Economic decision-making in psychopathy: a comparison with ventromedial prefrontal lesion patients

Functional Neuroimaging in Psychopathy

BACKGROUND AND AIM

Psychopathy is associated with cognitive and affective deficits causing disruptive, harmful and selfish behaviour. These have considerable societal costs due to recurrent crime and property damage. A better understanding of the neurobiological bases of psychopathy could improve therapeutic interventions, reducing the related social costs. To analyse the major functional neural correlates of psychopathy, we reviewed functional neuroimaging studies conducted on persons with this condition.

METHODS

We searched the PubMed database for papers dealing with functional neuroimaging and psychopathy, with a specific focus on how neural functional changes may correlate with task performances and human behaviour.

RESULTS

Psychopathy-related behavioural disorders consistently correlated with dysfunctions in brain areas of the orbitofrontal-limbic (emotional processing and somatic reaction to emotions; behavioural planning and responsibility taking), anterior cingulate-orbitofrontal (correct assignment of emotional valence to social stimuli; violent/aggressive behaviour and challenging attitude) and prefrontal-temporal-limbic (emotional stimuli processing/response) networks. Dysfunctional areas more consistently included the inferior frontal, orbitofrontal, dorsolateral prefrontal, ventromedial prefrontal, temporal (mainly the superior temporal sulcus) and cingulated cortices, the insula, amygdala, ventral striatum and other basal ganglia.

CONCLUSIONS

Emotional processing and learning, and several social and affective decision-making functions are impaired in psychopathy, which correlates with specific changes in neural functions.

Exploring Primary and Secondary Variants of Psychopathy in Adolescents in Detention and in the Community

The current study aims to ascertain how different variants of callous-unemotional traits differ in their psychopathology, exposure to aggression and violence, and aggressive and violent behavior. If secondary/distressed variants (high in callous-unemotional traits and high in anxiety) and primary/traditional variants (high in callous-unemotional traits and low in anxiety) differ along these dimensions, it may speak to their different etiologies, treatment needs (e.g., trauma focused), and responsiveness to treatment. The current sample consisted of 799 adolescents from high schools (n = 419) and juvenile detention centers (n = 380). Participants were interviewed regarding their callous-unemotional traits, psychopathology, exposure to aggression and violence, and aggressive and violent behavior. Parents/guardians and teachers/staff members also reported on participants' callous-unemotional traits and aggressive and violent behavior. A model-based cluster analysis indicated that there were four clusters in the data set, based on callous-unemotional traits and anxiety: a nonvariant cluster, a primary/traditional callous-unemotional cluster, a secondary/distressed callous-unemotional cluster, and a "fearful" cluster. Secondary/distressed variants of psychopathy exhibited significantly greater symptoms of depression and psychoticism, more exposure to low level aggression and neighborhood violence, and more aggressive and violent behavior, as compared to the other clusters. Adolescents with callous-unemotional traits might not be a homogeneous group, but rather may differ in attitudes, behaviors, and exposure to risk, therefore differing in their treatment needs and responsiveness.

Emotion Regulation Difficulties in Boys with Oppositional Defiant Disorder/Conduct Disorder and the Relation with Comorbid Autism Traits and Attention Deficit Traits

Previous research has pointed towards a link between emotion dysregulation and aggressive behavior in children. Emotion regulation difficulties are not specific for children with persistent aggression problems, i.e. oppositional defiant disorder or conduct disorder (ODD/CD), children with other psychiatric conditions, such as autism spectrum disorders or attention-deficit/hyperactivity disorder, have emotion regulation difficulties too. On a behavioral level some overlap exists between these disorders and comorbidity is high. The aim of this study was therefore twofold: 1) to examine emotion regulation difficulties in 65 boys with ODD/CD in comparison to a non-clinical control group (NC) of 38 boys (8–12 years) using a performance measure (Ultimatum Game), parent report and self-report, and 2) to establish to what extent emotion regulation in the ODD/CD group was correlated with severity of autism and/or attention deficit traits. Results on the Ultimatum Game showed that the ODD/CD group rejected more ambiguous offers than the NC group, which is seen as an indication of poor emotion regulation. Parents also reported that the ODD/CD group experienced more emotion regulation problems in daily life than the NC group. In contrast to these cognitive and behavioral measures, self-reports did not reveal any difference, indicating that boys with ODD/CD do not perceive themselves as having impairments in regulating their emotions. Emotional decision making within the ODD/CD group was not related to variation in autism or attention deficit traits. These results support the idea that emotion dysregulation is an important problem within ODD/CD, yet boys with ODD/CD have reduced awareness of this.

