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Tully J, Pereira AC, Sethi A, Griem J, Cross B, Williams SC, Blair RJ, Murphy D, Blackwood N. Impaired striatal glutamate/GABA regulation in violent offenders with antisocial personality disorder and psychopathy. Mol Psychiatry 2024:10.1038/s41380-024-02437-4. [PMID: 38326560 DOI: 10.1038/s41380-024-02437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Men with antisocial personality disorder (ASPD) with or without psychopathy (+/-P) are responsible for most violent crime in society. Development of effective treatments is hindered by poor understanding of the neurochemical underpinnings of the condition. Men with ASPD with and without psychopathy demonstrate impulsive decision-making, associated with striatal abnormalities in functional neuroimaging studies. However, to date, no study has directly examined the potential neurochemical underpinnings of such abnormalities. We therefore investigated striatal glutamate: GABA ratio using Magnetic Resonance Spectroscopy in 30 violent offenders (16 ASPD-P, 14 ASPD + P) and 21 healthy non-offenders. Men with ASPD +/- P had a significant reduction in striatal glutamate : GABA ratio compared to non-offenders. We report, for the first time, striatal Glutamate/GABA dysregulation in ASPD +/- P, and discuss how this may be related to core behavioral abnormalities in the disorders.
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Affiliation(s)
- John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Jubilee Campus, University of Nottingham, Wollaton Rd, Lenton, Nottingham, NG8 1BB, United Kingdom.
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Andreia C Pereira
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Julia Griem
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Ben Cross
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Steve Cr Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE58AF, United Kingdom
| | - Robert James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
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Blackwood N, Zetzmann C, Trevino CR. Case report of selumetinib as a novel therapy in a neurofibromatosis type 2-associated ependymoma. Mol Ther Methods Clin Dev 2023; 31:101156. [PMID: 38058737 PMCID: PMC10696461 DOI: 10.1016/j.omtm.2023.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
We report partial response (PR) to novel therapy with selumetinib in a patient with neurofibromatosis type 2 (NF2). A 25-year-old male presented with bilateral vestibular schwannomas, spinal cord intramedullary ependymomas, cranial and spinal meningiomas, spinal nerve root mixed schwannoma-neurofibromas, and peripheral nerve sheath tumors. He tested negative for germline NF2, SWItch/sucrose non-fermentable-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1), and leucine zipper-like transcription regulator 1 (LZTR1) mutations. Molecular analysis of a resected cervical spine schwannoma-neurofibroma demonstrated an isolated somatic SMARCB1 mutation. Due to progression of all tumors, he was treated medically with both everolimus (10 mg/day) and selumetinib (25 mg/kg twice a day), but he rapidly transitioned to selumetinib monotherapy due to everolimus toxicity. 3 months of treatment resulted in PR in one spinal ependymoma and stable disease in other tumors. This PR was quantified by the differences in units of intensity in pre- and post-treatment magnetic resonance image. To the best of our knowledge, this is the first reported case for using selumetinib in NF2-associated tumors or ependymomas.
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Affiliation(s)
- Nigel Blackwood
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Christopher Zetzmann
- Tulane University School of Medicine, Department of Radiology, 1415 Tulane Avenue, New Orleans, LA 70112, USA
| | - Christopher R. Trevino
- Tulane University School of Medicine, Department of Medicine/Section of Hematology-Medical Oncology, 1430 Tulane Avenue, #8078, New Orleans, LA 70112, USA
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O' Brien S, Sethi A, Blair J, Viding E, Beyh A, Mehta MA, Dallyn R, Ecker C, Petrinovic MM, Doolan M, Blackwood N, Catani M, Murphy DGM, Scott S, Craig MC. Rapid white matter changes in children with conduct problems during a parenting intervention. Transl Psychiatry 2023; 13:339. [PMID: 37925439 PMCID: PMC10625622 DOI: 10.1038/s41398-023-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Studies report that the microstructural integrity of the uncinate fasciculus (UF; connecting the anterior temporal lobe to the orbitofrontal cortex) is abnormal in adults with psychopathy and children with conduct problems (CP), especially those with high callous-unemotional (CU) traits. However, it is unknown if these abnormalities are 'fixed' or 'reversible'. Therefore, we tested the hypothesis that a reduction in CP symptoms, following a parenting intervention, would be associated with altered microstructural integrity in the UF. Using diffusion tensor imaging tractography we studied microstructural differences (mean diffusivity (MD) and radial diffusivity (RD)) in the UF of 43 typically developing (TD) and 67 boys with CP before and after a 14-week parenting intervention. We also assessed whether clinical response in CP symptoms or CU traits explained changes in microstructure following the intervention. Prior to intervention, measures of MD and RD in the UF were increased in CP compared to TD boys. Following intervention, we found that the CP group had a significant reduction in RD and MD. Further, these microstructural changes were driven by the group of children whose CU traits improved (but not CP symptoms as hypothesized). No significant microstructural changes were observed in the TD group. Our findings suggest, for the first time, that microstructural abnormalities in the brains of children with CP may be reversible following parenting intervention.
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Affiliation(s)
- Suzanne O' Brien
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. suzanne.o'
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Blair
- Research Unit at Child and Adolescent Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ahmad Beyh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Dallyn
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christine Ecker
- Department of Child and Adolescent Psychiatry, University Hospital of the Goethe University, Frankfurt am Main, Germany
| | - Marija M Petrinovic
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Moira Doolan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Female Hormone Clinic, Maudsley Hospital, London, UK
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Yukhnenko D, Blackwood N, Lichtenstein P, Fazel S. Association of substance use and other psychiatric disorders with all-cause and external-cause mortality in individuals given community sentences in Sweden: a national cohort study. Lancet Reg Health Eur 2023; 33:100703. [PMID: 37954004 PMCID: PMC10636268 DOI: 10.1016/j.lanepe.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 11/14/2023]
Abstract
Background Consistently high rates of premature mortality have been reported in individuals who receive community sentences. However, few studies have explored potential modifiable risk factors for these rates, particularly mental health. We examined the association of substance use and other psychiatric disorders with all-cause and external-cause mortality in individuals convicted of a criminal offence and given a community sentence. Methods We did a longitudinal cohort study of 109,751 individuals given community sentences in Sweden using population-based registers. We calculated mortality rates for all-cause and external-cause mortality, hazard ratios for the association between psychiatric disorders and mortality, and population attributable fractions to quantify the contribution of psychiatric disorders to mortality risk. Findings During the follow-up, 5749 (5.2%) individuals died, including 2709 (2.5%) from external causes. Individuals with pre-existing substance use and other psychiatric disorders had an increased mortality risk from any cause (aHR = 2.28 [95% CI 2.15-2.42]) and from external causes (3.11 [2.85-3.40]) compared to individuals without known psychiatric or substance use disorders. Suicide was the most common cause of death in younger persons. Interpretation In individuals given community sentences, substance use and other psychiatric disorders were associated with an increased risk of premature death with suicide being the leading cause of death. Community supervision represents an opportunity to provide sentenced individuals with access to evidence-based treatment targeting substance misuse and psychiatric disorders to prevent potentially preventable deaths. Funding Wellcome Trust.
