[Neurobiological aspects of reactive and proactive violence in antisocial personality disorder and "psychopathy"]

Language evolution: examining the link between cross-modality and aggression through the lens of disorders

We demonstrate how two linguistic phenomena, figurative language (implicating cross-modality) and derogatory language (implicating aggression), both demand a precise degree of (dis)inhibition in the same cortico-subcortical brain circuits, in particular cortico-striatal networks, whose connectivity has been significantly enhanced in recent evolution. We examine four cognitive disorders/conditions that exhibit abnormal patterns of (dis)inhibition in these networks: schizophrenia (SZ), autism spectrum disorder (ASD), synaesthesia and Tourette's syndrome (TS), with the goal of understanding why the two phenomena altered reactive aggression and altered cross-modality cluster together in these disorders. Our proposal is that enhanced cross-modality (necessary to support language, in particular metaphoricity) was a result, partly a side-effect, of self-domestication (SD). SD targeted the taming of reactive aggression, but reactive impulses are controlled by the same cortico-subcortical networks that are implicated in cross-modality. We further add that this biological process of SD did not act alone, but was engaged in an intense feedback loop with the cultural emergence of early forms of language/grammar, whose high degree of raw metaphoricity and verbal aggression also contributed to increased brain connectivity and cortical control. Consequently, in conjunction with linguistic expressions serving as approximations/'fossils' of the earliest stages of language, these cognitive disorders/conditions serve as confident proxies of brain changes in language evolution, helping us reconstruct certain crucial aspects of early prehistoric languages and cognition, as well as shed new light on the nature of the disorders. This article is part of the theme issue 'Reconstructing prehistoric languages'.

Current Understanding of the Neurobiology of Agitation

Introduction

Managing agitation in the clinical setting is a challenge that many practitioners face regularly. Our evolving understanding of the etiological factors involved in aggressive acts has better informed our interventions through pharmacologic and behavioral strategies. This paper reviews the literature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology with proposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation.

Methods

We performed a review of the extant literature using PubMed as a primary database. Investigation focused on neurobiology of agitation and its relation to the current evidence base for particular interventions.

Results

There are well-established pathways that can lead to increased autonomic response and the potential for violence. Psychopathology and substance-induced perceptual distortions may lead to magnification and overestimation of environmental threat, heightening the potential for aggression. Additional challenges have arisen with the advent of several novel drugs of abuse, many of which lead to atypical clinical presentations and which can elude standard drug screens. Our interventions still lean on the evidence base found in Project BETA (Best Practices in Evaluation and Treatment of Agitation). Although not a new drug and not included in the Project BETA guidelines, ketamine and its use are also discussed, given its unique pharmacology and potential benefits when other protocoled interventions have failed.

Conclusion

Aggression can occur due to manifold reasons in the clinical setting. Having an informed understanding of the possible determinants of agitation can help with more tailored responses to individual patients, limiting the unnecessary use of medications or of interventions that could be deemed forceful.

From Physical Aggression to Verbal Behavior: Language Evolution and Self-Domestication Feedback Loop

We propose that human self-domestication favored the emergence of a less aggressive phenotype in our species, more precisely phenotype prone to replace (reactive) physical aggression with verbal aggression. In turn, the (gradual) transition to verbal aggression and to more sophisticated forms of verbal behavior favored self-domestication, with the two processes engaged in a mutually reinforcing feedback loop, considering that verbal behavior entails not only less violence and better survival but also more opportunities to interact longer and socialize with more conspecifics, ultimately enabling the emergence of more complex forms of language. Whereas in the case of self-domestication, sexual selection has been proposed to work against physical aggression traits, in the case of verbal insult, the selection has been proposed to work in favor of verbal aggression. The tension between these two seemingly opposing forces gets resolved/alleviated by a tendency to replace physical aggression with verbal aggression and with verbal behavior more generally. This also helps solve the paradox of the Self-Domestication Hypothesis regarding aggression, more precisely why aggression in humans has been reduced only when it comes to reactive aggression, but not when it comes to proactive aggression, the latter exhibiting an increase in the advent of modern language. We postulate that this feedback loop was particularly important during the time period arguably between 200 and 50 kya, when humans were not fully modern, neither in terms of their skull/brain morphology and their behavior/culture nor in terms of their self-domestication. The novelty of our approach lies in (1) giving an active role to early forms of language in interacting with self-domestication processes; (2) providing specific linguistic details and functions of this early stage of grammar (including insult and humor); (3) supplying neurobiological, ontogenetic, and clinical evidence of a link between (reactive) aggression and (reactive) verbal behavior; (4) identifying proxies of the earlier stages in evolution among cognitive disorders; and (5) identifying specific points of contact and mutual reinforcement between these two processes (self-domestication and early language evolution), including reduction in physical aggression and stress/tension, as well as sexual selection.