It's immoral, but I'd do it! Psychopathy traits affect decision-making in sacrificial dilemmas and in everyday moral situations

This research investigated whether emotional hyporeactivity affects moral judgements and choices of action in sacrificial moral dilemmas and in everyday moral conflict situations in which harm to other's welfare is differentially involved. Twenty-six participants with high trait psychopathy (HP) and 25 with low trait psychopathy (LP) were selected based on the primary psychopathy scale of the Levenson Self-Report Psychopathy Scale. HP participants were more likely to sacrifice one person to save others in sacrificial dilemmas and to pursue a personal advantage in everyday moral situations entailing harm to another's good. While deciding in these situations, HP participants experienced lower unpleasantness as compared to LP participants. Conversely, no group differences emerged in choice of action and unpleasantness ratings for everyday moral situations that did not entail harm to others. Importantly, moral judgements did not differ in the two groups. These results suggest that high psychopathy trait affects choices of action in sacrificial dilemmas because of reduced emotional reactivity to harmful acts. The dissociation between choice of action and moral judgement suggests that the former is more closely related to emotional experience. Also, emotion seems to play a critical role in discriminating harmful from harmless acts and in driving decisions accordingly.

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

BACKGROUND

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

SCOPE AND METHODOLOGY

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

FINDINGS AND CONCLUSION

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.

Fairness decisions in response to emotions: a functional MRI study among criminal justice-involved boys with conduct disorder

Research suggests that individuals with conduct disorder (CD) are marked by social impairments, such as difficulties in processing the affective reactions of others. Little is known, though, about how they make decisions during social interactions in response to emotional expressions of others. In this study, we therefore investigated the neural mechanisms underlying fairness decisions in response to communicated emotions of others in aggressive, criminal justice-involved boys with CD (N = 32) compared with typically developing (TD) boys (N = 33), aged 15-19 years. Participants received written emotional responses (angry, disappointed or happy) from peers in response to a previous offer and then had to make fairness decisions in a version of the Dictator Game. Behavioral results showed that CD boys did not make differential fairness decisions in response to the emotions, whereas the TD boys did show a differentiation and also responded more unfair to happy reactions than the CD boys. Neuroimaging results revealed that when receiving happy vs disappointed and angry reactions, the CD boys showed less activation than the TD boys in the temporoparietal junction and supramarginal gyrus, regions involved in perspective taking and attention. These results suggest that boys with CD have difficulties with processing explicit emotional cues from others on behavioral and neural levels.

EMOTICOM: A Neuropsychological Test Battery to Evaluate Emotion, Motivation, Impulsivity, and Social Cognition

In mental health practice, both pharmacological and non-pharmacological treatments are aimed at improving neuropsychological symptoms, including cognitive and emotional impairments. However, at present there is no established neuropsychological test battery that comprehensively covers multiple affective domains relevant in a range of disorders. Our objective was to generate a standardized test battery, comprised of existing, adapted and novel tasks, to assess four core domains of affective cognition (emotion processing, motivation, impulsivity and social cognition) in order to facilitate and enhance treatment development and evaluation in a broad range of neuropsychiatric disorders. The battery was administered to 200 participants aged 18-50 years (50% female), 42 of whom were retested in order to assess reliability. An exploratory factor analysis identified 11 factors with eigenvalues greater than 1, which accounted for over 70% of the variance. Tasks showed moderate to excellent test-retest reliability and were not strongly correlated with demographic factors such as age or IQ. The EMOTICOM test battery is therefore a promising tool for the assessment of affective cognitive function in a range of contexts.

Reduced Affective Biasing of Instrumental Action With tDCS Over the Prefrontal Cortex

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We assessed whether tDCS over the anterior prefrontal cortex can reduce affective biasing of instrumental action.

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Cathodal prefrontal tDCS reduced affective biasing of instrumental action.

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Anodal prefrontal tDCS did not reduce affective biasing of instrumental action.

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We demonstrate the potential utility of prefrontal tDCS as a tool for reducing affective biasing of instrumental behavior.

Background

Instrumental action is well known to be vulnerable to affective value. Excessive transfer of affective value to instrumental action is thought to contribute to psychiatric disorders. The brain region most commonly implicated in overriding such affective biasing of instrumental action is the prefrontal cortex.

Objective

The aim of the present study was to reduce affective biasing of instrumental action using transcranial direct current stimulation (tDCS) in young healthy human volunteers.

Methods

In a double-blind, randomized between-group design, 120 participants received anodal, cathodal and sham tDCS while at the same time (online) performing a task that assessed affective biasing of instrumental action. We placed tDCS electrodes over the anterior part of the prefrontal cortex based on evidence from brain stimulation work demonstrating the role of this brain region in controlling affective biasing of instrumental action.

Results

We showed that prefrontal tDCS reduced affective biasing of instrumental action. Specifically, prefrontal tDCS reduced the degree to which aversive (versus appetitive) cues potentiated instrumental avoidance and suppressed instrumental approach. Contrary to our hypothesis, this effect was seen for cathodal tDCS rather than anodal tDCS.

Conclusion

The results demonstrate the potential utility of prefrontal tDCS as a tool for reducing affective biasing of instrumental behavior, thus opening avenues for interventional research on psychiatric disorders that implicate excessive transfer of affective value.

