Neuropsychology and Law 2

Question 1

Traumatic Brain Injury (TBI)

Answer 1

Alteration in brain physiology or anatomy caused by an external force.
Its severity is determined by the Glasgow Coma Scale which measures motor, verbal and eye-opening responses immediately after a TBI.

Question 2

Aggression

Answer 2

Major complication of TBI, verbal aggression is the most common (28.4%) –> link with criminality.

Question 3

Frontal lobe dysfunctions

Answer 3

• Impulsivity and inability to modify behaviour.
• Cognitive impairments in attention, memory and planning.
• Changes in personality, lack of awareness and anxiety/depression.

Question 4

Risk factors for aggression

Answer 4

a) frontal lobe lesions;
b) amygdala –> disinhibition, impulsivity, inability to adjust behaviours;
c) injury severity, history of TBIs, aggressive traits pre-TBI, substance abuse and depressive/anxiety disorders.

Question 5

Risk factor for incarceration

Answer 5

TBIs increase the likelihood of incarceration due to personality flaws leading to criminal behaviour. Incarceration becomes an easy solution which, tho, hampers the potential for full rehabilitation.

Question 6

Schizophrenia

Answer 6

A severe mental disorder that affects thinking, emotions, and behaviour. It can involve hallucinations, delusions, and disorganised thinking, which may lead to unpredictable or aggressive behaviour.

Question 7

Organic Aggressive Syndrome (OAS)

Answer 7

Aggression is reactive, non-reflective, non-instrumental, explosive, periodic and edodystonic (individual feels bad).
Uncommon + only in patients with severe TBIs.

Question 8

Aggressive non-purposeful behaviour

Answer 8

Non-purposeful but instrumental: directed at a specific person in response to a perceived threat/towards a specific end.

Question 9

Violent, purposeful and instrumental aggression

Answer 9

Violence for revenge, for hire or in the defence of self/others.

Question 10

Environmental factors

Answer 10

Patients with (pre-injury) anxiety, attention deficits, (post-injury) disabilities, lower socio-economic status and more severe injuries developed more serious aggressive symptoms.
Overall, a TBI strengthens already existing behaviours.

Question 11

Frontal lobe

Answer 11

Responsible for cognition, emotion regulation, decision-making and behaviour control.

Question 12

Temporal lobe

Answer 12

Responsible for memory, language and emotional processing.

Question 13

Neuroanatomy of aggression post TBIs

Answer 13

Head injuries affecting the frontal and temporal lobes can lead to shearing and staining forces impacting the system of communication between different brain areas.

Question 14

Dorsolateral Prefrontal Subcortical Circuit (DLPFC)

Answer 14

Involved in cognitive processes such as retrieving, categorising, organising, and sequencing information, problem solving, abstraction, judgment and insight.

If injured, impairs problem solving and increases the tendency towards environmentally bound behaviour –> maladaptive responses (e.g. aggression) to environmentally stressful situations.

Question 15

Lateral Orbitofrontal Subcortical Circuit (LOSC)

Answer 15

Supports socially appropriate behaviours, imbuing limbic driven appetites and emotions with social insight and judgment, and putting the brakes on contextually inappropriate behavioural responses.

Injury leads to irritability, impulsiveness, lability, tactlessness and environmental dependency (aggression).

Question 15

Cingulum

Answer 15

Serves as a neuro behaviourally critical pathway. When compromised increases risk for externally and internally directed impulsive aggression.

Question 16

Suicide

Answer 16

Suicidal thoughts and attempts may be increased post TBI due to depression and aggressive behaviours, as well as due to alcohol abuse (by 5.7 times).

Question 17

Frontotemporal dementia (FTD)

Answer 17

Neurodegenerative disorder (late 50s) affecting the frontal and anterior temporal regions. Patients have a personality change with relatively intact cognition + (potentially) primary aggressive aphasia, etc.
Patients are trasgressive towards social norms (e.g, sociopathic behaviours), loss of empathy, and disinhibited, compulsive acts.

Question 18

M’ Naughten Rules

Answer 18

The perpetrator be incapable, by reason of mental illness, of understanding the nature of the criminal act or of knowing that the act was wrong.

Used for judgments of not guilty by reason of insanity.

Question 19

MRI

Answer 19

Magnetic resonance imaging

Question 20

PET

Answer 20

Positron emission tomography

Question 21

Impulsive Risk Taking (bottom-up self-control)

Answer 21

Whether prisoners, after 3 months, develop tendency to act impulsively or engage in risky behaviours.

Question 22

Executive Function (top-down self-control)

Answer 22

Whether, after 3 months, prisoners’ ability to think critically, plan ahead, make better decision is affected by a controlled environment.