Romero-Martínez Ángel, Bressanutti Sara, Moya-Albiol Luis
Psychobiology Department, University of València, Blasco Ibañez Avenue 21, 46010 Valencia, Spain.
J Clin Med. 2020 Mar 24;9(3):882. doi: 10.3390/jcm9030882.
The field of neurocriminology has proposed several treatments (e.g., pharmacological, brain surgery, androgen-deprivation therapy, neurofeedback) to reduce violence proneness, but unfortunately, their effectiveness has been limited due to their side-effects. Therefore, it is necessary to explore alternative techniques to improve patients' behavioural regulation with minimal undesirable effects. In this regard, non-invasive brain stimulation techniques, which are based on applying changing magnetic fields or electric currents to interfere with cortical excitability, have revealed their usefulness in alleviating the symptomatology of several mental disorders. However, to our knowledge, there are no reviews that assess whether these techniques are useful for reducing violence proneness. Therefore, we conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria using the following databases: PsycINFO, PubMed, Dialnet, Psicodoc, Web of Knowledge, and the Cochrane Library. We initially identified 3746 entries, and eventually included 56 publications. Most of the studies were unanimous in concluding that the application of these techniques over the prefrontal cortex (PFC) was not sufficient to promote anger and irritability reductions in euthymic individuals of both genders. Nevertheless, the application of non-invasive brain stimulation techniques, especially transcranial direct current stimulation, over the right PFC seemed to reduce violent reactions in these individuals by interfering with the interpretation of the unfavourable situations (e.g., threating signals) or inner states that evoked anger. In antisocial and pathological populations, the conclusions were provided by a few pilot studies with important methodological weaknesses. The main conclusion of these studies was that bilateral stimulation of the PFC satisfactorily reduced anger and irritability only in inmates, patients with autism spectrum disorders (ASD), people who suffered a closed-head injury, and agitated patients with Alzheimer's disease. Moreover, combining these techniques with risperidone considerably reduced aggressiveness in these patients. Therefore, it is necessary to be cautious about the benefits of these techniques to control anger, due the methodological weaknesses of these studies. Nonetheless, they offer valuable opportunities to prevent violence by designing new treatments combining brain stimulation with current strategies, such as psychotherapy and psychopharmacology, in order to promote lasting changes.
神经犯罪学领域已经提出了几种治疗方法（如药物治疗、脑部手术、雄激素剥夺疗法、神经反馈）来降低暴力倾向，但不幸的是，由于其副作用，它们的效果有限。因此，有必要探索替代技术，以在产生最小不良影响的情况下改善患者的行为调节。在这方面，基于施加变化的磁场或电流来干扰皮层兴奋性的非侵入性脑刺激技术，已显示出其在减轻几种精神障碍症状方面的有用性。然而，据我们所知，尚无评估这些技术是否有助于降低暴力倾向的综述。因此，我们按照系统评价与荟萃分析的首选报告项目（PRISMA）标准，使用以下数据库进行了一项系统评价：PsycINFO、PubMed、Dialnet、Psicodoc、Web of Knowledge和Cochrane图书馆。我们最初识别出3746条记录，最终纳入了56篇出版物。大多数研究一致得出结论，在男女心境正常个体的前额叶皮质（PFC）上应用这些技术不足以促进愤怒和易怒情绪的减轻。然而，在右侧PFC上应用非侵入性脑刺激技术，尤其是经颅直流电刺激，似乎通过干扰对不利情况（如威胁信号）或引发愤怒的内在状态的解读，来减少这些个体的暴力反应。在反社会和病态人群中，一些存在重要方法学缺陷的初步研究给出了结论。这些研究的主要结论是，仅在囚犯、自闭症谱系障碍（ASD）患者、闭合性颅脑损伤患者以及患有阿尔茨海默病的躁动患者中，对PFC进行双侧刺激能令人满意地减轻愤怒和易怒情绪。此外，将这些技术与利培酮联合使用可显著降低这些患者的攻击性。因此，鉴于这些研究的方法学缺陷，有必要对这些技术控制愤怒的益处持谨慎态度。尽管如此，它们通过设计将脑刺激与当前策略（如心理治疗和精神药理学）相结合的新治疗方法，为预防暴力提供了宝贵机会，以促进持久变化。
