Right to mental integrity and neurotechnologies: implications of the extended mind thesis

The possibility of neurotechnological interference with our brain and mind raises questions about the moral rights that would protect against the (mis)use of these technologies. One such moral right that has received recent attention is the right to mental integrity. Though the metaphysical boundaries of the mind are a matter of live debate, most defences of this moral right seem to assume an internalist (brain-based) view of the mind. In this article, we will examine what an extended account of the mind might imply for the right to mental integrity and the protection it provides against neurotechnologies. We argue that, on an extended account of the mind, the scope of the right to mental integrity would expand significantly, implying that neurotechnologies would no longer pose a uniquely serious threat to the right. In addition, some neurotechnologies may even be protected by the right to mental integrity, as the technologies would become part of the mind. We conclude that adopting an extended account of the mind has significant implications for the right to mental integrity in terms of its protective scope and capacity to protect against neurotechnologies, demonstrating that metaphysical assumptions about the mind play an important role in determining the moral protection provided by the right.

Progesterone receptor distribution in the human hypothalamus and its association with suicide

The human hypothalamus modulates mental health by balancing interactions between hormonal fluctuations and stress responses. Stress-induced progesterone release activates progesterone receptors (PR) in the human brain and triggers alterations in neuropeptides/neurotransmitters. As recent epidemiological studies have associated peripheral progesterone levels with suicide risks in humans, we mapped PR distribution in the human hypothalamus in relation to age and sex and characterized its (co-) expression in specific cell types. The infundibular nucleus (INF) appeared to be the primary hypothalamic structure via which progesterone modulates stress-related neural circuitry. An elevation of the number of pro-opiomelanocortin+ (POMC, an endogenous opioid precursor) neurons in the INF, which was due to a high proportion of POMC+ neurons that co-expressed PR, was related to suicide in patients with mood disorders (MD). MD donors who died of legal euthanasia were for the first time enrolled in a postmortem study to investigate the molecular signatures related to fatal suicidal ideations. They had a higher proportion of PR co-expressing POMC+ neurons than MD patients who died naturally. This indicates that the onset of endogenous opioid activation in MD with suicide tendency may be progesterone-associated. Our findings may have implications for users of progesterone-enriched contraceptives who also have MD and suicidal tendencies.

[Ethics and law in the application of new technology in forensic psychiatry]

Background Technological innovations often come hand in hand with ethical and legal challenges. This especially applies to forensic psychiatry due to its legal framework and the often accompanying obligatory nature of treatment. Aim To identify ethical and legal considerations related to new, non-linguistic technologies in which little to no written language is used, in a forensic psychiatric context. Method A concise ethical and legal analysis of several emerging technologies that can (potentially) be applied within forensic psychiatry, based on relevant scientific literature. Results Technologies such as virtual reality, biosensors, and neuro-interventions offer possibilities to improve forensic psychiatric treatment. However, little is known about their effectiveness and integration into treatment, but also regarding ethical and legal aspects. For each technology, we discuss three important considerations, amongst which persuasiveness, informed consent, privacy, data ownership, and mental integrity. These topics serve as starting points for future research. Conclusion To gain timely insight into ethical and legal considerations and incorporate them into development and implementation processes, it is important to integrate knowledge from ethicists, lawyers, healthcare providers, patients, researchers, technology developers, and policymakers.

Structured instruments for insanity defense evaluations: Opportunities and limitations

Insanity evaluations are often criticized for their-alleged-lack of objectivity, reliability and transparency. Structured tools to guide and support forensic evaluators during these evaluations have been developed-but they are rarely employed in forensic practice. In the present article, we consider the value of these tools for forensic practice in terms of opportunities and limitations. First, we briefly describe different insanity criteria used in Western countries. Next, we will review five structured instruments to guide insanity assessment together with their performance measures. Finally, we draw conclusions on the value of such instruments for forensic practice.

Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'

The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.

The various faces of vulnerability: offering neurointerventions to criminal offenders

In recent years, we have witnessed considerable progress in neurotechnologies that visualize or alter a person's brain and mental features. In the near future, some of these technologies could possibly be used to change neural parameters of high-risk behavior in criminal offenders, often referred to as neurointerventions. The idea of delivering neurointerventions to criminal justice populations has raised fundamental normative concerns, but some authors have argued that offering neurointerventions to convicted offenders could be permissible. However, such offers raise normative concerns too. One prominent worry that is often emphasized in the literature, relates to the vulnerability of convicted offenders in prison and forensic patients in mental health facilities. In this paper, we aim to show that as far as vulnerability is considered relevant within the context of offering medical interventions to offenders, it could contribute to arguments against as well as in favor of these offers.

