Psychopathy,platelet MAO activity and criminality among former juvenile delinquents

Psychopathy-related personality traits as well as platelet monoamine oxidase (MAO) activity and criminality from the age of 15 years were studied in a group of 68 male former juvenile delinquents and 32 control subjects. The former juvenile delinquents registered for crime as adults were found to have higher Psychopathy Check List (PCL) scores and lower platelet MA0 activity than either juvenile delinquents who were not registered criminals from the age of 15 years or non-criminal controls. Although PCL scores and platelet MAO activity were unrelated, a configural frequency analysis showed a significant interaction. Individuals with PCL scores, low platelet MAO activity and persistent criminal behaviour constituted a significant ‘type’. Among the 27 former juvenile delinquents who developed persistent criminality, 21 subjects (78%) had PCL scores greater than 0 and low platelet MAO activity, while none of these persistent criminals were characterized by a combination of zero PCL score and high platelet MAO activity.     

Psychobiology of borderline personality traits related to subtypes of eating disorders: a study of platelet MAO activity

Increased and decreased levers of platelet monoamine oxidase (MAO) activity have been reported in patients with eating disorders, indicating abnormalities of the serotonin turnover. However, whether these findings are related to eating disorders or are rather reflecting the pathophysiology of borderline personality traits in these patients is still unknown. Platelet MAO activity and comorbid personality disorders were investigated in 72 patients with different subtypes of eating disorders (ED) and in a group of 28 healthy controls. ED patients comprised the following subtypes: 25 anorexia nervosa (AN) restrictive, 14 AN binge eating-purging (AN b-p), 3 anorexia nervosa not otherwise specified (AN NOS) and 30 bulimia nervosa (BN). Personality disorders and traits were assessed with the Structured Interview for Personality Disorders (SCID-II), the Zanarini Rating Scale for Borderline Personality Disorder, and the Barrat Impulsiveness Scale. Platelet MAO activity was significantly lower in ED patients with comorbid borderline personality disorder (BPD) than in ED without Borderline personality disorder (BDP). Platelet MAO activity was significantly and inversely correlated with the number and severity of BPD clinical features. In the subsample of patients with binge eating-purging symptoms (AN b-p, AN NOS and BN), platelet MAO activity was significantly lower in binge-purge patients with comorbid BPD than in binge-purge patients without BPD. The whole group of eating disorders had a significantly reduced lever of platelet MAO activity compared with the control group. The results suggest that low platelet MAO activity might characterize eating disorders with comorbid borderline personality traits, reflecting greater serotonin dysfunction in these patients. The role of decreased platelet MAO as an endophenotype with specific clinical manifestations should be explored in future studies.     

Mental and personality disorders as well as personality traits in a Swedish male criminal population

The study describes personality traits and the presence of personality disorders and mental disorders in a consecutive series of 130 male prisoners in Swedish jails sentenced for serious criminality. The investigation included a psychiatric examination by means of the Structured Clinical Interview (SCID) as well as information taken from criminal records. Personality assessments were made by means of self-report questionnaires, the Karolinska Scales of Personality (KSP) and the DSM-IV and ICD-10 Personality Disorder Questionnaire (DIP-Q). The most common mental disorders were alcohol and drug abuse/dependence, which were present in 55% of the subjects. Personality disorders, too, were common, being present in 56% of the subjects. In the KSP, high scores were found in scales related to impulsiveness, sensation-seeking, nervous tension and distress, cognitive-social anxiety, hostility and aggression. Very low scores were found in the Socialization scale, reflecting a high degree of psychopathy-related personality traits. Despite the high morbidity, the global level of functioning was unexpectedly high, 66 according to GAF. The male prisoners sentenced for heavy criminality had a high degree of both mental disorders and personality disorders. Furthermore, psychopathy-related personality traits were common.     

Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population.

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects.Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.     

Personality traits in social phobia.

