Investigating the neural correlates of psychopathy: a critical review

Psychopathy and Impairments in Emotion Regulation: A systematic review and Meta-analysis

Considering the sparse but rapidly growing literature concerning the relationship between psychopathy and emotion regulation, taking stock of accumulating knowledge in a systematic review and meta-analysis of the existing results is needed. We performed a systematic search (up to May 30, 2024) following PRISMA guidelines of five scientific databases (PsycINFO, PsycARTICLES, MEDLINE, PubMed, Scopus and Web of Science). Also, gray literature was searched. After removing the duplicates, a total of 8.786 records were screened, and 73 articles were selected based on the inclusion criteria used for systematic review. The meta-analytic procedure was performed on 55 identified studies consistent with the criteria adopted, which overall comprised 29.856 individuals. The current systematic and meta-analysis review has clarified the association between impairments of emotional regulation abilities and facets of psychopathy. More specifically, analyses indicated that emotional dysregulation is associated with overall levels of psychopathic traits, as well as with both the lifestyle and affective components of psychopathy, which suggests the utility of assessing these features when designing interventions focused on modulating negative emotional states and enhancing regulation of impulsive behaviors.

Psychopathy and medial frontal cortex: A systematic review reveals predominantly null relationships

Theories have posited that psychopathy is caused by dysfunction in the medial frontal cortex, including ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), and dorsomedial prefrontal cortex (dmPFC). Recent reviews have questioned the reproducibility of neuroimaging findings within this field. We conducted a systematic review to describe the consistency of magnetic resonance imaging (MRI) findings according to anatomical subregion (vmPFC, ACC, dmPFC), experimental task, psychopathy assessment, study power, and peak coordinates of significant effects. Searches of PsycInfo and MEDLINE databases produced 77 functional and 24 structural MRI studies that analyzed the medial frontal cortex in relation to psychopathy in adult samples. Findings were predominantly null (85.4 % of 1573 tests across the three medial frontal regions). Studies with higher power observed null effects at marginally lower rates. Finally, peak coordinates of significant effects were widely dispersed. The evidence failed to support theories positing the medial frontal cortex as a consistent neural correlate of psychopathy. Theory and methods in the field should be revised to account for predominantly null neuroimaging findings.

Studying the social mind: An updated summary of findings from the Vietnam Head Injury Study

Lesion mapping studies allow us to evaluate the potential causal contribution of specific brain areas to human cognition and complement other cognitive neuroscience methods, as several authors have recently pointed out. Here, we present an updated summary of the findings from the Vietnam Head Injury Study (VHIS) focusing on the studies conducted over the last decade, that examined the social mind and its intricate neural and cognitive underpinnings. The VHIS is a prospective, long-term follow-up study of Vietnam veterans with penetrating traumatic brain injury (pTBI) and healthy controls (HC). The scope of the work is to present the studies from the latest phases (3 and 4) of the VHIS, 70 studies since 2011, when the Raymont et al. paper was published (Raymont et al., 2011). These studies have contributed to our understanding of human social cognition, including political and religious beliefs, theory of mind, but also executive functions, intelligence, and personality. This work finally discusses the usefulness of lesion mapping as an approach to understanding the functions of the human brain from basic science and clinical perspectives.

Impaired salience network switching in psychopathy

Growing evidence suggests that psychopathy is related to altered connectivity within and between three large-scale brain networks that support core cognitive functions, including allocation of attention. In healthy individuals, default mode network (DMN) is involved in internally-focused attention and cognition such as self-reference. Frontoparietal network (FPN) is anticorrelated with DMN and is involved in externally-focused attention to cognitively demanding tasks. A third network, salience network (SN), is involved in detecting salient cues and, crucially, appears to play a role in switching between the two anticorrelated networks, DMN and FPN, to efficiently allocate attentional resources. Psychopathy has been related to reduced anticorrelation between DMN and FPN, suggesting SN's role in switching between these two networks may be diminished in the disorder. To test this hypothesis, we used independent component analysis to derive DMN, FPN, and SN activity in resting-state fMRI data in a sample of incarcerated men (N = 148). We entered the activity of the three networks into dynamic causal modeling to test SN's switching role. The previously established switching effect of SN among young, healthy adults was replicated in a group of low psychopathy participants (posterior model probability = 0.38). As predicted, SN's switching role was significantly diminished in high psychopathy participants (t(145) = 26.39, p < .001). These findings corroborate a novel theory of brain function in psychopathy. Future studies may use this model to test whether disrupted SN switching is related to high psychopathy individuals' abnormal allocation of attention.

Cortical and subcortical grey matter correlates of psychopathic traits in a Japanese community sample of young adults: sex and configurations of factors' level matter!

While neuroimaging research has examined the structural brain correlates of psychopathy predominantly in clinical/forensic male samples from western countries, much less is known about those correlates in non-western community samples. Here, structural magnetic resonance imaging data were analyzed using voxel- and surface-based morphometry to investigate the neuroanatomical correlates of psychopathic traits in a mixed-sex sample of 97 well-functioning Japanese adults (45 males, 21-39 years; M = 27, SD = 5.3). Psychopathic traits were assessed using the Self-Report Psychopathy Scale (SRP-SF; 4th Edition). Multiple regression analysis showed greater Factor 1 scores were associated with higher gyrification in the lingual gyrus, and gray matter volume in the anterior cingulate cortex and amygdala/hippocampus border. Total psychopathy and Factor 1 scores interacted with sex to, respectively, predict cortical thickness in the precuneus and gyrification in the superior temporal gyrus. Finally, Factor 1 and Factor 2 traits interacted to predict gyrification in the posterior cingulate cortex. These preliminary data suggest that, while there may be commonalities in the loci of structural brain correlates of psychopathic traits in clinical/forensic and community samples, the nature of that association might be different (i.e. positive) and may vary according to sex and configurations of factors' level.

