Department of Psychiatry, Otto-von-Guericke University, Magdeburg, Germany,
Eur Arch Psychiatry Clin Neurosci. 2013 Oct;263(7):607-16. doi: 10.1007/s00406-013-0403-6. Epub 2013 Apr 9.
The aim of this study was to determine the frequency and extent of brain anomalies in a large sample of incarcerated violent offenders not previously considered neuropsychiatrically ill, in comparison with non-violent offenders and non-offending controls. MRI and CT brain scans from 287 male prison inmates (162 violent and 125 non-violent) not diagnosed as mentally ill before that were obtained due to headache, vertigo or psychological complaints during imprisonment were assessed and compared to 52 non-criminal controls. Brain scans were rated qualitatively with respect to evidence of structural brain damage. Each case received a semiquantitative rating of "normal" (=0), "questionably abnormal" (=1) or "definitely abnormal" (=2) for the lateral ventricles, frontal/parietal cortex and medial temporal structures bilaterally as well as third ventricle. Overall, offenders displayed a significantly higher rate of morphological abnormality, with the violent offenders scoring significantly higher than non-violent offenders and controls. This difference was statistically detectable for frontal/parietal cortex, medial temporal structures, third ventricle and the left but not the right lateral ventricle. The remarkable prevalence of brain pathology in convicted violent prisoners detectable by neuroradiological routine assessment not only highlights the importance of frontal and temporal structures in the control of social, and specifically of violent behaviour, but also raises questions on the legal culpability of violent offenders with brain abnormalities. The high proportion of undetected presence of structural brain damage emphasizes the need that in violent criminals, the comprehensive routine neuropsychiatric assessment usually performed in routine forensic psychiatric expertises should be complemented with brain imaging.
本研究旨在确定大量未被认为患有神经精神疾病的监禁暴力罪犯中脑异常的频率和程度，与非暴力罪犯和非犯罪对照进行比较。由于头痛、眩晕或监禁期间的心理投诉，对 287 名未被诊断为精神疾病的男性监狱囚犯（162 名暴力犯和 125 名非暴力犯）的 MRI 和 CT 脑部扫描进行了评估，并与 52 名非犯罪对照进行了比较。脑扫描在结构脑损伤方面进行了定性评估。每个病例均获得了双侧外侧脑室、额/顶叶皮质和内侧颞叶结构以及第三脑室的“正常”（=0）、“可疑异常”（=1）或“肯定异常”（=2）的半定量评分。总体而言，罪犯表现出明显更高的形态异常率，暴力罪犯的评分明显高于非暴力罪犯和对照组。这种差异在额叶/顶叶皮质、内侧颞叶结构、第三脑室和左侧但不是右侧外侧脑室中具有统计学意义。通过神经影像学常规评估可检测到的被定罪的暴力囚犯的脑病理学的显著流行率不仅突出了额叶和颞叶结构在控制社会行为、特别是暴力行为方面的重要性，而且还对具有脑异常的暴力罪犯的法律责任提出了质疑。结构脑损伤未被发现的存在比例很高，强调了在暴力罪犯中，通常在常规法医精神病学专家评估中进行的全面常规神经精神病学评估应辅以脑部成像。