Emotion Regulation in Adolescent Males with Attention-Deficit Hyperactivity Disorder: Testing the Effects of Comorbid Conduct Disorder

Although attention-deficit hyperactivity disorder (ADHD) has been linked to emotion dysregulation, few studies have experimentally investigated this whilst controlling for the effects of comorbid conduct disorder (CD). Economic decision-making games that assess how individuals respond to offers varying in fairness have been used to study emotion regulation. The present study compared adolescent boys with ADHD (n = 90), ADHD + CD (n = 94) and typical controls (n = 47) on the Ultimatum Game and examined the contribution of ADHD and CD symptom scores and callous and unemotional traits to acceptance levels of unfair offers. There were no significant differences in acceptance rates of fair and highly unfair offers between groups, and only boys with ADHD did not significantly differ from the controls. However, the subgroup of boys with ADHD and additional high levels of aggressive CD symptoms rejected significantly more ambiguous (i.e., moderately unfair) offers than any other subgroup, suggesting impaired emotion regulation in those with ADHD and aggressive CD. Correlations within the CD group showed that the rejection rate to moderately unfair offers was predicted by aggressive CD symptom severity, but not callous and unemotional traits. These findings highlight the fact that ADHD is a heterogeneous condition from an emotion regulation point of view.

Cognitive reflection predicts the acceptance of unfair ultimatum game offers

In the ultimatum game, one player proposes a split of money between him- or herself and another player, who can accept the offer (and both players keep the allocated money) or reject the offer (and both players get nothing). The present study examined predictors of accepting unfair ultimatum offers. In Study 1, 184 participants responded to an unfair ultimatum offer, completed a measure of cognitive reflection, and completed a self-report measure of rational and experiential thinking. Slightly more than half of the participants (54.3%) accepted the unfair offer, and cognitive reflection was positively correlated with accepting unfair offers. The rational and experiential thinking scales were not significantly correlated with ultimatum decisions. In Study 2, 306 participants responded to 20 ultimatum offers that varied in fairness and completed an expanded measure of cognitive reflection. Performance on the cognitive reflection measure predicted the number of ultimatum offers accepted. These results suggest that rejecting ultimatum offers is related to intuitive, heuristic-based thinking, whereas accepting offers is related to deliberate, analytic-based thinking.

Altered resting-state functional connectivity in cortical networks in psychopathy

Psychopathy is a personality disorder characterized by callous antisocial behavior and criminal recidivism. Here we examine whether psychopathy is associated with alterations in functional connectivity in three large-scale cortical networks. Using fMRI in 142 adult male prison inmates, we computed resting-state functional connectivity using seeds from the default mode network, frontoparietal network, and cingulo-opercular network. To determine the specificity of our findings to these cortical networks, we also calculated functional connectivity using seeds from two comparison primary sensory networks: visual and auditory networks. Regression analyses related network connectivity to overall psychopathy scores and to subscores for the "factors" and "facets" of psychopathy: Factor 1, interpersonal/affective traits; Factor 2, lifestyle/antisocial traits; Facet 1, interpersonal; Facet 2, affective; Facet 3, lifestyle; Facet 4, antisocial. Overall psychopathy severity was associated with reduced functional connectivity between lateral parietal cortex and dorsal anterior cingulate cortex. The two factor scores exhibited contrasting relationships with functional connectivity: Factor 1 scores were associated with reduced functional connectivity in the three cortical networks, whereas Factor 2 scores were associated with heightened connectivity in the same networks. This dissociation was evident particularly in the functional connectivity between anterior insula and dorsal anterior cingulate cortex. The facet scores also demonstrated distinct patterns of connectivity. We found no associations between psychopathy scores and functional connectivity within visual or auditory networks. These findings provide novel evidence on the neural correlates of psychopathy and suggest that connectivity between cortical association hubs, such as the dorsal anterior cingulate cortex, may be a neurobiological marker of the disorder.

Empathy and motivation for justice: Cognitive empathy and concern, but not emotional empathy, predict sensitivity to injustice for others

Why do people tend to care for upholding principles of justice? This study examined the association between individual differences in the affective, motivational and cognitive components of empathy, sensitivity to justice, and psychopathy in participants (N 265) who were also asked to rate the permissibility of everyday moral situations that pit personal benefit against moral standards of justice. Counter to common sense, emotional empathy was not associated with sensitivity to injustice for others. Rather, individual differences in cognitive empathy and empathic concern predicted sensitivity to justice for others, as well as the endorsement of moral rules. Psychopathy coldheartedness scores were inversely associated with motivation for justice. Moreover, hierarchical multiple linear regression analysis revealed that self-focused and other-focused orientations toward justice had opposing influences on the permissibility of moral judgments. High scores on psychopathy were associated with less moral condemnation of immoral behavior. Together, these results contribute to a better understanding of the information processing mechanisms underlying justice motivation, and may guide interventions designed to foster justice and moral behavior. In order to promote justice motivation, it may be more effective to encourage perspective taking and reasoning than emphasizing emotional sharing with the misfortune of others.

Social neuroscience in psychiatry: unravelling the neural mechanisms of social dysfunction

Social neuroscience is a flourishing, interdisciplinary field that investigates the underlying biological processes of social cognition and behaviour. The recent application of social neuroscience to psychiatric research advances our understanding of various psychiatric illnesses that are characterized by impairments in social cognition and social functioning. In addition, the upcoming line of social neuroscience research provides new techniques to design and evaluate treatment interventions that are aimed at improving patients' social lives. This review provides a contemporary overview of social neuroscience in psychiatry. We draw together the major findings about the neural mechanisms of social cognitive processes directed at understanding others and social interactions in psychiatric illnesses and discuss their implications for future research and clinical practice.