The purpose was to assess personality traits in subjects with a DSM-IV diagnosis of social phobia. Thirty-two subjects were administered the Structured Clinical Interview for DSM-IV for Axes I and II disorders (SCID I and II). Personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Current and lifetime axis I co-morbidity was diagnosed in 28% and 53% of the subjects, respectively. In total, 59% had at least one personality disorder and 47% were diagnosed with an avoidant personality disorder. The social phobics scored significantly higher than a Swedish normative sample on the KSP measuring anxiety proneness, irritability, detachment, and indirect aggression but lower on the scales for socialisation and social desirability. The presence as compared to absence of avoidant personality disorder in the social phobics was associated with significantly higher psychic anxiety and inhibition of aggression. In addition, symptom severity was higher in social phobics with an avoidant personality disorder. Generally, the results support the view that social phobia and avoidant personality disorder reflect different aspects of a social anxiety spectrum.     

Long-term validity of biological markers of psychopathy and criminal recidivism: follow-up 6-8 years after forensic psychiatric investigation

This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.     

Mood disorder history and personality assessment in premenstrual dysphoric disorder.

BACKGROUND: Menstrually related dysphoria is known to be associated with other affective disorders, notably major depressive disorder and puerperal depression. The relationship between premenstrual dysphoric disorder (PMDD) and maladaptive personality disorders and traits, however, is less established, at least in part because of the methodological and nosologic difficulties in the diagnosis of both PMDD and personality disorders. This study seeks to address this problem to elucidate the relationship between PMDD, other affective disturbances commonly experienced by women, and maladaptive personality. METHOD: Axis I and II disorders were examined using standardized instruments and stringent diagnostic criteria (DSM-IV and the International Personality Disorders Examination) in 34 women with DSM-IV PMDD and 22 healthy women without severe premenstrual mood changes. RESULTS: Seventy-seven percent of the PMDD group had suffered from a past Axis I disorder in comparison with 17% of the control group. Two thirds of the parous women with PMDD had suffered from major depressive disorder in the puerperium. Personality disorder diagnoses were not highly represented in either group of women. The women with PMDD had significantly more obsessional personality traits (p < .001 ) but not absolute personality disorder diagnoses. CONCLUSION: Obsessional symptoms are known to cluster with the affective disorders and may reflect underlying temperamental and biological vulnerability. This study provides further evidence of the link between serotonergic dysregulation, personality vulnerability, and mood changes related to the female reproductive cycle.     

Bipolar disorder with comorbid cluster B personality disorder features: impact on suicidality

BACKGROUND: Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions between bipolar disorder and cluster B personality disorders remain a source of unresolved clinical controversy. The extent to which comorbid personality disorders impact course and outcome for bipolar patients also has received little systematic study. METHOD: One hundred DSM-IV bipolar I (N = 73) or II (N = 27) patients consecutively underwent diagnostic evaluations with structured clinical interviews for DSM-IV Axis I and cluster B Axis II disorders, along with assessments of histories of childhood trauma or abuse. Cluster B diagnostic comorbidity was examined relative to lifetime substance abuse, suicide attempt histories, and other clinical features. RESULTS: Thirty percent of subjects met DSM-IV criteria for a cluster B personality disorder (17% borderline, 6% antisocial, 5% histrionic, 8% narcissistic). Cluster B diagnoses were significantly linked with histories of childhood emotional abuse (p = .009), physical abuse (p = .014), and emotional neglect (p = .022), but not sexual abuse or physical neglect. Cluster B comorbidity was associated with significantly more lifetime suicide attempts and current depression. Lifetime suicide attempts were significantly associated with cluster B comorbidity (OR = 3.195, 95% CI = 1.124 to 9.088), controlling for current depression severity, lifetime substance abuse, and past sexual or emotional abuse. CONCLUSIONS: Cluster B personality disorders are prevalent comorbid conditions identifiable in a substantial number of individuals with bipolar disorder, making an independent contribution to increased lifetime suicide risk.     

