisocial behaviour had both independent and synergic negative relationships with abstract verbal reasoning for a group of 42 female polydrug abusers whose main drug was heroin. This finding suggests that the observed lower cognitive performance may reflect the family history of alcoholism or antisocial behaviour rather than just drug abuse and is consistent with theories predicting a relative deficiency in high language skill by persons with antisocial personality disorders.

The role of antisocial, affective, and childhood behavioral characteristics in alcoholics' neuropsychological performance

Chronic alcoholics demonstrate cognitive deficits when compared with nonalcoholics. These deficits are typically attributed to the direct effects of ethanol and its metabolites on the central nervous system (CNS). There are other factors, however, that differentiate alcoholics from controls, such as personality or behavioral characteristics. These factors may affect neuropsychological performance and thus alter the interpretation of alcoholic cognitive deficits as resulting solely from alcohol's toxic effects. To investigate this question, male and female alcoholics and peer nonalcoholic controls were compared on personality, behavioral, and cognitive measures. Alcoholics had greater numbers of antisocial behaviors, childhood behavioral disorder symptoms (CBD), and affective symptomatology, and had poorer neuropsychological performance than controls. The three personality and behavioral factors were positively intercorrelated with each other, and were negatively related to cognitive performance. The CBD factor proved to be the most consistent predictor of neuropsychological performance for both alcoholics and controls, and males and females. While the behavioral factors differentiated alcoholics from controls and predicted performance, significant differences between the groups in cognitive performance still remained when these factors were taken into account.

Cognitive functioning, ASP, and family history of alcoholism in young men at risk for alcoholism

Previous research has suggested that individuals with a family history of alcoholism may have cognitive deficits that predate, and possibly predispose, to the onset of alcoholism. However, these deficiencies may result from other factors, e.g., comorbid psychopathology. The current study investigated the neuropsychological functioning of young adult males at high risk for alcohol abuse due to a family history of alcoholism (FH) and/or a personal history of antisocial personality disorder (ASP). A family history of alcoholism (FH+) alone was not associated with neuropsychological impairment. Subjects with ASP, however, exhibited some difficulty with higher level motor control and with verbal concept formation compared with nonASP subjects. No clear pattern of FH x ASP interaction was evident in the measures examined. These findings suggest that previous findings suggesting cognitive deficiencies in FH+ individuals may have been related to a failure to consider co-morbid ASP. The deficits exhibited by the ASP subjects may reflect both reduced inhibitory control and a deficiency in higher level verbal skills. These deficiencies may leave ASP individuals less capable of utilizing higher level language skills to regulate behavior.

Psychiatry and the frontal lobes

The frontal lobes of the brain have long been regarded as enigmatic in their function and perhaps should be considered even more so in states of dysfunction. Observed associations between structural lesions and psychiatric symptoms and the demonstration of disturbed function and morphology in the frontal lobes of individuals suffering from major psychiatric disorders have led to increased interest in this brain area. Psychiatrists have been particularly concerned with seeking the aetiogenesis of common diagnostic entities and this article attempts to synthesize the available facts. A brief overview of relevant biological data precedes a description of methods of neuropsychological testing and the clinical features arising from frontal lobe damage. A discussion of the role of the frontal lobes in some aspects of personality function follows. Neuropsychiatric features associated with known frontal lobe pathology are described, prefacing a discussion of those psychiatric conditions where an aetiological role for frontal lobe dysfunction has been proposed.

Determinants of neuropsychological impairment in antisocial substance abusers

Persons displaying Antisocial Personality Disorder (ASP) may be at risk for neuropsychological impairment due to a number of developmental and later life experiences to which they are prone. Thirty substance abusers meeting research criteria for ASP were compared to a demographically matched non-ASP cohort on neuropsychological test performance. The ASP subjects were found to have a higher prevalence of neuropsychological deficit. The groups were then compared on factors which might lead to brain impairment. Presence of ASP was associated with earlier and heavier past drinking patterns, more negative health and behavioral effects of alcohol abuse, and greater abuse of other drugs in addition to alcohol. The ASP alcoholics also reported a high prevalence of serious head injury (58%), although they did not differ from non-ASP alcoholics in this regard. Implications for the neuropsychology of alcoholism and for treatment are discussed.

Frontal-lobe dysfunction and antisocial behavior: a review

Despite the many functions attributed to the frontal-lobe in previous writings and studies, empirically derived and reliable frontal-lobe abilities are limited and specific. Research that examines frontal-lobe dysfunction (as evidenced by neuropsychological tests that measure these specific abilities) and its relationship to antisocial behavior is reviewed. Frontal-lobe dysfunction is discussed in the context of the "minimal brain dysfunction" hypothesis of criminal behavior. Three studies reviewed examine criminal behavior, three examine specifically violent criminal behavior, and three focus on psychopathy. The nature of the research reviewed leaves the relationship between frontal-lobe neuropsychological dysfunction and crime open to further study.