Some Ethical Considerations About the Use of Biomarkers for the Classification of Adult Antisocial Individuals

It has been argued that a biomarker-informed classification system for antisocial individuals has the potential to overcome many obstacles in current conceptualizations of forensic and psychiatric constructs and promises better targeted treatments. However, some have expressed ethical worries about the social impact of the use of biological information for classification. Many have discussed the ethical and legal issues related to possibilities of using biomarkers for predicting antisocial behavior. We argue that prediction should not raise the most pressing ethical worries. Instead, issues connected with “biologization”, such as stigmatization and negative effects on self-image, need more consideration. However, we conclude that also in this respect there are no principled ethical objections against the use of biomarkers to guide classification and treatment of adult antisocial individuals

Hazardous alcohol use and alcohol use disorders in women : characteristics and vulnerability factors

The overall aim of this thesis was to study vulnerability factors associated with hazardous alcohol consumption during pregnancy and alcohol use disorders among Swedish women. Different risk-factors and characteristics were studied, and examined for their ability to discriminate or identify different subtypes (type I/late onset and type II/early onset) of alcohol dependence ( alcoholism ). In study I, an RCT at ANC in Stockholm (control, n = 156, intervention, n =147) we examined the ability of Swedish antenatal care to identify alcohol-related risk pregnancies, and the utility of some tools that could improve its performance (AUDIT, TLFB and biomarkers). In study II, a pilot cohort (n = 139) was screened for alcohol use disorders, and assessed for psychopathology, personality traits, and alcohol use during the first trimester. Subjects reporting consumption exceeding a conservative threshold for harmful use were offered a diagnostic psychiatric interview. The main findings of the pilot study were replicated using a large sample of women in the third trimester (n = 715). In study III and IV, a case-control study, detailed assessment was obtained from 200 treatment-seeking alcohol dependent women and 189 healthy population controls. All women were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality traits. Cases and controls were genotyped for markers in the CRHR1, MAOA and OPRM1 genes. In study V, female twins from the Swedish Twin Registry (n =13 501) answered questions to establish lifetime alcohol use disorders, and subjects with alcoholism were classified for subtype. Heritability estimates were obtained, and environmental factors associated with alcoholism and its subtypes were studied. Sixteen percent of pregnant women drank at levels that could be defined as riskconsumption . Significantly more of these were identified by intensified screening compared to regular antenatal screening procedures (p = 0.0001), while biomarkers were of little use. Only a minority of women with hazardous alcohol consumption during pregnancy fulfilled alcohol dependence criteria. Psychiatric distress in those with risk-consumption did not differ from those with low or no consumption during pregnancy, but subjects with continued alcohol use scored higher on novelty seeking. Among women with alcohol dependence, early onset/type II alcoholism is a valid construct. We found that alcohol dependent women classified as type II had more severe alcohol problems and significantly higher rates of illicit drug use. Family history of alcoholism was also considerably more common among type II than subjects than those classified as type I. Both alcoholism subtypes scored higher than normal on anxiety and impulsivity traits, but type II subjects scored markedly higher than either of the other groups on aggression (p = 0.00004). Despite a higher density of family history among type II subjects in the clinical cohort, our twin study did not support a difference in heritability between early onset/type II and late onset/type I alcoholism. Both genetic and environmental factors play an important role for susceptibility to alcoholism in women, in particular the early onset subtype. Childhood trauma is a category of environmental factors that plays a major role. The effect of emotional neglect and physical trauma was accounted for by familial background factors, which can be both genetic and environmental. In addition, childhood sexual abuse was an independent individual risk factor for alcohol dependence. Effects of sexual abuse were in part mediated trough psychiatric problems. Overall, treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women

Neuroscience in Forensic Psychiatry and Psychology: An Introduction to the Special Issue

