ADVANCES IN NEUROPSYCHIATRY: Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review

Abstract

Objectives-To establish the link between frontal lobe dysfunction and violent and criminal behaviour, based on a review of relevant literature. Methods-Articles relating evidence of frontal lobe dysfunction with violence or crime were collected through a MEDLINE search using the keyword "frontal lobe" combined with the terms "aggression," "violence," "crime," "antisocial personality disorder," "psychopathy," "impulse control disorders", and "episodic dyscontrol." Reference lists were then searched for additional articles. Results-High rates of neuropsychiatric abnormalities reported in persons with violent and criminal behaviour suggest an association between aggressive dyscontrol and brain injury, especially involving the frontal lobes. The studies reviewed support an association between frontal lobe dysfunction and increased aggressive and antisocial behaviour. Focal orbitofrontal injury is specifically associated with increased aggression. Deficits in frontal executive function may increase the likelihood of future aggression, but no study has reliably demonstrated a characteristic pattern of frontal network dysfunction predictive of violent crime. Conclusions-Clinically significant focal frontal lobe dysfunction is associated with aggressive dyscontrol, but the increased risk of violence seems less than is widely presumed. Evidence is strongest for an association between focal prefrontal damage and an impulsive subtype of aggressive behaviour. (J Neurol Neurosurg Psychiatry 2001;71:720-726)

The Spectrum of Sociopathy in Dementia

“…13,14,31 When frontal lobe-injured patients commit antisocial acts, they are mostly disinhibited; that is, they are impulsively reactive to environmental stimuli, with decreased concern for the consequences of their behavior. 9,32 Also, damage to adjacent OFC regions of prefrontal cortex impairs automatic feedback from social cues, particularly angry or aversive expressions, and the control of impulsive responses. 9,13,23,33–37 In sum, frontally-impaired patients commit impulsive acts without emotion or concern for the consequences.…”

“…9,32 Also, damage to adjacent OFC regions of prefrontal cortex impairs automatic feedback from social cues, particularly angry or aversive expressions, and the control of impulsive responses. 9,13,23,33–37 In sum, frontally-impaired patients commit impulsive acts without emotion or concern for the consequences. Similar to these acute frontal-lesioned patients, many dementia patients with frontal-predominant disease commit disinhibited antisocial acts without premeditation or foresight.…”

“…First, most acquired sociopathy from acute frontal lesions appears to result from disinhibition, poor impulse control, and a tendency to react to immediate environmental stimuli. 9 Many dementia patients, however, have sociopathy that is not primarily due to dis-inhibition, but due to other mechanisms. Second, the sociopathy of dementia differs from antisocial/psychopathic personality disorder.…”

“…10,11 Dementia patients do not develop antisocial/psychopathic personality traits such as manipulation, deception, grandiosity, instrumental or goal-directed aggression, and calculated moral transgressions, but may have shallow emotions, lack of empathy, lack of remorse, a poor ability to learn from punishment, and reactive aggression. 9,12 Some investigators, however, report that lesions of VMPFC and adjacent areas, if acquired early in life, can impair the development of socio-moral knowledge and judgment, similar to the impairment of psychopathic personality. 13,14 Among patients with FTD, other investigators have shown decreased emotional responsiveness to others and a tendency to respond to moral dilemmas in a calculated fashion.…”

Avaliação neuropsicológica das funções executivas: considerações metodológicas

“…Estudos recentes têm evidenciado que o comprometimento das FE ocorre não apenas em pacientes com lesões frontais, mas também em pacientes com lesões do tálamo (Van der Werf, Witter, Uylings, & Jolles, 2000), nas demências degenerativas (Crawford, Blacmore, Lamb, & Simpson, 2000;Green, 2000), no comportamento antisocial (Brower & Price, 2001), na dislexia (Brosnan et al, 2002) ou como resultado do processo de alteração normal do envelhecimento (West, 1996;Woodruff-Pak, 1999). As extensas conexões do córtex frontal com outras regiões corticais e subcorticais impõem obstáculos que dificultam as pesquisas clínicas das FE nos diferentes quadros neuropsiquiátricos (Royall et al, 2002).…”