In the last decade neuroimaging techniques have been broadly used to investigate psychiatric diseases. Whereas conventional magnetic resonance (MR) sequences are generally unrevealing in patients with neurosis or psychosis, functional MR Imaging (fMRI) studies have shown altered activation of brain regions in various psychiatric conditions.
Psychopathy, one of the least understood of mental disorders, is characterized by the failure to develop any sense of moral responsibility and the capability of performing violent or antisocial acts. Advanced MRI techniques may be useful in delineating the neurobiology of psychopathy and in improving the knowledge of this personality disorder.
Previous studies showed that individuals with high levels of psychopathic traits have lower activity in several affect-processing brain areas, particularly the amygdala and the anterior insula, and in regions typically associated with reward processing and cognitive control, including the ventral striatum and dorsolateral prefrontal cortex. These data suggest that affective-interpersonal and lifestyle-antisocial facets of psychopathy may be associated with different patterns of atypical neural activity, which deserves future investigation. The aim of our project is to perform a multiparametric MR study in criminal psychopaths in order to evaluate morphologic changes in specific brain region involved in this disorder and to assess possible abnormalities in functional connectivity within the brain.This study will include adult male subjects prospectively recruited from a cohort of prison inmates with varying degrees of psychopathy. All subjects will undergo a neurocognitive and psychiatric evaluation.
MRI structural and functional data will be correlated with clinical data in order to assess how morpho-functional change sin the brain relate to the Hare's Psychopathy Checklist-Revised (PCL-r), the most widely used clinimetric tool in this domain.
Since R.E.M.S. were opened in Italy in 2008 no studies have been published in literature, so we haven't yet any data about Italian criminal population reclused in these structures. This is particularly surprising considering the high impact of this population on society.
In the REMS of ASL Rm5, NGRI and social dangerous people undergo a very intense psychiatric treatment that include a complete assessment of mental functioning, PCL-r for measuring psychopathic pathways and a risk assessment to evaluate future probability of violence. Clinicians should consider future circumstances that will be likely riskful and address which changes can be made to decrease those risks. However, an assessment based only on psychopathological pattern does not allow to predict recidivism at the short-medium terms, because psychopathic could be able to conceal their symptoms.
Improving psychiatric assessment with better understanding of brain functioning is fundamental to extend the knowledge about this particular subgroup of criminal, and could aid in reducing crime rates through the reduction of recidivism rates.
The strength of this project consists in the synergy between a neuroradiology unit equipped with a high-field MR system, where research team has a specific expertise in multimodal brain investigations and a psychiatric unit of the R.E.M.S in the ASL Rm5, devoted to forensic sample especially on psychopathic evaluation.
The study will generate a comprehensive database including detailed biographical, clinical, judicial and neuropsychological data of NGRI social dangerous with functional and morphological brain characteristics of the same subjects. Such a data set will offer unique opportunities to explore the neural correlates of psychopathy.
The multidisciplinary approach to psychopaty provides innovative information over current state of the art, improving knowledge of this complex disease to better understand differences between psychopathic criminals and non-psychopathic criminal. We aim to draw up a protocol trying to predict violence and recidivism of crimes that could also be useful to develop specific treatment to reduce risk of violent behavior.