Psychometric properties of the Impulsive/Premeditated Aggression Scale in Portuguese community and forensic samples / Propriedades psicométricas da versão portuguesa da Escala de Agressão Impulsiva e Premeditada em amostras comunitárias e forenses

Abstract Introduction Aggression can be defined according to impulsive or premeditated features. Impulsivity is defined as an uncontrolled and unplanned form of aggression. On the contrary, premeditation requires planning and is goal-oriented. Objective The purpose of this study was to validate the basic psychometric properties of the Impulsive/Premeditated Aggression Scale (IPAS) into European Portuguese. The scale evaluates aggression according to impulsive and premeditated features, which are considered the predominant forms of aggressive behavior, and can be used in community, forensic and clinical settings. Methods Participants from a community sample (n = 957; 424 male) and incarcerated individuals (n = 115, all male) completed the IPAS. Results Internal consistency and reliability indicated that the scale has good psychometric properties in both samples. Data from a principal component analysis (PCA) demonstrated similarities to previous structures reported in the literature. Conclusions The scale demonstrated to be sensitive to the bimodal classification of aggression in community and forensic samples, indicating its utility in the characterization of aggressive patterns.

Resumo Introdução A agressão pode ser definida de acordo com as características de impulsividade ou premeditação. A impulsividade é definida como uma forma descontrolada e não planeada de agressão. Pelo contrário, a premeditação requer planejamento e orienta-se para um objetivo. Objetivos O objetivo deste estudo foi validar as propriedades psicométricas básicas da Escala de Agressão Impulsiva e Premeditada (Impulsive/Premeditated Aggression Scale - IPAS) para o português europeu. A escala avalia a agressão de acordo com características impulsivas e premeditadas, que são consideradas as formas predominantes do comportamento agressivo, e pode ser usada em contextos comunitário, forense e clínico. Métodos A escala foi aplicada a participantes de uma amostra comunitária (n = 957; 424 homens) e reclusos (n = 115, todos homens). Resultados A consistência interna e a confiabilidade indicaram que a escala possui boas propriedades psicométricas para as duas amostras. Os dados da análise de componentes principais (principal component analysis - PCA) demonstraram semelhanças com estruturas fatoriais previamente reportadas na literatura. Conclusão A escala revelou ser sensível à classificação bimodal da agressão em amostras comunitárias e forenses, indicando sua utilidade na caracterização de padrões agressivos.

Narcissism and aggression in impulsive-premeditated violent criminals / 中华行为医学与脑科学杂志

Objective To explore the characteristics of narcissism in a sample of violent criminal and analyze the relationship between narcissism and impulsive-premeditated violent aggression.Methods A total of 88 violent criminal were administered by means of cluster random sampling with the Chinese version of the Impulsivepremeditated Aggression Scale and the Narcissistic Personality Questionnaire.Results (1) Comparing with the impulsive violent criminal,premeditated violent criminal had higher level of Overt narcissism,and the difference was statistically significant(59.77±10.89,54.67±10.15; P＜0.05).(2) Overt narcissism had significantly positive correlation with premeditated aggression(r=0.560; P＜0.01) ;and covert narcissism had significantly positive correlation with impulsive aggression(r=0.440; P＜0.01).(3)The authority and self-admiration traits of overt narcissism had significantly positive prediction to premeditated aggression(β=0.442,P＜0.01;β=0.297,P＜0.05);The vulnerability trait of covert narcissism has significantly positive prediction to impulsive aggression(β=0.526,P＜0.01).Conclusion Overt narcissism can result in premeditated aggression;Covert narcissism can result in impulsive aggression.

Resonancia magnética funcional en el diagnóstico clínico del déficit de atención y de la agresión impulsiva infantil: Una propuesta exploratoria / Functional magnetic resonance imaging in the clinical diagnostic of the attention deficit disorder and the impulsive aggression in children: An exploratory proposal