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Affiliation(s)
| | - Nigel Blackwood
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Tully J, Sethi A, Griem J, Paloyelis Y, Craig MC, Williams SCR, Murphy D, Blair RJ, Blackwood N. Oxytocin normalizes the implicit processing of fearful faces in psychopathy: a randomized crossover study using fMRI. Nat Ment Health 2023; 1:420-427. [PMID: 38665476 PMCID: PMC11041724 DOI: 10.1038/s44220-023-00067-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2024]
Abstract
Adults with antisocial personality disorder with (ASPD + P) and without (ASPD - P) psychopathy commit the majority of violent crimes. Empathic processing abnormalities are particularly prominent in psychopathy, but effective pharmacological interventions have yet to be identified. Oxytocin modulates neural responses to fearful expressions in healthy populations. The current study investigates its effects in violent antisocial men. In a placebo-controlled, randomized crossover design, 34 violent offenders (19 ASPD + P; 15 ASPD - P) and 24 healthy non-offenders received 40 IU intranasal oxytocin or placebo and then completed an fMRI morphed faces task examining the implicit processing of fearful facial expressions. Increasing intensity of fearful facial expressions failed to appropriately modulate activity in the bilateral mid-cingulate cortex in violent offenders with ASPD + P, compared with those with ASPD - P. Oxytocin abolished these group differences. This represents evidence of neurochemical modulation of the empathic processing of others' distress in psychopathy.
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Affiliation(s)
- John Tully
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Julia Griem
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Yannis Paloyelis
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Michael C. Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Steven C. R. Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Robert James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Facer-Irwin E, Blackwood N, Bird A, MacManus D. Trauma, post-traumatic stress disorder and violence in the prison population: prospective cohort study of sentenced male prisoners in the UK. BJPsych Open 2023; 9:e47. [PMID: 36866723 PMCID: PMC10044336 DOI: 10.1192/bjo.2022.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Violence is a common problem in prisons. Post-traumatic stress disorder (PTSD), a prevalent disorder in prison populations, has been identified as a risk factor for violent behaviour in community and military populations. Although cross-sectional associations between PTSD and prison violence have been documented, prospective cohort studies are required. AIMS To investigate whether PTSD is an independent risk factor for prison violence, and examine the potential role of PTSD symptoms and other trauma sequelae on the pathway from trauma exposure to violent behaviour in prison. METHOD A prospective cohort study was conducted in a large, medium security prison in London, UK. A random sample of sentenced prisoners arriving into custody (N = 223) took part in a clinical research interview, which assessed trauma histories, mental disorders including PTSD, and other potential sequelae of trauma (anger, emotion dysregulation). Incidents of violent behaviour were measured with prison records covering the 3 months after reception into custody. Stepped binary logistic regression and a series of binary mediation models were performed. RESULTS Prisoners who met current (past month) criteria for PTSD were more likely to engage in violent behaviour during the first 3 months of imprisonment, after adjusting for other independent risk factors. The relationship between lifetime exposure to interpersonal trauma and violent behaviour in custody was mediated by total PTSD symptom severity. Hyperarousal and negatively valenced cognitive and emotional appraisal symptoms were particularly implicated in this pathway. CONCLUSIONS The identification and treatment of PTSD has the potential to reduce violence in prison populations.
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Affiliation(s)
- Emma Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nigel Blackwood
- HMP Wandsworth, South London & Maudsley NHS Foundation Trust, UK; and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Annie Bird
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Deirdre MacManus
- HMP Wandsworth, South London and Maudsley NHS Trust, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and London and South East NHS Veterans' Mental Health Service, Camden and Islington NHS Trust, UK
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Yukhnenko D, Blackwood N, Lichtenstein P, Fazel S. Psychiatric disorders and reoffending risk in individuals with community sentences in Sweden: a national cohort study. Lancet Public Health 2023; 8:e119-e129. [PMID: 36669512 PMCID: PMC10914666 DOI: 10.1016/s2468-2667(22)00312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Community sentences are widely used in many countries, often comprising the majority of criminal justice sanctions. Psychiatric disorders are highly prevalent in community-sentenced populations and are thus potential targets for treatment interventions designed to reduce reoffending. We examined the association between psychiatric disorders and reoffending in a national cohort of individuals given community sentences in Sweden, with use of a sibling control design to account for unmeasured familial confounding. METHODS We did a longitudinal cohort study of 82 415 individuals given community sentences between Nov 1, 1991, and Dec 31, 2013, in Sweden using data from population-based registers. We calculated hazard ratios (HRs) for any reoffending and violent reoffending with Cox regression models. We compared community-sentenced siblings with and without psychiatric disorders to control for potential familial confounding. Additionally, we calculated population attributable fractions to assess the contribution of psychiatric disorders to reoffending behaviours. The primary outcomes of the study were any (general) reoffending and violent reoffending. FINDINGS Between Nov 1, 1991, and Dec 31, 2013, those given community sentences who were diagnosed with any psychiatric disorder had an increased reoffending risk in men (adjusted HR 1·59, 95% CI 1·56-1·63 for any reoffending; 1·60, 1·54-1·66 for violent reoffending) and women (1·71, 1·61-1·82 for any reoffending; 2·19, 1·88-2·54 for violent reoffending). Risk estimates remained elevated after adjustment for familial confounding. Schizophrenia spectrum disorders, personality disorders, and substance use disorders had stronger associations with violent reoffending than did other psychiatric disorders. Assuming causality, the adjusted population attributable risk of psychiatric disorders on violent reoffending was 8·3% (95% CI 6·6-10·0) in the first 2 years of community follow-up in men and 30·9% (22·7-39·0) in women. INTERPRETATION Psychiatric disorders were associated with an increased risk of any reoffending and violent reoffending in the community-sentenced population. The magnitude of the association between psychiatric disorders and reoffending varied by individual diagnosis. Substance use disorders had the highest absolute and relative risks. Most of the increased risk for any reoffending in individuals with psychiatric disorders could be attributed to comorbid substance misuse. Given their high prevalence, substance use disorders should be the focus of treatment programmes in community-sentenced populations. FUNDING Wellcome Trust.