Psychopathic traits modulate microstructural integrity of right uncinate fasciculus in a community population

Individuals with psychopathy possess emotional and behavioral abnormalities. Two neural regions, involved in behavioral control and emotion regulation, are often implicated: amygdala and ventromedial prefrontal cortex (VMPFC). Recently, in studies using adult criminal populations, reductions in microstructural integrity of the white matter connections (i.e., uncinate fasciculus (UF)) between these two neural regions have been discovered in criminals with psychopathy, supporting the notion of neural dysfunction in the amygdala-VMPFC circuit. Here, a young adult, community sample is used to assess whether psychopathic traits modulate microstructural integrity of UF, and whether this relationship is dependent upon levels of trait anxiety, which is sometimes used to distinguish subtypes of psychopathy. Results reveal a negative association between psychopathic traits and microstructural integrity of UF, supporting previous findings. However, no moderation of the relationship by trait anxiety was discovered. Findings provide further support for the notion of altered amygdala-VMPFC connectivity in association with higher psychopathic traits.

Architecture and morphology of the human ventromedial prefrontal cortex

A previous report identified the location of comparable architectonic areas in the ventral frontal cortex of the human and macaque brains [S. Mackey & M. Petrides (2010) Eur. J. Neurosci., 32, 1940-1950]. The present article provides greater detail with regard to the definition of architectonic areas within the ventromedial part of the human ventral frontal cortex and describes their location: (i) in Montreal Neurological Institute proportional stereotactic space; and (ii) in relation to sulcal landmarks. Structural magnetic resonance scans of four brains were obtained before the preparation of the histological specimens, so that the architectonic parcellation could be reconstructed in its original three-dimensional volume. The areal density of individual cortical layers was sampled quantitatively in the ventromedial prefrontal cortex of eight brains (16 hemispheres). The agranular cortex along the ventral edge of the corpus callosum and posterior margin of the ventromedial surface is replaced by a graded series of increasingly granular and more complexly laminated areas that succeed one another in a posterior-to-anterior direction. In parallel, the width of the supragranular layers (i.e. layers II and III) increases as compared with the infragranular layers (i.e. layers V and VI) from posterior to anterior. A measure of how rapidly cortical features change at areal boundaries also showed that the rate of change in the granule and pyramidal cell densities of layers IV and V, respectively, was greater at the borders between posterior areas than between anterior areas. This article will facilitate the anatomical identification and comparison of experimental data involving the human vmPFC.

The neuropsychology of self-reflection in psychiatric illness

The development of robust neuropsychological measures of social and affective function-which link critical dimensions of mental health to their underlying neural circuitry-could be a key step in achieving a more pathophysiologically-based approach to psychiatric medicine. In this article, we summarize research indicating that self-reflection (the inward attention to personal thoughts, memories, feelings, and actions) may be a useful model for developing such a paradigm, as there is evidence that self-reflection is (1) measurable with self-report scales and performance-based tests, (2) linked to the activity of a specific neural circuit, and (3) dimensionally related to mental health and various forms of psychopathology.

Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience

Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.

Psychopathy: cognitive and neural dysfunction

Psychopathy is a developmental disorder marked by emotional deficits and an increased risk for antisocial behavior. It is not equivalent to the diagnosis Antisocial Personality Disorder, which concentrates only on the increased risk for antisocial behavior and not a specific cause—ie, the reduced empathy and guilt that constitutes the emotional deficit. The current review considers data from adults with psychopathy with respect to the main cognitive accounts of the disorder that stress either a primary attention deficit or a primary emotion deficit. In addition, the current review considers data regarding the neurobiology of this disorder. Dysfunction within the amygdala's role in reinforcement learning and the role of ventromedial frontal cortex in the representation of reinforcement value is stressed. Data is also presented indicating potential difficulties within parts of temporal and posterior cingulate cortex. Suggestions are made with respect to why these deficits lead to the development of the disorder.

To treat a psychopath

Some people are now quite optimistic about the possibility of treating psychopathy with drugs that directly modulate brain function. I argue that this optimism is misplaced. Psychopathy is a global disorder in an individual's worldview, including his social and moral outlook. Because of the unity of this Weltanschauung, it is unlikely to be treatable in a piecemeal fashion. Recent neuroscientific methods do not give us much hope that we can replace, in a wholesale manner, problematic views of the world with more socially desirable ones. There are, therefore, principled reasons that psychopathy is so singularly treatment resistant.

Intelligence and psychopathy: a correlational study on insane female offenders

BACKGROUND

The occurrence of a significant relationship between psychopathic traits and intelligence is still open to debate. Most of the relevant information has been obtained from crystallized IQ tests or on psychopathic male offenders. In this study we hypothesized a negative correlation between psychopathic traits and fluid intelligence on a sample of criminal female in-patients.