Prison and the brain

Imprisonment is a common punishment in most countries. Goals of imprisonment are often not only retribution, but also prevention. Specific prevention aims to reduce the risk of reoffending of the imprisoned offender. The question is whether the goals of retribution and specific prevention contradict each other. Retribution is not only expressed in taking away ones freedom, but also in the prison environment itself. Prisoners live in a sober regime, with a minimal amount of autonomy. There are few cognitive challenges, meaningful social interaction is reduced significantly, and many prisoners are highly sedentary. In other words, prison can be viewed as an impoverished environment. In the last few decades, much knowledge has been gained on the influence of enriched versus impoverished environment on the brain. In this chapter, we discuss the influence of the impoverished prison environment on brain functions of prisoners, with an emphasis on self-regulation and executive functions, since these functions are (1) often impaired in offenders, (2) highly sensitive to environmental influences, and (3) crucial for successful resocialization. We conclude this chapter by discussing possibilities for and potential effects of enriching prison environments.

Social-affective functioning and learning in psychopathy

Psychopathy is a personality construct for which impairments in multiple aspects of social and affective functioning are considered to be central. Individuals with elevated levels of psychopathic traits tend to exhibit maladaptive behaviors that are harmful to themselves and others, and seem to be limited in how they perceive and experience affective states. This chapter provides a brief overview of biopsychological theories and studies of psychopathy targeting impairments in affective processing and behavioral adaptation through learning. Also, current gaps in the literature will be discussed in addition to findings highlighting the need to routinely reexamine the validity and robustness of decades-old views on psychopathy in the light of recent multidisciplinary empirical research. The chapter ends with a short reflection on how alternative views may offer novel insights that may bring significant advances in the study of the biopsychological factors underlying psychopathy.

Psychopathic and autistic traits differentially influence the neural mechanisms of social cognition from communication signals

Psychopathy is associated with severe deviations in social behavior and cognition. While previous research described such cognitive and neural alterations in the processing of rather specific social information from human expressions, some open questions remain concerning central and differential neurocognitive deficits underlying psychopathic behavior. Here we investigated three rather unexplored factors to explain these deficits, first, by assessing psychopathy subtypes in social cognition, second, by investigating the discrimination of social communication sounds (speech, non-speech) from other non-social sounds, and third, by determining the neural overlap in social cognition impairments with autistic traits, given potential common deficits in the processing of communicative voice signals. The study was exploratory with a focus on how psychopathic and autistic traits differentially influence the function of social cognitive and affective brain networks in response to social voice stimuli. We used a parametric data analysis approach from a sample of 113 participants (47 male, 66 female) with ages ranging between 18 and 40 years (mean 25.59, SD 4.79). Our data revealed four important findings. First, we found a phenotypical overlap between secondary but not primary psychopathy with autistic traits. Second, primary psychopathy showed various neural deficits in neural voice processing nodes (speech, non-speech voices) and in brain systems for social cognition (mirroring, mentalizing, empathy, emotional contagion). Primary psychopathy also showed deficits in the basal ganglia (BG) system that seems specific to the social decoding of communicative voice signals. Third, neural deviations in secondary psychopathy were restricted to social mirroring and mentalizing impairments, but with additional and so far undescribed deficits at the level of auditory sensory processing, potentially concerning deficits in ventral auditory stream mechanisms (auditory object identification). Fourth, high autistic traits also revealed neural deviations in sensory cortices, but rather in the dorsal auditory processing streams (communicative context encoding). Taken together, social cognition of voice signals shows considerable deviations in psychopathy, with differential and newly described deficits in the BG system in primary psychopathy and at the neural level of sensory processing in secondary psychopathy. These deficits seem especially triggered during the social cognition from vocal communication signals.

The Societal Response to Psychopathy in the Community

The harm usually associated with psychopathy requires therapeutically, legally, and ethically satisfactory solutions. Scholars from different fields have, thus, examined whether empirical evidence shows that individuals with psychopathic traits satisfy concepts, such as responsibility, mental disorder, or disability, that have specific legal or ethical implications. The present paper considers the less discussed issue of whether psychopathy is a disability. As it has been shown for the cases of the responsibility and mental disorder status of psychopathic individuals, we argue that it is undecided whether psychopathy is a disability. Nonetheless, based on insights from disability studies and legislations, we propose that interventions to directly modify the propensities of individuals with psychopathic tendencies should be balanced with modifications of the social and physical environments to accommodate their peculiarities. We also suggest how this social approach in some practical contexts that involve non-offender populations might be effective in addressing some of the negative effects of psychopathy.

How reliable are amygdala findings in psychopathy? A systematic review of MRI studies

The amygdala is a key component in predominant neural circuitry models of psychopathy. Yet, after two decades of neuroimaging research on psychopathy, the reproducibility of amygdala findings is questionable. We systematically reviewed MRI studies (81 of adults, 53 of juveniles) to determine the consistency of amygdala findings across studies, as well as within specific types of experimental tasks, community versus forensic populations, and the lowest- versus highest-powered studies. Three primary findings emerged. First, the majority of studies found null relationships between psychopathy and amygdala structure and function, even in the context of theoretically relevant tasks. Second, findings of reduced amygdala activity were more common in studies with low compared to high statistical power. Third, the majority of peak coordinates of reduced amygdala activity did not fall primarily within the anatomical bounds of the amygdala. Collectively, these findings demonstrate significant gaps in the empirical support for the theorized role of the amygdala in psychopathy and indicate the need for novel research perspectives and approaches in this field.

A Multidimensional Examination of Psychopathy Traits and Gray Matter Volume in Adults

Uncovering the neurobiological abnormalities that may contribute to the manifestation of psychopathic traits is an important step toward understanding the etiology of this disorder. Although many studies have examined gray matter volume (GMV) in relation to psychopathy, few have examined how dimensions of psychopathic traits interactively relate to GMV, an approach that holds promise for parsing heterogeneity in neurobiological risk factors for this disorder. The aim of this study was to investigate the affective-interpersonal (Factor 1) and impulsive-antisocial (Factor 2) dimensions of psychopathy in relation to cortical surface and subcortical GMV in a mixed-gender, high-risk community sample with significant justice-system involvement (N = 156, 50.0% men). Cortex-wide analysis indicated that (i) the Factor 1 traits correlated negatively with GMV in two cortical clusters, one in the right rostral middle frontal region and one in the occipital lobe, and (ii) the interaction of the affective-interpersonal and impulsive-antisocial traits was negatively associated with GMV bilaterally in the parietal lobe, such that individuals high on both trait dimensions evidenced reduced GMV relative to individuals high on only one psychopathy factor. An interactive effect also emerged for bilateral amygdalar and hippocampal GMV, such that Factor 1 psychopathic traits were significantly negatively associated with GMV only at high (but not low) levels of Factor 2 traits. Results extend prior research by demonstrating the neurobiological correlates of psychopathy differ based on the presentation of Factor 1 and 2 traits.

