1
|
Mustika D, Nishimura Y, Ueno S, Tominaga S, Shimizu T, Tajiri N, Jung CG, Hida H. Central amygdala is related to the reduction of aggressive behavior by monosodium glutamate ingestion during the period of development in an ADHD model rat. Front Nutr 2024; 11:1356189. [PMID: 38765817 PMCID: PMC11099272 DOI: 10.3389/fnut.2024.1356189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Monosodium glutamate (MSG), an umami substance, stimulates the gut-brain axis communication via gut umami receptors and the subsequent vagus nerves. However, the brain mechanism underlying the effect of MSG ingestion during the developmental period on aggression has not yet been clarified. We first tried to establish new experimental conditions to be more appropriate for detailed analysis of the brain, and then investigated the effects of MSG ingestion on aggressive behavior during the developmental stage of an ADHD rat model. Methods Long-Evans, WKY/Izm, SHR/Izm, and SHR-SP/Ezo were individually housed from postnatal day 25 for 5 weeks. Post-weaning social isolation (PWSI) was given to escalate aggressive behavior. The resident-intruder test, that is conducted during the subjective night, was used for a detailed analysis of aggression, including the frequency, duration, and latency of anogenital sniffing, aggressive grooming, and attack behavior. Immunohistochemistry of c-Fos expression was conducted in all strains to predict potential aggression-related brain areas. Finally, the most aggressive strain, SHR/Izm, a known model of attention-deficit hyperactivity disorder (ADHD), was used to investigate the effect of MSG ingestion (60 mM solution) on aggression, followed by c-Fos immunostaining in aggression-related areas. Bilateral subdiaphragmatic vagotomy was performed to verify the importance of gut-brain interactions in the effect of MSG. Results The resident intruder test revealed that SHR/Izm rats were the most aggressive among the four strains for all aggression parameters tested. SHR/Izm rats also showed the highest number of c-Fos + cells in aggression-related brain areas, including the central amygdala (CeA). MSG ingestion significantly decreased the frequency and duration of aggressive grooming and attack behavior and increased the latency of attack behavior. Furthermore, MSG administration successfully increased c-Fos positive cell number in the intermediate nucleus of the solitary tract (iNTS), a terminal of the gastrointestinal sensory afferent fiber of the vagus nerve, and modulated c-Fos positive cells in the CeA. Interestingly, vagotomy diminished the MSG effects on aggression and c-Fos expression in the iNTS and CeA. Conclusion MSG ingestion decreased PWSI-induced aggression in SHR/Izm, which was mediated by the vagus nerve related to the stimulation of iNTS and modulation of CeA activity.
Collapse
Affiliation(s)
- Dewi Mustika
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Physiology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Yu Nishimura
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinya Ueno
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shiori Tominaga
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Shimizu
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Food and Nutrition, Shokei University Junior College, Kumamoto, Japan
| | - Naoki Tajiri
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Cha-Gyun Jung
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideki Hida
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
2
|
Chung CF, Dugré JR, Potvin S. Dysconnectivity of the Nucleus Accumbens and Amygdala in Youths with Thought Problems: A Dimensional Approach. Brain Connect 2024; 14:226-238. [PMID: 38526373 DOI: 10.1089/brain.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background: Youths with thought problems (TP) are at risk to develop psychosis and obsessive-compulsive disorder (OCD). Yet, the pathophysiological mechanisms underpinning TP are still unclear. Functional magnetic resonance imaging (fMRI) studies have shown that striatal and limbic alterations are associated with psychosis-like and obsessive-like symptoms in individuals at clinical risk for psychosis, schizophrenia, and OCD. More specifically, nucleus accumbens (NAcc) and amygdala are mainly involved in these associations. The current study aims to investigate the neural correlates of TP in youth populations using a dimensional approach and explore potential cognitive functions and neurotransmitters associated with it. Methods: Seed-to-voxels functional connectivity analyses using NAcc and amygdala as regions-of-interest were conducted with resting-state fMRI data obtained from 1360 young individuals, and potential confounders related to TP such as anxiety and cognitive functions were included as covariates in multiple regression analyses. Replicability was tested in using an adult cohort. In addition, functional decoding and neurochemical correlation analyses were performed to identify the associated cognitive functions and neurotransmitters. Results: The altered functional connectivities between the right NAcc and posterior parahippocampal gyrus, between the right amygdala and lateral prefrontal cortex, and between the left amygdala and the secondary visual area were the best predictors of TP in multiple regression model. These functional connections are mainly involved in social cognition and reward processing. Conclusions: The results show that alterations in the functional connectivity of the NAcc and the amygdala in neural pathways involved in social cognition and reward processing are associated with severity of TP in youths.