Introduction: On brain and crime

Crime is a complex phenomenon involving many factors, among which are situational and societal factors. What counts as a crime may also vary across space and time. Often, it is the interplay of several factors that may lead to criminal behavior. Scientifically, brain function is important to consider, first of all because the brain is central to behavior as such, including criminal behavior. Second, because there is increasing evidence for the relevance of specific brain dysfunctions in some criminal behavior, particularly developmental findings related to nonadaptive behavior. Many of our behavioral tendencies are rooted in our childhood (experiences), and this, it appears, is also, at least to some extent, true for nonadaptive behavior. This chapter considers several overarching issues regarding the relationship between-and the science of-brain and crime, some from a conceptual, some from a legal, and others from a developmental perspective.

Neurotechnology to reduce recidivism: Ethical and legal challenges

Crime comes with enormous costs, not only financial but also in terms of loss of mental and physical health and, in some cases, even loss of life. Recidivism is responsible for a considerable percentage of the crimes, and therefore, society deems reducing recidivism a priority. To reduce recidivism, several types of interventions can be used, such as education and employment-focused rehabilitation programs which are intended to improve psychological and social factors. Another way to prevent reoffending is to influence the offender's brain functions. For example, medication can be offered to treat delusions or to diminish sexual drive. In the near future, innovative neurotechnologies are expected to improve prediction and prevention of reoffending. Potential positive effects of such neurotechniques include a safer society and earlier release of prisoners who are no longer "at high risk" to relapse into criminal behavior. Meanwhile, employing these neurotechniques in the criminal justice system raises fundamental concerns, for example, about autonomy, privacy and mental integrity. This chapter aims to identify some of the ethical and legal challenges of using neurotechnologies to reduce recidivism.

Virtual reality interventions for victims of crime: A systematic review

In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost-effectiveness of these interventions compared to in-person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face-to-face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime.

Robot Evolution: Ethical Concerns

Rapid developments in evolutionary computation, robotics, 3D-printing, and material science are enabling advanced systems of robots that can autonomously reproduce and evolve. The emerging technology of robot evolution challenges existing AI ethics because the inherent adaptivity, stochasticity, and complexity of evolutionary systems severely weaken human control and induce new types of hazards. In this paper we address the question how robot evolution can be responsibly controlled to avoid safety risks. We discuss risks related to robot multiplication, maladaptation, and domination and suggest solutions for meaningful human control. Such concerns may seem far-fetched now, however, we posit that awareness must be created before the technology becomes mature.

Commercial DNA tests and police investigations: a broad bioethical perspective

Over 30 million people worldwide have taken a commercial at-home DNA test, because they were interested in their genetic ancestry, disease predisposition or inherited traits. Yet, these consumer DNA data are also increasingly used for a very different purpose: to identify suspects in criminal investigations. By matching a suspect's DNA with DNA from a suspect's distant relatives who have taken a commercial at-home DNA test, law enforcement can zero in on a perpetrator. Such forensic use of consumer DNA data has been performed in over 200 criminal investigations. However, this practice of so-called investigative genetic genealogy (IGG) raises ethical concerns. In this paper, we aim to broaden the bioethical analysis on IGG by showing the limitations of an individual-based model. We discuss two concerns central in the debate: privacy and informed consent. However, we argue that IGG raises pressing ethical concerns that extend beyond these individual-focused issues. The very nature of the genetic information entails that relatives may also be affected by the individual customer's choices. In this respect, we explore to what extent the ethical approach in the biomedical genetic context on consent and consequences for relatives can be helpful for the debate on IGG. We argue that an individual-based model has significant limitations in an IGG context. The ethical debate is further complicated by the international, transgenerational and commercial nature of IGG. We conclude that IGG should not only be approached as an individual but also-and perhaps primarily-as a collective issue.

