Emotional Reactivity and Capacity for Emotional Control in Psychopathic Individua

描述（由申请人提供）：精神病是一种人格障碍，由一系列人际、情感和行为特征组成。精神病患者要为不成比例的民事破坏负责，包括刑事的和非刑事的。精神病的社会成本，包括财政和情感因素，可与其他流行率相似的主要精神疾病相媲美（约占总人口的1%）。然而，相对于其他主要疾病（如精神分裂症），人们对这种疾病的病因学基础知之甚少。该领域最主流的理论假设精神病患者无法体验到足以调节行为控制或激发回避学习的负面影响（如恐惧、焦虑）。虽然一致的文献确实证实了精神病患者对厌恶刺激的反应性降低，但精神病患者真正无法正常反应的程度几乎完全没有得到研究。鉴于无行为能力模型对社会、临床和法律问题的广泛影响，这种假设接受批判性审查似乎是不可或缺的。因此，本R21应用程序的目的是使用生理和功能磁共振成像技术来批判性地质疑精神变态者真的无法体验对厌恶刺激的正常反应的假设。为此，我们将利用一种情绪调节范式（Ochsner et al., 2004）来评估：a)基线情绪反应，b)自愿调节情绪反应的能力，将被监禁的个体样本分为三组：在精神病检查表-修订版（PCL-R; Hare, 1991）上得分高的（30分及以上；n = 27），中等（20至29分之间；n = 27）和低（低于20分；n = 27）。在这个情绪调节任务中，参与者将看到一系列负面或中性的图片刺激，并通过屏幕上的指示，指示他们要么“观看”图片（控制条件），要么“增加”或“减少”他们对图片自然产生的情绪反应。该范式提供了一种独特的能力，不仅可以评估精神变态者的自然情绪反应——正如之前的工作所做的那样——还可以评估他们在主要意图时增加或减少情绪反应的能力。目前对这种疾病的描述必须假定无法增加或减少情绪，因为它们假定对这些情绪系统的访问非常有限。然而，有迹象表明，精神病患者能够自愿调节他们的情绪反应，这表明，至少在某些情况下，他们可以对厌恶的刺激表现出反应。这些发现可以在法医和司法系统中为新的诊断概念、新的预防和治疗方法以及新的管理选择打开大门。

DESCRIPTION (provided by applicant): Psychopathy is a personality disorder comprised of a constellation of interpersonal, affective and behavioral characteristics. Individuals with psychopathy are responsible for a disproportionate amount of civil disruption, both criminal and noncriminal. The societal cost of psychopathy, including fiscal and emotional components, rivals those of other major mental illnesses of similar prevalence (~1% general population). However, relative to other major disorders (e.g., schizophrenia), little is known about the etiological bases of the disorder. The most dominant theories in the field posit the psychopath incapable of experiencing negative affect (e.g. fear, anxiety) at levels sufficient to mediate behavioral control or motivate avoidance learning. While a consistent literature has indeed confirmed that psychopaths show reduced reactivity to aversive stimuli, the extent to which psychopaths are truly incapable of normal reactivity remains almost entirely uninvestigated. Given the broad implications of an incapacity model for social, clinical and legal issues, it seems integral that such an assumption receive critical review. As such, the aim of this R21 application is to use physiological and functional magnetic resonance imaging techniques to critically interrogate the assumption that psychopaths are truly incapable of experiencing normal reactivity to aversive stimuli. To this end, we will utilize an emotion- regulation paradigm (Ochsner et al., 2004) capable of evaluating: a) the baseline emotional reactivity, and b) the ability to voluntarily modulate emotional reactivity, within a sample of incarcerated individuals stratified into three groups: those who score high (30 and above; n = 27), moderate (between 20 and 29; n = 27), and low (below 20; n = 27) on the Psychopathy Checklist - Revised (PCL-R; Hare, 1991). Within this emotion- regulation task, participants will be presented with a series of negatively-valent or neutral picture stimuli, and will be instructed, via on-screen instruction, to either "WATCH" the picture (control condition), or to "INCREASE" or "DECREASE" their naturally-occurring emotional response to that picture. The paradigm affords a unique ability to evaluate not just the psychopaths' natural emotional response - as has been undertaken in previous work - but also their ability to increase or decrease that emotional response when that is their primary intention. Current accounts of the disorder must posit an inability to increase or decrease emotion, since they posit broadly limited access to these emotional systems. Indication that psychopaths are capable of voluntarily modulating their emotional reactivity would, however, suggest that they can, at least under certain circumstances, manifest reactivity to aversive stimuli. Such findings could open doors for new diagnostic conceptualizations, new preventative and therapeutic approaches, and new management options within forensic and judicial systems. PUBLIC HEALTH RELEVANCE: Individuals with psychopathy are responsible for a disproportionate amount of civil disruption, both criminal and noncriminal. While current models of the disorder posit an inability to experience negative affect at levels comparable to nonpsychopathic individual, the extent to which this decreased negative affect exists as a core inability remains largely untested. To test this assumption, instead of evaluating psychopaths' natural level of emotional reactivity to aversive stimuli, as has often been undertaken in the past, the present study proposes to use fMRI while explicitly asking psychopaths to maximize and minimize their emotional reactivity. Current accounts of the disorder must posit an inability to increase or decrease emotion, since they posit broadly limited access to these emotional systems. Indication that psychopaths are capable of voluntarily modulating their emotional reactivity would, however, suggest that they can, at least under certain circumstances, manifest reactivity to aversive stimuli. Such findings could open doors for new diagnostic conceptualizations, new preventative and therapeutic approaches, and new management options within forensic and judicial systems.