Collapse
Affiliation(s)
- Chen-Fang Chung
- Centre de Recherche de l'Institut, Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addiction, Faculty of medicine, University of Montreal, Montreal, Canada
| | - Jules R Dugré
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stéphane Potvin
- Centre de Recherche de l'Institut, Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addiction, Faculty of medicine, University of Montreal, Montreal, Canada
| |
Collapse
|
3
|
Armand S, Langley C, Johansen A, Ozenne B, Overgaard-Hansen O, Larsen K, Jensen PS, Knudsen GM, Sahakian BJ, Stenbæk DS, Fisher PM. Functional brain responses to emotional faces after three to five weeks of intake of escitalopram in healthy individuals: a double-blind, placebo-controlled randomised study. Sci Rep 2024; 14:3149. [PMID: 38326352 PMCID: PMC10850508 DOI: 10.1038/s41598-024-51448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Short-term intake of selective serotonin reuptake inhibitors (SSRIs) modulates threat-related amygdala responses in healthy individuals. However, how SSRI intake over a clinically relevant time period modulates threat-related amygdala responses is less clear. In a semi-randomised, double-blind, placebo-controlled study of 64 healthy individuals (SSRI n = 32, placebo n = 32), we examined the effect of 3-5 weeks of SSRI escitalopram (20 mg daily) on brain response to angry, fearful and neutral faces using BOLD fMRI. Data was analysed using a whole-brain region-wise approach extracting standardised effects (i.e., Cohen's D). The study was conducted at the Copenhagen University Hospital. A priori, we hypothesised that SSRI would attenuate amygdala responses to angry and fearful faces but not to neutral ones. Whether SSRI modulates correlations between amygdala responses to emotional faces and negative mood states was also explored. Compared to placebo, 3-5 weeks of SSRI intake did not significantly affect the amygdala response to angry, fearful, or neutral faces (|Cohen's D|< 0.2, PFWER = 1). Whole-brain, region-wise analyses revealed significant differences in frontal (|Cohen's D|< 0.6, PFWER < .01) and occipital regions (|Cohen's D|< 0.5, PFWER < .01). SSRI did not modulate correlations between amygdala responses to emotional faces and negative mood states. Our findings indicate that a 3-5 week SSRI intake impacts cortical responses to emotional stimuli, an effect possibly involved in SSRI's therapeutic efficacy.Trial registration Clinical Trials NCT04239339.
Collapse
Affiliation(s)
- Sophia Armand
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Annette Johansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Overgaard-Hansen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kristian Larsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Steen Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dea Siggard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Patrick MacDonald Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Kolla NJ, Tully J, Bertsch K. Neural correlates of aggression in personality disorders from the perspective of DSM-5 maladaptive traits: a systematic review. Transl Psychiatry 2023; 13:330. [PMID: 37884552 PMCID: PMC10603082 DOI: 10.1038/s41398-023-02612-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.
Collapse
Affiliation(s)
- Nathan J Kolla
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
- NeuroImagine Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
5
|
Tully J, Sethi A, Griem J, Paloyelis Y, Craig MC, Williams SCR, Murphy D, Blair RJ, Blackwood N. Oxytocin normalizes the implicit processing of fearful faces in psychopathy: a randomized crossover study using fMRI. NATURE. MENTAL HEALTH 2023; 1:420-427. [PMID: 38665476 PMCID: PMC11041724 DOI: 10.1038/s44220-023-00067-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2024]
Abstract
Adults with antisocial personality disorder with (ASPD + P) and without (ASPD - P) psychopathy commit the majority of violent crimes. Empathic processing abnormalities are particularly prominent in psychopathy, but effective pharmacological interventions have yet to be identified. Oxytocin modulates neural responses to fearful expressions in healthy populations. The current study investigates its effects in violent antisocial men. In a placebo-controlled, randomized crossover design, 34 violent offenders (19 ASPD + P; 15 ASPD - P) and 24 healthy non-offenders received 40 IU intranasal oxytocin or placebo and then completed an fMRI morphed faces task examining the implicit processing of fearful facial expressions. Increasing intensity of fearful facial expressions failed to appropriately modulate activity in the bilateral mid-cingulate cortex in violent offenders with ASPD + P, compared with those with ASPD - P. Oxytocin abolished these group differences. This represents evidence of neurochemical modulation of the empathic processing of others' distress in psychopathy.