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Affiliation(s)
| | - Nigel Blackwood
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Sethi A, O'Brien S, Blair J, Viding E, Mehta M, Ecker C, Blackwood N, Doolan M, Catani M, Scott S, Murphy DGM, Craig MC. Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent Training. Biol Psychiatry 2022:S0006-3223(22)01658-4. [PMID: 36642564 DOI: 10.1016/j.biopsych.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Parenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person's fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. METHODS We conducted a prospective, case-control study of boys with CPs and typically developing (TD) boys. Both groups (ages 5-10 years) completed 2 magnetic resonance imaging sessions (18 ± 5.8 weeks apart) with ASB assessed at each visit. Participants included boys with CPs following referral to a parenting intervention group and TD boys recruited from the same schools and geographical regions. Final functional magnetic resonance imaging data were available for 36 TD boys and 57 boys with CPs. Boys with CPs were divided into those whose ASB improved (n = 27) or persisted (n = 30) following the intervention. Functional magnetic resonance imaging data assessing fear reactivity were then analyzed using a longitudinal group (TD/improving CPs/persistent CPs) × time point (pre/post) design. RESULTS Amygdala hypoactivity to fear was observed only in boys with CPs who had persistent ASB and was absent in those whose ASB improved following intervention. CONCLUSIONS Our findings suggest that amygdala hypoactivity to fear is a marker for ASB that is resistant to change following a parenting intervention and a putative target for future treatments.
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Affiliation(s)
- Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suzanne O'Brien
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. suzanne.o'
| | - James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Copenhagen, Capital Region of Denmark, Denmark
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Mitul Mehta
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Christine Ecker
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Moira Doolan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Catani
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Female Hormone Clinic Maudsley Hospital, London, United Kingdom; National Autism Unit, Bethlem Royal Hospital, London, United Kingdom
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Facer-Irwin E, Karatzias T, Bird A, Blackwood N, MacManus D. PTSD and complex PTSD in sentenced male prisoners in the UK: prevalence, trauma antecedents, and psychiatric comorbidities. Psychol Med 2022; 52:2794-2804. [PMID: 33431085 PMCID: PMC9647511 DOI: 10.1017/s0033291720004936] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities. METHOD Randomly selected male, sentenced prisoners in a large medium-security prison in south London (N = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms. RESULTS A total of 7.7% (95% CI 4.5-12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1-22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD. CONCLUSIONS This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.
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Affiliation(s)
- Emma Facer-Irwin
- Researcher; Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Thanos Karatzias
- Professor of Mental Health; School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
- Clinical & Health Psychologist; Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, Scotland
| | - Annie Bird
- Research Assistant; Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Nigel Blackwood
- Clinical Reader in Forensic Psychiatry; Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Consultant Forensic Psychiatrist; HMP Wandsworth, South London & Maudsley NHS Foundation Trust, London, England
| | - Deirdre MacManus
- Clinical Reader in Forensic Psychiatry; Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Consultant Forensic Psychiatrist; London and South East NHS Veterans’ Mental Health Service, Camden and Islington NHS Trust; HMP Wandsworth, South London and Maudsley NHS Trust, London, England
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Dickson H, Vamvakas G, Blackwood N. Education and social care predictors of offending trajectories: A UK administrative data linkage study. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesTotal annual costs of crime in England and Wales is estimated at £50bn.The age-crime curve indicates that criminal behavioural peaks in adolescence and decreases in adulthood. Life-course persistent offenders begin to behave antisocially early in childhood and continue this behaviour into adulthood. By contrast, adolescent-limited offenders exhibit most of their antisocial behaviour during adolescence, with a minority continuing to offend into adulthood. However, evidence suggests that this curve conceals distinct developmental trajectories. Prospective cohort study data has highlighted distinct risk factors for these offending trajectories, but this research is limited because of small sample sizes for disadvantaged groups, selection bias and infrequency of data collection.
ApproachThe current study began in February 2022 and is one of the first to use UK linked national crime and education records. The aim is to: (1) establish the offending trajectories of individuals between the ages of 10 and 32 years following their first recorded conviction or caution using national crime records; and (2) develop prediction models of these offending trajectories using administrative education and social care data.
ResultsIn my talk, I will share findings on the offending trajectories identified and present some early results on the key education and social care drivers of the offending trajectories.
ConclusionsFindings from the project have the potential to identify previously unknown, or confirm lesser known, offending trajectories using real world data based on the UK population. It may also lead to the detection of previously unknown risk or protective factors for offending, which has implications for early intervention and could help inform criminal justice system responses to early antisocial behaviour.
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Brown P, Bakolis I, Appiah-Kusi E, Hallett N, Hotopf M, Blackwood N. Prevalence of mental disorders in defendants at criminal court. BJPsych Open 2022; 8:e92. [PMID: 35545846 PMCID: PMC9169500 DOI: 10.1192/bjo.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychiatric morbidity in prisons and police custody is well established, but little is known about individuals attending criminal court. There is international concern that vulnerable defendants are not identified, undermining their right to a fair trial. AIMS To explore the prevalence of a wide range of mental disorders in criminal defendants and estimate the proportion likely to be unfit to plead. METHOD We employed two-stage screening methodology to estimate the prevalence of mental illness, neurodevelopmental disorders and unfitness to plead, in 3322 criminal defendants in South London. Sampling was stratified according to whether defendants attended court from the community or custody. Face-to-face interviews, using diagnostic instruments and assessments of fitness to plead, were administered (n = 503). Post-stratification probability weighting provided estimates of the overall prevalence of mental disorders and unfitness to plead. RESULTS Mental disorder was more common in those attending court from custody, with 48.5% having at least one psychiatric diagnosis compared with 20.3% from the community. Suicidality was frequently reported (weighted prevalence 71.2%; 95% CI 64.2-77.3). Only 16.7% of participants from custody and 4.6% from the community were referred to the liaison and diversion team; 2.1% (1.1-4.0) of defendants were estimated to be unfit to plead, with a further 3.2% (1.9-5.3) deemed 'borderline unfit'. CONCLUSIONS The prevalence of mental illness and neurodevelopmental disorders in defendants is high. Many are at risk of being unfit to plead and require additional support at court, yet are not identified by existing services. Our evidence challenges policy makers and healthcare providers to ensure that vulnerable defendants are adequately supported at court.