Fifteen-minute consultation: The angry child

Children who present with difficult behaviours due to underlying anger are commonly presented to paediatricians for help and advice. This paper gives a basic structure of how to approach the subject, by exploring whether the problems occur at home, school or both, and analysing the behaviour by focusing on antecedents, behaviour and consequences. It is important to find the underlying causes in order to know what to recommend, as this can vary from medication, anger management strategies, school-based interventions, parenting programmes or family therapy.

[Psychiatric, Cognitive and Emotional Profile in Ex-combatants of Illegal Armed Groups in Colombia]

INTRODUCTION

Exposure to armed conflict produces biological adaptations oriented to handle the highly stressful conditions in war environments. The special features of The Colombian armed create a special scenario to evaluate the human behavior.

OBJECTIVE

In this study, psychiatric, cognitive and emotional processing characteristics of a group of Colombian armed illegal forces of ex-combatants are described.

METHODS

Sixty-three ex combatants and 22 controls were assessed with WAIS (IQ), INECO frontal screening (executive functions), Interpersonal Reactivity Index (empathy), emotional features recognition and MINI (psychiatric profile).

RESULTS

When compared to the control group, ex-combatants showed higher frequency of antisocial personality disorder (P=.031) and behavioral dissocial disorder (P=.017). In cognitive profile, the ex-combatants showed a lower score in the executive function test (Me=18.50; RQ=4.00), control (Me=23.00; RQ=5.25), with a poor personal distress in emphatic profile (Me=10.00; RQ=5.00) compared to control group (Me=37.00; RQ=7.25).

CONCLUSIONS

We found differences in cognitive and psychiatric profile in ex-combatants in comparison with controls.

[ADHD and conduct disorders - trends in the German-speaking countries]

Since 2009 trends in research and practice have been described for externalising disorders (ADHD and conduct disorders) in the German-speaking countries. In particular, publications of children and adolescent psychiatry and clinical child psychology have been examined and scientific contributions from the 32nd Congress of the German Society for Child and Adolescent Psychiatry have been included. In the German-speaking countries studies regarding conduct disorders (including bullying and psychopathy) have noticeably increased in complexity and differentiation and caught up with the extensive discussion about ADHD.

Persönlichkeitsstörungen im Jugendalter

Ziel dieses Beitrags ist es, die aktuelle Kontroverse zum Thema Persönlichkeitsstörungen im Jugendalter darzustellen und für den deutschsprachigen Raum Trends sowie Perspektiven in Forschung und Praxis seit 2009 zu skizzieren. Dazu wurden vor allem Publikationen aus der Kinder- und Jugendpsychiatrie und der Klinischen Kinderpsychologie neben wissenschaftlichen Beiträgen des 32. Kongresses der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie gesichtet. Aktuelle Forschungsergebnisse verweisen darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können und diagnostiziert werden sollten. Zugleich fehlt es noch an spezifischen Instrumenten, welche die Besonderheiten von Persönlichkeitsstörungen im Jugendalter abbilden und von Adoleszenzkrisen differenzieren können. Die Prävalenz von Persönlichkeitsstörungen scheint im Jugendalter höher als im Erwachsenenalter zu liegen. Eine Subform der antisozialen Persönlichkeitsstörung, die auch bei Jugendlichen zu finden ist, stellt die Psychopathy dar. Insgesamt wird deutlich, dass es noch weiterer diagnostischer Langzeitstudien bedarf, um zu klären, unter welchen Bedingungen Persönlichkeitsstörungen manifest werden, welche Faktoren ihren Verlauf beeinflussen und wie sie sich durch Interventionen verändern lassen.

