Emotional Reactivity and Capacity for Emotional Control in Psychopathic Individua

描述(申请人提供)：精神病是一种由一系列人际、情感和行为特征组成的人格障碍。精神病患者对刑事和非刑事的公民骚乱负有不成比例的责任。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(如精神分裂症)，人们对这种疾病的病因学基础知之甚少。该领域最占主导地位的理论认为，精神病患者没有能力经历负面情绪(如恐惧、焦虑)，其水平足以调节行为控制或激发回避学习。虽然一致的文献确实证实，精神病患者对厌恶刺激的反应能力降低，但精神变态患者真正无法正常反应的程度几乎完全没有调查。鉴于丧失工作能力模式对社会、临床和法律问题的广泛影响，这种假设受到批判性审查似乎是不可或缺的。因此，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体验到对厌恶刺激的正常反应这一假设。为此，我们将利用情绪调节范式(Ochsner等人，2004年)，能够评估：a)基线情绪反应性，以及b)自愿调节情绪反应性的能力，在被监禁的个体中被分成三组：那些得分高的(30分以上；n=27)，中等的(20到29分之间；n=27)，和低(低于20分的；n=27)在精神病检查表-修订版(PCL-R；Hare，1991)上。在这项情绪调节任务中，参与者将被呈现一系列负价或中性的图片刺激，并将通过屏幕上的指示，被指示要或“观看”图片(控制条件)，或“增加”或“减少”他们对该图片自然产生的情绪反应。这一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--就像以前的工作中所做的那样--而且还可以评估他们增加或减少情绪反应的能力，当这是他们的主要意图时。目前对这种障碍的描述必须假设他们没有能力增加或减少情绪，因为他们假设进入这些情绪系统的途径非常有限。然而，表明精神病患者能够自愿调节他们的情绪反应的迹象表明，至少在某些情况下，他们可以对厌恶的刺激表现出反应。这些发现可能为新的诊断概念化、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。 与公共健康相关：患有精神病的个人对刑事和非刑事的民事破坏负有不成比例的责任。虽然目前的障碍模型假设无法体验与非精神病态个体相当的水平的负面情绪，但这种减少的负面情绪作为核心能力存在的程度在很大程度上仍未得到测试。为了检验这一假设，本研究不像过去经常进行的那样，评估精神病患者对厌恶刺激的自然情绪反应水平，而是建议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。目前对这种障碍的描述必须假设他们没有能力增加或减少情绪，因为他们假设进入这些情绪系统的途径非常有限。然而，表明精神病患者能够自愿调节他们的情绪反应的迹象表明，至少在某些情况下，他们可以对厌恶的刺激表现出反应。这些发现可能为新的诊断概念化、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.