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，包括人际关系，情感和行为特征。患有精神病的人对不成比例的民事破坏负有责任，包括刑事和非刑事。精神病的社会成本，包括财政和情感因素，与其他类似患病率的主要精神疾病（约占总人口的1%）相媲美。然而，相对于其他主要疾病（例如，精神分裂症），很少有人知道的病因基础的障碍。该领域最主要的理论认为，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（例如恐惧，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调查。鉴于无行为能力模式对社会、临床和法律的问题的广泛影响，似乎必须对这种假设进行严格审查。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询问精神病患者确实无法对厌恶刺激进行正常反应的假设。为此，我们将利用情绪调节范式（Ochsner et al.，2004）能够评估：a）基线情绪反应，和B）自愿调节情绪反应的能力，在被监禁的个体样本中分为三组：那些得分高的人（30及以上; n = 27），中度（20 - 29; n = 27）和低（20以下; n = 27）的精神病检查表-修订版（PCL-R; Hare，1991）。在该情绪调节任务中，参与者将被呈现一系列负价或中性图片刺激，并且将通过屏幕上的指令被指示“观看”图片（控制条件），或者“增加”或“减少”他们对该图片的自然发生的情绪反应。这种范式提供了一种独特的能力，不仅可以评估精神病患者的自然情绪反应--正如以前的研究所做的那样--而且可以评估他们增加或减少情绪反应的能力，如果这是他们的主要意图的话。目前对这种障碍的解释肯定是无法增加或减少情绪，因为它们广泛地限制了对这些情绪系统的访问。然而，精神病态者能够主动调节自己的情绪反应，这表明他们至少在某些情况下可以对厌恶性刺激表现出反应。这些发现可以为新的诊断概念，新的预防和治疗方法以及法医和司法系统内的新管理选择打开大门。 公共卫生相关性：患有精神病的人对不成比例的民事破坏负有责任，包括刑事和非刑事。虽然目前的精神障碍模型表明，与非精神病患者相比，他们无法体验到负面影响，但这种负面影响的减少在多大程度上作为核心能力缺失而存在，这在很大程度上尚未得到验证。为了验证这一假设，而不是评估精神病患者的自然水平的情绪反应厌恶刺激，因为在过去经常进行，本研究提出使用功能磁共振成像，同时明确要求精神病患者最大化和最小化他们的情绪反应。目前对这种障碍的解释肯定是无法增加或减少情绪，因为它们广泛地限制了对这些情绪系统的访问。然而，精神病态者能够主动调节自己的情绪反应，这表明他们至少在某些情况下可以对厌恶性刺激表现出反应。这些发现可以为新的诊断概念，新的预防和治疗方法以及法医和司法系统内的新管理选择打开大门。

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.