On the Use and Misuse of Genomic and Neuroimaging Science in Forensic Psychiatry: Current Roles and Future Directions

Effects of Substance Use and Antisocial Personality on Neuroimaging-Based Machine Learning Prediction of Schizophrenia

BACKGROUND AND HYPOTHESIS

Neuroimaging-based machine learning (ML) algorithms have the potential to aid the clinical diagnosis of schizophrenia. However, literature on the effect of prevalent comorbidities such as substance use disorder (SUD) and antisocial personality (ASPD) on these models' performance has remained unexplored. We investigated whether the presence of SUD or ASPD affects the performance of neuroimaging-based ML models trained to discern patients with schizophrenia (SCH) from controls.

STUDY DESIGN

We trained an ML model on structural MRI data from public datasets to distinguish between SCH and controls (SCH = 347, controls = 341). We then investigated the model's performance in two independent samples of individuals undergoing forensic psychiatric examination: sample 1 was used for sensitivity analysis to discern ASPD (N = 52) from SCH (N = 66), and sample 2 was used for specificity analysis to discern ASPD (N = 26) from controls (N = 25). Both samples included individuals with SUD.

STUDY RESULTS

In sample 1, 94.4% of SCH with comorbid ASPD and SUD were classified as SCH, followed by patients with SCH + SUD (78.8% classified as SCH) and patients with SCH (60.0% classified as SCH). The model failed to discern SCH without comorbidities from ASPD + SUD (AUC = 0.562, 95%CI = 0.400-0.723). In sample 2, the model's specificity to predict controls was 84.0%. In both samples, about half of the ASPD + SUD were misclassified as SCH. Data-driven functional characterization revealed associations between the classification as SCH and cognition-related brain regions.

CONCLUSION

Altogether, ASPD and SUD appear to have effects on ML prediction performance, which potentially results from converging cognition-related brain abnormalities between SCH, ASPD, and SUD.

Eye tracking and child sexual offenders: a systematic review

Eye tracking is used in sexology to identify attractiveness and sexual desire indirectly. This systematic review summarizes results of works that have used eye tracking to analyse paedophilic interest in order to investigate its potential as a useful forensic tool. Six studies met the inclusion criteria. Five of them concerned a large study project and used approximatively the same sample of paedophiles (inpatients), forensic patients (without a sexual interest in children) and healthy controls to make comparisons between the three groups. One study added 11 self-declared paedophiles (outpatients) for a comparison between inpatient paedophiles, outpatient paedophiles and controls (healthy and forensic inpatients). One study compared a group of child sexual offenders with non-offenders. All studies used static pictures of male and female subjects at different pubertal stages. Some studies divided every picture into a different area of interest. Dependent variables used are fixation latency (early attention) and relative fixation time, (later attention). Each study identified significant differences between the paedophile group versus other groups: shorter fixation latency on child pictures, longer fixation time on child pictures and number of fixation most important on child pictures. Two scores (age preference index and attentional control index) showed hight and/or moderate sensitivity and specificity. Although the results suggest the eye tracking can discriminate between paedophile interest and non-paedophile interest, there are too few studies on this specific topic and further research is needed with larger and different sample, carried out by different research teams. If these findings were confirmed, it remains unclear as to their impact in a forensic context when presented openly in Court.

Neuroscientific evidence in the courtroom: a review

The use of neuroscience in the courtroom can be traced back to the early twentieth century. However, the use of neuroscientific evidence in criminal proceedings has increased significantly over the last two decades. This rapid increase has raised questions, among the media as well as the legal and scientific communities, regarding the effects that such evidence could have on legal decision makers. In this article, we first outline the history of neuroscientific evidence in courtrooms and then we provide a review of recent research investigating the effects of neuroscientific evidence on decision-making broadly, and on legal decisions specifically. In the latter case, we review studies that measure the effect of neuroscientific evidence (both imaging and nonimaging) on verdicts, sentencing recommendations, and beliefs of mock jurors and judges presented with a criminal case. Overall, the reviewed studies suggest mitigating effects of neuroscientific evidence on some legal decisions (e.g., the death penalty). Furthermore, factors such as mental disorder diagnoses and perceived dangerousness might moderate the mitigating effect of such evidence. Importantly, neuroscientific evidence that includes images of the brain does not appear to have an especially persuasive effect (compared with other neuroscientific evidence that does not include an image). Future directions for research are discussed, with a specific call for studies that vary defendant characteristics, the nature of the crime, and a juror’s perception of the defendant, in order to better understand the roles of moderating factors and cognitive mediators of persuasion.