Dis-social personality disorder

Deviant behavior is gaining in clinical importance if it is founded on stable, characteristic, and enduring patterns of psychopathologically relevant personality traits which have their onset in childhood or adolescence. The classification of these traits shows variations, so that a distinction between the ICD-10 diagnosis of dis-social personality disorder, DSM-IV diagnosis of antisocial personality disorder, and the concept "psychopathy" is necessary. Our knowledge about the biological basis of antisocial behavior includes neurophysiologic, psychophysiologic, and genetic findings. Also relevant are results of neurotransmitter studies and structural resp. functional neuroimaging findings. Psychosocial risk factors include parental deficits, rejection, disregard, unstable relations, and abuse. Efficient psychotherapeutic treatment is cognitive-behavioral. Pharmacologic treatment is largely "off-label". The diagnosis of antisocial and dis-social personality disorders allows no conclusions on criminal responsibility. In addition to psychiatric diagnostics, considerations on the severity of the disorder and its effects on the ability to inhibit actions are necessary.     

Platelet MAO activity and personality characteristics

Low levels of platelet monoamine oxidase have been found in schizophrenic and bipolar depressive patients. The enzyme activity seems to correlate negatively with certain personality traits (social activity, sensation seeking, hypomania, positive affect and monotony avoidance) which are correlated to some extent with the score “extraversion” from the Eysenck Personality Questionnaire (EPQ). The present study was carried out in an attempt to investigate further the possible correlation between platelet MAO activity and the personality traits measured by the EPQ. 41 schizophrenic patients and 20 healthy probands were blindly examined for platelet MAO activity and personality characteristics. The enzyme activity was found to correlate negatively with the extra-version score in patients and healthy probands, which is in agreement with the data from other studies. This correlation is discussed and a hypothesis suggested.     

Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity

The functional linkage between platelet MAO activity and psychopathology was explored by analyzing temperamental correlates in 40 male subjects by means of scales from the Eysenck Personality Questionnaire (EPQ), the Zuckerman Sensation Seeking Inventory, and the Karolinska Scales of Personality (KSP). Linear correlations were found with two sensation seeking scales, replicating earlier findings. However, nonlinear correlations predominated. Subjects with intermediate platelet MAO activity had higher scores in conformity scales and lower scores in anxiety and hostility scales than low and high MAO subgroups. Low MAO subjects showed a pattern of higher scores in KSP Impulsiveness, EPQ Neuroticism, and KSP Somatic Anxiety and Irritability and lower scores in KSP Socialization, in line with personality profiles found in alcoholics, psychopaths, and suicide attempters who also tend to have low platelet MAO activity. High MAO subjects scored lower in sensation seeking and conformity scales and higher in KSP Psychasthenia, Muscular Tension and Suspicion scales, consistent with clinical links between high platelet MAO activity and anxiety and paranoia.     

瑞典大学人格量表在强迫症患者中的应用

目的采用瑞典大学人格量表（SSP）探讨强迫症患者的人格特质及其与不同临床特征的关系。方法收集33例符合DSM-IV诊断标准的强迫症患者及31例健康对照,采用瑞典大学人格量表（SSP）评估两组样本的人格特质,采用Yale-Brown强迫量表（Y-BOCS）、汉密尔顿焦虑量表（HA-MA）和汉密尔顿抑郁量表（HAMD）评估强迫症患者临床特征。结果强迫症组躯体性焦虑、精神性焦虑、应激敏感性、怨恨、兴奋性和不信任分量表分别为57.70±11.64、63.19±10.41、66.77±10.31、61.14±7.56、54.09±9.13、57.15±11.57,健康对照组分别为46.18±8.30、52.08±8.42、55.79±7.69、56.37±7.92、48.03±7.69、51.59±9.97,强迫症组高于对照组,差异有统计学意义。其余分量表的差异无统计学意义。强迫症患者SSP社交愿望分与Y-BOCS总分呈正相关（r=0.349,P〈0.05）;躯体性焦虑、精神性焦虑和应激敏感性分与HAMA、HAMD总分呈正相关;社交愿望分与HAMA呈正相关;怨恨分与HAMD呈正相关。结论强迫症患者具有神经质和攻击性人格特质;强迫症患者的人格特质与强迫、焦虑和抑郁症状之间可能存在一定的相关性。     

Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia

The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders.     