Forensic Brain-Reading and Mental Privacy in European Human Rights Law: Foundations and Challenges

A central question in the current neurolegal and neuroethical literature is how brain-reading technologies could contribute to criminal justice. Some of these technologies have already been deployed within different criminal justice systems in Europe, including Slovenia, Italy, England and Wales, and the Netherlands, typically to determine guilt, legal responsibility, or recidivism risk. In this regard, the question arises whether brain-reading could permissibly be used against the person's will. To provide adequate legal protection from such non-consensual brain-reading in the European legal context, ethicists have called for the recognition of a novel fundamental legal right to mental privacy. In this paper, we explore whether these ethical calls for recognising a novel legal right to mental privacy are necessary in the European context. We argue that a right to mental privacy could be derived from, or at least developed within in the jurisprudence of the European Court of Human Rights, and that introducing an additional fundamental right to protect against (forensic) brain-reading is not necessary. What is required, however, is a specification of the implications of existing rights for particular neurotechnologies and purposes.

Is Virtually Everything Possible? The Relevance of Ethics and Human Rights for Introducing Extended Reality in Forensic Psychiatry

Extended Reality (XR) systems, such as Virtual Reality (VR) and Augmented Reality (AR), provide a digital simulation either of a complete environment, or of particular objects within the real world. Today, XR is used in a wide variety of settings, including gaming, design, engineering, and the military. In addition, XR has been introduced into psychology, cognitive sciences and biomedicine for both basic research as well as diagnosing or treating neurological and psychiatric disorders. In the context of XR, the simulated 'reality' can be controlled and people may safely learn to cope with their feelings and behavior. XR also enables to simulate environments that cannot easily be accessed or created otherwise. Therefore, Extended Reality systems are thought to be a promising tool in the resocialization of criminal offenders, more specifically for purposes of risk assessment and treatment of forensic patients. Employing XR in forensic settings raises ethical and legal intricacies which are not raised in case of most other healthcare applications. Whereas a variety of normative issues of XR have been discussed in the context of medicine and consumer usage, the debate on XR in forensic settings is, as yet, straggling. By discussing two general arguments in favor of employing XR in criminal justice, and two arguments calling for caution in this regard, the present paper aims to broaden the current ethical and legal debate on XR applications to their use in the resocialization of criminal offenders, mainly focusing on forensic patients.

The insanity defence without mental illness? Some considerations

In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages.

Classification of comorbidity in obsessive-compulsive disorder: A latent class analysis

OBJECTIVE

Patients with OCD differ markedly from one another in both number and kind of comorbid disorders. In this study, we set out to identify and characterize homogeneous subgroups of OCD patients based on their comorbidity profile.

METHODS

In a cohort of 419 adult subjects with OCD, the lifetime presence of fifteen comorbid disorders was assessed. Latent class analysis was used to identify comorbidity-based subgroups. Groups were compared with regard to core clinical characteristics: familiality, childhood trauma, age at onset, illness severity, OCD symptom dimensions, personality characteristics, and course of illness.

RESULTS

The study sample could be divided in a large group (n = 311) with a low amount of comorbidity that could be further subdivided into two subgroups: OCD simplex (n = 147) and OCD with lifetime major depressive disorder (n = 186), and a group (n = 108) with a high amount of comorbidity that could be further subdivided into a general anxiety-related subgroup (n = 49), an autism/social phobia-related subgroup (n = 27), and a psychosis/bipolar-related subgroup (n = 10). Membership of the high-comorbid subgroup was associated with higher scores on childhood trauma, illness severity, and the aggression/checking symptom dimension and lower scores on several personality characteristics.

CONCLUSION

Grouping OCD patients based on their comorbidity profile might provide more homogeneous, and therefore, more suitable categories for future studies aimed at unraveling the etiological mechanisms underlying this debilitating disorder.

Accessing medical biobanks to solve crimes: ethical considerations

Millions of human biological samples are stored worldwide for medical research or treatment purposes. These biospecimens are of enormous potential value to law enforcement as DNA profiles can be obtained from these samples. However, forensic use of such biospecimens raises a number of ethical questions. This article aims to explore ethical issues of using human bodily material in medical biobanks for crime investigation and prosecution purposes. Concerns about confidentiality, trust, autonomy and justice will be discussed. We explore how to balance these concerns against the importance of crime solving. Relevant case examples of forensic use of medical biobanks show that requests by law enforcement to access biobanks are handled in disparate ways. We identify some core ethical issues and conclude that further research on these issues is needed to provide ethical guidance.