Exploring the neural correlates of (altered) moral cognition in psychopaths

Research into the neurofunctional mechanisms of psychopathy has gathered momentum over the last years. Previous neuroimaging studies have identified general changes in brain activity of psychopaths. In an exploratory meta-analysis, we here investigated the neural correlates of impaired moral cognition in psychopaths. Our analyses replicated general effects in the dorsomedial prefrontal cortex, lateral prefrontal cortex, fronto-insular cortex, and amygdala, which have been reported recently. In addition, we found aberrant brain activity in the midbrain and inferior parietal cortex. Our preliminary findings suggest that alterations in both regions may represent more specific functional brain changes related to (altered) moral cognition in psychopaths. Furthermore, future studies including a more comprehensive corpus of neuroimaging studies on moral cognition in psychopaths should re-examine this notion.

Unzipping empathy in psychopathy: Empathy and facial affect processing in psychopaths

Psychopathy is a neurodevelopmental disorder that has a highly deleterious effect upon both individuals and society at large. Psychopaths grossly neglect and disrespect the interests of others. Their antisocial behavior is thought to originate from a lack of empathy. However, empathy is multidimensional in nature, as evidenced by the considerable heterogeneity in extant theorizing on the subject. Here, we present the "Zipper model of empathy" that reconsiders how both its affective and cognitive components converge in mature empathic behavior. Furthermore, the Zipper model of empathy is expedient for explaining the empathy deficits in psychopathy, insofar as it brings together current theories on the dysfunctional affective components of empathy, violence inhibition, and automatic versus goal-directed attention. According to the literature, the neurobiological underpinnings of these theories are amygdala-centered; however, this article traces this specifically to the basolateral and central amygdala subregions. When viewed together, the cognitive and affective components of empathy are zipped together in a natural fashion in healthy empathic behavior, whereas psychopaths leave the zipper substantially unzipped in pursuit of their purely self-centered goals.

Electroencephalographic and morphometric abnormalities in psychopath offenders

The main goals of the present study were to replicate and extend current knowledge related to paralimbic dysfunctions associated with psychopathy. The research evaluated the quantitative electroencephalography, current density (CD) source and synchronization likelihood analysis during the rest condition and structural magnetic resonance imaging images to compare volumetric and cortical thickness, in inmates recruited from two prisons located in Havana City. The Psychopathy Checklist-Revised (PCL-R) was used as a quantitative measure of psychopathy. This study showed most beta energy and less alpha activity in male psychopath offenders. Low-resolution electromagnetic tomography signified an increase of beta activity in psychopath offender groups within paralimbic regions. The superior temporal gyrus volume was associated with the F1 factor while the fusiform, anterior cingulate and associative occipital areas were primarily associated with the F2 factor of PCL-R scale. Cortical thickness in the left dorsal anterior cingulate cortex and the temporal pole was negatively associated with PCL-R total score.

Brain Basis of Psychopathy in Criminal Offenders and General Population

Psychopathy is characterized by persistent antisocial behavior, impaired empathy, and egotistical traits. These traits vary also in normally functioning individuals. Here, we tested whether such antisocial personalities are associated with similar structural and neural alterations as those observed in criminal psychopathy. Subjects were 100 non-convicted well-functioning individuals, 19 violent male offenders, and 19 matched controls. Subjects underwent T1-weighted magnetic resonance imaging and viewed movie clips with varying violent content during functional magnetic resonance imaging. Psychopathic traits were evaluated with Levenson Self-Report Psychopathy Scale (controls) and Psychopathy Checklist-Revised (offenders). Psychopathic offenders had lower gray matter density (GMD) in orbitofrontal cortex and anterior insula. In the community sample, affective psychopathy traits were associated with lower GMD in the same areas. Viewing violence increased brain activity in periaqueductal grey matter, thalamus, somatosensory, premotor, and temporal cortices. Psychopathic offenders had increased responses to violence in thalamus and orbitofrontal, insular, and cingulate cortices. In the community sample, impulsivity-related psychopathy traits were positively associated with violence-elicited responses in similar areas. We conclude that brain characteristics underlying psychopathic spectrum in violent psychopathy are related to those observed in well-functioning individuals with asocial personality features.

Psychopathy

Psychopathy is a personality disorder characterized by a constellation of affective, interpersonal, lifestyle and antisocial features whose antecedents can be identified in a subgroup of young people showing severe antisocial behaviour. The prevalence of psychopathy in the general population is thought to be ~1%, but is up to 25% in prisoners. The aetiology of psychopathy is complex, with contributions of both genetic and environmental risk factors, and gene-environment interactions and correlations. Psychopathy is characterized by structural and functional brain abnormalities in cortical (such as the prefrontal and insular cortices) and subcortical (for example, the amygdala and striatum) regions leading to neurocognitive disruption in emotional responsiveness, reinforcement-based decision-making and attention. Although no effective treatment exists for adults with psychopathy, preliminary intervention studies targeting key neurocognitive disturbances have shown promising results. Given that psychopathy is often comorbid with other psychiatric disorders and increases the risk of physical health problems, educational and employment failure, accidents and criminality, the identification of children and young people at risk for this personality disorder and preventative work are important. Indeed, interventions that target the antecedents of psychopathic features in children and adolescents have been found to be effective.

Is the Psychopathic Brain an Artifact of Coding Bias? A Systematic Review

Questionable research practices are a well-recognized problem in psychology. Coding bias, or the tendency of review studies to disproportionately cite positive findings from original research, has received comparatively little attention. Coding bias is more likely to occur when original research, such as neuroimaging, includes large numbers of effects, and is most concerning in applied contexts. We evaluated coding bias in reviews of structural magnetic resonance imaging (sMRI) studies of PCL-R psychopathy. We used PRISMA guidelines to locate all relevant original sMRI studies and reviews. The proportion of null-findings cited in reviews was significantly lower than those reported in original research, indicating coding bias. Coding bias was not affected by publication date or review design. Reviews recommending forensic applications—such as treatment amenability or reduced criminal responsibility—were no more accurate than purely theoretical reviews. Coding bias may have contributed to a perception that structural brain abnormalities in psychopaths are more consistent than they actually are, and by extension that sMRI findings are suitable for forensic application. We discuss possible sources for the pervasive coding bias we observed, and we provide recommendations to counteract this bias in review studies. Until coding bias is addressed, we argue that this literature should not inform conclusions about psychopaths' neurobiology, especially in forensic contexts.

