„Psychopathy”

Zusammenfassung

„Psychopathy” stellt ein Konzept zur Beschreibung einer schweren Form der dissozialen Persönlichkeitsstörung dar. Die Fähigkeit für emotionales Erleben, Empathie, Kontrolle von aggressiven Impulsen und Lernen aus negativen Erfahrungen ist bei dieser forensisch auffallenden Gruppe von Straftätern stark beeinträchtigt. In Abgrenzung von dieser primären Persönlichkeitsstörung kann eine entsprechende dissoziale Störung auch sekundär posttraumatisch, „Pseudopsychopathy”, auftreten. Mit modernen bildgebenden Verfahren können strukturelle und funktionelle Veränderungen nachgewiesen werden, die auf ein neurobiologisches Korrelat der gestörten Emotionsregulation bei „Psychopathy” hinweisen. Neben der historischen Entwicklung des „Psychopathy”-Konzeptes werden die klinischen Persönlichkeitseigenschaften, neurophysiologische und Bildgebungsbefunde unter Berücksichtigung der aktuellen Literatur dargestellt. Die Befunde legen ein neurobiologisches Modell zu Aggression und Emotion bei einer schweren dissozialen Persönlichkeitsstörung nahe; mögliche juristische Implikationen hinsichtlich der Schuldfähigkeitsbeurteilung von Straftätern mit dieser Störung werden diskutiert.

Summary

Psychopathy is a severe dissocial personality disorder. Central to this disorder are difficulties in emotion regulation, empathy, learning from negative experiences and aggressive-impulsive behaviour. These functions are also impaired in traumatic “pseudopsychopathy”. Modern neuroimaging approaches uncover the structural morphological and functional imaging variances in “psychopathy” as the neural basis of impaired emotion regulation. In this article the history of psychopathy, behavioural and personality factors, peripheral measures of neural activity and neuroimaging are illustrated considering latest research findings. These data suggest a neurobiological model of disturbed processing of aggression and emotion in severe dissocial personality disorders can be attributed by a neurobiological model. It is discussed whether a psychopath can be fully accountable for a criminal deed.

Schlüsselwörter

„Psychopathy” - dissoziale Persönlichkeitsstörung - Emotionsverarbeitung - orbito-frontaler Kortex - Amygdala

Keywords

Psychopathy - dissocial personality disorder - regulation of emotion - orbito frontal cortex - amygdala

