Forensic Neurology and the Role of Neurologists in Forensic Evaluations.

Forensic psychiatrists may be asked to opine on neurological evidence or neurological diseases outside the scope of their expertise. This article discusses the value of involving experts trained in behavioral neurology in such cases. First, we describe the field of behavioral neurology and neuropsychiatry, the subspecialty available to both neurologists and psychiatrists focused on the behavioral, cognitive, and neuropsychiatric manifestations of neurological diseases. Next, we discuss the added value of behavioral neurologists in forensic cases, including assisting in the diagnostic evaluation for complex neuropsychiatric diseases, using expertise in localization to provide a strong scientific basis for linking neurodiagnostic testing to relevant neuropsychiatric symptoms, and assisting in relating these symptoms to the relevant legal question in cases where such symptoms may be less familiar to forensic psychiatrists, such as frontal lobe syndromes. We discuss approaches to integrating behavioral neurology with forensic psychiatry, highlighting the need for collaboration and mentorship between disciplines. Finally, we discuss several forensic cases highlighting the additional value of experts trained in behavioral neurology. We conclude that forensic psychiatrists should involve behavioral neurology experts when encountering neurological evidence that falls outside their scope of expertise, and the need for further cross-disciplinary collaboration and training.

Forensic Neurology and the Role of Neurologists in Forensic Evaluations.

There is a clear need for experts with the requisite knowledge and experience to offer medicolegal opinions pertaining to various neuropsychiatric conditions. There is also an important distinction between clinical and medicolegal roles, and the need for training and expertise applicable to forensic assessment. But there remain few available experts with credentials spanning neuropsychiatry and forensic assessment. This creates a dilemma whereby parties involved in litigation featuring neuropsychiatric illness or injury are frequently forced to choose between experts with either knowledge and skills applicable to neuropsychiatric conditions or experts with skills and experience applicable to forensic assessment. Either choice introduces risk. Whether flawed medicolegal opinions are a consequence of deficient medical knowledge or an inadequate forensic evaluation process, the result remains the same, with triers of fact potentially being exposed to problematic testimony. There is, however, a more fundamental problem that implicates patient care more broadly: spurious dichotomies created by the historical segregation of psychiatry and neurology. Optimizing clinical care for patients with neuropsychiatric conditions, improving medical education in support of such care, and enabling forensic neuropsychiatric assessment must then start with more proactive efforts to reintegrate psychiatry and neurology.

La neurobiología del asesino: aspectos neuroanatómicos, genéticos, bioquímicos, extrínsecos y sociales / The neurobiology of the killer: neuroanatomical, genetic, biochemical, extrinsic and social aspects / A neurobiologia do assassino: aspectos neuroanatômicos, genéticos, bioquímicos, extrínsecos e sociais

El cuestionamiento del por qué alguien querría asesinar a otra persona aún no tiene una respuesta única: ¿supervivencia, odio, placer, venganza? Frente a este fenómeno, las neurociencias ofrecen un espacio de comprensión relevante y actual para dar respuesta a este interrogante. Diversos estudios clínicos y en neuroimagen han mostrado diversas alteraciones anatómicas, bioquímicas, genéticas y su relación con una variedad de redes neuronales asociadas a conductas agresivas. Subregiones en la corteza prefrontal, la amígdala, el hipocampo y el lóbulo temporal juegan un papel importante en el desarrollo y el funcionamiento de la biología de la agresión. Variaciones genéticas en la regulación de proteinas y neurotransmisores tales como la serotonina y la dopamina han sido establecidas como mediadores en las conductas agresivas y homicidas. Las interacciones epigenéticas y los mediadores sociales representan importantes factores de riesgo adicionales para la agresividad. El presente artículo sistematiza algunos de los factores que influyen en la conducta homicida. Delimita sus factores de riesgo y correlato neurobiológico, así como aporta información basada en evidencia que ayude en la prevención de dichos comportamientos, la comprensión multidimensional del delito y el desarrollo de intervenciones efectivas fundamentadas en las neurociencias cognitivas forenses.

The question of why someone would want to murder another person still has no single answer: survival, hatred, pleasure, revenge? In the face of this phenomenon, neuroscience offers a relevant and current area of understanding to answer this question. Several clinical and neuroimaging studies have shown diverse anatomical, biochemical and genetic alterations and their relationship with a variety of neural networks associated with aggressive behaviors. Subregions in the prefrontal cortex, amygdala, hippocampus and temporal lobe play an important role in the development and functioning of the biology of aggression. Genetic variations in the regulation of proteins and neurotransmitters such as serotonin and dopamine have been established as mediators of aggressive and homicidal behaviors. Epigenetic interactions and social mediators represent additional important risk factors for aggression. The present article systematizes some of the factors that influence homicidal behavior. It delineates their risk factors and neurobiological correlates, as well as provides evidence-based information to aid in the prevention of such behaviors, the multidimensional understanding of crime, and the development of effective interventions based on forensic cognitive neuroscience.

A questão de pôr que alguém quereria matar outra pessoa ainda não tem uma única resposta: sobrevivência, ódio, prazer, vingança? Diante deste fenômeno, as neurociências oferecem uma área relevante e atual de compreensão para responder a esta pergunta. Vários estudos clínicos e de neuroimagem têm mostrado diversas alterações anatômicas, bioquímicas e genéticas e sua relação com uma variedade de redes neurais associadas a comportamentos agressivos. Sub-regiões no córtex pré-frontal, amígdala, hipocampo e lobo temporal desempenham um papel importante no desenvolvimento e funcionamento da biologia da agressão. Variações genéticas na regulação de proteínas e neurotransmissores como a serotonina e a dopamina foram estabelecidas como mediadores de comportamentos agressivos e homicidas. As interações epigenéticas e os mediadores sociais representam fatores de risco adicionais importantes para a agressão. Este artigo sistematiza alguns dos fatores que influenciam o comportamento homicida. Ela delineia seus fatores de risco e correlatos neurobiológicos e fornece informações baseadas em evidências para ajudar na prevenção de tais comportamentos, na compreensão multidimensional do crime e no desenvolvimento de intervenções eficazes baseadas na neurociência cognitiva forense.