Pathological generosity: an atypical impulse control disorder after a left subcortical stroke

White matter hyperintensities associated with impulse control disorders in Parkinson's Disease

Impulse control disorders (ICDs) in Parkinson's disease (PD) are increasingly recognized as clinically significant non-motor features that potentially impair the quality of life. White matter hyperintensities (WMHs), detected by magnetic resonance imaging, are frequently observed in PD and can be associated with both motor- and certain non-motor symptoms. Given the limited number of non-motor features studied in this context, our aim was to reveal the potential association between the severity of WMHs and ICDs in PD. Fluid-attenuated inversion recovery magnetic resonance images were retrospectively evaluated in 70 patients with PD (48 males; 59.3 ± 10.1 years). The severity of WMHs was assessed by Fazekas scores and by the volume and number of supratentorial WMHs. ICDs were evaluated using the modified Minnesota Impulsive Disorders Interview. Significant interaction between age and the severity of WMHs was present for ICDs. In our younger patients (< 60.5 years), severity of WMHs was positively associated with ICDs (p = 0.004, p = 0.021, p < 0.001 and p < 0.001, respectively for periventricular white matter and total Fazekas scores and the volume and number of WMHs). Our study supports the hypothesis that WMHs of presumed vascular origin may contribute to ICDs in PD. Future prospective studies are needed to assess the prognostic relevance of this finding.

Reckless Generosity, Parkinson's Disease and Dopamine: A Case Series and Literature Review

BACKGROUND

Impulse control disorders (ICDs) are a frequent side effect of dopamine replacement therapy (DRT) in Parkinson's disease (PD). Reckless generosity might expand the spectrum of known ICDs.

CASES

Over 18 months, we encountered three PD patients exhibiting reckless generosity under DRT, leading to disastrous financial and social consequences.

LITERATURE REVIEW

Except for another case series describing reckless generosity in three PD patients, only one study has examined generosity in PD patients; with findings suggesting that PD patients with ICDs are less sensitive to the aversive aspects of the lack of reciprocation in social settings. Studies with healthy individuals suggest that increased availability of dopamine might reduce social discounting and promote egalitarian behavior, and thereby increase generous behavior towards strangers. Genetic studies show that polymorphisms in dopamine D4 receptors influence generous behavior.

CONCLUSIONS

Reckless generosity in PD patients with DRT might be underreported and should therefore be carefully be screened for by clinicians. A potential mechanism underlying this ICD-related behavior might be a sensitization of the mesolimbic and mesocortical dopaminergic system, leading to reduced social discounting and maladaptive reward-learning. Further research is needed to investigate the prevalence and underlying mechanisms of reckless generosity in PD patients.

"But he's my brother": The impact of family obligation on moral judgments and decisions

We created practical moral dilemmas for which participants imagined witnessing a transgression by a target person. The identity of the transgressor was manipulated to be either a stranger or the participant's brother. In Experiment 1, whether the target person committed a violation was left ambiguous. Participants made factual (how strongly they believe the target person actually committed a transgression) and unethicality judgments regarding the incident, and rated their willingness to report the transgressor to the police. Given ambiguity (Experiment 1), participants interpreted the facts in favor of their brother, but not in favor of a stranger. This interpretation led to moral judgments and willingness to report that favored family over strangers, while creating overall coherence in reasoning. In Experiment 2, we eliminated the ambiguity of the factual situation so that the possibility of achieving coherence between unethicality of an act and leniency toward a family member was blocked. Nonetheless, participants were less willing to report their brother to the police. Experiment 3 replicated the findings of the first two experiments within an integrated study design. Results from path analyses indicated that the factual judgment depended on factual understanding of an event, but willingness to report depended on identity of the target (i.e., brother vs. stranger), even at the cost of reduced coherence in reasoning. Moral decisions are thus strongly influenced by agent-relative obligations, such as duty to protect a family member.

Moral conduct and social behavior

Over the past 150 years, the frontal lobes (FLs) have been implicated in the neural mediation of both normal and abnormal moral conduct and social behavior (MCSB). Despite the remarkable advances that have permeated this period up to the present, a comprehensive account of the neural underpinnings of MCSB has stubbornly defied the best minds of psychology, psychiatry, and neurology. The goal of this chapter is to review a few practical and conceptual achievements that have proved heuristically valuable as an impetus for further advance of knowledge. In virtually all cases in which MCSB was compromised by brain damage, the injuries were located (i) in the prefrontal cortices, (ii) in their connections with the temporal poles and anterior insula, or (iii) in related subcortical structures and pathways, such as the thalamic dorsomedial nucleus or the anterior thalamic radiation. The clinicoanatomic associations among these structures originated the "frontal network systems" concept, which satisfactorily explains the occurrence of classical FL syndromes in patients with lesions outside the prefrontal cortices. Overall, clinicoanatomic observational studies and experimental evidence from patients with acquired sociopathy/psychopathy indicate that abnormalities of MCSB are the final common pathway of single or mixed impairments of subordinate psychologic and neural domains that support MCSB. Independent studies on normal volunteers concur with this view, indicating that MCSB is shaped by the dynamic interplay of subordinate psychologic domains, such as moral sensitivity and judgment, and their neural correlates.

Prosocial deficits in behavioral variant frontotemporal dementia relate to reward network atrophy

INTRODUCTION

Empathy and shared feelings of reward motivate individuals to share resources with others when material gain is not at stake. Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disease that affects emotion- and reward-relevant neural systems. Although there is diminished empathy and altered reward processing in bvFTD, how the disease impacts prosocial behavior is less well understood.

METHODS

A total of 74 participants (20 bvFTD, 15 Alzheimer's disease [AD], and 39 healthy controls) participated in this study. Inspired by token-based paradigms from animal studies, we developed a novel task to measure prosocial giving (the "Giving Game"). On each trial of the Giving Game, participants decided how much money to offer to the experimenter, and prosocial giving was the total amount that participants gave to the experimenter when it cost them nothing to give. Voxel-based morphometry was then used to identify brain regions that were associated with prosocial giving.

RESULTS

Prosocial giving was lower in bvFTD than in healthy controls; prosocial giving in AD did not differ significantly from either of the other groups. Whereas lower prosocial giving was associated with atrophy in the right pulvinar nucleus of the thalamus, greater prosocial giving was associated with atrophy in the left ventral striatum.

CONCLUSION

These findings suggest that simple acts of generosity deteriorate in bvFTD due to lateralized atrophy in reward-relevant neural systems that promote shared feelings of positive affect.

A neural link between generosity and happiness

Generous behaviour is known to increase happiness, which could thereby motivate generosity. In this study, we use functional magnetic resonance imaging and a public pledge for future generosity to investigate the brain mechanisms that link generous behaviour with increases in happiness. Participants promised to spend money over the next 4 weeks either on others (experimental group) or on themselves (control group). Here, we report that, compared to controls, participants in the experimental group make more generous choices in an independent decision-making task and show stronger increases in self-reported happiness. Generous decisions engage the temporo-parietal junction (TPJ) in the experimental more than in the control group and differentially modulate the connectivity between TPJ and ventral striatum. Importantly, striatal activity during generous decisions is directly related to changes in happiness. These results demonstrate that top–down control of striatal activity plays a fundamental role in linking commitment-induced generosity with happiness.

Generous behaviour increases happiness, but the neural underpinnings of this link are unknown. Here, authors show that promising to be generous changes the neural response in the temporo-parietal junction, and that the connection between this region and the ventral striatum was related to happiness.

Suicide as a derangement of the self-sacrificial aspect of eusociality

Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial self-sacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented.