Violent offenders respond to provocations with high amygdala and striatal reactivity

The ability to successfully suppress impulses and angry affect is fundamental to control aggressive reactions following provocations. The aim of this study was to examine neural responses to provocations and aggression using a laboratory model of reactive aggression. We used a novel functional magnetic resonance imaging point-subtraction aggression paradigm in 44 men, of whom 18 were incarcerated violent offenders and 26 were control non-offenders. We measured brain activation following provocations (monetary subtractions), while the subjects had the possibility to behave aggressively or pursue monetary rewards. The violent offenders behaved more aggressively than controls (aggression frequency 150 vs 84, P = 0.03) and showed significantly higher brain reactivity to provocations within the amygdala and striatum, as well as reduced amygdala-prefrontal and striato-prefrontal connectivity. Amygdala reactivity to provocations was positively correlated with task-related behavior in the violent offenders. Across groups, striatal and prefrontal reactivity to provocations was positively associated with trait anger and trait aggression. These results suggest that violent individuals display abnormally high neural sensitivity to social provocations, a sensitivity related to aggressive behavior. These findings provide novel insight into the neural pathways that are sensitive to provocations, which is critical to more effectively shaped interventions that aim to reduce pathological aggressive behavior.

[Heroin abuse among Danish prisoners on remand. I. Prevalence related to form of administration]

Two groups of Danish prisoners on remand (in solitary confinement and not in solitary confinement) were examined by interview on reception (n = 133 & n = 95) in order to evaluate the prevalence and form of administration of opioid abuse/dependence. About 50% had abused opioids during their lifetime; one third were dependent at the time of reception. Twenty percent of opioid dependent prisoners administered opioids by smoking. More intravenous users were treated with methadone before and during imprisonment than those who were dependent on smoking opioids. Few were objectively suffering from withdrawal symptoms. The psycho-social impact of dependence on smoking heroin and intravenous heroin one month prior to imprisonment was at the same level and substantial as measured by the Global Assessment Scale.

[Heroin abuse among Danish prisoners on remand. II. Consequences related to form of administration]

Heroin-abusing Danish prisoners remanded in custody were based on interviews grouped as either smoking dependent (n = 18) or intravenous dependent (n = 55). Intravenous users had a longer duration and earlier debut of abuse than users who smoked opiates. Only intravenous users had serious somatic complications. Both groups of opioid dependent prisoners were marked by severe psychosocial dysfunction and considerable psychiatric co-morbidity. The intravenous users were generally more affected than the smokers concerning social and psychiatric parameters and earlier criminality, perhaps due to their longer duration of abuse.

[Status of forensic patients in the health system]

Forensic patients can be defined as patients subjected to a criminal law trial procedure or cases for whom a court decision has been taken at the time of treatment. The forensic cases may be subdivided into the following categories: Pre-trial: 1. Cases transferred to hospital as substitution for remand prison. 2. Cases transferred to hospital anticipating a verdict of admission to psychiatric hospital. 3. Cases transferred to hospital on a medical decision alone. 4. Cases admitted for examination to establish a psychiatric court report. Post-trial: 1. Cases sentenced to psychiatric treatment. 2. Cases serving a sentence. 3. Cases subjected to a condition of psychiatric treatment. For each group legislation and precepts concerning distribution of cases among hospitals, special requirements, rights and restrictions are expounded. The application of the "Civil Psychiatry Law of 1989" is discussed with reference to the forensic cases categories. Guidelines for the reception of forensic cases in psychiatric hospital departments are indicated.