METHOD

We carried out a correlational study on a selected sample of 56 criminal female offenders. Variables that were measured include the Hare Psychopathy Checklist Revised (PCL-R) total score (and, separately, the scores from its four subscales: Interpersonal, Affective, Lifestyle and Antisocial) and fluid IQ measured by Raven's Progressive Matrices (RPM).

RESULTS

Pearson's correlation between RPM IQ and total PCL-R score was negative (r(54) = -0.55, p < 0.001); women with greater psychopathy traits (total PCL-R score) had lower IQ scores. Negative correlations were also found between IQ and the four PCL-R subscales, Interpersonal, Affective, Lifestyle and Antisocial (r(54) = -0.35, p < 0.01, r(54) = -0.52, p < 0.001, r(54) = -0.53, p < 0.001, and r(54) = -0.49, p < 0.001 respectively).

CONCLUSIONS

The results indicate a general negative relationship between PCL-R and IQ, equally distributed across the four subcomponents of the psychopathic trait, and support the view that unsuccessful psychopathic women have poor planning and are unable to foresee and represent future consequences of their actions.

The role of the midcingulate cortex in monitoring others' decisions

A plethora of research has implicated the cingulate cortex in the processing of social information (i.e., processing elicited by, about, and directed toward others) and reward-related information that guides decision-making. However, it is often overlooked that there is variability in the cytoarchitectonic properties and anatomical connections across the cingulate cortex, which is indicative of functional variability. Here we review evidence from lesion, single-unit recording and functional imaging studies. Taken together, these support the claim that the processing of information that has the greatest influence on social behavior can be localized to the gyral surface of the midcingulate cortex (MCC_g). We propose that the MCC_g is engaged when predicting and monitoring the outcomes of decisions during social interactions. In particular, the MCC_g processes statistical information that tracks the extent to which the outcomes of decisions meet goals when interacting with others. We provide a novel framework for the computational mechanisms that underpin such social information processing in the MCC_g. This framework provides testable hypotheses for the social deficits displayed in autism spectrum disorders and psychopathy.

Regret in the context of unobtained rewards in criminal offenders

In this study, we investigated whether differences in the experience of regret may be a potential explanation for damaging behaviours associated with psychopathy and criminal offending. Participants were incarcerated offenders (n = 60) and non-incarcerated controls (n = 20). Psychopathic traits were characterised with the Psychopathic Checklist: Screening Version. Regret was assessed by responses to outcomes on a simulated gambling task. Incarcerated offenders experienced a reduced sense of regret as compared to non-incarcerated controls. We obtained some evidence that specific psychopathic factors and facets could differentially relate to the experience and use of emotions. Our data provide initial evidence of important associations between negative emotions and decision behaviour in the context of criminal offending.

A negative emotional and economic judgment bias in major depression

Although major depression is projected to be among the top three causes of disability-adjusted life years lost in 2030, relatively little is known concerning the extent to which depressed mood states can bias social-economic decision making away from optimal outcomes. One experimental framework to study the interaction between negative emotion and social-economic decisions is the ultimatum game (UG), where the fair, cooperative player altruistically punishes the unfair, non-cooperative player. To assess a potential susceptibility of altruistic punishment to depressed mood, we repeatedly administered the UG task to a cohort of 20 currently depressed patients with a diagnosis of recurrent major depressive disorder and 20 healthy controls. Furthermore, valence and arousal ratings of emotionally laden pictures were obtained from all participants in order to assess a depressed mood-related distortion of emotion judgments. Compared to healthy controls, depressed patients over-sanctioned unfair proposals in the UG and judged emotional stimuli too negatively. Thus, major depression is associated with a negative emotional bias that hampers social-economic decision making and produces large personal costs.

Cooperation and depressive symptoms

BACKGROUND

Deficits in pro-social cooperation are common in many individuals with mental illnesses such as depression. For decades, researchers have used economic game paradigms to compare cross-cultural cooperative behavior. However, research using economic games to assess cooperative behavior in clinical populations is in the early stages. We hypothesized that individuals with greater depressive symptoms would struggle to maintain reciprocity in iterative games, but not in single-iteration games measuring personal values.

METHODS

Participants (n=41) played four computer-based economic games (prisoner's dilemma, the public goods game, the ultimatum game, and the trust game) measuring different aspects of cooperation. Participants completed the Depression Anxiety and Stress Scale (DASS) and other measures of personality and demographics. Analyses assessed the relationships between game performance and psychological distress as measured by the DASS.

RESULTS

Significant correlations were found between game performance and depressive symptoms, but not symptoms of anxiety or stress. Performance in the prisoner's dilemma and public goods game was significantly related to depression in a linear regression even when known associations with depressive affect such as age, gender, race, education, marital status, and neuroticism were controlled for.

CONCLUSIONS

Depressive symptoms were associated with an inability to sustain reciprocal cooperation. Participants showed the predicted deficits in cooperation in these economic games. Economic games show the potential for assessing the social deficits associated with depressive symptoms.

