Sensorimotor gating characteristics of violent men with comorbid psychosis and dissocial personality disorder: Relationship with antisocial traits and psychosocial deprivation

Abstract

Evidence suggests violence amongst those with psychosis is not aetiologically homogeneous, and that a large proportion of those who engage in violent behaviour have a comorbid antisocial personality disorder. Initial investigations indicate that this subgroup has distinct historical and neuropsychological characteristics, which may indicate diverse treatment needs. This study investigated sensorimotor gating characteristics of violent men with diagnoses of both psychosis and dissocial personality disorder (DPD) (n=21) relative to violent men with psychosis alone (n=12), DPD alone (n=14) and healthy, non-violent male controls (n=27), using the prepulse inhibition (PPI) paradigm. The results indicated that, relative to the psychosis alone and healthy control groups, the comorbid group had lower PPI, especially at 60-ms prepulse-to-pulse interval. The DPD group took an intermediary position and did not differ from any group. Antisocial personality traits (factor two scores of the Psychopathy Checklist - Revised), and greater severity of childhood psychosocial deprivation (including physical and sexual abuse), were significantly correlated with poor PPI across the clinical sample. The findings suggest diverse sensorimotor gating profiles amongst subgroups of violent offenders, with comorbid psychosis and DPD showing most impairment. This is consistent with a 'double dose' of deficit explanation amongst those with both diagnoses, explained at least in part by presence of antisocial personality traits and childhood psychosocial deprivation.

Decision-making ability in psychosis: a systematic review and meta-analysis of the magnitude, specificity and correlates of impaired performance on the Iowa and Cambridge Gambling Tasks

“…Very low-quality evidence suggested they had lower decision-making performance than people with bipolar disorder ( k = 3, N = 258, g = −0.35, 95% CI −0.60 to −0.11, I 2 0%). Very low-quality evidence from single studies suggested their decision-making performance was significantly lower than people with depression (Da Silva, 2017), and similar to people diagnosed with either high-functioning autism (Zhang et al ., 2015) or dissocial personality disorder (Sedgwick, 2016). Their performance compared with people with obsessive-compulsive disorder was non-significantly lower in one study (Whitney et al ., 2004), but significantly better in another (Cavallaro et al ., 2003).…”

Sensorimotor gating deficits in schizophrenia: Advancing our understanding of the phenotype, its neural circuitry and genetic substrates

“…The impairment of PPI in psychosis can also be complicated by comorbid disorders; this fact is underscored by Sedwick et al (2017) in this issue, who report that in a population of violent men in a high-secure forensic psychiatric hospital, with or without psychosis, PPI is impaired among individuals meeting criteria for an antisocial personality disorder (specifically, the ICD-10 classification of Dissocial Personality Disorder (DPD)). This observation is generally consistent with several points raised elsewhere within this issue, i.e.…”

Schizotypy and psychopathic tendencies interactively improve misattribution of affect in boys with conduct problems

“…This hypothesis has yet to be tested in a sample of adolescents, but several studies have examined the impact of SSDs with comorbid antisocial personality pathology on psychological functioning in adult men. In one study, prepulse inhibition of the startle response (that is, a reduction of the response to a startling stimulus (pulse) when this is preceded by a lower intensity stimulus (prepulse), serving as a mechanism that limits excess sensory input) was compared between violent men with comorbid dissocial PD and psychosis, violent men with psychosis alone or dissocial PD alone, and healthy controls [ 56 ]. Patients with comorbid diagnoses showed impaired prepulse inhibition compared with violent men with psychosis alone and a healthy control group, and this finding was interpreted to reflect a double dose of deficit [ 56 ].…”

“…In one study, prepulse inhibition of the startle response (that is, a reduction of the response to a startling stimulus (pulse) when this is preceded by a lower intensity stimulus (prepulse), serving as a mechanism that limits excess sensory input) was compared between violent men with comorbid dissocial PD and psychosis, violent men with psychosis alone or dissocial PD alone, and healthy controls [ 56 ]. Patients with comorbid diagnoses showed impaired prepulse inhibition compared with violent men with psychosis alone and a healthy control group, and this finding was interpreted to reflect a double dose of deficit [ 56 ]. However, performance in the comorbid group was similar to that of dissocial PD patients, and there was a negative effect of PCL-R Factor 2 (Lifestyle, Antisocial) scores on prepulse inhibition [ 56 ].…”

“…Patients with comorbid diagnoses showed impaired prepulse inhibition compared with violent men with psychosis alone and a healthy control group, and this finding was interpreted to reflect a double dose of deficit [ 56 ]. However, performance in the comorbid group was similar to that of dissocial PD patients, and there was a negative effect of PCL-R Factor 2 (Lifestyle, Antisocial) scores on prepulse inhibition [ 56 ]. As such, these differences may more simply reflect the presence of antisocial personality pathology more generally, rather than the effects of comorbid diagnoses.…”