Psychological Mechanisms of Behavioral Dysregulation
Condition: Neural Systems; Psychopathology
Study type: Observational

Summary: 
      This study is directed toward a better understanding of how the brain regulates emotions and
      social and antisocial behavior. It will look at the use of the orbital frontal cortex and
      amygdala of the brain. Brain changes are involved in solving conflicts and the feelings that
      such conflicts produce. Conflicts may occur with other people or with general social rules.
      The researchers' expectations are that the findings will be useful in developing therapies
      that may improve people's ability to solve social conflicts and reduce antisocial behavior.

      Adults ages 20 to 50 years of age with psychopathy and a second set of comparison adults, all
      of whom have been released from the Fairfax County Adult Detention Center, may be eligible
      for this study.

      The neurocognitive component of the study, the one pertaining to performance of various
      tasks, will involve 20 adults with psychopathy and 20 comparison adults. The neuroimaging
      component, in which a magnetic resonance imaging (MRI) scan is used, will involve 18 adults
      and 18 comparison adults. Two visits by participants will be entailed. At the first visit,
      patients will undergo the following procedures and tests:

        -  Physical examination

        -  Test of vital signs, lying and standing.

        -  Electrocardiogram.

        -  Collection of blood for chemistry and hematology.

        -  Urinalysis and liver function tests.

        -  Screen for HIV and hepatitis.

        -  Pregnancy test, if applicable, at the first visit and at all further visits.

      Depending on the group to which they are assigned, at the second visit, patients will undergo
      an MRI scan or take part in a variety of computer-based tasks to measure different forms of
      thinking skills, emotional responses, and decision making. During the MRI scan, patients will
      lie still on a table that will slide into the enclosed tunnel of the MRI scanner. They will
      be asked to lie as still as possible. As the scanner takes pictures, patients will hear
      knocking or beeping sounds, and they will wear earplugs to reduce the noise. Patients will be
      able to communicate with the MRI staff at all times during the scan, and they may ask to be
      moved out of the machine at any time. While lying in the MRI scanner, patients will be asked
      to perform tasks presented via a screen. These tasks will involve looking at pictures or
      words, and patients will be asked to make decisions about the pictures. The MRI scan will
      take no more than 2 hours. In regard to the computer-based tasks that participants will
      perform, the tasks are often games presented on a computer. Via computer, or on paper, there
      may be presentations of pictures that bring about an emotion.

      There will be no direct treatment or therapeutic benefits to participation in this study.
      However, the knowledge gained may help people in the future.
    

Detailed description: 
      The Psychopathy Checklist-Revised (Hare, 1991) allows the identification of a relatively
      homogeneous population of individuals who present with marked emotional dysfunction (reduced
      empathy, guilt and attachment to others) as well as a notable propensity for goal-directed
      antisocial behavior. Identification of the neuro-biological underpinnings of their emotional
      dysfunction is of crucial importance as the level of emotion dysfunction is an important
      predictor of long term prognosis.

      Currently, there are two main positions regarding the neural systems that are dysfunctional
      in individuals with psychopathy: First, that the pathology is associated with amygdala
      dysfunction; Secondly, that the pathology is associated with orbital frontal cortex
      dysfunction. A third, more recent position, stresses the interconnections between these two
      systems and the role that development may play in the disorder.

      The current project will determine the performance of individuals with psychopathy and
      comparison individuals on measures which recruit the amygdala and orbital frontal cortex. In
      addition, a series of functional neuro-imaging studies will directly assess neural responses
      in these two systems in individuals with psychopathy. Finally, a structural imaging study
      will examine anatomical differences between the groups. The project should provide clear data
      that will constrain future theorizing on the pathology implicated in this disorder.
    

Keywords: Amygdala; Facial Affect; Instrumental Learning; Psychopathy; Emotion; Orbitofrontal Cortex; Healthy Volunteer; HV