Collapse
Affiliation(s)
- John Tully
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Julia Griem
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Yannis Paloyelis
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Michael C. Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Steven C. R. Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Robert James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| |
Collapse
|
6
|
Sankar A, Ozenne B, Dam VH, Svarer C, Jørgensen MB, Miskowiak KW, Frokjaer VG, Knudsen GM, Fisher PM. Association between brain serotonin 4 receptor binding and reactivity to emotional faces in depressed and healthy individuals. Transl Psychiatry 2023; 13:165. [PMID: 37169780 PMCID: PMC10175268 DOI: 10.1038/s41398-023-02440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
Brain serotonergic (5-HT) signaling is posited to modulate neural responses to emotional stimuli. Dysfunction in 5-HT signaling is implicated in major depressive disorder (MDD), a disorder associated with significant disturbances in emotion processing. In MDD, recent evidence points to altered 5-HT4 receptor (5-HT4R) levels, a promising target for antidepressant treatment. However, how these alterations influence neural processing of emotions in MDD remains poorly understood. This is the first study to examine the association between 5-HT4R binding and neural responses to emotions in patients with MDD and healthy controls. The study included one hundred and thirty-eight participants, comprising 88 outpatients with MDD from the NeuroPharm clinical trial (ClinicalTrials.gov identifier: NCT02869035) and 50 healthy controls. Participants underwent an [11C]SB207145 positron emission tomography (PET) scan to quantify 5-HT4R binding (BPND) and a functional magnetic resonance imaging (fMRI) scan during which they performed an emotional face matching task. We examined the association between regional 5-HT4R binding and corticolimbic responses to emotional faces using a linear latent variable model, including whether this association was moderated by depression status. We observed a positive correlation between 5-HT4R BPND and the corticolimbic response to emotional faces across participants (r = 0.20, p = 0.03). This association did not differ between groups (parameter estimate difference = 0.002, 95% CI = -0.008: 0.013, p = 0.72). Thus, in the largest PET/fMRI study of associations between serotonergic signaling and brain function, we found a positive association between 5-HT4R binding and neural responses to emotions that appear unaltered in MDD. Future clinical trials with novel pharmacological agents targeting 5-HT4R are needed to confirm whether they ameliorate emotion processing biases in MDD.
Collapse
Affiliation(s)
- Anjali Sankar
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke H Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Martin B Jørgensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Mental Health Services, Capital Region of Denmark, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Fritz M, Soravia SM, Dudeck M, Malli L, Fakhoury M. Neurobiology of Aggression-Review of Recent Findings and Relationship with Alcohol and Trauma. BIOLOGY 2023; 12:biology12030469. [PMID: 36979161 PMCID: PMC10044835 DOI: 10.3390/biology12030469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Aggression can be conceptualized as any behavior, physical or verbal, that involves attacking another person or animal with the intent of causing harm, pain or injury. Because of its high prevalence worldwide, aggression has remained a central clinical and public safety issue. Aggression can be caused by several risk factors, including biological and psychological, such as genetics and mental health disorders, and socioeconomic such as education, employment, financial status, and neighborhood. Research over the past few decades has also proposed a link between alcohol consumption and aggressive behaviors. Alcohol consumption can escalate aggressive behavior in humans, often leading to domestic violence or serious crimes. Converging lines of evidence have also shown that trauma and posttraumatic stress disorder (PTSD) could have a tremendous impact on behavior associated with both alcohol use problems and violence. However, although the link between trauma, alcohol, and aggression is well documented, the underlying neurobiological mechanisms and their impact on behavior have not been properly discussed. This article provides an overview of recent advances in understanding the translational neurobiological basis of aggression and its intricate links to alcoholism and trauma, focusing on behavior. It does so by shedding light from several perspectives, including in vivo imaging, genes, receptors, and neurotransmitters and their influence on human and animal behavior.