Neuroprediction and A.I. in Forensic Psychiatry and Criminal Justice: A Neurolaw Perspective

Advances in the use of neuroimaging in combination with A.I., and specifically the use of machine learning techniques, have led to the development of brain-reading technologies which, in the nearby future, could have many applications, such as lie detection, neuromarketing or brain-computer interfaces. Some of these could, in principle, also be used in forensic psychiatry. The application of these methods in forensic psychiatry could, for instance, be helpful to increase the accuracy of risk assessment and to identify possible interventions. This technique could be referred to as 'A.I. neuroprediction,' and involves identifying potential neurocognitive markers for the prediction of recidivism. However, the future implications of this technique and the role of neuroscience and A.I. in violence risk assessment remain to be established. In this paper, we review and analyze the literature concerning the use of brain-reading A.I. for neuroprediction of violence and rearrest to identify possibilities and challenges in the future use of these techniques in the fields of forensic psychiatry and criminal justice, considering legal implications and ethical issues. The analysis suggests that additional research is required on A.I. neuroprediction techniques, and there is still a great need to understand how they can be implemented in risk assessment in the field of forensic psychiatry. Besides the alluring potential of A.I. neuroprediction, we argue that its use in criminal justice and forensic psychiatry should be subjected to thorough harms/benefits analyses not only when these technologies will be fully available, but also while they are being researched and developed.

[The (im?)possibility of a biological substrate for mental disorders]

The constructivist position is often used for psychiatric diseases, in contrast with the general medical view. In the medical view a biological substrate is decisive for a classification as 'disease', which is not the case in the constructivist position.<br/> AIM: We investigate how both positions relate to each other in psychiatric diseases. <br/> METHOD: Analysis based on a conceptual analysis of Ian Hacking's book The Social Construction of What? (1999).<br/> RESULTS: Different objects ought to be distinguished in a constructivist analysis of psychiatric diseases; the disease itself and the idea or concept of that disease. These different objects interact with each other. These interactions can be made explicit by distinguishing interactive kinds from indifferent kinds. Doing so makes it clear that even if a disease is not determined by a biological substrate, this does not imply that a biological substrate is something completely separate from that disease.<br/> CONCLUSION: Hacking's philosophy makes it possible to move beyond the opposition between the medical and the constructivist account of psychiatric diseases by combining both accounts.

Translating clinical findings to the legal norm: the Defendant's Insanity Assessment Support Scale (DIASS)

Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on the jurisdictions. Yet, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at crime time. Despite some efforts having been made to guide and structure criminal responsibility evaluations, a valid instrument that could be useful to guide forensic psychiatrists' criminal responsibility assessments in different jurisdictions is lacking. This is a gap that needs to be addressed, considering the significant forensic and procedural implications of psychiatric evaluations. In addition, differences in methodology used in insanity assessments may also have consequences for the principle of equal rights for all citizens before the law, which should be guaranteed in the European Union. We developed an instrument, the Defendant's Insanity Assessment Support Scale (DIASS), which can be useful to support, structure, and guide the insanity assessment across different jurisdictions, in order to improve reliability and consistency of such evaluations.

Legal insanity and risk: An international perspective on the justification of indeterminate preventive commitment

Modern legal systems typically link the insanity or diminished responsibility of an offender for a crime committed in the past to his future dangerousness. This nexus serves across legal systems as a justification for the indeterminate commitment of the offender with diminished or no criminal responsibility. Conceptually, however, insanity and risk are not related legal issues. Moreover, empirical research suggests that there is only a weak link between insanity, diminished responsibility and mental illness on the one hand and risk of recidivism on the other. Other risk factors seem to be more important. The inference of risk from insanity or diminished responsibility that lies at the heart of the indeterminate commitment of mentally disordered offenders is therefore problematic. This should lead to a reconsideration of the preconditions for indeterminate commitment of mentally disordered defendants.

Forensic psychiatric evaluations of defendants: Italy and the Netherlands compared

BACKGROUND

Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands.

AIM

We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric evaluation of defendants, including legal insanity and the management of mentally ill offenders deemed insane. This research is carried out not only to identify similarities and differences regarding the assessment of mentally ill offenders in Italy and the Netherlands, but, in addition, to identify strengths and weaknesses of the legislation and procedures used for the evaluation of the mentally ill offenders in the two countries.