Exaggerated intergroup bias in economical decision making games: differential effects of primary and secondary psychopathic traits

Psychopathic personality traits are linked with selfish and non-cooperative responses during economical decision making games. However, the possibility that these responses may vary when responding to members of the in-group and the out-group has not yet been explored. We aimed to examine the effects of primary (selfish, uncaring) and secondary (impulsive, irresponsible) psychopathic personality traits on the responses of non-offending participants to the in-group and the out-group (defined in terms of affiliation to a UK University) across a series of economical decision making games. We asked a total of 60 participants to act as the proposer in both the dictator game and the ultimatum game. We found that across both tasks, those who scored highly for secondary psychopathic traits showed an elevated intergroup bias, making more generous offers toward members of the in-group relative to the out-group. An exaggerated intergroup bias may therefore represent a motivational factor for the antisocial behavior of those with elevated secondary psychopathic traits.

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.

Cool and hot executive function impairments in violent offenders with antisocial personality disorder with and without psychopathy

BACKGROUND

Impairments in executive function characterize offenders with antisocial personality disorder (ASPD) and offenders with psychopathy. However, the extent to which those impairments are associated with ASPD, psychopathy, or both is unknown.

METHODS

The present study examined 17 violent offenders with ASPD and psychopathy (ASPD+P), 28 violent offenders with ASPD without psychopathy (ASPD-P), and 21 healthy non-offenders on tasks assessing cool (verbal working memory and alteration of motor responses to spatial locations) and hot (reversal learning, decision-making under risk, and stimulus-reinforcement-based decision-making) executive function.

RESULTS

In comparison to healthy non-offenders, violent offenders with ASPD+P and those with ASPD-P showed similar impairments in verbal working memory and adaptive decision-making. They failed to learn from punishment cues, to change their behaviour in the face of changing contingencies, and made poorer quality decisions despite longer periods of deliberation. Intriguingly, the two groups of offenders did not differ significantly from the non-offenders in terms of their alteration of motor responses to spatial locations and their levels of risk-taking, indicated by betting, and impulsivity, measured as delay aversion. The performance of the two groups of offenders on the measures of cool and hot executive function did not differ, indicating shared deficits.

CONCLUSIONS

These documented impairments may help to explain the persistence of antisocial behaviours despite the known risks of the negative consequences of such behaviours.

Distinct neural activation patterns underlie economic decisions in high and low psychopathy scorers

Psychopathic traits affect social functioning and the ability to make adaptive decisions in social interactions. This study investigated how psychopathy affects the neural mechanisms that are recruited to make decisions in the ultimatum game. Thirty-five adult participants recruited from the community underwent functional magnetic resonance imaging scanning while they performed the ultimatum game under high and low cognitive load. Across load conditions, high psychopathy scorers rejected unfair offers in the same proportion as low scorers, but perceived them as less unfair. Among low scorers, the perceived fairness of offers predicted acceptance rates, whereas in high scorers no association was found. Imaging results revealed that responses in each group were associated with distinct patterns of brain activation, indicating divergent decision mechanisms. Acceptance of unfair offers was associated with dorsolateral prefrontal cortex activity in low scorers and ventromedial prefrontal cortex activity in high scorers. Overall, our findings point to distinct motivations for rejecting unfair offers in individuals who vary in psychopathic traits, with rejections in high psychopathy scorers being probably induced by frustration. Implications of these results for models of ventromedial prefrontal cortex dysfunction in psychopathy are discussed.

The role of self-blaming moral emotions in major depression and their impact on social-economical decision making

People with major depressive disorder (MDD) are more prone to experiencing moral emotions related to self-blame, such as guilt and shame. DSM-IV-TR recognizes excessive or inappropriate guilt as one of the core symptoms of current MDD, whereas excessive shame is not part of the criteria for MDD. However, previous studies specifically assessing shame suggested its involvement in MDD. In the first part of this review, we will consider literature discussing the role of self-blaming moral emotions in MDD. These self-blaming moral emotions have been purported to influence people when they make social and financial decisions in cognitive studies, particularly those using neuroeconomical paradigms. Such paradigms aim to predict social behavior in activities of daily living, by using important resource tangibles (especially money) in laboratory conditions. Previous literature suggests that guilt promotes altruistic behavior via acting out reparative tendencies, whereas shame reduces altruism by means of increasing social and interpersonal distance. In the second part of this review, we will discuss the potential influence of self-blaming moral emotions on overt behavior in MDD, reviewing clinical and experimental studies in social and financial decision-making, in which guilt, and shame were manipulated. This is not a well-established area in the depression literature, however in this opinion paper we will argue that studies of moral emotions and their impact on behavioral decision-making are of potential importance in the clinical field, by linking specific symptoms of a disorder to a behavioral outcome which may lead to stratification of clinical diagnoses in the future.

Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience

Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.