Serum testosterone levels, mental disorders and criminal behaviour.

OBJECTIVE: Although previous studies have revealed an association between androgens and aggression, there is a lack of knowledge of this issue in different mental disorders. METHOD: The associations between serum testosterone levels and criminal behaviour in different mental disorders were examined using data collected from forensic psychiatric male patients (20 schizophrenics and 42 subjects with personality disorders). RESULTS: Male criminals with personality disorders had significantly higher serum levels of total and free testosterone than criminal schizophrenics. Among schizophrenics, total (P=0.01) and free testosterone (P=0.01) declined significantly more with age compared to healthy controls and patients with personality disorders, and also correlated with duration of neuroleptic drug use (r=-0.60, P=0.000 for total and r=-0.46, P=0.0001 for free testosterone). The recidivists with personality disorder had higher total (P=0.04) and free testosterone (P=0.05) levels than non-recidivists with personality disorder. CONCLUSION: Personality disordered criminals with multiple offences had high serum testosterone levels. The low testosterone concentrations among schizophrenics may be due either to long-term use of neuroleptic agents or to the mental illness itself and its possible inhibition of the pituitary-gonadal axis.     

Personality traits and platelet MAO activity in alcohol and drug abusing teenage boys

The aim of this study has been to investigate whether teenage boys with mixed drug abuse differ from those with pure alcohol abuse as concerns personality traits and platelet monoamine oxidase activity. The series included 1129 consecutive 18-year-old males called to the Enlistment Center in the northern part of Sweden. A special inventory was constructed based on Zuckerman Sensation Seeking Scale (SSS), Eysenck's Personality Inventory (EPI), the Karolinska Scales of Personality (KSP) and questions about alcohol and drug consumption. The subjects with mixed drug abuse (n = 96) had high scores in the two subscales of SSS and KSP related to ability to stand boredom, high scores in both subscales of EPI and KSP related to impulsivity, high scores in Thrill and Adventure Seeking (TAS) and Experience Seeking (ES) of SSS as well as low platelet monoamine oxidase activity. The males with pure alcohol abuse (n = 33) also showed signs of monotony avoidance and impulsivity, but this type of abuse was not clearly related to low platelet monoamine oxidase activity and not to the aspects of curiosity included in the SSS such as TAS and ES. These findings are consistent with the picture earlier found as concerns "Type II" alcoholism which has an early onset, is genetically transmitted, is associated with mixed drug abuse and social complications.     

Thrombocyte monoamine oxidase activity and personality traits in women with severe premenstrual syndrome

Women with premenstrual syndrome (PMS) of such severity that they actively had sought medical attention for their symptoms were compared with healthy female students with regard to platelet MAO activity and temperamental correlates by means of the Karolinska Scales of Personality (KSP), scales from the Eysenck Personality Questionnaire (EPQ) and Eysenck's IVE inventory. The women with PMS were divided into two groups; irritability and depression as predominating symptom. No variation in platelet MAO was found during the menstrual cycle, either in patients or in controls. Both PMS groups had significantly lower platelet MAO activity than the controls. There was no difference between the two groups with PMS. Also with regard to personality traits there were considerable differences between the females with PMS and the controls. There were few differences between the two groups of PMS patients. Thus, the patients scored significantly higher as regards somatic anxiety, muscular tension, indirect aggression, verbal aggression and neuroticism and lower as regards socialization than the controls.