Biological Evidence Regarding Psychopathy Does Not Affect Mock Jury Sentencing

Research on the biological factors influencing criminal behavior is increasingly being introduced into court, necessitating research on how such evidence is perceived and influences decision makers. Research on how this evidence influences sentencing recommendations is inconclusive. In this study, we focus on biological evidence related to psychopathy, a construct commonly associated with criminal behavior. Approximately 800 community members were presented with a case vignette detailing an individual who is described as having a high level of psychopathic traits. Participants received either psychological information about psychopathy (i.e., no biological evidence), evidence the defendant had genetic risk factors for psychopathy, or written neuroimaging evidence the defendant had brain deficits associated with psychopathy. Participants then recommended a sentence. Overall, recommended sentence lengths did not differ between evidence conditions. These findings add to a growing body of research suggesting that biological evidence may not have as much of an influence on jurors as previously thought.

Predicting Violent Behavior: What Can Neuroscience Add?

The ability to accurately predict violence and other forms of serious antisocial behavior would provide important societal benefits, and there is substantial enthusiasm for the potential predictive accuracy of neuroimaging techniques. Here, we review the current status of violence prediction using actuarial and clinical methods, and assess the current state of neuroprediction. We then outline several questions that need to be addressed by future studies of neuroprediction if neuroimaging and other neuroscientific markers are to be successfully translated into public policy.

The forensic use of behavioral genetics in criminal proceedings: Case of the MAOA-L genotype

The role of behavioral genetic evidence in excusing and mitigating criminal behavior is unclear. Research has suggested that a low activity genotype of the enzyme monoamine oxidase (MAOA-L) may increase the risk for aggressive and antisocial behavior. By examining criminal proceedings in which MAOA-L genotype evidence was introduced, we explored the forensic uses of behavioral genetic science. Westlaw and LexisNexis legal databases were electronically searched for cases from 1995 to 2016 to identify court documents from cases involving the MAOA-L genotype. Evidence of the MAOA-L genotype was included in records from 11 criminal cases (9 U.S. and 2 Italian). In the guilt phase, genotype evidence was ruled admissible in one of two cases, and may have contributed to a conviction on a lesser charge. In the sentencing phase, genotype evidence was admissible in four of five cases, one of which ended with a lesser sentence. Five cases used genotype evidence for post-conviction appeals, two of which resulted in sentence reductions. Even when charges or sentences are reduced it is difficult to gauge the effect of evidence of the MAOA-L genotype. Genotype evidence may lack persuasive effect because the impact of the allele on a particular accused is difficult to establish.

After the Biomedical Technology Revolution: Where to Now for a Bio-Psycho-Social Approach to Social Work?

In the late twentieth century, the bio-psycho-social framework emerged as a powerful influence on the conceptualisation and delivery of health and rehabilitation services including social work services in these fields. The bio-psycho-social framework is built on a systems view of health and well-being ( Garland and Howard, 2009). The systems perspective encourages medical and allied health professions, including social work, to recognise and to respond to the multiple systems impacting on individual health and well-being ( Engel, 2003). This paper analyses how advances in biomedical technology, particularly in the fields of neuroscience and human genomics, are challenging the bio-psycho-social approach to practice. The paper examines the pressures on the social work profession to embrace biomedical science and points to the problems in doing so. The conclusion points to some tentative ways forward for social workers to engage critically with biomedical advances and to strengthen the bio-psycho-social framework in the interests of holistic and ethical approaches to social work practice.

Promises, promises for neuroscience and law

Stunning technical advances in the ability to image the human brain have provoked excited speculation about the application of neuroscience to other fields. The 'promise' of neuroscience for law has been touted with particular enthusiasm. Here, we contend that this promise elides fundamental conceptual issues that limit the usefulness of neuroscience for law. Recommendations for overcoming these challenges are offered.

On the (non) persuasive power of a brain image

The persuasive power of brain images has captivated scholars in many disciplines. Like others, we too were intrigued by the finding that a brain image makes accompanying information more credible (McCabe & Castel in Cognition 107:343-352, 2008). But when our attempts to build on this effect failed, we instead ran a series of systematic replications of the original study-comprising 10 experiments and nearly 2,000 subjects. When we combined the original data with ours in a meta-analysis, we arrived at a more precise estimate of the effect, determining that a brain image exerted little to no influence. The persistent meme of the influential brain image should be viewed with a critical eye.