The strategy of psychopathy: primary psychopathic traits predict defection on low-value relationships

Recent evidence suggests that psychopathy is a trait continuum. This has unappreciated implications for understanding the selective advantage of psychopathic traits. Although clinical psychopathy is typically construed as a strategy of unconditional defection, subclinical psychopathy may promote strategic conditional defection, broadening the adaptive niche of psychopathy within human societies. To test this, we focus on a ubiquitous real-life source of conditional behaviour: the expected relational value of social partners, both in terms of their quality and the likely quantity of future interactions with them. We allow for conversational interaction among participants prior to their playing an unannounced, one-shot prisoner's dilemma game, which fosters naturalistic interpersonal evaluation and conditional behaviour, while controlling punishment and reputation effects. Individuals scoring higher on factor 1 (callous affect, interpersonal manipulation) of the Levenson self-report psychopathy scale defected conditionally on two kinds of low-value partners: those who interrupted them more during the conversation, and those with whom they failed to discover cues to future interaction. Both interaction effects support the hypothesis that subclinical primary psychopathy potentiates defection on those with low expected relational value. These data clarify the function and form of psychopathic traits, while highlighting adaptive variation in human social strategies.

Amygdala dysfunction attenuates frustration-induced aggression in psychopathic individuals in a non-criminal population

BACKGROUND

Individuals with psychopathy have an increased tendency toward certain types of aggression. We hypothesized that successful psychopaths, who have no criminal convictions but can be diagnosed with psychopathy in terms of personality characteristics, are skilled at regulating aggressive impulses, compared to incarcerated unsuccessful psychopaths.

METHODS

In this block-designed functional magnetic resonance imaging (fMRI) study, we sought to clarify the neural mechanisms underlying differences in frustration-induced aggression as a function of psychopathy in non-criminal populations. Twenty male undergraduate students who completed a self-report psychopathy questionnaire were scanned while they completed a task in which they either could or could not punish other individuals who made unfair offers of monetary distribution.

RESULTS

Individuals with high psychopathic tendencies were less likely to make a decision to inflict costly punishment on people proposing unfair offers. During this decision-making, psychopathy was associated with less amygdala activity in response to the unfairness of offers. Moreover, the amygdala dysfunction in psychopathic individuals was associated with reduced functional connectivity with dopaminergic-related areas, including the striatum, when punishment was available compared to when it was unavailable.

LIMITATIONS

The possibility that levels of psychopathic traits in a regular population were milder than in incarcerated populations cannot be ruled out.

CONCLUSIONS

The findings indicate that amygdala dysfunction underlies affective deficits of psychopathy. We propose that the insensitivity of the amygdala to the affective significance of social stimuli contributes to an increased risk of violation of social norms, but enhances the ability to attenuate impulses toward maladaptive aggression in successful psychopaths.

Utilitarian moral judgment in psychopathy

Psychopathic behavior is characteristically amoral, but to date research studies have largely failed to identify any systematic differences in moral judgment capability between psychopaths and non-psychopaths. In this study, we investigate whether significant differences in moral judgment emerge when taking into account the phenotypic heterogeneity of the disorder through a well-validated distinction between psychopathic subtypes. Three groups of incarcerated participants [low-anxious psychopaths (n = 12), high-anxious psychopaths (n = 12) and non-psychopaths (n = 24)] completed a moral judgment test involving hypothetical dilemmas. The moral dilemmas featured 'personal' (i.e. involving direct physical harm) or 'impersonal' (i.e. involving indirect or remote harm) actions. Compared to non-psychopaths, both groups of psychopaths were significantly more likely to endorse the impersonal actions. However, only the low-anxious psychopaths were significantly more likely to endorse the personal harms when commission of the harm would maximize aggregate welfare-the 'utilitarian' choice. High-anxious psychopaths and non-psychopaths did not significantly differ in their personal moral judgments. These results provide novel laboratory evidence of abnormal moral judgment in psychopaths, as well as additional support for the importance of considering psychopathic subtypes.

Understanding interpersonal function in psychiatric illness through multiplayer economic games

Interpersonal factors play significant roles in the onset, maintenance, and remission of psychiatric conditions. In the current major diagnostic classification systems for psychiatric disorders, some conditions are defined by the presence of impairments in social interaction or maintaining interpersonal relationships; these include autism, social phobia, and the personality disorders. Other psychopathologies confer significant difficulties in the social domain, including major depression, posttraumatic stress disorder, and psychotic disorders. Still other mental health conditions, including substance abuse and eating disorders, seem to be exacerbated or triggered in part by the influence of social peers. For each of these and other psychiatric conditions, the extent and quality of social support is a strong determinant of outcome such that high social support predicts symptom improvement and remission. Despite the central role of interpersonal factors in psychiatric illness, the neurobiology of social impairments remains largely unexplored, in part due to difficulties eliciting and quantifying interpersonal processes in a parametric manner. Recent advances in functional neuroimaging, combined with multiplayer exchange games drawn from behavioral economics, and computational/quantitative approaches more generally, provide a fitting paradigm within which to study interpersonal function and dysfunction in psychiatric conditions. In this review, we outline the importance of interpersonal factors in psychiatric illness and discuss ways in which neuroeconomics provides a tractable framework within which to examine the neurobiology of social dysfunction.