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Affiliation(s)
- Penelope Brown
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Elizabeth Appiah-Kusi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nigel Blackwood
- South London and Maudsley NHS Foundation Trust, UK; and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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12
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Abstract
OBJECTIVE We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences. METHODS We searched seven bibliographic databases and additionally conducted targeted searches for studies that investigated risk factors for any repeat offending in individuals who had received community (non-custodial) sentences. We included investigations that reported data on at least one risk factor and allowed calculations of odds ratios (ORs). If a similar risk factor was reported in three or more primary studies, they were grouped into domains, and pooled ORs were calculated. RESULTS We identified 15 studies from 5 countries, which reported data on 14 independent samples and 246,608 individuals. We found that several dynamic (modifiable) risk factors were associated with criminal recidivism in community-sentenced populations, including mental health needs (OR = 1.4, 95% confidence interval (CI): 1.2-1.6), substance misuse (OR = 2.3, 95% CI: 1.1-4.9), association with antisocial peers (OR = 2.2, 95% CI: 1.3-3.7), employment problems (OR = 1.8, 95% CI: 1.3-2.5), marital status (OR = 1.6, 95%: 1.4-1.8), and low income (OR = 2.0, 95% CI: 1.1-3.4). The strength of these associations was comparable to that of static (non-modifiable) risk factors, such as age, gender, and criminal history. CONCLUSION Assessing dynamic (modifiable) risk factors should be considered in all individuals given community sentences. The further integration of mental health, substance misuse, and criminal justice services may reduce reoffending risk in community-sentenced populations.
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Affiliation(s)
- Denis Yukhnenko
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Nigel Blackwood
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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13
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Kozhuharova P, Dickson H, Tully J, Blackwood N. Impaired processing of threat in psychopathy: A systematic review and meta-analysis of factorial data in male offender populations. PLoS One 2019; 14:e0224455. [PMID: 31661520 PMCID: PMC6818800 DOI: 10.1371/journal.pone.0224455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background Psychopathy is a personality disorder characterised by two underlying factors. Factor 1 (affective and interpersonal deficits) captures affective deficits, whilst Factor 2 (antisocial and impulsive/disorganised behaviours) captures life course persistent antisocial behaviours. Impaired processing of threat has been proposed as an aetiologically salient factor in the development of psychopathy, but the relationship of this impairment to the factorial structure of the disorder in adult male offenders is unclear. Objectives To investigate whether threat processing deficits are characteristic of psychopathy as a unitary construct or whether such deficits are specifically linked to higher scores on individual factors. Data sources A systematic review of the literature was conducted by searching PubMed, Web of Science and PsycINFO. Methods Studies were included if they (1) reported physiological measures of threat response as the primary outcome measure (2) indexed psychopathy using a well-validated clinician rated instrument such as the PCL-R (3) investigated male offenders between 18 and 60 years of age (4) reported threat processing analyses using both Factor 1 and Factor 2 scores (5) provided sufficient data to calculate effect sizes and (6) were published in English-language peer-reviewed journals. We identified twelve studies with data on 1112 participants for the meta-analysis of the relationship with Factor 1 scores, and nine studies with data on 801 participants for the meta-analysis of the relationship with Factor 2 scores. We conducted the meta-analyses to calculate correlations using random-effects models. Results PCL-R/SV Factor 1 scores were significantly and negatively related to threat processing indices (r = -0.22, (95%CI [-0.28, -.017]). Neither PCL-R/SV Factor 2 scores (r = -0.005, 95%CI [-0.10, 0.09]), nor PCL-R total score (r = -0.05, (95%CI [-0.15, -0.04]) were related to threat processing indices. No significant heterogeneity was detected for the Factor score results. Conclusions The meta-analyses of the distinct psychopathy factors suggest that the threat processing deficits observed in male offenders with psychopathy are significantly associated with higher scores on Factor 1. A similar relationship does not exist with Factor 2 scores. Our findings highlight the importance of investigating the potentially discrete relationships between aetiological variables and the two factor constructs in the disorder.
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Affiliation(s)
- Petya Kozhuharova
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Cognition, Neuroscience and Neuroimaging (CNNI), Department of Psychology, Roehampton University, London, United Kingdom
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - John Tully
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
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14
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Yukhnenko D, Wolf A, Blackwood N, Fazel S. Recidivism rates in individuals receiving community sentences: A systematic review. PLoS One 2019; 14:e0222495. [PMID: 31539388 PMCID: PMC6754149 DOI: 10.1371/journal.pone.0222495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/02/2019] [Indexed: 11/18/2022] Open
Abstract
Objective We aimed to systematically review recidivism rates in individuals given community sentences internationally. We sought to explore sources of variation between these rates and how reporting practices may limit their comparability across jurisdictions. Finally, we aimed to adapt previously published guidelines on recidivism reporting to include community sentenced populations. Methods We searched MEDLINE, PsycINFO, SAGE and Google Scholar for reports and studies of recidivism rates using non-specific and targeted searches for the 20 countries with the largest prison populations worldwide. We identified 28 studies with data from 19 countries. Of the 20 countries with the largest prison populations, only 2 reported recidivism rates for individuals given community sentences. Results The most commonly reported recidivism information between countries was for 2-year reconviction, which ranged widely from 14% to 43% in men, and 9% to 35% in women. Explanations for recidivism rate variations between countries include when the follow-up period started and whether technical violations were taken into account. Conclusion Recidivism rates in individuals receiving community sentences are typically lower in comparison to those reported in released prisoners, although these two populations differ in terms of their baseline characteristics. Direct comparisons of the recidivism rates in community sentenced cohorts across jurisdictions are currently not possible, but simple changes to existing reporting practices can facilitate these. We propose recommendations to improve reporting practices.
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Affiliation(s)
- Denis Yukhnenko
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Achim Wolf
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Nigel Blackwood
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
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15
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Ganesh S, Bertagnolli AD, Bristow LA, Padilla CC, Blackwood N, Aldunate M, Bourbonnais A, Altabet MA, Malmstrom RR, Woyke T, Ulloa O, Konstantinidis KT, Thamdrup B, Stewart FJ. Single cell genomic and transcriptomic evidence for the use of alternative nitrogen substrates by anammox bacteria. ISME J 2018; 12:2706-2722. [PMID: 29991764 DOI: 10.1038/s41396-018-0223-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 11/09/2022]
Abstract
Anaerobic ammonium oxidation (anammox) contributes substantially to ocean nitrogen loss, particularly in anoxic marine zones (AMZs). Ammonium is scarce in AMZs, raising the hypothesis that organic nitrogen compounds may be ammonium sources for anammox. Biochemical measurements suggest that the organic compounds urea and cyanate can support anammox in AMZs. However, it is unclear if anammox bacteria degrade these compounds to ammonium themselves, or rely on other organisms for this process. Genes for urea degradation have not been found in anammox bacteria, and genomic evidence for cyanate use for anammox is limited to a cyanase gene recovered from the sediment bacterium Candidatus Scalindua profunda. Here, analysis of Ca. Scalindua single amplified genomes from the Eastern Tropical North Pacific AMZ revealed genes for urea degradation and transport, as well as for cyanate degradation. Urease and cyanase genes were transcribed, along with anammox genes, in the AMZ core where anammox rates peaked. Homologs of these genes were also detected in meta-omic datasets from major AMZs in the Eastern Tropical South Pacific and Arabian Sea. These results suggest that anammox bacteria from different ocean regions can directly access organic nitrogen substrates. Future studies should assess if and under what environmental conditions these substrates contribute to the ammonium budget for anammox.