Collapse
Affiliation(s)
- Michael Fritz
- School of Health and Social Sciences, AKAD University of Applied Sciences, 70191 Stuttgart, Germany
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, BKH Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Sarah-Maria Soravia
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, BKH Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, BKH Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Layal Malli
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon
| | - Marc Fakhoury
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon
| |
Collapse
|
8
|
Tonnaer F, van Zutphen L, Raine A, Cima M. Amygdala connectivity and aggression. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:87-106. [PMID: 37633721 DOI: 10.1016/b978-0-12-821375-9.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Neurobiological models propose that reactive aggression is predicated on impairments in amygdala-prefrontal connectivity that subserves moral decision-making and emotion regulation. The amygdala is a key component within this neural network that modulates reactive aggression. We provide a review of amygdala dysfunctional brain networks leading to reactive aggressive behavior. We elaborate on key concepts, focusing on moral decision-making and emotion regulation in a developmental context, and brain network connectivity factors relating to amygdala (dys)function-factors which we suggest predispose to reactive aggression. We additionally discuss insights into the latest treatment interventions, providing the utilization of the scientific findings for practice.
Collapse
Affiliation(s)
- Franca Tonnaer
- Department of Research, Ventio Crime Prevention Science Institute, Rijckholt, The Netherlands
| | - Linda van Zutphen
- Department of Conditions for LifeLong Learning, Educational Sciences, Open University, Heerlen, The Netherlands
| | - Adrian Raine
- Department of Criminology, Richard Perry University, Berkeley, CA, United States; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Maaike Cima
- Department of Research, Ventio Crime Prevention Science Institute, Rijckholt, The Netherlands; Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Department of Research, VIGO Groep, Nijmegen, The Netherlands.
| |
Collapse
|
9
|
Deming P, Heilicher M, Koenigs M. How reliable are amygdala findings in psychopathy? A systematic review of MRI studies. Neurosci Biobehav Rev 2022; 142:104875. [PMID: 36116578 DOI: 10.1016/j.neubiorev.2022.104875] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Philip Deming
- Department of Psychology, Northeastern University, 360 Huntington Ave., Boston, MA 02115, USA.
| | - Mickela Heilicher
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd., Madison, WI 53719, USA
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd., Madison, WI 53719, USA
| |
Collapse
|
10
|
Fisher PM, Ozenne B, Ganz M, Frokjaer VG, Dam VN, Penninx BW, Sankar A, Miskowiak K, Jensen PS, Knudsen GM, Jorgensen MB. Emotional faces processing in major depressive disorder and prediction of antidepressant treatment response: A NeuroPharm study. J Psychopharmacol 2022; 36:626-636. [PMID: 35549538 DOI: 10.1177/02698811221089035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent neuropsychiatric illness for which it is important to resolve underlying brain mechanisms. Current treatments are often unsuccessful, precipitating a need to identify predictive markers. AIM We evaluated (1) alterations in brain responses to an emotional faces functional magnetic resonance imaging (fMRI) paradigm in individuals with MDD, compared to controls, (2) whether pretreatment brain responses predicted antidepressant treatment response, and (3) pre-post change in brain responses following treatment. METHODS Eighty-nine medication-free, depressed individuals and 115 healthy controls completed the fMRI paradigm. Depressed individuals completed a nonrandomized, open-label, 8-week treatment with escitalopram, including the option to switch to duloxetine after 4 weeks. We examined patient-control group differences in regional fMRI responses at baseline, whether baseline fMRI responses predicted treatment response at 8 weeks, including early life stress moderating effects, and change in fMRI responses in 36 depressed individuals rescanned following 8 weeks of treatment. RESULTS Task reaction time was 5% slower in patients. Multiple brain regions showed significant task-related responses, but we observed no statistically significant patient-control group differences (Cohen's d < 0.35). Patient pretreatment brain responses did not predict antidepressant treatment response (area under the curve of the receiver operator characteristic (AUC-ROC) < 0.6) and brain responses were not statistically significantly changed after treatment (Cohen's d < 0.33). CONCLUSION This represents the largest prediction study to date examining emotional faces fMRI features as predictors of antidepressant treatment response. Brain response to this fMRI emotional faces paradigm did not distinguish depressed individuals from healthy controls, nor was it predictive of antidepressant treatment response.Clinical Trial Registration: Site: https://clinicaltrials.gov, Trial Number: NCT02869035, Trial Title: Treatment Outcome in Major Depressive Disorder.