A Plea for Preregistration in Personality Disorders Research: The Case of Psychopathy

In response to a crisis of confidence, several methodological initiatives have been launched to improve the robustness of psychological science. Given its real-world implications, personality disorders research is all too important to not follow suit. The authors offer a plea for preregistration in personality disorders research, using psychopathic personality (psychopathy) as a prominent case example. To suit action to word, the authors report on a preregistered study and use it to help refute common misconceptions about preregistration as well as to illustrate that the key strength of preregistration: transparency outweighs its (perceived) disadvantages. Although preregistration will not conclusively settle the many debates roiling the field of psychopathy and other personality disorders, it can help to verify the robustness of empirical observations that inform such debates.

Translational Application of a Neuro-Scientific Multi-Modal Approach Into Forensic Psychiatric Evaluation: Why and How?

A prominent body of literature indicates that insanity evaluations, which are intended to provide influential expert reports for judges to reach a decision "beyond any reasonable doubt," suffer from a low inter-rater reliability. This paper reviews the limitations of the classical approach to insanity evaluation and the criticisms to the introduction of neuro-scientific approach in court. Here, we explain why in our opinion these criticisms, that seriously hamper the translational implementation of neuroscience into the forensic setting, do not survive scientific scrutiny. Moreover, we discuss how the neuro-scientific multimodal approach may improve the inter-rater reliability in insanity evaluation. Critically, neuroscience does not aim to introduce a brain-based concept of insanity. Indeed, criteria for responsibility and insanity are and should remain clinical. Rather, following the falsificationist approach and the convergence of evidence principle, the neuro-scientific multimodal approach is being proposed as a way to improve reliability of insanity evaluation and to mitigate the influence of cognitive biases on the formulation of insanity opinions, with the final aim to reduce errors and controversies.

Psychopathy is associated with fear-specific reductions in neural activity during affective perspective-taking

Psychopathic individuals are notorious for their callous disregard for others' emotions. Prior research has linked psychopathy to deficits in affective mechanisms underlying empathy (e.g., affective sharing), yet research relating psychopathy to cognitive mechanisms underlying empathy (e.g., affective perspective-taking and Theory of Mind) requires further clarification. To elucidate the neurobiology of cognitive mechanisms of empathy in psychopathy, we administered an fMRI task and tested for global as well as emotion-specific deficits in affective perspective-taking. Adult male incarcerated offenders (N = 94) viewed images of two people interacting, with one individual's face obscured by a shape. Participants were cued to either identify the emotion of the obscured individual or identify the shape from one of two emotion or shape choices presented on each trial. Target emotions included anger, fear, happiness, sadness, and neutral. Contrary to predictions, psychopathy was unrelated to neural activity in the Affective Perspective-taking > Shape contrast. In line with predictions, psychopathy was negatively related to task accuracy during affective perspective-taking for fear, happiness, and sadness. Psychopathy was related to reduced hemodynamic activity exclusively during fear perspective-taking in several areas: left anterior insula extending into posterior orbitofrontal cortex, right precuneus, left superior parietal lobule, and left superior occipital cortex. Although much prior research has emphasized psychopathy-related abnormalities in affective mechanisms mediating empathy, current results add to growing evidence of psychopathy-related abnormalities in a cognitive mechanism related to empathy. These findings highlight brain regions that are hypoactive in psychopathy when explicitly processing another's fear.

Morphology of the criminal brain: gray matter reductions are linked to antisocial behavior in offenders

Aggression and psychopathy are multifaceted conditions determined interpersonal and antisocial factors. Only a few studies analyze the link between these separate factors and specific brain morphology distinctively. A voxel-based morphometry (VBM) analysis was performed on 27 violent offenders and 27 controls aiming to associate sub-features of aggressive and psychopathic behavior with specific gray matter volumes. Trait aggression was assessed using two self-report tests (Aggression Questionnaire, AQ, and Reactive-Proactive-Aggression Questionnaire, RPQ) and psychopathy with the Psychopathy Checklist-Revised (PCL-R). Total and sub-scale scores of these tests were correlated to the brain morphometry of the offenders group in separate analyses. It was found that psychopathic behavior was negatively correlated with prefrontal gray matter volume and that this result was primarily driven by the antisocial behavior sub-scale of the PCL-R. Furthermore, less gray matter in right superior frontal and left inferior parietal regions with increasing antisocial behavior could be observed. One cluster comprising the right middle and superior temporal gyrus was negatively correlated with both, reactive aggression and antisocial behavior. These results outline (1) the importance of distinctively analyzing sub-features that contribute to aggressive and psychopathic behavior, given that the negative correlation of psychopathy global scores with prefrontal volume was driven by one single facet of the PCL-R scale (antisocial behavior). Moreover, these results indicate (2) fronto-temporo-parietal network deficits in antisocial, criminal offenders, with a particular strong effect in the temporal lobe.

The Empathic Brain of Psychopaths: From Social Science to Neuroscience in Empathy

Empathy is a crucial human ability, because of its importance to prosocial behavior, and for moral development. A deficit in empathic abilities, especially affective empathy, is thought to play an important role in psychopathic personality. Empathic abilities have traditionally been studied within the social and behavioral sciences using behavioral methods, but recent work in neuroscience has begun to elucidate the neural underpinnings of empathic processing in relation to psychopathy. In this review, current knowledge in the social neuroscience of empathy is discussed and a comprehensive view of the neuronal mechanisms that underlie empathy in psychopathic personality is provided. Furthermore, it will be argued that using classification based on overt behavior, we risk failing to identify important mechanisms involved in the psychopathology of psychopathy. In the last decade, there is a growing attention in combining knowledge from (neuro)biological research areas with psychology and psychiatry, to form a new basis for categorizing individuals. Recently, a converging framework has been put forward that applies such approach to antisocial individuals, including psychopathy. In this bio-cognitive approach, it is suggested to use information from different levels, to form latent categories on which individuals are grouped, that may better reflect underlying (neurobiological) dysfunctions. Subsequently, these newly defined latent categories may be more effective in guiding interventions and treatment. In conclusion, in my view, the future understanding of the social brain of psychopaths lies in studying the complex networks in the brain in combination with the use of other levels of information (e.g., genetics and cognition). Based on that, profiles of individuals can be formed that can be used to guide neurophysiological informed personalized treatment interventions that ultimately reduce violent transgressions in individuals with psychopathic traits.