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Affiliation(s)
- Sangita Ganesh
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, 30332, GA, USA.,Radiant Genomics, Emeryville, 94608, CA, USA
| | - Anthony D Bertagnolli
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - Laura A Bristow
- Biogeochemistry Group, Max Planck Institute for Marine Microbiology, Bremen, Germany
| | - Cory C Padilla
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - Nigel Blackwood
- Department of Biology, University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Montserrat Aldunate
- Graduate Program in Oceanography, Department of Oceanography, Faculty of Natural Sciences and Oceanography, University of Concepción, Casilla 160-C, Concepción, Chile.,Departamento de Oceanografía, Universidad de Concepción, Casilla 160-C, Concepción, 4070386, Chile
| | - Annie Bourbonnais
- Marine Chemistry & Geochemistry, Woods Hole Oceanographic Institution, 266 Woods Hole Road, Woods Hole, 02543, MA, USA.,School for Marine Science and Technology, University of Massachusetts Dartmouth, 706 Rodney French Blvd, New Bedford, 02744, MA, USA
| | - Mark A Altabet
- School for Marine Science and Technology, University of Massachusetts Dartmouth, 706 Rodney French Blvd, New Bedford, 02744, MA, USA
| | - Rex R Malmstrom
- Department of Energy Joint Genome Institute, 2800 Mitchell Drive, Walnut Creek, 94598, CA, USA
| | - Tanja Woyke
- Department of Energy Joint Genome Institute, 2800 Mitchell Drive, Walnut Creek, 94598, CA, USA
| | - Osvaldo Ulloa
- Departamento de Oceanografía, Universidad de Concepción, Casilla 160-C, Concepción, 4070386, Chile
| | | | - Bo Thamdrup
- Department of Biology and Nordic Center for Earth Evolution (NordCEE), University of Southern Denmark, Odense, Denmark
| | - Frank J Stewart
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, 30332, GA, USA.
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Brown P, Stahl D, Appiah-Kusi E, Brewer R, Watts M, Peay J, Blackwood N. Fitness to plead: Development and validation of a standardised assessment instrument. PLoS One 2018; 13:e0194332. [PMID: 29698396 PMCID: PMC5919482 DOI: 10.1371/journal.pone.0194332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/15/2018] [Indexed: 12/02/2022] Open
Abstract
The ability of an individual to participate in courtroom proceedings is assessed by clinicians using legal ‘fitness to plead’ criteria. Findings of ‘unfitness’ are so rare that there is considerable professional unease concerning the utility of the current subjective assessment process. As a result, mentally disordered defendants may be subjected unfairly to criminal trials. The Law Commission in England and Wales has proposed legal reform, as well as the utilisation of a defined psychiatric instrument to assist in fitness to plead assessments. Similar legal reforms are occurring in other jurisdictions. Our objective was to produce and validate a standardised assessment instrument of fitness to plead employing a filmed vignette of criminal proceedings. The instrument was developed in consultation with legal and clinical professionals, and was refined using standard item reduction methods in two initial rounds of testing (n = 212). The factorial structure, test-retest reliability and convergent validity of the resultant instrument were assessed in a further round (n = 160). As a result of this iterative process a 25-item scale was produced, with an underlying two-factor structure representing the foundational and decision-making abilities underpinning fitness to plead. The sub-scales demonstrate good internal consistency (factor 1: 0·76; factor 2: 0·65) and test-retest stability (0·7) as well as excellent convergent validity with scores of intelligence, executive function and mentalising abilities (p≤0·01 in all domains). Overall the standardised Fitness to Plead Assessment instrument has good psychometric properties. It has the potential to ensure that the significant numbers of mentally ill and cognitively impaired individuals who face trial are objectively assessed, and the courtroom process critically informed.
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Affiliation(s)
- Penelope Brown
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Elizabeth Appiah-Kusi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Rebecca Brewer
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Michael Watts
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jill Peay
- Department of Law, London School of Economics, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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17
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Tully J, Gabay AS, Brown D, Murphy DGM, Blackwood N. The effect of intranasal oxytocin on neural response to facial emotions in healthy adults as measured by functional MRI: A systematic review. Psychiatry Res 2018; 272:17-29. [PMID: 29272737 PMCID: PMC6562202 DOI: 10.1016/j.pscychresns.2017.11.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 12/28/2022]
Abstract
Abnormalities in responses to human facial emotions are associated with a range of psychiatric disorders. Addressing these abnormalities may therefore have significant clinical applications. Previous meta-analyses have demonstrated effects of the neuropeptide oxytocin on behavioural response to facial emotions, and effects on brain, as measured by functional MRI. Evidence suggests that these effects may be mediated by sex and the role of eye gaze. However, the specific effect of oxytocin on brain response to facial emotions in healthy adults has not been systematically analysed. To address this question, this further systematic review was conducted. Twenty-two studies met our inclusion criteria. In men, oxytocin consistently attenuated brain activity in response to negative emotional faces, particularly fear, compared with placebo, while in women, oxytocin enhanced activity. Brain regions consistently involved included the amygdala, fusiform gyrus and anterior cingulate cortex. In some studies, oxytocin increased fixation changes towards the eyes with enhanced amygdala and/or fusiform gyrus activation. By enhancing understanding of emotion processing in healthy subjects, these pharmacoimaging studies provide a theoretical basis for studying deficits in clinical populations. However, progress to date has been limited by low statistical power, methodological heterogeneity, and a lack of multimodal studies.