Collapse
Affiliation(s)
- Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ganz
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Nh Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brenda Wjh Penninx
- BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anajli Sankar
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Miskowiak
- BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Jensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin B Jorgensen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,BrainDrugs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
11
|
Wagels L, Habel U, Raine A, Clemens B. Neuroimaging, hormonal and genetic biomarkers for pathological aggression — success or failure? Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
The Modulatory Role of Serotonin on Human Impulsive Aggression. Biol Psychiatry 2021; 90:447-457. [PMID: 34266672 DOI: 10.1016/j.biopsych.2021.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/29/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022]
Abstract
The hypothesis of chronically low brain serotonin levels as pathophysiologically linked to impulsive aggression has been around for several decades. Whereas the theory was initially based on indirect methods to probe serotonin function, our understanding of the neural mechanisms involved in impulsive aggression has progressed with recent advances in neuroimaging. The review integrates evidence based on data from several neuroimaging domains in humans. In vivo molecular neuroimaging findings demonstrate associations between impulsive aggression and high serotonin 1B and serotonin 4 receptor binding, high serotonin transporter levels, and low monoamine oxidase A levels, suggesting that low interstitial serotonin levels are a neurobiological risk factor for impulsive aggressive behavior. Imaging genetics suggests that serotonergic-related genetic polymorphisms associate with antisocial behavior, and some evidence indicates that the low-expressing monoamine oxidase A genotype specifically predisposes to impulsive aggression, which may be mediated by effects on corticolimbic function. Interventions that (presumably) alter serotonin levels have effects on brain activity within brain regions involved in impulsive aggression, notably the amygdala, dorsal striatum, anterior cingulate, insula, and prefrontal cortex. Based on these findings, we propose a model for the modulatory role of serotonin in impulsive aggression. Future studies should ensure that clinical features unique for impulsive aggression are appropriately assessed, and we propose investigations of knowledge gaps that can help confirm, refute, or modify our proposed model of impulsive aggression.
Collapse
|
13
|
Varkevisser T, van Lutterveld R, Heesink L, van Honk J, Geuze E. Voxel-based morphometry and cortical thickness in combat veterans suffering from impulsive aggression. Psychol Med 2021; 51:1299-1309. [PMID: 32029023 PMCID: PMC8223237 DOI: 10.1017/s0033291720000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/15/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Problems with impulsive aggression occur in many forms of psychiatric dysfunction, and are a common complaint among combat veterans. The present study sought to examine the neuroanatomical correlates of combat-related impulsive aggression. METHODS T1-weighted magnetic resonance images were acquired from 29 male veterans with impulsive aggression and 30 non-aggressive combat controls. Subcortical volumetry was conducted with the amygdala and hippocampus and their main constituent subdivisions as regions-of-interest (ROIs) (basolateral, centromedial amygdala; head, body, tail of hippocampus). Cortical thickness measurements were extracted for the dorsolateral prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Within-group correlations with psychometric measures were also explored. RESULTS No significant group differences in cortical thickness or subcortical grey matter volumes were observed for any of the ROIs. Also, no significant correlations with any of the psychometric measures were recorded. Exploratory whole-brain analysis of cortical thickness revealed a significant group × anxiety interaction effect in a cluster located in the left lingual gyrus. CONCLUSIONS The current findings indicate that problems with impulsive aggression may not be directly associated with alterations in cortical thickness or amygdalar/hippocampal (sub)volumes. The observed interplay between impulsive aggression problems and anxiety-related symptoms is consistent with prior work showing the two phenomena may share the same underlying (neural) mechanisms.
Collapse
Affiliation(s)
- Tim Varkevisser
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - Remko van Lutterveld
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
| | - Lieke Heesink
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - Jack van Honk
- Utrecht University, Utrecht, The Netherlands
- University of Cape Town, Cape Town, South Africa
| | - Elbert Geuze
- University Medical Center, Utrecht, The Netherlands
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, The Netherlands
| |
Collapse
|
14
|
Kim SJ, Kim MK, Shin YB, Kim HE, Kwon JH, Kim JJ. Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder. J Behav Addict 2021; 10:88-98. [PMID: 33625381 PMCID: PMC8969862 DOI: 10.1556/2006.2021.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/30/2020] [Accepted: 01/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Impulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD. METHODS Resting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala. RESULTS Connectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls. CONCLUSION These findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.