• Literatur

• 1 Abott A. Into the mind of a killer. Nature 2001; 410: 296-98.
• 2 Adolphs R, Tranel D, Damasio H, Damasio AR. Fear and the human amygdala. J Neurosci 1995; 15: 5879-91.
• 3 Adolphs R, Tranel D, Damasio AR. The human amygdala in social judgement. Nature 1998; 393: 470-4.
• 4 Anderson SW. et al. Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nat Neurosci 1999; 2: 1032-7.
• 5 Blair RJ, Jones L, Clark F, Smith M. The psychopathic individual: a lack of responsiveness to distress cues?. Psychophysiology 1997; 34: 192-8.
• 6 Blair RJ. Neurocognitive models of aggression, the antisocial personality disorders and psychopathy. J Neurosurg Neurol Psychiatry 2001; 71: 727-31.
• 7 Blair RJ. Neurobiological basis of psychopathy. British Journal of Psychiatry 2003; 182: 5-7.
• 8 Blair RJ, Cipolotti L. Impaired social response reversal. A case of ‘acquired sociopathy’. Brain 2000; 123 (Pt 6) 1122-41.
• 9 Bradley MM, Cuthbert BN, Lang PJ. Picture media and emotion: effects of a sustained affective context. Psychophysiology 1996; 33: 662-70.
• 10 Brower MC, Price BH. Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review. J Neurol Neurosurg Psychiatry 2001; 71: 720-6.
• 11 Canli T, Amin Z. Neuroimaging of emotion and personality : Scientific evidence and ethical considerations. Brain and Cognition 2002; 50: 414-31.
• 12 Cleckley H. The mask of sanity. 3rd Ed.. St. Louis, MO: Mosby; 1955
• 13 Cuthbert BN, Bradley MM, Lang PJ. Probing picture perception: activation and emotion. Psychophysiology 1996; 33: 103-11.
• 14 Critchley HD. et al. The functional neuroanatomy of social behaviour: changes in cerebral blood flow when people with autistic disorder process facial expressions. Brain 2000; 123 (Pt 11) 2203-12.
• 15 Damasio AR. et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci 2000; 3: 1049-56.
• 16 Davidson RJ, Irwin W. The functional neuroanatomy of emotion and affective style. Trends Cogn Sci 1999; 3: 11-21.
• 17 Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation -- a possible prelude to violence. Science 2000; 28 (289) 591-4.
• 18 Dilling H, Mombour W, Schmidt MHH. Internationale Klassifikation psychischer Störungen ICD – 10 (WHO). 2. Aufl. Bern. Göttingen, Toronto, Seattle: Hans Huber; 1993
• 19 D`Silva K, Duggan C, McCarthy L. Does treatment really make psychopaths worse. A review of the evidence. J of Personality disorders 2004; 18: 163-177.
• 20 Ekman P, Friesen WV. A new pan-cultural facial expression of emotion. Motivation and Emotion 1986; 10: 159-168.
• 21 Fernandez M. et al. Brain function in a patient with torture related post-traumatic stress disorder before and after treatment: a positron emission tomography provocation study. Neurosci. Lett 2001; 12 (297) 101-4.
• 22 Fowles DC. The three arousal model: implications of gray’s two-factor learning theory for heart rate, electrodermal activity, and psychopathy. Psychophysiology 1980; 17: 87-104.
• 23 Fowles DC, Missel KA. Electrodermal hyporeactivity, motivation, and psychopathy: theoretical issues. Prog Exp Pers Psychopathol Res 1994; 263-83.
• 24 Greenwald MK. et al. Startle potentiation: shock sensitization, aversive learning, and affective picture modulation. Behav Neurosci 1998; 112: 1069-79.
• 25 Hare RD, Frazelle J, Cox DN. Psychopathy and physiological responses to threat of an aversive stimulus. Psychophysiology 1978; 15 (02) 165-72.
• 26 Hare RD. Psychopathy and electrodermal responses to nonsignal stimulation. Biol Psychol 1978; 6: 237-46.
• 27 Hare RD, McPherson LM. Violent and aggressive behavior by criminal psychopaths. Int J Law Psychiatry 1984; 7: 35-50.
• 28 Hare RD, McPherson LM, Forth AE. Male psychopaths and their criminal careers. J Consult Clin Psychol 1988; 56: 710-4.
• 29 Hare RD. Manual for the Hare Psychopathy Checklist-Revised. Toronto: Multi-health Systems; 1991
• 30 Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. J Abnorm Psychol 1991; 100: 391-8.
• 31 Hare RD, Clark D, Grann M, Thornton D. Psychopathy and the predictive validity of the PCL-R: an international perspective. Behav Sci Law 2000; 18: 623-645.
• 32 Hartmann J, Hollweg M, Nedopil N. Quantitative Erfassung dissozialer und psychopathischer Persönlichkeiten bei der strafrechtlichen Begutachtung. Nervenarzt 2001; 72: 365-70.
• 33 Herpertz SC. et al. Emotion in criminal offenders with psychopathy and borderline personality disorder. Arch Gen Psychiatry 2001; 58: 737-45.
• 34 Intrator J. et al. A brain imaging (single photon emission computerized tomography) study of semantic and affective processing in psychopaths. Biol Psychiatry 1997; 42: 96-103.
• 35 Kiehl KA. et al. An event-related potential investigation of response inhibition in schizophrenia and psychopathy. Biol Psychiatry 2000; 48: 210-21.
• 36 Kiehl KA. et al. Reduced P300 responses in criminal psychopaths during a visual oddball task. Biol Psychiatry 1999; 45: 1498-507.
• 37 Kiehl KA. et al. Semantic and affective processing in psychopaths: an event-related potential (ERP) study. Psychophysiology 1999; 36: 765-74.
• 38 Kiehl KA. et al. Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging. Biol Psychiatry 2001; 50: 677-84.
