See think act scale: Validation of the Dutch version of a measure of relational security in high secure forensic psychiatric care.

Relational security is considered an essential form of security in forensic psychiatric care. Research on relational security is important, but is hampered by the lack of instruments to assess and monitor this concept in clinical practice. Within this current study the psychometric properties of the Dutch version of the See Think Act (STA) scale, an instrument designed to measure relational security as perceived by forensic staff members within secure settings, was studied. Results show that the internal consistency of the STA total scale was good. However, the internal consistency of the subscales was relatively low compared to other studies using the original English or the Chinese version of the STA scale. The factor structure found in the original English version of the scale was not confirmed within this sample. With regard to the validity of the instrument results were promising, finding relationships with aspects of ward climate and team reflexivity. Further research and development is needed regarding the STA scale, making it more suitable for monitoring and studying this clinically relevant concept in forensic care.

Psychopathic tendency in violent offenders is associated with reduced aversive Pavlovian inhibition of behavior and associated striatal BOLD signal.

Background: Violent offenders with psychopathic tendencies are characterized by instrumental, i.e., planned, callous, and unemotional (aggressive) behavior and have been shown to exhibit abnormal aversive processing. However, the consequences of abnormal aversive processing for instrumental action and associated neural mechanisms are unclear. Materials and methods: Here we address this issue by using event-related functional magnetic resonance imaging (fMRI) in 15 violent offenders with high psychopathic tendencies and 18 matched controls during the performance of an aversive Pavlovian-to-instrumental transfer paradigm. This paradigm allowed us to assess the degree to which aversive Pavlovian cues affect instrumental action and associated neural signaling. Results: Psychopathic tendency scores were associated with an attenuation of aversive Pavlovian inhibition of instrumental action. Moreover, exploratory analyses revealed an anomalous positive association between aversive inhibition of action and aversive inhibition of BOLD signal in the caudate nucleus of violent offenders with psychopathic tendencies. In addition, psychopathic tendency also correlated positively with amygdala reactivity during aversive versus neutral cues in Pavlovian training. Conclusion: These findings strengthen the hypothesis that psychopathic tendencies in violent offenders are related to abnormal impact of aversive processing on instrumental behavior. The neural effects raise the possibility that this reflects deficient transfer of aversive Pavlovian inhibitory biases onto neural systems that implement instrumental action, including the caudate nucleus.

Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care.

In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.

Parsing fear: A reassessment of the evidence for fear deficits in psychopathy.

Psychopathy is a personality disorder characterized by interpersonal manipulation and callousness, and reckless and impulsive antisocial behavior. It is often seen as a disorder in which profound emotional disturbances lead to antisocial behavior. A lack of fear in particular has been proposed as an etiologically salient factor. In this review, we employ a conceptual model in which fear is parsed into separate subcomponents. Important historical conceptualizations of psychopathy, the neuroscientific and empirical evidence for fear deficits in psychopathy are compared against this model. The empirical evidence is also subjected to a meta-analysis. We conclude that most studies have used the term "fear" generically, amassing different methods and levels of measurement under the umbrella term "fear." Unlike earlier claims that psychopathy is related to general fearlessness, we show there is evidence that psychopathic individuals have deficits in threat detection and responsivity, but that the evidence for reduced subjective experience of fear in psychopathy is far less compelling. (PsycINFO Database Record

Unfair offers, unfair offenders? Fairness considerations in incarcerated individuals with and without psychopathy.

Offenders with psychopathy have often committed crimes violating social norms, which may suggest a biased moral reasoning in psychopathy. Yet, as findings on utilitarian decisions remain conflicting, the current study investigated different aspects of fairness considerations in offenders with psychopathy, offenders without psychopathy and healthy individuals (N = 18/14/18, respectively). Unfair offers in a modified Ultimatum Game (UG) were paired with different unselected alternatives, thereby establishing the context of a proposal, and made under opposing intentionality constraints (intentional vs. unintentional). As in previous studies, unfair offers were most often rejected when the alternative was fair and when the offer was made intentionally. Importantly, however, offenders with psychopathy demonstrated a similar rejection pattern to that of healthy individuals, i.e., taking the unselected alternative into account. In contrast, delinquents without psychopathy did not adjust their decision behavior to the alternatives to an offer, suggesting stronger impairments in social decision-making. Crucially, the mechanisms and processes underlying rejection decisions might differ, particularly with regard to cognitive vs. emotional competencies. While preserved cognitive perspective-taking could drive seemingly intact decision patterns in psychopathy, emotional empathy is likely to be compromised.

Reversal deficits in individuals with psychopathy in explicit but not implicit learning conditions.