Collapse
Affiliation(s)
- Soo-Jeong Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Kyeong Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Bin Shin
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hesun Erin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Kwon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW To review the current literature on biobehavioral mechanisms involved in reactive aggression in a transdiagnostic approach. RECENT FINDINGS Aggressive reactions are closely related to activations in the brain's threat circuitry. They occur in response to social threat that is experienced as inescapable, which, in turn, facilitates angry approach rather than fearful avoidance. Provocation-induced aggression is strongly associated with anger and deficits in cognitive control including emotion regulation and inhibitory control. Furthermore, the brain's reward system plays a particular role in anger-related, tit-for-tat-like retaliatory aggression in response to frustration. More research is needed to further disentangle specific brain responses to social threat, provocation, and frustration. A better understanding of the psychological and neurobiological mechanisms involved in reactive aggression may pave the way for specific mechanism-based treatments, involving biological or psychotherapeutic approaches or a combination of the two.
Collapse
|
16
|
Gouveia FV, Hamani C, Fonoff ET, Brentani H, Alho EJL, de Morais RMCB, de Souza AL, Rigonatti SP, Martinez RCR. Amygdala and Hypothalamus: Historical Overview With Focus on Aggression. Neurosurgery 2019; 85:11-30. [PMID: 30690521 PMCID: PMC6565484 DOI: 10.1093/neuros/nyy635] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.
Collapse
Affiliation(s)
| | - Clement Hamani
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Erich Talamoni Fonoff
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo, Medical School, Sao Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Sao Paulo, Brazil
| | - Eduardo Joaquim Lopes Alho
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | | | - Aline Luz de Souza
- Department of Neurology, Division of Functional Neurosurgery of the Institute of Psychiatry, University of Sao Paulo School, Medicine School, Sao Paulo, Brazil
| | | | | |
Collapse
|
17
|
Delfin C, Krona H, Andiné P, Ryding E, Wallinius M, Hofvander B. Prediction of recidivism in a long-term follow-up of forensic psychiatric patients: Incremental effects of neuroimaging data. PLoS One 2019; 14:e0217127. [PMID: 31095633 PMCID: PMC6522126 DOI: 10.1371/journal.pone.0217127] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/04/2019] [Indexed: 02/06/2023] Open
Abstract
One of the primary objectives in forensic psychiatry, distinguishing it from other psychiatric disciplines, is risk management. Assessments of the risk of criminal recidivism are performed on a routine basis, as a baseline for risk management for populations involved in the criminal justice system. However, the risk assessment tools available to clinical practice are limited in their ability to predict recidivism. Recently, the prospect of incorporating neuroimaging data to improve the prediction of criminal behavior has received increased attention. In this study we investigated the feasibility of including neuroimaging data in the prediction of recidivism by studying whether the inclusion of resting-state regional cerebral blood flow measurements leads to an incremental increase in predictive performance over traditional risk factors. A subsample (N = 44) from a cohort of forensic psychiatric patients who underwent single-photon emission computed tomography neuroimaging and clinical psychiatric assessment during their court-ordered forensic psychiatric investigation were included in a long-term (ten year average time at risk) follow-up. A Baseline model with eight empirically established risk factors, and an Extended model which also included resting-state regional cerebral blood flow measurements from eight brain regions were estimated using random forest classification and compared using several predictive performance metrics. Including neuroimaging data in the Extended model increased the area under the receiver operating characteristic curve (AUC) from .69 to .81, increased accuracy from .64 to .82 and increased the scaled Brier score from .08 to .25, supporting the feasibility of including neuroimaging data in the prediction of recidivism in forensic psychiatric patients. Although our results hint at potential benefits in the domain of risk assessment, several limitations and ethical challenges are discussed. Further studies with larger, carefully characterized clinical samples utilizing higher-resolution neuroimaging techniques are warranted.
Collapse
Affiliation(s)
- Carl Delfin
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Hedvig Krona
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden
| | - Peter Andiné
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Erik Ryding
- Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden
| | - Märta Wallinius
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden
| | - Björn Hofvander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden
- Division of Forensic Psychiatry, Region Skåne, Trelleborg, Sweden
| |
Collapse
|