• 39 Kiehl K. A et al. Temporal lobe abnormalities in semantic processing by criminal psychopaths as revealed by functional magnetic resonance imaging. Psychiatry Research: Neuroimaging 2004; 130: 27-42.
• 40 Kröber HL. Die psychiatrische Diskussion um die verminderte Zurechnungs- und Schuldfähigkeit. In Kröber H.-L-, Albrecht H.-J. (Hrsg.). Verminderte Schuldfähigkeit und psychiatrische Maßregel. (S. 33–68). Baden-Baden: Nomos; 2001
• 41 Laakso MP. et al. Psychopathy and the posterior hippocampus. Behavioral Brain Research 2001; 118: 187-93.
• 42 Lang PJ, Bradley MM, Cuthbert BN. Emotion, attention, and the startle reflex. Psychol Rev 1990; 97: 377-95.
• 43 Lang PJ. et al. Emotion and psychopathology: a startle probe analysis. Prog Exp Pers Psychopathol Res 1993; 16: 163-99.
• 44 Lang PJ. et al. Looking at pictures: affective, facial, visceral, and behavioral reactions. Psychophysiology 1993; 30: 261-73.
• 45 Lang PJ. et al. Emotion, Motivation, and Anxiety: Brain mechanisms and Psychophysiology. Biol. Psychiatry 1998; 44: 1248-63.
• 46 LeDoux JE. Emotion: clues from the brain. Annu Rev Psychol 1995; 46: 209-35.
• 47 LeDoux J. The Emotional Brain. New York: Simon and Schuster; 1996
• 48 Levenston GK. et al. The psychopath as observer: emotion and attention in picture processing. J Abnorm Psychol 2000; 109: 373-85.
• 49 Meinhardt J. Emotionen und kognitive Verarbeitungskapazität. Shaker (Aachen). 2000
• 50 Mitchell D. et al Risky decisions and response reversal: is there evidence of orbitofrontal cortex dysfunction in psychopathic individuals?. Neuropsychologia 2002; 12: 2013-22.
• 51 Müller JL. et al. Abnormalities in emotion processing within cortical and subcortical regions in criminal psychopaths. Evidence from an fMRI study using pictures with emotional contents. Biological Psychiatry. 2002
• 52 Müller JL. et al. Psychopathie und Hirntrauma. Ein Beitrag zur Neurobiologie der Gewalt. Nervenheilkunde 2001; 20: 330-7.
• 53 Paradiso S. et al. Cerebral blood flow changes associated with attribution of emotional valence to pleasant, unpleasant, and neutral visual stimuli in a PET study of normal subjects. Am J Psychiatry 1999; 156: 1618-29.
• 54 Patrick CJ, Bradley MM, Lang PJ. Emotion in the criminal psychopath: startle reflex modulation. J Abnorm Psychol 1993; 102: 82-92.
• 55 Patrick CJ. Emotion and psychopathy: startling new insights. Psychophysiology 1994; 31: 319-30.
• 56 Patrick CJ, Cuthbert BN, Lang PJ. Emotion in the criminal psychopath: fear image processing. J Abnorm Psychol 1994; 103: 523-34.
• 57 Phillips ML. et al. Neural responses to facial and vocal expressions of fear and disgust. Proc R Soc Lond B Biol Sci 1998; 265: 1809-17.
• 58 Pietrini P. et al. Neural correlates of imaginal aggressive behavior assessed by positron emission tomography in healthy subjects. Am J Psychiatry 2000; 157: 1772-81.
• 59 Raine A. et al. Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murderers. Behav Sci Law 1998; 16: 319-32.
• 60 Raine A. et al. Prefrontal glucose deficits in murderers lacking psychosocial deprivation. Neuropsychiatry Neuropsychol Behav Neurol 1998; 11: 1-7.
• 61 Saß H, Wittchen H-U, Zaudig M, Houben I. Diagnostische Kriterien des Diagnostischen und Statistischen Manuals Psychischer Störungen DSMIV. Göttingen, Bern, Toronto, Seattle: Hogrefe Verlag; 1998
• 62 Saß H. Persönlichkeit-Dissozialität-Verantwortung. In Müller-Isberner R, Gonzalez Cabeza S. (Hrsg.). Forensische Psychiatrie.(S.1–15). Godesberg: Forum Verlag; 1998
• 63 Schneider F. et al. Functional Imaging of Conditioned Aversive Emotional Responses in Antisocial Personality Disorder. Neuropsychobiology 2000; 42: 192-201.
• 64 Schneider K. Klinische Psychopathologie. 13. unver. Aufl. Stuttgart, New York: Thieme; 1959
• 65 Seto MC, Barbaree HE. Psychopathy, Treatment behavior, and Sex Offender recidivism. J of interpersonal violence 1999; 12: 1235-48.
• 66 Soderstrom H. et al. Reduced frontotemporal perfusion in psychopathic personality. Psychiatry Research: Neuroimaging 2002; 114: 81-94.
• 67 Soderstrom H. Psychopathy as a disorder of empathy. European Child & Adolescent Psychiatry 2003; 12: 249-52.
• 68 Teasdale JD. et al. Functional MRI study of the cognitive generation of affect. Am J Psychiatry 1999; 156: 209-15.
• 69 Tiihonen J. et al. Amygdaloid volume loss in psychopathy. Society for Neuroscience Abstracts 2000; 2017.
• 70 Volavka J. The neurobiology of violence: an update. J Neuropsychiatry Clin Neurosci 1999; 11: 307-14.
• 71 Walter H, Stephan A. Moralität, Rationalität und die Emotionen. Interdisziplinäre Schriftenreihe des Humboldt-Studienzentrums Universität Ulm. 2004
• 72 Weiskopf N. et al. Physiological self-regulation of regional brain activity using real-time functional magnetic resonance imaging (fMRI): methodology and exemplary data. NeuroImage 2003; 19: 577-86.
• 73 Witter H. Grundriss der gerichtlichen Psychologie und Psychiatrie. Berlin, Heidelberg, New York: Springer; 1970
• 74 Wright CI. et al. Differential prefrontal cortex and amygdala habituation to repeatedly presented emotional stimuli. Neuroreport 2001; 12: 379-83.