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Affiliation(s)
- John Tully
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
| | - Anthony S Gabay
- Department of Neuroimaging, Kings College London, London, United Kingdom
| | - Danielle Brown
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
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Sarkar S, Dell’Acqua F, Froudist Walsh S, Blackwood N, Scott S, Craig MC, Deeley Q, Murphy DGM. A Whole-Brain Investigation of White Matter Microstructure in Adolescents with Conduct Disorder. PLoS One 2016; 11:e0155475. [PMID: 27271503 PMCID: PMC4894575 DOI: 10.1371/journal.pone.0155475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The biological basis of severe antisocial behaviour in adolescents is poorly understood. We recently reported that adolescents with conduct disorder (CD) have significantly increased fractional anisotropy (FA) of the uncinate fasciculus (a white matter (WM) tract that connects the amygdala to the frontal lobe) compared to their non-CD peers. However, the extent of WM abnormality in other brain regions is currently unclear. METHODS We used tract-based spatial statistics to investigate whole brain WM microstructural organisation in 27 adolescent males with CD, and 21 non-CD controls. We also examined relationships between FA and behavioural measures. Groups did not differ significantly in age, ethnicity, or substance use history. RESULTS The CD group, compared to controls, had clusters of significantly greater FA in 7 brain regions corresponding to: 1) the bilateral inferior and superior cerebellar peduncles, corticopontocerebellar tract, posterior limb of internal capsule, and corticospinal tract; 2) right superior longitudinal fasciculus; and 3) left cerebellar WM. Severity of antisocial behavior and callous-unemotional symptoms were significantly correlated with FA in several of these regions across the total sample, but not in the CD or control groups alone. CONCLUSIONS Adolescents with CD have significantly greater FA than controls in WM regions corresponding predominantly to the fronto-cerebellar circuit. There is preliminary evidence that variation in WM microstructure may be dimensionally related to behaviour problems in youngsters. These findings are consistent with the hypothesis that antisocial behaviour in some young people is associated with abnormalities in WM 'connectivity'.
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Affiliation(s)
- Sagari Sarkar
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Flavio Dell’Acqua
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Seán Froudist Walsh
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Nigel Blackwood
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Stephen Scott
- King’s College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Michael C. Craig
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Quinton Deeley
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Declan G. M. Murphy
- King’s College London, Sackler Institute for Translational Neurodevelopment and the Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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19
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Kolla NJ, Attard S, Craig G, Blackwood N, Hodgins S. Monoamine oxidase A alleles in violent offenders with antisocial personality disorder: high activity associated with proactive aggression. Crim Behav Ment Health 2014; 24:368-372. [PMID: 25510659 DOI: 10.1002/cbm.1917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/22/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Nathan J Kolla
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Canada
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20
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Kolla NJ, Gregory S, Attard S, Blackwood N, Hodgins S. Disentangling possible effects of childhood physical abuse on gray matter changes in violent offenders with psychopathy. Psychiatry Res 2014; 221:123-6. [PMID: 24361393 PMCID: PMC4024660 DOI: 10.1016/j.pscychresns.2013.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 10/03/2013] [Accepted: 11/30/2013] [Indexed: 11/19/2022]
Abstract
Violent offenders with psychopathy present a lifelong pattern of callousness and aggression and fail to benefit from rehabilitation programs. This study presents the first, albeit preliminary, evidence suggesting that some of the structural brain anomalies distinguishing violent offenders with psychopathy may result from physical abuse in childhood.
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Affiliation(s)
- Nathan J Kolla
- Centre for Addiction and Mental Health, Research Imaging Centre, 250 College Street, Room B26, Toronto, ON, Canada M5T 1R8.
| | - Sarah Gregory
- Centre for Addiction and Mental Health, Research Imaging Centre, 250 College Street, Room B26, Toronto, ON, Canada M5T 1R8
| | - Stephen Attard
- Centre for Addiction and Mental Health, Research Imaging Centre, 250 College Street, Room B26, Toronto, ON, Canada M5T 1R8
| | - Nigel Blackwood
- Centre for Addiction and Mental Health, Research Imaging Centre, 250 College Street, Room B26, Toronto, ON, Canada M5T 1R8
| | - Sheilagh Hodgins
- Centre for Addiction and Mental Health, Research Imaging Centre, 250 College Street, Room B26, Toronto, ON, Canada M5T 1R8
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21
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Kolla NJ, Malcolm C, Attard S, Arenovich T, Blackwood N, Hodgins S. Childhood maltreatment and aggressive behaviour in violent offenders with psychopathy. Can J Psychiatry 2013; 58:487-94. [PMID: 23972111 DOI: 10.1177/070674371305800808] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To document experiences of childhood maltreatment among violent offenders with antisocial personality disorder (ASPD) distinguishing between those with and without the syndrome of psychopathy (+P and -P), and to determine whether maltreatment is associated with proactive and reactive aggression. METHOD The sample included 10 violent offenders with ASPD+P, 15 violent offenders with ASPD-P, and 15 non offenders. All participants completed interviews with the same forensic psychiatrist focusing on physical, sexual, and emotional abuse prior to age 18 using the Early Trauma Inventory. Aggression was assessed using the Reactive-Proactive Questionnaire. RESULTS Violent offenders with ASPD+P reported significantly more severe childhood physical abuse, but not more sexual or emotional abuse, than violent offenders with ASPD-P and non offenders. Psychopathy Checklist-Revised (PCL-R) scores, but not childhood physical abuse, were associated with proactive aggression. Childhood physical abuse was associated with reactive aggression, as was an interaction term indicating that when both PCL-R scores and childhood physical abuse were high, so was reactive aggression. CONCLUSIONS Among violent offenders, PCL-R scores were positively associated with proactive aggression, while experiences of childhood maltreatment were not. This finding concurs with previous studies of children and adults and suggests that proactive aggression may be a behavioural marker of psychopathic traits. By contrast, childhood physical abuse was associated with reactive aggression, even among violent offenders with high PCL-R scores. This latter finding suggests a strong influence of childhood physical abuse on the development of reactive aggression that persists over the lifespan.
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Affiliation(s)
- Nathan J Kolla
- Centre for Addiction and Mental Health, Toronto, Ontario.
