FRI, Oct 8 \ 18.30-21.00 \ Biology of Sexual Aggression

080
BIOLOGICAL ASPECTS OF AGGRESSIVE BEHAVIOR

Lefteris Lykouras
Professor of Psychiatry, Athens University, Attikon Hospital, Athens, Greece

Environmental and psychological factors influencing aggressive behavior have been studied for several centuries. However, only in the past three decades neurobiologic factors that may modulate impulsive aggression have been examined. Several lines of evidence establish a relevance of central neurotransmission to aggressive and impulsive behavior. For example, evidence coming from extensive research in humans and in animals, points to a strong relationship between serotonergic dysfunction and aggression. Increased catecholaminergic activity also appears to play a role in the manifestation of aggressive behavior. Other neurobiologic systems like arginine or vasopressin may influence impulsive aggression. There have been few studies indicating that interactions between neurobiologic systems such as testosterone and serotonin may have a significant effect on aggressive and violent behavior. Today, it becomes clear that genetic factors predisposing to aggressive and violent behavior do exist. Family, adoption and twin studies suggest that manifestation of aggression requires the presence of both genetic and environmental factors. Genetic research on violence provides promises and continues to examine specific molecular genetic markers and their association phenotypes.

081
DRUG THERAPY OF AGGRESSIVE BEHAVIOR

Vasilis Alevizos
Professor of Psychiatry, Athens University, Aiginition Hospital, Athens, Greece
valeviz@med.uoa.gr

When assessing patients with aggression, the clinician should focus on careful history taking to diagnose any medical condition that could underlie the aggressive behavior. A wide range of medications are effective in the treatment and prophylaxis of aggression. Antipsychotics are the most commonly used medications for the treatment of acute and chronic aggression that derives from psychosis. Benzodiazepines may also be indicated for the treatment of acute aggression. Intramuscular lorazepam is an affective medication for the emergency treatment of aggressive patients. When aggression persists beyond several weeks, maintenance treatment is indicated, guided by the underlying illness that is responsible for the aggressive behavior. In psychotic patients, if the aggression persists in the absence of psychotic symptoms, other medications, such as antimanic and anticonvulsants, anxiolytics, antidepressants and β-blockers can be used. Lithium and anticonvulsants (carbamazepine, valproate) have been shown to be of value in the treatment of aggression in patients with bipolar disorder as well as in patients with mental retardation, traumatic brain injury, in children and adolescents, in prison inmates and in patients with dementias. Antidepressants (SSRIs), acting on the serotonergic system, and buspirone, a serotonin 1A agonist, have been reported to be useful in the treatment of aggression associated with brain disorders. Finally, it has been shown that β-blockers (propranolol, nadolol and pindolol) are specific and effective agents for the treatment of aggression in patients with neuropsychiatric disorders. However, the side effects of the above agents often complicate treatment.

082
PRENATAL FACTORS ASSOCIATED WITH THE DEVELOPMENT OF SEXUAL OFFENDERS

Ron Langevin, PhD, Mara Langevin, RN
rlangevin@sprint.ca

A sample of 1091 sex offenders was examined for a number of factors which potentially may influence brain and endocrine system development. Among the findings, sex offenders tended to come from large families. A third of the offenders had four or more siblings (range 0 to 23) and they themselves averaged third born (range 1 to 16), with 22% of the offenders being fourth or later born among thier sibs. Their mother tended to be older at the birth of the subjects in this study and they had a higher incidence of diabetes than seen in the general Canadian population. The significance of these factors on the development of sexual disorders is discussed.

083
BIOLOGICAL ASPECTS OF PEDOPHILIA

Wolfgang Berner, Andreas Hill, Peer Briken
Institute for Sex-Research and Forensic Psychiatry, Hamburg, Germany
berner@ukie.uni-hamburg.de

Brain-morphological research (Neuro-imaging) in sex offenders produced some hints of prefrontal dysfunctions, which may reflect impulsivity or a tendency to act in an unspecific sexual way. An increase in specific deviant and aggressive sexuality is more associated with temporal lesions and in rare cases with temporal –lobe epilepsy (Critchely et al. 2000,Mendez et al. 2000). The cortico-striatum-loop may be affected in cases of obsessive-compulsive symptoms, sometimes a form of pedosexual activities. Genetic relations between the occurrence of Tourette-syndrome and pedosexual symptomatologies could be made probable in the some families and corroborate the idea of connections between OCD-syndroms and obsessive sexuality, as well as the hypothesis of dopamin-receptor variations as found in other cases of uncontrollable “craving”. The effects of SSRI in treatment of pedosexual strivings are a further argument for the relevance of dopamin-serotonin antagonism in forms of “sexual craving”. Blood levels of hormones are less interesting than signs of hormonal dysregulations like abnormal outputs of LH after provocation with LH-RH or Cortisol after provocation with mCPP. Neuropsychological testing revealed signs of impulsivity, response-inhibition, left-handedness, and reduced intelligence which might also be unspecific signs of early brain damage which would further correspond to Blanchards(2002) findings of more brain injuries in pedophiles before the age of six years.
Blanchard R, Christensen BK, Stron SM, Cantor JM, Kuban ME, Klassen P, Dickey R, Blak T (2002) Retrospective self-reports of childhood accidents causing unconcioussness in phallometrically diagnosed pedophiles. Arch Sex Behaviour 31: 511-26
Critchley HD, Simmons A, Daly EM, Russell A, van Amelsvoort T, Robertson DM, Glover A, Murphy DG (2000) Prefrontal and medial temporal correlates of repetitive violence to self and others. Biol Psychiatry 47:928-34
Mendez MF, Chow D, Ringman J, Twitchell G, Hinkin Ch (2000) Pädophilia and temporal lobe disturbances. J Neuropsychiatry Clin Neurosci 12: 71 –76
Berner,W., Berger,P., Hill,A (2003).: Sexual Sadism. International Journal of Offender Therapy and Comparative Criminology 47(4) 383 – 395)

084
THE USE OF POLYGRAPHY IN THE TREATMENT AND MANAGEMENT OF SEXUAL OFFENDERS

Don Grubin, MD MRCPsych.
Professor of Forensic Psychiatry, (Hon) Consultant Forensic Psychiatrist
University of Newcastle, Newcastle upon Tyne, England
don.grubin@ncl.ac.uk

The polygraph is used widely in the United States in the treatment and management of sexual offenders. Although clinicians are often enthusiastic advocates of it, the evidence on which this is based is thin, and the procedure is not without controversy. In Europe polygraphy is used by some police forces, but it has not been applied in treatment settings. In order to evaluate its potential role in sex offender treatment, we have commenced a large scale pilot study in which polygraphy has been introduced into the sex offender treatment programmes of 10 probation areas in England. In addition to describing the context of polygraph use in post-conviction settings, data from the first year of the pilot study will be presented.

085
THE RATIONALE FOR MEDICAL TREATMENT OF SEXUAL OFFENDERS

Martin Kafka, MD, PhD
Dept of Psychiatry, Harvard Medical School, Boston, USA
Mpkafka@aol.com

By asking an essential question, "Why would men of normal intelligence knowingly commit sexually motivated crimes?" the author will discuss specific brain pathways and neurotransmitters that have been identified as associated with the behavioral expression of male sexual motivation, impulse control, social judgment and reward salience. He will then propose that medical interventions that modify specific neurotransmitters associated with these pathways can diminish sexually motivated crimes. In particular, the relationship between androgens, especially testosterone, and brain monoamine neurotransmitters, especially serotonin, will be discussed.