Various neurobiological abnormalities have been documented in those with psychopathy.
Which of the following is one such feature?
A. Various neurobiological findings have been demonstrated in those with psychopathy. These include impairments in appreciation of the emotional significance of external experience, strikingly low levels of baseline and reactive autonomic arousal and reduced fear-based learning. Although impaired verbal abilities have been demonstrated as a consistent risk factor for serious antisocial and delinquent behaviour, those with psychopathic traits often show serious antisocial behaviour, despite showing no impairment in their verbal abilities. In fact, Individuals who were high on callous–unemotional traits (a feature of psychopathy) with higher scores on the measure of verbal abilities reported the greatest violent delinquency in a sample of adolescent delinquents. For non-psychopathic individuals, a significant difference in P300 amplitude was noted between target and non-target stimuli. But in psychopathic individuals reliable P300 amplitude differences between the target and non-target visual conditions were not seen.
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Which of the following is associated with a risk of aggression or violent behaviour in those without serious mental illness?
E. Even in those who are violent but do not have a demonstrable mental illness, the likelihood of having had a neurodevelopmental insult is high. This is shown by the presence of higher rates of minor physical anomalies in violently delinquent adolescents. Similarly, higher rates of neurological soft signs, maternal smoking during pregnancy, and obstetric complications have also been demonstrated. Defects in executive functioning and impulse control have also been shown to correlate with violence in the non-mentally ill samples.
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In those who experience childhood maltreatment which of the following has been associated with a later risk of antisocial behaviour?
B. Children differ in their response to maltreatment in terms of future risk of criminal behaviour. Although maltreatment increases the risk of later criminality by about 50%, most maltreated children do not become delinquents or adult criminals. It is possible that certain genetic susceptibility factors could influence the causal pathway. Caspi et al. demonstrated that the effect of childhood maltreatment on antisocial behaviour was significantly weaker among males with high MAO-A activity than among males with low MAO-A activity. It was also shown that girls with a low MAO-A activity genotype but not those with high MAO-A activity were more likely to develop conduct disorder if they were maltreated. Hence, high MAO-A activity has a protective influence against maltreatment for both sexes.
The most common group of mental disorders diagnosed among homicide offenders is:
A. Depending on the definitions used, the rates of ‘mental disorder’ vary greatly among homicide offenders. The national confidential inquiry into suicide and homicide by people with mental illness in the UK established the frequency of mental illness in a complete national sample of homicides as 44% (lifetime history of mental disorder). At the time of the homicide, 14% had symptoms of mental illness. The most frequent diagnosis was personality disorder (11%), closely followed by alcohol dependence (10%) and drug dependence. Among major mental illnesses, affective disorders (10%) were more common than schizophrenia (7%).
The proportion of those who commit homicide who are in contact with mental health services within the previous year is:
B. From the national confidential inquiry on homicide (1996–9) data, only 8–11% of the total sample of all homicide offenders (n=1594) were in contact with mental health services at some time in the preceding year. The main diagnoses in those with any previous contact with mental health services were schizophrenia (24%), personality disorder (18%), and depressive disorder (16%). Psychiatric reports were not available for nearly one-quarter of all homicide cases.
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