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De Brito SA, Viding E, Kumari V, Blackwood N, Hodgins S. Cool and hot executive function impairments in violent offenders with antisocial personality disorder with and without psychopathy. PLoS One 2013; 8:e65566. [PMID: 23840340 PMCID: PMC3688734 DOI: 10.1371/journal.pone.0065566] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/26/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Abstract
CONTEXT The population of men who display persistent antisocial and violent behavior is heterogeneous. Callous-unemotional traits in childhood and psychopathic traits in adulthood characterize a distinct subgroup. OBJECTIVE To identify structural gray matter (GM) differences between persistent violent offenders who meet criteria for antisocial personality disorder and the syndrome of psychopathy (ASPDP) and those meeting criteria only for ASPD (ASPD-P). DESIGN Cross-sectional case-control structural magnetic resonance imaging study. SETTING Inner-city probation services and neuroimaging research unit in London, England. PARTICIPANTS Sixty-six men, including 17 violent offenders with ASPDP, 27 violent offenders with ASPD-P, and 22 healthy nonoffenders participated in the study. Forensic clinicians assessed participants using the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist-Revised. MAIN OUTCOME MEASURES Gray matter volumes as assessed by structural magnetic resonance imaging and volumetric voxel-based morphometry analyses. RESULTS Offenders with ASPDP displayed significantly reduced GM volumes bilaterally in the anterior rostral prefrontal cortex (Brodmann area 10) and temporal poles (Brodmann area 20/38) relative to offenders with ASPD-P and nonoffenders. These reductions were not attributable to substance use disorders. Offenders with ASPD-P exhibited GM volumes similar to the nonoffenders. CONCLUSIONS Reduced GM volume within areas implicated in empathic processing, moral reasoning, and processing of prosocial emotions such as guilt and embarrassment may contribute to the profound abnormalities of social behavior observed in psychopathy. Evidence of robust structural brain differences between persistently violent men with and without psychopathy adds to the evidence that psychopathy represents a distinct phenotype. This knowledge may facilitate research into the etiology of persistent violent behavior.
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Affiliation(s)
- Sarah Gregory
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, King's College London, England, UK
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Corcoran R, Bentall RP, Rowse G, Moore R, Cummins S, Blackwood N, Howard R, Shryane NM. Making sense of theory of mind and paranoia: the psychometric properties and reasoning requirements of a false belief sequencing task. Cogn Neuropsychiatry 2011; 16:547-61. [PMID: 21838640 DOI: 10.1080/13546805.2011.574418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION. This study used Item-Response Theory (IRT) to model the psychometric properties of a false belief picture sequencing task. Consistent with the mental time travel hypothesis of paranoia, we anticipated that performance on this deductive theory of mind (ToM) task would not be associated with the presence of persecutory delusions but would be related to other clinical, cognitive, and demographic factors. METHOD. A large (N=237) and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed 2 ToM tasks: the false belief sequencing task and a ToM stories task that was used to assess the validity of the false belief sequencing task as a measure of ToM. RESULTS. A unidimensional IRT model was found to fit the data well. Latent ToM ability as measured by the false belief sequencing task was negatively related with age and positively with IQ. In contrast to the ToM stories measure, there was no association between clinical diagnosis or symptoms and false belief picture sequencing after controlling for age and IQ. CONCLUSIONS. In line with mental time travel hypothesis of paranoia (Corcoran, 2010 ), performance on this deductive nonverbal ToM task is not related to the presence of paranoid symptoms. This measure is best suited for assessing ToM functioning where participants' performance falls just short of the average latent ToM ability. Furthermore, it is sensitive to the effects of increasing age and decreasing IQ.
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Affiliation(s)
- Rhiannon Corcoran
- Division of Psychiatry, School of Community Health Sciences, University of Nottingham, UK.
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Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, Moore R, Corcoran R. The Cognitive and Affective Structure of Paranoid Delusions. ACTA ACUST UNITED AC 2009; 66:236-47. [DOI: 10.1001/archgenpsychiatry.2009.1] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Corcoran R, Rowse G, Moore R, Blackwood N, Kinderman P, Howard R, Cummins S, Bentall RP. A transdiagnostic investigation of 'theory of mind' and 'jumping to conclusions' in patients with persecutory delusions. Psychol Med 2008; 38:1577-1583. [PMID: 18005499 DOI: 10.1017/s0033291707002152] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A tendency to make hasty decisions on probabilistic reasoning tasks and a difficulty attributing mental states to others are key cognitive features of persecutory delusions (PDs) in the context of schizophrenia. This study examines whether these same psychological anomalies characterize PDs when they present in the context of psychotic depression. METHOD Performance on measures of probabilistic reasoning and theory of mind (ToM) was examined in five subgroups differing in diagnostic category and current illness status. RESULTS The tendency to draw hasty decisions in probabilistic settings and poor ToM tested using story format feature in PDs irrespective of diagnosis. Furthermore, performance on the ToM story task correlated with the degree of distress caused by and preoccupation with the current PDs in the currently deluded groups. By contrast, performance on the non-verbal ToM task appears to be more sensitive to diagnosis, as patients with schizophrenia spectrum disorders perform worse on this task than those with depression irrespective of the presence of PDs. CONCLUSIONS The psychological anomalies associated with PDs examined here are transdiagnostic but different measures of ToM may be more or less sensitive to indices of severity of the PDs, diagnosis and trait- or state-related cognitive effects.
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Affiliation(s)
- R Corcoran
- Division of Psychiatry, School of Community Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Shryane NM, Corcoran R, Rowse G, Moore R, Cummins S, Blackwood N, Howard R, Bentall RP. Deception and false belief in paranoia: modelling theory of mind stories. Cogn Neuropsychiatry 2008; 13:8-32. [PMID: 18092223 DOI: 10.1080/13546800701748805] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study used Item Response Theory (IRT) to model the psychometric properties of a Theory of Mind (ToM) stories task. The study also aimed to determine whether the ability to understand states of false belief in others and the ability to understand another's intention to deceive are separable skills, and to establish which is more sensitive to the presence of paranoia. METHOD A large and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed a ToM stories task measuring false belief and deception at first and second order. RESULTS A three-factor IRT model was found to best fit the data, consisting of first- and second-order deception factors and a single false-belief factor. The first-order deception and false-belief factors had good measurement properties at low trait levels, appropriate for samples with reduced ToM ability. First-order deception and false beliefs were both sensitive to paranoid ideation with IQ predicting performance on false belief items. CONCLUSIONS Separable abilities were found to underlie performance on verbal ToM tasks. However, paranoia was associated with impaired performance on both false belief and deception understanding with clear impairment at the simplest level of mental state attribution.
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Affiliation(s)
- Nick M Shryane
- Institute for Social Change, University of Manchester, Manchester, UK
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Corcoran R, Cummins S, Rowse G, Moore R, Blackwood N, Howard R, Kinderman P, Bentall RP. Reasoning under uncertainty: heuristic judgments in patients with persecutory delusions or depression. Psychol Med 2006; 36:1109-1118. [PMID: 16734944 DOI: 10.1017/s003329170600794x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions. METHOD People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence. RESULTS The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening. CONCLUSION This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.
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Affiliation(s)
- Rhiannon Corcoran
- Division of Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK.