RESULTS

Italy and the Netherlands share some basic characteristics of their criminal law systems. Yet, forensic psychiatric practices differ significantly, even if we consider only evaluations of defendants. A strong point of Italy concerns its test for legal insanity which defines the legal norm and enables a straightforward communication between the experts and the judges on this crucial matter. A strong point of the Netherlands concerns more standardized practices including guidelines and the use of risk assessment tools, which enable better comparisons and scientific research in this area.

CONCLUSIONS

We argue that there appears to be room for improvement on both sides with regards to the evaluation of mentally ill offenders. More generally, a transnational approach to these issues, as applied in this paper, could help to advance forensic psychiatric services in different legal systems.

Prison and the brain: Neuropsychological research in the light of the European Convention on Human Rights

Prison is by its nature a deliberately impoverished environment, with few physical, mental and social activities. Various studies have shown negative effects of an impoverished environment on animal as well as human brain functions. A recent study in a Dutch remand prison showed that brain functions connected with self-regulation decline after 3 months of imprisonment. Reduced self-regulation appears to be a risk factor for recidivism. In this article, we examine the legal implications of these neuropsychological findings in a European context. Firstly, we analyse these results in the light of the principle of rehabilitation as interpreted in case law of the European Court of Human Rights. Secondly, we explore how the neuropsychological insights could be relevant in the context of the prohibition of torture, inhuman and degrading treatment (Article 3 of the European Convention on Human Rights (ECHR)). We argue that if the impoverished prison environment hampers rehabilitation, states are positively obliged to take appropriate measures to counter these effects. Ultimately, negative effects on brain functioning by impoverished prison environments could even raise an issue under Article 3 ECHR. Furthermore, we argue that neuropsychological insights have to be taken into account when establishing the threshold according to which the European Court on Human Rights judges prison conditions. We conclude that in the light of these considerations further research on the neuropsychological effects of the prison environment is required.

Forensic psychiatry and neurolaw: Description, developments, and debates

Neuroscience produces a wealth of data on the relationship between brain and behavior, including criminal behavior. The research field studying the possible and actual impact of neuroscience on the law and legal practices, is called neurolaw. It is a new and rapidly developing domain of interdisciplinary research. Since forensic psychiatry has to do with both neuroscience and the law, neurolaw is of specific relevance for this psychiatric specialty. In this contribution, I will discuss three main research areas in neurolaw - revision, assessment, and intervention - and explore their relevance for forensic psychiatry. I will identify some valuable possibilities as well as some notable challenges - both technical and ethical - for forensic psychiatry regarding neurolaw developments.

Ethical Issues to Consider Before Introducing Neurotechnological Thought Apprehension in Psychiatry

When it becomes available, neuroscience-based apprehension of subjective thoughts is bound to have a profound impact on several areas of society. One of these areas is medicine. In principle, medical specialties that are primarily concerned with mind and brain are most likely to apply neurotechnological thought apprehension (NTA) techniques. Psychiatry is such a specialty, and the relevance of NTA developments for psychiatry has been recognized. In this article, I discuss ethical issues regarding the use of NTA techniques in psychiatric contexts. First, I consider the notion of neurotechnological "thought apprehension," as well as some limitations of present-day NTA applications. Next, I identify ethical priorities for its possible future use in psychiatry. The topics I explore concern key (bio)ethical issues: confidentiality, trust and distrust, consent and coercion, and, finally, responsibility. I conclude that mental health-related use of NTA entails some specific ethical concerns that deserve careful attention before introducing these technologies in psychiatric practice.

Perceptions of free will in obsessive-compulsive disorder: a quantitative analysis

BACKGROUND

The aim of this study was to explore perceptions of free will in the repetitive behaviors of patients with obsessive-compulsive disorder (OCD) and to explore their relation with core clinical characteristics.

METHODS

Experiences of free will were assessed with the Symptomatology And Perceived Free will rating scale (SAPF) in 295 subjects with a lifetime diagnosis of OCD. Patients' scores on the SAPF were subjected to an explorative principal axis factor analysis (PAF). Factor scores were regressed on five OCD symptom dimensions and on seven clinical variables: illness duration, severity of OCD, insight, anxiety and depression, suicidal ideation and quality of life.

