Neuropsychiatric background factors to violent crime

Abstract

Introduction and aims. Mental disorders among perpetrators of violent and sexual crimes differ from those in the general population in prevalence, course, and patterns of comorbidity. The Göteborg Forensic Neuropsychiatry Projects was initiated to map neuropsychiatric vulnerability factors (disorders, deficits, symptoms, and neurobiological aberrations) among violent offenders and analyze the findings in relation to life histories of violent crimes and aggression. Subjects and Methods. A total of 170 violent and sexual offenders referred to pretrial forensic psychiatric investigation were examined in two Pilot and one Main study. Lifetime psychiatric disorders, including childhood-onset neuropsychiatric disorders (autism spectrum disorders, attention deficit (AD)/hyperactivity disorder (HD), tics, and mental retardation), conduct disorder (CD), adult mental disorders, substance abuse, and personality disorders, including psychopathic traits, were assessed by means of clinical diagnostic interviews, symptom ratings, and neuropsychological tests. Regional and chemical CNS activity and possible pathological changes were investigated by brain imaging (MRI and SPECT) and cerebrospinal fluid analyses (monoamine metabolites, albumin ratios, Ig-indices, tau protein, and GAP-43). Results. All mental disorders had high prevalences. Within the study group, retrospectively rated childhood AD/HD and CD were independently the closest psychiatric covariates to adulthood psychopathy and violent criminality. Frontotemporal regional blood flow was decreased compared to controls and negatively correlated with interpersonal aspects of psychopathy. The CSF HVA/5-HIAA ratio correlated with all aspects of psychopathy. There was a higher than expected prevalence of protein leakage across the blood-brain barrier and minor pathological changes on MRI scans, but no consistent pattern of brain disease or damage. Interpersonal traits of psychopathy covaried especially with decreased limbic blood flow, while the emotional traits covaried with attention deficits, and the behavioral traits with hyperactivity/impulsivity and CSF HVA/5-HIAA. Conclusion. Childhood-onset neuropsychiatric disorders and disruptive behaviors are core problems also among adult offenders and call for comprehensive and structured diagnostic practices with a lifetime perspective, including neurobiological assessments, and targeted care with individually designed treatment programs.