This special issue is dedicated to the potential role of neuroscience in forensic psychiatry and psychology. Although neuroscientific insights are increasingly incorporated in clinical practice, they received less attention in forensic mental healthcare and in the forensic mental health literature. In the last decade there has been an increased interest in using neuroscientific knowledge in the assessment and treatment of psychopathology related to antisocial and violent behavior. Consequently, neuroscientific methods may, for example, be used in detecting psychiatric problems in defendants, one of the topics covered by the scientific field of neurolaw. This current article introduces this special issue by providing an introduction to the neurobiology of antisocial and criminal behavior and will set off discussing how neuroscientific insights may be used in forensic clinical practice

Psychopathy: Philosophical and Empirical Challenges

Introduction to the special issue entitled "Psychopathy: Philosophical and Empirical Challenges

Psychopathy: Philosophical and Empirical Challenges

Introduction to the special issue entitled "Psychopathy: Philosophical and Empirical Challenges

Can Neuroscience Help Predict Future Antisocial Behavior?

Part I of this Article reviews the tools currently available to predict antisocial behavior. Part II discusses legal precedent regarding the use of, and challenges to, various prediction methods. Part III introduces recent neuroscience work in this area and reviews two studies that have successfully used neuroimaging techniques to predict recidivism. Part IV discusses some criticisms that are commonly levied against the various prediction methods and highlights the disparity between the attitudes of the scientific and legal communities toward risk assessment generally and neuroscience specifically. Lastly, Part V explains why neuroscience methods will likely continue to help inform and, ideally, improve the tools we use to help assess, understand, and predict human behavior

In what sense are mental disorders brain disorders? Explicating the concept of mental disorder within RDoC

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions

The development of psychiatric disorders and adverse behaviors : from context to prediction

Psychiatric disorders by definition cause significant impairment in an individual’s daily functioning. Certain disorders, such as borderline personality disorder (BPD) and eating disorders, have worse prognosis and high mortality rates compared to other psychiatric disorders. Similarly, adverse behaviors such as self-harm, suicide, and crime are often present in individuals with psychiatric disorders. It is of interest to further understand the etiology and associations of BPD and eating disorders to uncover potential avenues and opportunities for intervention. Moreover, prediction modeling has recently come of interest to psychiatric epidemiologists with the rise of large data sets. Prediction modeling may provide valuable information about the nature of risk factors and eventually aid clinical diagnostics and prognostics. Thus, the studies included in this thesis seek to examine the etiology, associations, and prediction approaches of psychiatric disorders and adverse behaviors. Study I examined the individual and familial association between type 1 diabetes (T1D) and eating disorder diagnoses. We used national health care records from Denmark (n = 1,825,920) and Sweden (n = 2,517,277) to calculate the association within individuals, full siblings, half siblings, full cousins, and half cousins. Individuals with T1D had twice the hazard rate ratio of being diagnosed with an eating disorder compared to the general population. There was conflicting evidence for the risk of an eating disorder in full siblings of T1D patients. However, there was no evidence to support a further familial relationship between the two conditions. Study II aimed to illuminate the nature of the correlates for BPD across time, sex, and for their full siblings. We examined 87 variables across psychiatric disorders, somatic illnesses, trauma, and adverse behaviors (such as self-harm). In a sample of 1,969,839 Swedes with 12,175 individuals diagnosed with BPD, we found that BPD was associated with nearly all of the examined variables. The associations were largely consistent across time and between the sexes. Finally, we found that having a sibling diagnosed with BPD was associated with psychiatric disorders, trauma, and adverse behaviors but not somatic illnesses. Study III created a prediction model that could predict who would have high or low psychiatric symptoms at age 15 based on data from parental reports and national health care registers collected at age 9 or 12. Additionally, we compared multiple types of machine learning algorithms to assess predictive performance. The sample included 7,638 twins from the Child and Adolescent Twin Study in Sweden (CATSS). Our model was able to predict the outcome with reasonable performance but is not suitable for use in clinics. Each model performed similarly indicating that researchers with similar data and research questions do not need to forgo standard logistic regression. Study IV aimed to determine if an individual will exhibit suicidal behaviour (self-harm or suicidal thoughts), aggressive behaviour, both, or neither before adulthood with prediction modeling. Through variable importance scores we examined the usefulness of genetic variables within the model. A total of 5,974 participants from CATSS and 2,702 participants from the Netherlands Twin Register (NTR) were included in the study. The model had adequate performance in both the CATSS and NTR datasets for all classes except for the suicidal behaviors class in the NTR, which did not perform better than chance. The included genetic data had higher variable importance scores than questionnaire data completed at age 9 or 12, indicating that genetic biomarkers can be useful when combined with other data types. In conclusion, the development of psychiatric disorders and symptoms are associated with many factors across somatic illnesses, other psychiatric disorders, trauma, and harmful behaviors. The results of this thesis demonstrates the limitations of prediction modeling in psychiatric clinics but highlights their use in research and on the path forward towards personalized medicine