Attention deficit disorder (ADD) refers to a neurobehavioral condition commonly initiated in childhood. Its clinical diagnosis involves poor attention, distractibility, difficulties to inhibit motor behaviors and cognitive impulsivity. It is suggested that ADD is classified in two general types correlated with different neurocognitive qualities. One is manifested in executive frontal dysfunctions (ADD). In the other type dominates hyperactivity/ impulsivity (ADHD) and it is associated with deficiencies in working memory and alterations in the dorsolateral prefrontal cortex. Results obtained by using electroencephalography, event-related potential paradigms and voxel brain morphometry suggest anomalies in the brain structure and function correlated with ADD, particularly in the frontal, parietal and temporal cortices, in addition to regions involved in the fronto-estriatal connections. On the other hand, functional magnetic resonance imaging (fMRI) constitutes a technique to obtain brain images which can be interpreted as regions and networks of neural activity elicited during the performance of a cognitive process. Based on the information that the ADD patients are susceptible to cognitive interferences, some researches have applied the classical and the counting versions of the Stroop task paradigms in fMRI. In comparison with control subjects, adult patients show alack of neural activation in the anterior cingulated cortex. Nevertheless, results in children are more controversial and attribute neurobiological and social factors in the ADD etiology. The anterior cingulated cortex and prefrontal region of the human brain conform the execution system of attention and their function is essential for emotional processes. The neurocognitive relation between attention and emotion involves the influence of the affective system in the alert and execution systems of attention through reciprocal connections between limbic and frontal regions, which permit a mnemonic and affective valuation of the attended environment. Understanding the relations between attention and emotion is essential in basic and clinical approaches, due to the co-morbidity of ADD with some emotional disorders, such as the oppositional defiant disorder, anxiety and impulsive aggression, the last one elicited by uncontrolled experiences of anger. In this sense, some studies describe that the metabolic brain activity correlated with the experience of anger is manifested in the frontal, anterior cingulated and insular cortices and the temporal pole. Clinical situations require individualized decisions on the immediate and emergent treatment of one case. Furthermore, when the clinical case refers to a behavioral disorder probably related with neurobiological dysfunctions, a comparison of test with control subjects is necessary. In this sense, the present work constitutes an fMRI study designed to evaluate neurological functional alterations in a child patient diagnosed with ADHD, with persistent severe impulsive aggression behaviors that required a swift evaluation to enhance the diagnosis and treatment proposed by other clinical techniques. Besides the patient, three infant participants were evaluated. One of them was diagnosed with ADD but did not manifest aggressive or impulsive behaviors and was not under any pharmacological treatment. The other two healthy children had no neurological and psychiatric disorders history. All the participants presented similar intellectual coefficient and performed the same cognitive and emotional tests. In the case of the patient, test were applied in two conditions: under the proposed pharmacological treatment and without medication. The attention test consisted in a version of the counting Stroop task in Spanish language, presented in a block design through the E-Prime software. Subjects practiced the task in a personal computer before the functional image acquisition and were trained to answer by using a bottom response system that will be used in the scanner. For the emotional-anger paradigm, children were interviewed about scenes and situations of their personal experience which elicited anger and calm. Situations were ordered and planned in a block design to be executed in the magnetic resonance instrument. During the functional images acquisition children listened to the situations conducted by imaginery techniques. Functional images were acquired in a 1.5 T G.E. instrument in the Magnetic Resonance Unit of the Hospital Ángeles Metropolitano in Mexico City. Data were analyzed by using the SPM 5 software applying a contrast using FWE with p < 0.05. Brain coordinates obtained in SPM 5 were converted to the Talairach Deamond system in order to obtain the Brodmann areas related to those coordinates. During the performance of the counting Stroop task, the patient with ADHD under medication manifested activation in frontal areas, but not during the medication suspension trial. Frontal activity identified in this patient in the treatment trial was similar to that identified in the unaggressive ADD patient. In both cases, ADHD without medication and ADD, a lack of activity was identified in the anterior cingulate cortex (ACC). Nevertheless, activation in ACC, in parietal and temporal regions was present in the aggressive patient under treatment but not in the suspension condition. These results may suggest that an inadequate attention process distort the environment stimuli, which is necessary for the subject's correct affective evaluation of the situation. During the experience of anger, the patient under treatment manifested activity in the parahippocampal region, as well as in the anterior and posterior cingulate cortices. Results discussed in this work agree with those previously reported and offer cues to complement the diagnosis and treatment of ADD/ADHD and their relations with emotional disorders. Particularly, the design used here could be used for the analysis and evaluation of some pharmacological and behavioral treatments clinically applied in ADD. In addition, it helps to understand the participation of multipotential brain regions and neural networks involved in several cognitive processes, such as attention, working memory and emotion. Finally, we proposed some ideas to interpret these results using fMRI and ADD: 1. It is necessary a consensual and standard integration of neuropsychological tests which identify different cognitive qualities of ADD. 2. The selection of children samples to study the neurobiology of ADD must include several variables associated with its etiology, such as parental relations, social and scholar environments. 3. Experimental paradigms could be designed to be performed using different neuroimaging techniques, such as fMRI or event-related potential. Thus, the results of the same test can be used to complement different approaches. 4. Results obtained by fMRI must not be understood in a phrenologycal and deterministic approach, but as brain region activations indicating dynamic neural networks.