Current Challenges in Translational and Clinical fMRI and Future Directions

Translational neuroscience is an important field that brings together clinical praxis with neuroscience methods. In this review article, the focus will be on functional neuroimaging (fMRI) and its applicability in clinical fMRI studies. In the light of the "replication crisis," three aspects will be critically discussed: First, the fMRI signal itself, second, current fMRI praxis, and, third, the next generation of analysis strategies. Current attempts such as resting-state fMRI, meta-analyses, and machine learning will be discussed with their advantages and potential pitfalls and disadvantages. One major concern is that the fMRI signal shows substantial within- and between-subject variability, which affects the reliability of both task-related, but in particularly resting-state fMRI studies. Furthermore, the lack of standardized acquisition and analysis methods hinders the further development of clinical relevant approaches. However, meta-analyses and machine-learning approaches may help to overcome current shortcomings in the methods by identifying new, and yet hidden relationships, and may help to build new models on disorder mechanisms. Furthermore, better control of parameters that may have an influence on the fMRI signal and that can easily be controlled for, like blood pressure, heart rate, diet, time of day, might improve reliability substantially.

Data-driven biological subtypes of depression: systematic review of biological approaches to depression subtyping

Research into major depressive disorder (MDD) is complicated by population heterogeneity, which has motivated the search for more homogeneous subtypes through data-driven computational methods to identify patterns in data. In addition, data on biological differences could play an important role in identifying clinically useful subtypes. This systematic review aimed to summarize evidence for biological subtypes of MDD from data-driven studies. We undertook a systematic literature search of PubMed, PsycINFO, and Embase (December 2018). We included studies that identified (1) data-driven subtypes of MDD based on biological variables, or (2) data-driven subtypes based on clinical features (e.g., symptom patterns) and validated these with biological variables post-hoc. Twenty-nine publications including 24 separate analyses in 20 unique samples were identified, including a total of ~ 4000 subjects. Five out of six biochemical studies indicated that there might be depression subtypes with and without disturbed neurotransmitter levels, and one indicated there might be an inflammatory subtype. Seven symptom-based studies identified subtypes, which were mainly determined by severity and by weight gain vs. loss. Two studies compared subtypes based on medication response. These symptom-based subtypes were associated with differences in biomarker profiles and functional connectivity, but results have not sufficiently been replicated. Four out of five neuroimaging studies found evidence for groups with structural and connectivity differences, but results were inconsistent. The single genetic study found a subtype with a distinct pattern of SNPs, but this subtype has not been replicated in an independent test sample. One study combining all aforementioned types of data discovered a subtypes with different levels of functional connectivity, childhood abuse, and treatment response, but the sample size was small. Although the reviewed work provides many leads for future research, the methodological differences across studies and lack of replication preclude definitive conclusions about the existence of clinically useful and generalizable biological subtypes.

Reduced engagement of the anterior cingulate cortex in the dishonest decision-making of incarcerated psychopaths

A large body of research indicates that psychopathic individuals lie chronically and show little remorse or anxiety. Yet, little is known about the neurobiological substrates of dishonesty in psychopathy. In a sample of incarcerated individuals (n = 67), we tested the hypothesis that psychopathic individuals show reduced activity in the anterior cingulate cortex (ACC) when confronted with an opportunity for dishonest gain, reflecting dishonest behavior that is relatively unhindered by response conflict. During functional magnetic resonance imaging, incarcerated offenders with different levels of psychopathy performed an incentivized prediction task wherein they were given real and repeated opportunities for dishonest gain. We found that while incarcerated offenders showed a high rate of cheating, levels of psychopathic traits did not influence the frequency of dishonesty. Higher psychopathy scores predicted decreased activity in the ACC during dishonest decision-making. Further analysis revealed that the ACC was functionally connected to the dorsolateral prefrontal cortex, and that ACC activity mediated the relationship between psychopathic traits and reduced reaction times for dishonest behavior. These findings suggest that psychopathic individuals behave dishonestly with relatively low levels of response conflict and that the ACC may play a critical role in this pattern of behavior.

A view behind the mask of sanity: meta-analysis of aberrant brain activity in psychopaths

Psychopathy is a disorder of high public concern because it predicts violence and offense recidivism. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. No reliable pattern of altered neural activity has been disclosed so far. This study sought to identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology. First, we used activation likelihood estimation (p < 0.05, corrected) to meta-analyze brain activation changes associated with psychopathy across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 experiments. Second, we characterized the ensuing regions functionally by employing metadata of a large-scale neuroimaging database (p < 0.05, corrected). Psychopathy was consistently associated with decreased brain activity in the right laterobasal amygdala, the dorsomedial prefrontal cortex, and bilaterally in the lateral prefrontal cortex. A robust increase of activity was observed in the fronto-insular cortex on both hemispheres. Data-driven functional characterization revealed associations with semantic language processing (left lateral prefrontal and fronto-insular cortex), action execution and pain processing (right lateral prefrontal and left fronto-insular), social cognition (dorsomedial prefrontal cortex), and emotional as well as cognitive reward processing (right amygdala and fronto-insular cortex). Aberrant brain activity related to psychopathy is located in prefrontal, insular, and limbic regions. Physiological mental functions fulfilled by these brain regions correspond to disturbed behavioral patterns pathognomonic for psychopathy. Hence, aberrant brain activity may not just be an epiphenomenon of psychopathy but directly related to the psychopathology of this disorder.

Emotion regulation mediates the relationship between verbal learning and internalizing, trauma-related and externalizing symptoms among early-onset, persistently delinquent adolescents

Research supports cascading relationships among internalizing and externalizing symptoms, and academic problems. This constellation of problems characterizes Early-Onset/Persistent Delinquent [EOPD] youth and appropriately targeted interventions accounting for this comorbidity may improve outcomes. To investigate these relationships in EOPD youth, we characterized their cross-diagnostic psychopathology and verbal (word-list) learning/memory and evaluated: 1) verbal learning/memory profiles of Withdrawn/Depressed relative to Non-Withdrawn/Depressed youth; 2) cognitive and psychiatric predictors of verbal learning; and 3) emotion regulation as a mediator of psychiatric and cognitive relationships. Results indicated Withdrawn/Depressed youth recalled significantly fewer words during immediate, and some delayed, recall conditions. Less word-learning was predicted by: Withdrawn/Depressed classification, higher trauma-specific re-experiencing symptoms, greater emotion dysregulation, weaker executive skills, fewer trauma-avoidance and aggressive symptoms, and earlier alcohol-use onset. Emotion regulation strongly mediated the relationship between verbal learning and psychopathology, but not cognitive skills, among youth at high-risk for school dropout. Mental health and education implications are discussed.

Canonical correlation analysis of brain prefrontal activity measured by functional near infra-red spectroscopy (fNIRS) during a moral judgment task

Individuals differ in the extent to which they make decisions in different moral dilemmas. In this study, we investigated the relationship between functional brain activities during moral decision making and psychopathic personality traits in a healthy population. We measured the hemodynamic activities of the brain by functional near-infrared spectroscopy (fNIRS). FNIRS is an evolving non-invasive neuroimaging modality which is relatively inexpensive, patient friendly and robust to subject movement. Psychopathic traits were evaluated through a self-report questionnaire called the Psychopathic Personality Inventory Revised (PPI-R). We recorded functional brain activities of 30 healthy subjects while they performed a moral judgment (MJ) task. Regularized canonical correlation analysis (R-CCA) was applied to find the relationships between activation in different regions of prefrontal cortex (PFC) and the core psychopathic traits. Our results showed a significant canonical correlation between PFC activation and PPI-R content scale (PPI-R-CS). Specifically, coldheartedness and carefree non-planfulness were the only PPI-R-CS factors that were highly correlated with PFC activation during personal (emotionally salient) MJ, while Machiavellian egocentricity, rebellious nonconformity, coldheartedness, and carefree non-planfulness were the core traits that exhibited the same dynamics as PFC activation during impersonal (more logical) MJ. Furthermore, ventromedial prefrontal cortex (vmPFC) and left lateral PFC were the most positively correlated regions with PPI-R-CS traits during personal MJ, and the right vmPFC and right lateral PFC in impersonal MJ.

A Systematic Literature Review of Neuroimaging of Psychopathic Traits

INTRODUCTION

Core psychopathy is characterized by grandiosity, callousness, manipulativeness, and lack of remorse, empathy, and guilt. It is often comorbid with conduct disorder and antisocial personality disorder (ASPD). Psychopathy is present in forensic as well as prison and general populations. In recent years, an increasing amount of neuroimaging studies has been conducted in order to elucidate the obscure neurobiological etiology of psychopathy. The studies have yielded heterogenous results, and no consensus has been reached.

AIMS

This study systematically reviewed and qualitatively summarized functional and structural neuroimaging studies conducted on individuals with psychopathic traits. Furthermore, this study aimed to evaluate whether the findings from different MRI modalities could be reconciled from a neuroanatomical perspective.

MATERIALS AND METHODS

After the search and auditing processes, 118 neuroimaging studies were included in this systematic literature review. The studies consisted of structural, functional, and diffusion tensor MRI studies.

RESULTS

Psychopathy was associated with numerous neuroanatomical abnormalities. Structurally, gray matter anomalies were seen in frontotemporal, cerebellar, limbic, and paralimbic regions. Associated gray matter volume (GMV) reductions were most pronounced particularly in most of the prefrontal cortex, and temporal gyri including the fusiform gyrus. Also decreased GMV of the amygdalae and hippocampi as well the cingulate and insular cortices were associated with psychopathy, as well as abnormal morphology of the hippocampi, amygdala, and nucleus accumbens. Functionally, psychopathy was associated with dysfunction of the default mode network, which was also linked to poor moral judgment as well as deficient metacognitive and introspective abilities. Second, reduced white matter integrity in the uncinate fasciculus and dorsal cingulum were associated with core psychopathy. Third, emotional detachment was associated with dysfunction of the posterior cerebellum, the human mirror neuron system and the Theory of Mind denoting lack of empathy and persistent failure in integrating affective information into cognition.

CONCLUSIONS

Structural and functional aberrancies involving the limbic and paralimbic systems including reduced integrity of the uncinate fasciculus appear to be associated with core psychopathic features. Furthermore, this review points towards the idea that ASPD and psychopathy might stem from divergent biological processes.

A Bayesian Account of Psychopathy: A Model of Lacks Remorse and Self-Aggrandizing

This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal psychopathic traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation.

The relationship between trait psychopathy and emotional intelligence: A meta-analytic review

Psychopathy is a personality construct that has been related to important emotional deficits. These findings have led to a growing interest in exploring if psychopathic traits are associated with emotional intelligence (EI). However, the literature exploring this association has revealed conflicting results. The aim of the present study was to provide a reliable estimate of the relationship between psychopathy traits and EI (measured as performance-based ability) through meta-analysis. A quantitative and systematic review of the literature using Scopus, Medline, Pubmed, and PsicINFO showed a total of 13 studies meeting inclusion criteria with a combined sample of 2401 participants. The meta-analysis revealed a significant negative relationship between both constructs, showing that higher psychopathic trait scores are related to lower EI levels. We propose several future research lines to clarify possible gaps and ambiguities in the current literature and a set of interesting clinical implications for the prevention, evaluation, and treatment of psychopathic traits by including EI factors in traditional models of psychopathy.

Disrupted Prefrontal Regulation of Striatal Subjective Value Signals in Psychopathy

Psychopathy is a personality disorder with strong links to criminal behavior. While research on psychopathy has focused largely on socio-affective dysfunction, recent data suggest that aberrant decision making may also play an important role. Yet, the circuit-level mechanisms underlying maladaptive decision making in psychopathy remain unclear. Here, we used a multi-modality functional imaging approach to identify these mechanisms in a population of adult male incarcerated offenders. Psychopathy was associated with stronger subjective value-related activity within the nucleus accumbens (NAcc) during inter-temporal choice and with weaker intrinsic functional connectivity between NAcc and ventromedial prefrontal cortex (vmPFC). NAcc-vmPFC connectivity strength was negatively correlated with NAcc subjective value-related activity; however, this putative regulatory pattern was abolished as psychopathy severity increased. Finally, weaker cortico-striatal regulation predicted more frequent criminal convictions. These data suggest that cortico-striatal circuit dysregulation drives maladaptive decision making in psychopathy, supporting the notion that reward system dysfunction comprises an important neurobiological risk factor.