Neurophysiological correlates of laboratory-induced aggression in young men with and without a history of violence

In order to further understand the mechanisms involved in planning an aggressive act, we conducted an event-related potential (ERP) study of young men with and without a history of violence. Participants completed a competitive reaction time task (based on the Taylor aggression paradigm) against a virtual opponent. In "passive" blocks, participants were punished by the opponent when losing the trial but could not punish, when winning, whereas in "active" blocks, participants were able to punish the opponent when winning, but were not punished when losing. Participants selected punishment strength in a decision phase prior to each reaction time task and were informed whether they had won or lost in the outcome phase. Additionally, a flanker task was conducted to assess basic performance monitoring. Violent participants selected stronger punishments, especially in "active" blocks. During the decision phase, a frontal P200 was more pronounced for violent participants, whereas non-violent participants showed an enhanced frontal negativity around 300 ms. The P200 might reflect the decision to approach the opponent at a very early state, the latter negativity could reflect inhibition processes, leading to a more considerate reaction in non-violent participants. During the outcome phase, a Feedback-Related Negativity was seen in both groups. This effect was most pronounced when losing entailed a subsequent inability to retaliate. The groups did not differ in the flanker task, indicating intact basic performance monitoring. Our data suggest that the planning of an aggressive act is associated with distinct brain activity and that such activity is differentially represented in violent and non-violent individuals.

Evidenzbasierte psychotherapeutische Interventionen für Kinder und Jugendliche mit aggressivem Verhalten

Bei der Behandlung von Kindern und Jugendlichen mit aggressivem Verhalten ist in den vergangenen Jahren vor allem im englischsprachigen Ausland ein Trend zum Einsatz evidenzbasierter psychotherapeutischer Interventionen zu verzeichnen. In diesem Beitrag werden–getrennt für Kindes- und Jugendalter–die am besten evaluierten Therapieprogramme (u. a. Multisystemic Therapy, Functional Family Therapy, The Incredible Years) für diese Indikation dargestellt. Es werden aktuelle Fragen der Implementation und Disseminierung evidenzbasierter Interventionen für aggressive Kinder und Jugendliche diskutiert (z. B. Qualitätssicherung, Therapietreue). Abschließend werden Perspektiven für eine Implementation evidenzbasierter Interventionen in Deutschland aufgezeigt.

Erfassung und Klassifikation von Persönlichkeitspathologie im Jugendalter

Fragestellung: Die Frage der Diagnostik und Klassifikation von Persönlichkeitsstörungen im Jugendalter ist immer noch eine kontrovers diskutierte Thematik. Methodik: In dieser Übersichtsarbeit werden die aktuellen Forschungsbefunde zur Komorbidität und Diagnostik von Persönlichkeitsstörungen im Jugendalter sowie ihre neurobiologischen und -psychologischen Korrelate dargelegt. Ergebnisse: Aktuelle Forschungsergebnisse verweisen einerseits darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können. Andererseits wird bemängelt, dass kein einheitliches jugendspezifisches Konzept zur Erfassung von Persönlichkeitsstörungen existiert, das eine einheitliche Grundlage für die Erforschung dieses klinisch so bedeutsamen Störungsbildes bildet. Schlussfolgerungen: Es bedarf diagnostischer und Langzeitstudien im Rahmen von Netzwerken, die Aufschluss über die Frage der Klassifizierbarkeit von Persönlichkeitsstörungen in der Adoleszenz in Abgrenzung zu anderen jugendtypischen Störungsbildern geben.