El trastorno por déficit de atención (TDA) es un padecimiento neuroconductual iniciado en la infancia, cuyos criterios diagnósticos incluyen dificultades en la inhibición motora e impulsividad conductual. Tomando en cuenta la evidencia de que los pacientes con TDA son susceptibles a la interferencia cognitiva, la técnica de resonancia magnética funcional ha permitido la obtención de imágenes cerebrales que pueden interpretarse como redes de actividad neuronal, las cuales fueron desencadenadas durante la realización de la tarea Stroop o de interferencia. Algunos hallazgos en individuos sanos sugieren actividad predominante en la corteza anterior del cíngulo durante el proceso de atención selectiva requerido en la ejecución de esta tarea, en tanto que pacientes diagnosticados con TDA muestran ausencia de tal actividad. Diversos autores han señalado la relación neurocognitiva entre la atención y la emoción, a partir de la interacción entre estructuras límbicas y regiones frontales del cerebro. En el caso del TDA, esta relación es relevante debido a su comorbilidad con trastornos de tipo emocional, en particular en el caso de la agresión impulsiva. Ésta es desencadenada por estados incontrolables de ira, cuya experiencia inducida se ha correlacionado con la actividad cerebral de la región frontal, del polo temporal, de la corteza anterior del cíngulo y de la ínsula. Ahora bien, en el ámbito clínico es recurrente la necesidad de una evaluación individualizada y la decisión del tratamiento inmediato y urgente de un caso. El presente trabajo muestra un diseño utilizado en la valoración de alteraciones neurológicas funcionales en un paciente infantil diagnosticado con TDA, cuyos repetidos episodios de comportamientos agresivos requerían una evaluación pronta que complementara el diagnóstico y tratamiento provenientes de otras herramientas clínicas. Con un equipo de resonancia magnética de 1.5 T se registró la actividad cerebral del paciente durante la ejecución de una versión en español de la tarea Stroop por conteo y de un paradigma emocional que consistió en la evocación dirigida de escenas que desencadenaran ira en el sujeto. La obtención de imágenes funcionales se real izó tanto bajo el efecto del tratamiento farmacológico que seguía el paciente, como bajo la suspensión del mismo. Después, se comparó la actividad cerebral del paciente con otro caso infantil diagnosticado con TDA, pero sin presencia de comportamientos agresivos. La actividad cerebral de ambos casos de TDA se comparó con la registrada en dos niños con edad y coeficiente intelectual homogéneos, carentes de historial neurológico y psiquiátrico. Ninguno de los participantes manifestó alteraciones estructurales cerebrales. Los resultados funcionales durante la ejecución Stroop identificaron menor actividad en la corteza anterior del cíngulo en los dos casos diagnosticados con TDA. Durante la experiencia del estado de ira y en comparación con los otros participantes, el paciente bajo efecto del tratamiento manifestó actividad en la región parahipocampal, así como en las cortezas anterior y posterior del cíngulo. Los resultados coinciden con hallazgos reportados sobre la neurobiología del TDA y de la experiencia de ira. Además, otorgan herramientas para el diagnóstico y tratamiento de trastornos de la atención y su relación con trastornos emocionales. Este tipo de diseños contribuye al análisis y observación del efecto de algunos tratamientos, tanto farmacológicos como conductuales, aplicados en la clínica del TDA. En este caso, el tratamiento aplicado al paciente parece actuar a nivel del proceso de atención, pero no en el ámbito del control de la ira. También, proporciona pautas para comprender la participación de regiones cerebrales multipotenciales y las redes neuronales que involucran diferentes procesos cognitivos, como la emoción y la atención.