Dispositional negativity: An integrative psychological and neurobiological perspective

Dispositional negativity-the propensity to experience and express more frequent, intense, or enduring negative affect-is a fundamental dimension of childhood temperament and adult personality. Elevated levels of dispositional negativity can have profound consequences for health, wealth, and happiness, drawing the attention of clinicians, researchers, and policymakers. Here, we highlight recent advances in our understanding of the psychological and neurobiological processes linking stable individual differences in dispositional negativity to momentary emotional states. Self-report data suggest that 3 key pathways-increased stressor reactivity, tonic increases in negative affect, and increased stressor exposure-explain most of the heightened negative affect that characterizes individuals with a more negative disposition. Of these 3 pathways, tonically elevated, indiscriminate negative affect appears to be most central to daily life and most relevant to the development of psychopathology. New behavioral and biological data provide insights into the neural systems underlying these 3 pathways and motivate the hypothesis that seemingly "tonic" increases in negative affect may actually reflect increased reactivity to stressors that are remote, uncertain, or diffuse. Research focused on humans, monkeys, and rodents suggests that this indiscriminate negative affect reflects trait-like variation in the activity and connectivity of several key brain regions, including the central extended amygdala and parts of the prefrontal cortex. Collectively, these observations provide an integrative psychobiological framework for understanding the dynamic cascade of processes that bind emotional traits to emotional states and, ultimately, to emotional disorders and other kinds of adverse outcomes. (PsycINFO Database Record

Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost-benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior.

Classification and treatment of antisocial individuals: From behavior to biocognition

Antisocial behavior is a heterogeneous construct that can be divided into subtypes, such as antisocial personality and psychopathy. The adverse consequences of antisocial behavior produce great burden for the perpetrators, victims, family members, and for society at-large. The pervasiveness of antisocial behavior highlights the importance of precisely characterizing subtypes of antisocial individuals and identifying specific factors that are etiologically related to such behaviors to inform the development of targeted treatments. The goals of the current review are (1) to briefly summarize research on the operationalization and assessment of antisocial personality and psychopathy; (2) to provide an overview of several existing treatments with the potential to influence antisocial personality and psychopathy; and (3) to present an approach that integrates and uses biological and cognitive measures as starting points to more precisely characterize and treat these individuals. A focus on integrating factors at multiple levels of analysis can uncover person-specific characteristics and highlight potential targets for treatment to alleviate the burden caused by antisocial behavior.

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.

Neural responses to others' pain vary with psychopathic traits in healthy adult males

Disrupted empathic processing is a core feature of psychopathy. Neuroimaging data have suggested that individuals with high levels of psychopathic traits show atypical responses to others’ pain in a network of brain regions typically recruited during empathic processing (anterior insula, inferior frontal gyrus, and mid- and anterior cingulate cortex). Here, we investigated whether neural responses to others’ pain vary with psychopathic traits within the general population in a similar manner to that found in individuals at the extreme end of the continuum. As predicted, variation in psychopathic traits was associated with variation in neural responses to others’ pain in the network of brain regions typically engaged during empathic processing. Consistent with previous research, our findings indicated the presence of suppressor effects in the association of levels of the affective-interpersonal and lifestyle-antisocial dimensions of psychopathy with neural responses to others’ pain. That is, after controlling for the influence of the other dimension, higher affective-interpersonal psychopathic traits were associated with reduced neural responses to others’ pain, whilst higher lifestyle-antisocial psychopathic traits were associated with increased neural responses to others’ pain. Our findings provide further evidence that atypical function in this network might represent neural markers of disrupted emotional and empathic processing; that the two dimensions of psychopathy might tap into distinct underlying vulnerabilities; and, most importantly, that the relationships observed at the extreme end of the psychopathy spectrum apply to the nonclinical distribution of these traits, providing further evidence for continuities in the mechanisms underlying psychopathic traits across the general population.

Testosterone Modulates Altered Prefrontal Control of Emotional Actions in Psychopathic Offenders(1,2,3)

Psychopathic individuals are notorious for their controlled goal-directed aggressive behavior. Yet, during social challenges, they often show uncontrolled emotional behavior. Healthy individuals can control their social emotional behavior through anterior prefrontal cortex (aPFC) downregulation of neural activity in the amygdala, with testosterone modulating aPFC-amygdala coupling. This study tests whether individual differences in this neuroendocrine system relate to the paradoxical lack of emotional control observed in human psychopathic offenders. Emotional control was operationalized with an fMRI-adapted approach-avoidance task requiring rule-driven control over rapid emotional responses. Fifteen psychopathic offenders and 19 matched healthy control subjects made approaching and avoiding movements in response to emotional faces. Control of social emotional behavior was required during affect-incongruent trials, when participants had to override affect-congruent, automatic action tendencies and select the opposite response. Psychopathic offenders showed less control-related aPFC activity and aPFC-amygdala coupling during trials requiring control of emotional actions, when compared with healthy control subjects. This pattern was particularly pronounced in psychopathic individuals with high endogenous testosterone levels. These findings suggest that reduced prefrontal coordination underlies reduced behavioral control in psychopathic offenders during emotionally provoking situations. Even though the modest sample size warrants replication, the modulatory role of endogenous testosterone on the aPFC-amygdala circuit suggests a neurobiological substrate of individual differences that is relevant for the advancement of treatment and the reduction of recidivism.

Psychopathic traits are associated with cortical and subcortical volume alterations in healthy individuals

Research suggests psychopathy is associated with structural brain alterations that may contribute to the affective and interpersonal deficits frequently observed in individuals with high psychopathic traits. However, the regional alterations related to different components of psychopathy are still unclear. We used voxel-based morphometry to characterize the structural correlates of psychopathy in a sample of 35 healthy adults assessed with the Triarchic Psychopathy Measure. Furthermore, we examined the regional grey matter alterations associated with the components described by the triarchic model. Our results showed that, after accounting for variation in total intracranial volume, age and IQ, overall psychopathy was negatively associated with grey matter volume in the left putamen and amygdala. Additional regression analysis with anatomical regions of interests revealed total triPM score was also associated with increased lateral orbitofrontal cortex (OFC) and caudate volume. Boldness was positively associated with volume in the right insula. Meanness was positively associated with lateral OFC and striatum volume, and negatively associated with amygdala volume. Finally, disinhibition was negatively associated with amygdala volume. Results highlight the contribution of both subcortical and cortical brain alterations for subclinical psychopathy and are discussed in light of prior research and theoretical accounts about the neurobiological bases of psychopathic traits.