BACKGROUND: Psychopathy is a severe personality disorder that has been linked to impaired behavioural adaptation during reinforcement learning. Recent electrophysiological studies have suggested that psychopathy is related to impairments in intentionally using information relevant for adapting behaviour, whereas these impairments remain absent for behaviour relying on automatic use of information. We sought to investigate whether previously found impairments in response reversal in individuals with psychopathy also follow this dichotomy. We expected response reversal to be intact when the automatic use of information was facilitated. In contrast, we expected impaired response reversal when intentional use of information was required. METHODS: We included offenders with psychopathy and matched healthy controls in 2 experiments with a probabilistic cued go/no-go reaction time task. The task implicated the learning and reversal of 2 predictive contingencies. In experiment 1, participants were not informed about the inclusion of a learning component, thus making cue-dependent learning automatic/incidental. In experiment 2, the instructions required participants to actively monitor and learn predictive relationships, giving learning a controlled/intentional nature. RESULTS: While there were no significant group differences in acquisition learning in either experiment, the results revealed impaired response reversal in offenders with psychopathy when controlled learning was facilitated. Interestingly, this impairment was absent when automatic learning was predominant. LIMITATIONS: Possible limitations are the use of a nonforensic control group and of self-report measures for drug use. CONCLUSION: Response reversal deficits in individuals with psychopathy are modulated by the context provided by the instructions, according to the distinction between automatic and controlled processing in these individuals.

Psychopathy-related traits and the use of reward and social information: a computational approach.

Psychopathy is often linked to disturbed reinforcement-guided adaptation of behavior in both clinical and non-clinical populations. Recent work suggests that these disturbances might be due to a deficit in actively using information to guide changes in behavior. However, how much information is actually used to guide behavior is difficult to observe directly. Therefore, we used a computational model to estimate the use of information during learning. Thirty-six female subjects were recruited based on their total scores on the Psychopathic Personality Inventory (PPI), a self-report psychopathy list, and performed a task involving simultaneous learning of reward-based and social information. A Bayesian reinforcement-learning model was used to parameterize the use of each source of information during learning. Subsequently, we used the subscales of the PPI to assess psychopathy-related traits, and the traits that were strongly related to the model's parameters were isolated through a formal variable selection procedure. Finally, we assessed how these covaried with model parameters. We succeeded in isolating key personality traits believed to be relevant for psychopathy that can be related to model-based descriptions of subject behavior. Use of reward-history information was negatively related to levels of trait anxiety and fearlessness, whereas use of social advice decreased as the perceived ability to manipulate others and lack of anxiety increased. These results corroborate previous findings suggesting that sub-optimal use of different types of information might be implicated in psychopathy. They also further highlight the importance of considering the potential of computational modeling to understand the role of latent variables, such as the weight people give to various sources of information during goal-directed behavior, when conducting research on psychopathy-related traits and in the field of forensic psychiatry.

Differentiating psychopathy from general antisociality using the P3 as a psychophysiological correlate of attentional allocation.

Recent studies have shown that while psychopathy and non-psychopathic antisociality overlap, they differ in the extent to which cognitive impairments are present. Specifically, psychopathy has been related to abnormal allocation of attention, a function that is traditionally believed to be indexed by event-related potentials (ERPs) of the P3-family. Previous research examining psychophysiological correlates of attention in psychopathic individuals has mainly focused on the parietally distributed P3b component to rare targets. In contrast, very little is known about the frontocentral P3a to infrequent novel events in psychopathy. Thus, findings on the P3 components in psychopathy are inconclusive, while results in non-psychopathic antisocial populations are clearer and point toward an inverse relationship between antisociality and P3 amplitudes. The present study adds to extant literature on the P3a and P3b in psychopathy by investigating component amplitudes in psychopathic offenders (N = 20), matched non-psychopathic offenders (N = 23) and healthy controls (N = 16). Also, it was assessed how well each offender group was able to differentially process rare novel and target events. The offender groups showed general amplitude reductions compared to healthy controls, but did not differ mutually on overall P3a/P3b amplitudes. However, the psychopathic group still exhibited normal neurophysiological differentiation when allocating attention to rare novel and target events, unlike the non-psychopathic sample. The results highlight differences between psychopathic and non-psychopathic offenders regarding the integrity of the neurocognitive processes driving attentional allocation, as well as the usefulness of alternative psychophysiological measures in differentiating psychopathy from general antisociality.

A neurophysiological dissociation between monitoring one's own and others' actions in psychopathy.

BACKGROUND: Psychopathy is a severe personality disorder often leading to violent and disruptive antisocial behavior. Efficient and proper social behavior crucially relies on monitoring of one's own as well as others' actions, but the link between antisocial behavior in psychopathy and action monitoring in a social context has never been investigated. METHODS: Event-related potentials were used to disentangle monitoring of one's own and others' correct and incorrect actions in psychopathic subjects (n = 18) and matched healthy control subjects (n = 18). The error-related negativity (ERN) was investigated following own and other's responses in a social flanker task. RESULTS: Although both groups showed similar event-related potentials in response to own actions, amplitudes after the observation of others' action-outcome were greatly reduced in psychopathy. More specifically, the latter was not unique to observed errors, because the psychopathic group also showed reduced brain potentials after the observation of correct responses. In contrast, earlier processing of observed actions in the motor system, as indicated by the lateralized readiness potential, was unimpaired. CONCLUSIONS: Monitoring of own behavior is not affected in psychopathy, whereas processing of the outcome of others' actions is disturbed. Specifically, although psychopathic individuals do not have a problem with initial processing of the actions of others, they have problems with deeper analyses of the consequences of the observed action, possibility related to the reward value of the action. These results suggest that aspects of action monitoring in psychopathy are disturbed in social contexts and possibly play a central role in the acquisition of abnormal social behavior.

Early and late components of error monitoring in violent offenders with psychopathy.

BACKGROUND: One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS: Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS: Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS: Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.