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Moore R, Blackwood N, Corcoran R, Rowse G, Kinderman P, Bentall R, Howard R. Misunderstanding the intentions of others: an exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis. Am J Geriatr Psychiatry 2006; 14:410-8. [PMID: 16670245 DOI: 10.1097/01.jgp.0000200604.47367.38] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to explore the cognitive etiology of persecutory delusion formation and maintenance in very late-onset schizophrenia-like psychosis (SLP). METHOD Probabilistic reasoning, causal attributional style, and mentalizing ability were examined in 29 patients with SLP, 30 with onset of depression after the age of 60 years and 30 healthy comparison subjects. RESULTS Patients with SLP made significantly more errors than the healthy comparison group in deception, but not false belief, mentalizing tasks. There were no significant performance differences between groups on the probabilistic reasoning task or the attributional style task. CONCLUSIONS Mentalizing errors may contribute to the development and maintenance of persecutory delusions in SLP. These patients do not appear to show the wider range of cognitive biases described in deluded patients with schizophrenia with onset in younger adult life.
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Affiliation(s)
- Rosanna Moore
- Section of Old Age Psychiatry, Institute of Psychiatry, London, UK
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Abstract
OBJECTIVE In the United Kingdom (UK), an objective structured clinical examination (OSCE) has replaced the individual patient assessment (IPA) for part 1 of the membership examination of the Royal College of Psychiatrists (MRCPsych). The authors' assessment of the OSCE was conducted. METHOD Residents completed and evaluated an OSCE designed according to guidelines set by the Royal College of Psychiatrists. RESULTS These residents considered the OSCE fair (86%) and appropriate (89%) in assessing clinical ability. They believed that the OSCE reflected the skills required in clinical practice and found it preferable to the IPA. CONCLUSION The OSCE received positive evaluation from residents.
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Affiliation(s)
- Justin Sauer
- Institute of Psychiatry and Maudsley Hospital, Psychological Medicine (P070), London, United Kingdom.
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Abstract
This study aimed to identify the neural basis of probabilistic reasoning, a type of inductive inference that aids decision making under conditions of uncertainty. Eight normal subjects performed two separate two-alternative-choice tasks (the balls in a bottle and personality survey tasks) while undergoing functional magnetic resonance imaging (fMRI). The experimental conditions within each task were chosen so that they differed only in their requirement to make a decision under conditions of uncertainty (probabilistic reasoning and frequency determination required) or under conditions of certainty (frequency determination required). The same visual stimuli and motor responses were used in the experimental conditions. We provide evidence that the neo-cerebellum, in conjunction with the premotor cortex, inferior parietal lobule and medial occipital cortex, mediates the probabilistic inferences that guide decision making under uncertainty. We hypothesise that the neo-cerebellum constructs internal working models of uncertain events in the external world, and that such probabilistic models subserve the predictive capacity central to induction.
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Affiliation(s)
- Nigel Blackwood
- Division of Psychological Medicine, Institute of Psychiatry, PO Box 70, De Crespigny Park, London SE5 8AZ, UK.
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Abstract
Persecutory (paranoid) delusions are a frequently observed clinical phenomenon. In recent years, an increasing volume of research has attempted to explain these types of beliefs in terms of psychological mechanisms. Theories have emphasized early experience, perceptual abnormalities, motivational factors, and information-processing deficits. In this article we review relevant findings, including our own studies of the role of causal attributions and theory of mind deficits. We propose a new integrative model that builds on this work. The core of the model is an account of the way that causal attributions influence self-representations, which in turn influence future attributions: the attribution--self-representation cycle. We argue that biases in this cycle cause negative events to be attributed to external agents and hence contribute to the building of a paranoid world view. These abnormalities are amenable to investigation by functional neuroimaging, and recent studies have implicated specific areas of neuroactivation. However, these findings do not necessarily suggest that paranoid delusions are entirely biological in origin, and there is evidence that adverse early experience may play a role in determining the development of a cognitive vulnerability to paranoid thinking.
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Affiliation(s)
- R P Bentall
- Department of Psychology, University of Manchester, Coupland 1 Building, Oxford Rd., Manchester M13 9PL, UK
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Woodruff, Blackwood N, Ha Y, Wright I, Bullmore E, Brammer M, Howard R, Williams S, Shapleske J, Rossell S, Murray R. Is cortical responsivity increased in schizophrenics predisposed to hallucinations? Eur Psychiatry 1998. [DOI: 10.1016/s0924-9338(99)80003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Newman DK, Wallace J, Blackwood N, Spencer C. Promoting healthy bladder habits for seniors. Ostomy Wound Manage 1996; 42:18-22, 24-5, 28. [PMID: 9016149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Urinary incontinence (UI) effects people of all ages, but is especially prevalent in the elderly population. Also significant is a lack of knowledge about UI. A health promotion project was developed and implemented in six ethnically diverse, predominantly minority, inner city senior centers, a program designed to address an elder population, as they are very likely to be experiencing UI and lacking knowledge concerning healthy bladder habits. The project consisted of three phases: orientation/training of key staff members/peer educators at the six senior centers; educating elder consumers through four one-hour weekly sessions involving visual aids and completion of bladder records and quizzes, and follow-up sessions with senior staff/peer educators to reinforce previous training. One result was that training of peer educators needed further refinement to allow for a more significant role throughout the program. The program was very well received by the participants and roughly 80 percent felt they had more control over their bladder by the end of the last session. This project will continue into 1997 and in addition to information on UI, the project will include prostate health for men and gynecological health for women, as this need became evident throughout the program.
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Affiliation(s)
- D K Newman
- DKN & Associates, Inc, Philadelphia, Pennsylvania, USA
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Newman DK, Brannan P, Blackwood N, Spencer C, Wallace J. Managed urinary incontinence: an independent NP model. NP News 1995; 3:7-8. [PMID: 7553201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Grosz DE, Lipschitz DS, Eldar S, Finkelstein G, Blackwood N, Gerbino-Rosen G, Faedda GL, Plutchik R. Correlates of violence risk in hospitalized adolescents. Compr Psychiatry 1994; 35:296-300. [PMID: 7956186 DOI: 10.1016/0010-440x(94)90022-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Forty adolescent inpatients with histories of frequent interpersonal violent behavior were compared with 36 hospitalized adolescents without histories of overt violence using self-report questionnaires that measured violence risk, depression, impulsivity, and suicide risk. The two groups did not differ in terms of their demographic characteristics, but the violent patients had a higher prevalence of substance abuse and borderline personality disorder diagnoses. Violent adolescents were more impulsive and at higher suicide risk than nonviolent adolescents. In addition, violent adolescents had more positive histories of suicide attempts and had significantly higher family histories of attempted and completed suicide. In the total sample of adolescents, violence risk was significantly correlated with impulsivity and suicide risk, but not with depression.
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Affiliation(s)
- D E Grosz
- Division of Child and Adolescent Psychiatry, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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