Move to improve:The effect of physical activity on cognitive control and antisocial behavior

The current thesis investigated the effect of physical activity on antisocial behavior and the possible role of cognitive control in multi-problem young adults. Earlier research uncovered a robust association between impaired cognitive control and antisocial behavior, implying individuals displaying antisocial behavior may benefit from interventions targeting neurocognitive functioning. Impaired cognitive control can severely impact one's life, as it is needed to adequately plan, regulate, and adapt goal-directed behavior. Understandably, deficiencies in these capabilities may sustain or promote antisocial behavior through the impaired ability to anticipate negative consequences, suppress unwanted impulses, and adjust behavior according to social expectations. Physical activity has been previously proposed as an effective intervention for decreasing antisocial behavior in children and adolescents (aged < 18) from the general population and in adult offenders or adults suffering from substance use disorders, yet existing research in young adults (especially clinical or at-risk young adults) is scarce and inconclusive. The observed reduction in antisocial behavior may be the result of an enhancement in neurocognitive functioning, as prior studies indicate robust positive effects on cognitive control following increased physical activity in healthy (but sedentary) youth aged <18 and the elderly. However, to date, the effect of physical activity on cognitive control has not been examined in young adults suffering from multiple problems including aggression, delinquent behavior, frequent substance use, and other externalizing behaviors despite their possible associated executive deficits. To deepen our understanding of the relation between physical activity, antisocial behavior, and cognitive control, we first studied the possible potential of neurobiological and (neuro)behavioral measures of cognitive control in the prediction of and association with real-world behavior, i.e., behavior following a multimodal day treatment and antisocial behavior. We included three indices of neurocognitive functions, i.e., error processing, response inhibition, and interference, using different measurement techniques including functional magnetic resonance imaging and electroencephalographic paradigms in male multi-problem young adults (aged 18 – 27). In the following chapter, we reviewed and quantified the overall effectiveness of previous physical activity interventions in reducing antisocial behavior in a meta-analytic review. Subsequently, in the next two chapters, we discussed the association between physical activity and the impact on behavioral measures of cognitive control using a randomized controlled intervention study. And lastly, we investigated other ways in which physical activity might contribute to the development of positive behavior and the decrease of negative behavior, according to the multi-problem young adults, using a thematic approach. Our findings suggest that overall, increased physical activity may be used to treat antisocial behavior in adults displaying a range of externalizing behaviors. Furthermore, regarding cognitive control, the current results first associated a neurocognitive biomarker (ACC activity during response inhibition) with better outcomes (higher odds of engaging in daytime activities) a year after a multimodal day treatment program in populations displaying antisocial behavior, linking cognitive control to real-world positive behavior. Secondly, our data suggest enhanced neurocognitive functioning following a physical activity program in young adults with impaired cognitive control, who are suffering from multiple problems, including several forms of antisocial behavior. Taken together with prior studies, the results of the current dissertation suggest that a: physical activity interventions and programs may possibly provide an easy-to-implement treatment of antisocial behavior and b: this positive behavioral effect may be partially explained by an exercise-induced enhancement of cognitive control, although future studies including both cognitive control and antisocial behavior are needed to verify this hypothesis