Possible role of a dysregulation of the endogenous opioid system in antisocial personality disorder

Around half the inmates in prison institutions have antisocial personality disorder (ASPD). A recent theory has proposed that a dysfunction of the endogenous opioid system (EOS) underlies the neurobiology of borderline personality disorder (BPD). In the present theoretical paper, based on a comprehensive database and hand search of the relevant literature, this hypothesis is extended to ASPD, which may be the predominant expression of EOS dysfunction in men, while the same pathology underlies BPD in women. According to evidence from human and animal studies, the problematic behaviours of persons with antisocial, callous, or psychopathic traits may be seen as desperate, unconscious attempts to stimulate their deficient EOS, which plays a key role in brain reward circuits. If the needs of this system are not being met, the affected persons experience dysphoric mood, discomfort, or irritability, and strive to increase binding of endogenous opioids to receptors by using the rewarding effects of aggression by exertion of physical or manipulative power on others, by abusing alcohol or substances that have the reward system as target, by creating an "endorphin rush" by self-harm, by increasing the frequency of their sexual contacts, or by impulsive actions and sensation seeking. Symptoms associated with ASPD can be treated with opioid antagonists like naltrexone, naloxone, or nalmefene.

Interpersonal traits of psychopathy linked to reduced integrity of the uncinate fasciculus

Psychopathy is a personality disorder characterized by callous lack of empathy, impulsive antisocial behavior, and criminal recidivism. Here, we performed the largest diffusion tensor imaging (DTI) study of incarcerated criminal offenders to date (N = 147) to determine whether psychopathy severity is linked to the microstructural integrity of major white matter tracts in the brain. Consistent with the results of previous studies in smaller samples, we found that psychopathy was associated with reduced fractional anisotropy in the right uncinate fasciculus (UF; the major white matter tract connecting ventral frontal and anterior temporal cortices). We found no such association in the left UF or in adjacent frontal or temporal white matter tracts. Moreover, the right UF finding was specifically related to the interpersonal features of psychopathy (glib superficial charm, grandiose sense of self-worth, pathological lying, manipulativeness), rather than the affective, antisocial, or lifestyle features. These results indicate a neural marker for this key dimension of psychopathic symptomatology.

Neural signatures of third-party punishment: evidence from penetrating traumatic brain injury

The ability to survive within a cooperative society depends on impartial third-party punishment (TPP) of social norm violations. Two cognitive mechanisms have been postulated as necessary for the successful completion of TPP: evaluation of legal responsibility and selection of a suitable punishment given the magnitude of the crime. Converging neuroimaging research suggests two supporting domain-general networks; a mentalizing network for evaluation of legal responsibility and a central-executive network for determination of punishment. A whole-brain voxel-based lesion-symptom mapping approach was used in conjunction with a rank-order TPP task to identify brain regions necessary for TPP in a large sample of patients with penetrating traumatic brain injury. Patients who demonstrated atypical TPP had specific lesions in core regions of the mentalizing (dorsomedial prefrontal cortex [PFC], ventromedial PFC) and central-executive (bilateral dorsolateral PFC, right intraparietal sulcus) networks. Altruism and executive functioning (concept formation skills) were significant predictors of TPP: altruism was uniquely associated with TPP in patients with lesions in right dorsolateral PFC and executive functioning was uniquely associated with TPP in individuals with lesions in left PFC. Our findings contribute to the extant literature to support underlying neural networks associated with TPP, with specific brain-behavior causal relationships confirming recent functional neuroimaging research.

Neural networks underlying implicit and explicit moral evaluations in psychopathy

Psychopathy, characterized by symptoms of emotional detachment, reduced guilt and empathy and a callous disregard for the rights and welfare of others, is a strong risk factor for immoral behavior. Psychopathy is also marked by abnormal attention with downstream consequences on emotional processing. To examine the influence of task demands on moral evaluation in psychopathy, functional magnetic resonance imaging was used to measure neural response and functional connectivity in 88 incarcerated male subjects (28 with Psychopathy Checklist Revised (PCL-R) scores ⩾ 30) while they viewed dynamic visual stimuli depicting interpersonal harm and interpersonal assistance in two contexts, implicit and explicit. During the implicit task, high psychopathy was associated with reduced activity in the dorsolateral prefrontal cortex and caudate when viewing harmful compared with helpful social interactions. Functional connectivity seeded in the right amygdala and right temporoparietal junction revealed decreased coupling with the anterior cingulate cortex (ACC), anterior insula, striatum and ventromedial prefrontal cortex. In the explicit task, higher trait psychopathy predicted reduced signal change in ACC and amygdala, accompanied by decreased functional connectivity to temporal pole, insula and striatum, but increased connectivity with dorsal ACC. Psychopathy did not influence behavioral performance in either task, despite differences in neural activity and functional connectivity. These findings provide the first direct evidence that hemodynamic activity and neural coupling within the salience network are disrupted in psychopathy, and that the effects of psychopathy on moral evaluation are influenced by attentional demands.

Cognitive neuroscience of human counterfactual reasoning

Counterfactual reasoning is a hallmark of human thought, enabling the capacity to shift from perceiving the immediate environment to an alternative, imagined perspective. Mental representations of counterfactual possibilities (e.g., imagined past events or future outcomes not yet at hand) provide the basis for learning from past experience, enable planning and prediction, support creativity and insight, and give rise to emotions and social attributions (e.g., regret and blame). Yet remarkably little is known about the psychological and neural foundations of counterfactual reasoning. In this review, we survey recent findings from psychology and neuroscience indicating that counterfactual thought depends on an integrative network of systems for affective processing, mental simulation, and cognitive control. We review evidence to elucidate how these mechanisms are systematically altered through psychiatric illness and neurological disease. We propose that counterfactual thinking depends on the coordination of multiple information processing systems that together enable adaptive behavior and goal-directed decision making and make recommendations for the study of counterfactual inference in health, aging, and disease.

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.

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.