RESULTS

The PAF revealed three factors: the perceived ability to control and change one's course of action when faced with an obsession or compulsion (the "alternative possibilities" factor); the experience of obsessions or compulsions as intentional (the "intentionality" factor); and the experience of being the source or owner of the obsessions or compulsions (the "ownership" factor). Lower scores on the "alternative possibilities" factor were associated with lower scores on the washing dimension (β = 0.237, p = 0.004) and higher scores on the precision dimension (β = - 0.190, p = 0.025) and independently associated with longer illness duration (β = - 0.134, p = 0.039), higher illness severity (β = - 0.298, p < 0.001) and lower quality of life (β = 0.172, p = 0.046). Lower scores on the "intentionality" factor were independently associated with lower quality of life (β = 0.233, p = 0.027). Higher scores on the "ownership" factor were associated with higher scores on the precision dimension (β = 0.207, p = 0.023) and independently associated with poorer insight (β = 0.170, p = 0.045).

CONCLUSIONS

The most notable finding of this study is that a diminished experience of free will in OCD is associated with core clinical characteristics: illness duration and severity, insight and quality of life.

Reduced Self-Control after 3 Months of Imprisonment; A Pilot Study

Background: Prison can be characterized as an impoverished environment encouraging a sedentary lifestyle with limited autonomy and social interaction, which may negatively affect self-control and executive function. Here, we aim to study the effects of imprisonment on self-control and executive functions, and we report the change in neuropsychological outcome after 3 months of imprisonment.

Materials and Methods: Participants were 37 male inmates in a remand prison in Amsterdam, Netherlands, who completed six tests of a computerized neuropsychological test battery (the Cambridge Automated Neuropsychological Test Battery) in the first week of arrival. Participants were retested after 3 months of imprisonment. Change in performance was tested using the Wilcoxon Signed-Rank test.

Results: After 3 months of imprisonment, risk taking significantly increased (measured as an increase in the proportion of available points used for betting) and attention significantly deteriorated (measured as increased variability in reaction times on a sustained attention task), with large to medium effect sizes. In contrast, planning significantly improved (measured with a task analog to the Tower of London) with a medium effect size.

Discussion: Our study suggests that 3 months of imprisonment in an impoverished environment may lead to reduced self-control, measured as increased risk taking and reduced attentional performance. This is a significant and societally relevant finding, as released prisoners may be less capable of living a lawful life than they were prior to their imprisonment, and may be more prone to impulsive risk-taking behavior. In other words, the impoverished environment may contribute to an enhanced risk of reoffending.

Free will, neuroscience, and choice: towards a decisional capacity model for insanity defense evaluations

Free will has often been considered central to criminal responsibility. Yet, the concept of free will is also difficult to define and operationalize, and, moreover, it is intensely debated. In particular, the very existence of free will has been denied based on recent neuroscience findings. This debate has significant implications on those fields in which the link between free will and behaviour is the main focus of interest, such as forensic psychiatry. In fact, a tension is often experienced between the centrality of the notion of free will on the one hand, and its controversial status on the other. This tension needs to be addressed, especially in forensic psychiatry, since it is relevant for actual assessments of legal insanity. In the present paper we will try to operationalize “free will” using a fourpartite decision-making capacity model, which can be used in forensic assessment of insanity. We will describe its advantages and application to guide mental insanity assessments. Whereas free will is often considered problematic from a neuroscience perspective, this model, we argue, is compatible with neuroscience; moreover, evaluations using this model can also be informed and strengthened by neuroscientific findings, for example regarding inhibitory control.

Differences in executive functioning between violent and non-violent offenders

BACKGROUND

A growing body of neuropsychological and neurobiological research shows a relationship between functioning of the prefrontal cortex and criminal and violent behaviour. The prefrontal cortex is crucial for executive functions such as inhibition, attention, working memory, set-shifting and planning. A deficit in these functions - a prefrontal deficit - may result in antisocial, impulsive or even aggressive behaviour. While several meta-analyses show large effect sizes for the relationship between a prefrontal deficit, executive dysfunction and criminality, there are few studies investigating differences in executive functions between violent and non-violent offenders. Considering the relevance of identifying risk factors for violent offending, the current study explores whether a distinction between violent and non-violent offenders can be made using an extensive neuropsychological test battery.

METHOD

Male remand prisoners (N = 130) in Penitentiary Institution Amsterdam Over-Amstel were administered an extensive neuropsychological test battery (Cambridge Automated Neuropsychological Test Battery; CANTAB) measuring response inhibition, planning, attention, set-shifting, working memory and impulsivity/reward sensitivity.