The Use of Neuroeconomic Games to Examine Social Decision Making in Child and Adolescent Externalizing Disorders

Neuroeconomics is a new, interdisciplinary field in which economics, psychology, computational science, and neuroscience converge to allow for examinations of the neural basis of reward-related decision making in social and nonsocial contexts. The aims of this paper are, first, to discuss recent advances in the use of neuroeconomic games to examine social decision making in children and adolescents with externalizing behavior disorders, as an alternative to approaches based on Social Information Processing theory and Theory of Mind; and, second, to summarize the potential neuroeconomics holds for the study of social decision making in populations with externalizing (and other) disorders.

There's something about a fair split: intentionality moderates context-based fairness considerations in social decision-making

Fairness considerations are a strong motivational force in social decision-making. Here, we investigated the role of intentionality in response to unfair offers in the Ultimatum Game by manipulating both proposers' degree of control over the selection of offers and the context pertaining to the outcomes of offers proposers can choose from. As a result, the design enabled us to disentangle intention- and context-based decision-making processes. Rejection rates were higher when an unfair offer was intentionally chosen over a fair alternative than when it was chosen by the computer, outside proposers' control. This finding provides direct evidence for intention-based decision-making. Also, rejection rates in general were sensitive to the context in which an offer was made, indicating the involvement of both intention- and context-based processes in social decision-making. Importantly, however, the current study highlights the role of intention-based fairness considerations in basic decision-making situations where outcomes are explicitly stated and thus easy to compare. Based on these results, we propose that fairness can be judged on different, but additive levels of (social-) cognitive processing that might have different developmental trajectories.

Reduced prefrontal connectivity in psychopathy

Linking psychopathy to a specific brain abnormality could have significant clinical, legal, and scientific implications. Theories on the neurobiological basis of the disorder typically propose dysfunction in a circuit involving ventromedial prefrontal cortex (vmPFC). However, to date there is limited brain imaging data to directly test whether psychopathy may indeed be associated with any structural or functional abnormality within this brain area. In this study, we employ two complementary imaging techniques to assess the structural and functional connectivity of vmPFC in psychopathic and non-psychopathic criminals. Using diffusion tensor imaging, we show that psychopathy is associated with reduced structural integrity in the right uncinate fasciculus, the primary white matter connection between vmPFC and anterior temporal lobe. Using functional magnetic resonance imaging, we show that psychopathy is associated with reduced functional connectivity between vmPFC and amygdala as well as between vmPFC and medial parietal cortex. Together, these data converge to implicate diminished vmPFC connectivity as a characteristic neurobiological feature of psychopathy.

The role of prefrontal cortex in psychopathy

Psychopathy is a personality disorder characterized by remorseless and impulsive antisocial behavior. Given the significant societal costs of the recidivistic criminal acti\xadvity associated with the disorder, there is a pressing need for more effective treatment strategies and, hence, a better understanding of the psychobiological mechanisms underlying the disorder. The prefrontal cortex (PFC) is likely to play an important role in psychopathy. In particular, the ventromedial and anterior cingulate sectors of PFC are theorized to mediate a number of social and affective decision-making functions that appear to be disrupted in psychopathy. This article provides a critical summary of human neuroimaging data implicating prefrontal dysfunction in psychopathy. A growing body of evidence associates psychopathy with structural and functional abnormalities in ventromedial PFC and anterior cingulate cortex. Although this burgeoning field still faces a number of methodological challenges and outstanding questions that will need to be resolved by future studies, the research to date has established a link between psychopathy and PFC.

Behavioral effects of congenital ventromedial prefrontal cortex malformation

BACKGROUND

A detailed behavioral profile associated with focal congenital malformation of the ventromedial prefrontal cortex (vmPFC) has not been reported previously. Here we describe a 14 year-old boy, B.W., with neurological and psychiatric sequelae stemming from focal cortical malformation of the left vmPFC.

CASE PRESENTATION

B.W.'s behavior has been characterized through extensive review Patience of clinical and personal records along with behavioral and neuropsychological testing. A central feature of the behavioral profile is severe antisocial behavior. He is aggressive, manipulative, and callous; features consistent with psychopathy. Other problems include: egocentricity, impulsivity, hyperactivity, lack of empathy, lack of respect for authority, impaired moral judgment, an inability to plan ahead, and poor frustration tolerance.

CONCLUSIONS

The vmPFC has a profound contribution to the development of human prosocial behavior. B.W. demonstrates how a congenital lesion to this cortical region severely disrupts this process.

Cognitive control and individual differences in economic ultimatum decision-making

Much publicity has been given to the fact that people's economic decisions often deviate from the rational predictions of standard economic models. In the classic ultimatum game, for example, most people turn down financial gains by rejecting unequal monetary splits. The present study points to neglected individual differences in this debate. After participants played the ultimatum game we tested for individual differences in cognitive control capacity of the most and least economic responders. The key finding was that people who were higher in cognitive control, as measured by behavioral (Go/No-Go performance) and neural (No-Go N2 amplitude) markers, did tend to behave more in line with the standard models and showed increased acceptance of unequal splits. Hence, the cognitively highest scoring decision-makers were more likely to maximize their monetary payoffs and adhere to the standard economic predictions. Findings question popular claims with respect to the rejection of standard economic models and the irrationality of human economic decision-making.