RESULTS

Violent offenders performed significantly worse on the stop-signal task (partial correlation r = 0.205, p = 0.024), a task measuring response inhibition. No further differences were found between violent and non-violent offenders. Explorative analyses revealed a significant relationship between recidivism and planning (partial correlation r = -0.209, p = 0.016).

CONCLUSION

Violent offenders show worse response inhibition compared to non-violent offenders, suggesting a more pronounced prefrontal deficit in violent offenders than in non-violent offenders.

Competence in chronic mental illness: the relevance of practical wisdom

The concept of competence is central to healthcare because informed consent can only be obtained from a competent patient. The standard approach to competence focuses on cognitive abilities. Several authors have challenged this approach by emphasising the role of emotions and values. Combining cognition, emotion and values, we suggest an approach which is based on the notion of practical wisdom. This focuses on knowledge and on determining what is important in a specific situation and finding a balance between various values, which are enacted in an individual's personal life. Our approach is illustrated by two cases of patients with obsessive-compulsive disorder.

Who Establishes the Presence of a Mental Disorder in Defendants? Medicolegal Considerations on a European Court of Human Rights Case

Legal insanity is a peculiar element of criminal law, because it brings together two very different disciplines: psychiatry and psychology on the one hand and the law on the other. One of the basic questions regarding evaluations of defendants concerns the question of who should establish "true mental disorder," the judge or the behavioral expert? This question is complicated, and in this contribution it will be explored based on a Dutch case that was eventually decided by the European Court of Human Rights (ECtHR). We will argue that the ECtHR provides a valuable legal framework. Based on its merits, the framework could also be of interest to countries outside the Court's jurisdiction.

[Mandatory treatment of forensic psychiatric patients in the Netherlands: costs and benefits in perspective]

So far, it is not known what costs and benefits are connected with the tbs-measure, a measure that involves a mandatory treatment programme for forensic psychiatric patients.<br/> AIM: To explore the costs and benefits that the tbs-measure has on society, on other important stakeholders such as victims and/or next-of-kin and the forensic psychiatric patients themselves. <br/> METHOD: We studied the relevant literature.<br/> RESULTS: The average costs of the tbs-treatment programme are 1.5 million euros. Additional costs result from recidivism among patients after tbs-treatment. Of these, 21.2% commit another serious offence after 9 years; this recidivism rate is much lower than rates for former offenders who have not received tbs-treatment (63.8%). Other costs arise through the impact that crimes have on stake-holders. Among the benefits of the tbs-programme are a reduction in psychopathological symptoms and in risk factors and lower recommitment rates (including judicial, non-judicial, voluntary and mandatory recommitment rates). Yet another benefit is the resultant increase of protective factors.<br/> CONCLUSION: Forensic psychiatric patients form a unique group within the mental health system in the Netherlands; these patients have multiple complex psychiatric problems and display serious criminal behavior. This group cannot easily be treated elsewhere in the existing judicial or mental health care system because these systems differ in (judicial) frameworks and have different treatment goals, and the forensic psychiatric patients have different psychiatric disorders and display more serious criminal behaviour than patients in the alternative systems. The daily costs of treatment in the tbs-system are higher that in other systems - but they are not exorbitant, given the complexity of the group. The tbs-measure therefore contributes to the safety of society.

[The importance of neuropsychological assessment for forensic psychiatric evaluations of defendants]

In criminal law, increased interest is being shown in brain disorders, cognitive impairment and neuroimaging, particularly in connection with pre-trial reports. In a number of cases the contribution made by neuropsychology to the forensic diagnosis is considerable, and there is a need for further clarification.<br/> AIM: To clarify the relevance of the neuropsychological assessment of suspects and to explore the implications for forensic psychiatry.<br/> METHOD: We discuss recent literature and present a characteristic case selected from the Dutch jurisdiction.<br/> RESULTS: On the basis of neuropsychological assessment it is possible to obtain insight into the relation between brain disorders and criminal behaviour. The case that we present shows that the court may consider the influence of cognitive impairment on behavior to be very important.<br/> CONCLUSION: Neurocognitive disorders can make an important contribution to psychiatric assessments of defendants. In the forensic practice a combined diagnostic approach consisting of psychiatric evaluation, neurological assessment of behaviour, imaging techniques and neuropsychological assessment, is clearly preferable.