What is a traumatic brain injury (TBI)?
alteration in brain physiology/anatomy caused by external force which causes disturbances of cognitive or elementary neurologic function
How to measure the severtiy of a TBI?
How is severity devided?
Glasgow coma scale
-> measuring best motor, verbal and eye-opening response immediately after injury or used to measure recovery
Severity is divided into (1) mild (2) moderate (3) severe
Causes of TBI
falls (40.5%)
motor vehicle collisions (14.3%)
struck by/ against (15.5%)
assault (10.7%)
How many inmates have a history of TBI comapred to general population?
25-87% of inmates having a history of TBI compared to 8.5% of the general population
-> Therefore, much more TBI cases in prison
Patients with TBI have ……. risk for violence
an increased risk
an increased risk
Lane presented 4 cases of TBI patients. What could we notice?
All patients had some kind of pre-disturbance (like substance misuse, ADHD or difficult upbringing)
After TBI all patients got aggressive, inpatient hospitalized, showed personality change and impulsivity
All participants experienced worsening of their aggression after TBI
Specific TBI-related and unrelated risk factors for aggression post-TBI
Aggression may arise in TBI patients as a consequence of neuropsychiatric comorbidity. In many instances, acts of aggression that occur subsequent to a TBI are more directly related to pre-existing conditions than to neurotrauma.
injury severity
->Mild TBI is most likely not connected to aggression, only more severe forms
history of multiple TBI events
loss of consciousness
aggressive traits pre-TBI
history of substance abuse
re-existing conditions involving externally or internally aggressive behaviour (e.g. prior suicidal ideation and attempts)
Impulsivity
comorbid depressive and anxiety disorders
It is … to say that frontal lobe injuries are the sole cause for aggression.
oversimplified
Psychosocial factors post-injury for successful rehabiliataion
o Appropriate treatment
o Education
o Social support
o Extreme distress
Factors associated with violent outcomes in TBI
(1) comorbid depressive symptoms
(2) frontal lobe lesions and neuropsychological changes associated with impairment to the PFC
(3) A history of low educational attainment
Heuristic to examine the involvness of TBI in an agressive act
o A: the violent act meticulously (sorgfältig) planned over weeks to months (i.e., high purposefulness) and serving obvious goal (i.e., high instrumentality) is unlikely to be meaningfully associated with a single, uncomplicated, remote, mild TBI, regardless of whether the violent act is assault, homicide, or suicide
o D: violent acts that are highly impulsive and without discernible objectives (goal?) are more apt to be causally related to TBI, especially when those injuries are severe and involve damage to the ventral frontal networks
o B + C: Violent acts involving relatively modest degrees of purposefulness and instrumentality and that are associated with injuries of intermediate severity
Usually TBI according to heuristic
…+…
impulsive + without purpose
Risk factors for incarceration (Inhaftierung) after TBI
(1) low socioeconomic status
(2) low education
(3) male
(4) history of substance abuse
(5) psychiatric disorders
(6) tendency to engage in risky behaviour
These risk factors may -> TBI -> aggression OR risk factor -> aggression -> TBI
Aggression of TBI patients is mostly:
non-purposeful (i.e. impulsive) but instrumental , unplanned but in response to a perceived threat
Most often in patients with impairments of impulsive control (i.e. disinhibited), as well as those with comorbid severe cognitive impairments, depression, mania, anxiety or psychosis
Most TBI patient with post-TBI agression are more likely to have..
histories of mood disorders, substance abuse, legal intervention for prior aggressive behaviour
Risk factors for recidivism
1) sex
(2) unemployment
(3) substance abuse
(4) executive dysfunction
(5) decreased self regulation
Literature review on Prison Brains
Violent and non-Violent offender have impairments in…
Inhibition
WM
Attention
Problem solving (same outcome as control but needed more time)
-> Planning was less clear
Literature review on Prison Brains
Only Violent offender have impairments in…
set-shifting
Implication of Impaired set-shifting
prisoners may experience increased difficulties to desist from old dysfunctional behaviour and to think of other more effective solutions to their problems
Implication of Impaired WM
may contribute to the decline in the ability to work toward complex goals after prison (finding housing etc)
Meijers: Study on executive functions at 3 months of imprisonment
AIM + METHODS
investigate whether imprisonment reduces executive functions and self-control -> focused on change in impulsive risk taking (bottom-up self-control) and executive function (top-down self-control)
Methods:
o neuropsychological test battery to assess executive function in the first week of arrival and were retested after 3 months
Meijers: Study on executive functions at 3 months of imprisonment
RESULTS
Already after such a short time in prison we can see differences in functioning:
- Risk taking significantly increased
- Attention significantly deteriorated
- Planning significantly improved (contrary to hypothesis; possibly due to practice effects)
- Self-control significantly worsened (reflected on the CGT (impulsivity and risk-taking) that measured bottom-up control)
-> Top-down response inhibition remained constant
Why do all these functions getting worse?
Impoverished prison enviroment:
Often almost no physical activity
Decreased autonomy because staff make decisions
Social isolation
Lack of cognitive challenges
Leading to chronic stress and sleep disturbances
-> negatively effects the prefrontal brain functioning
-> the impoverished environment may contribute to an enhanced risk of reoffending.
What kind of disorder is Frontotemporal dementia?
progressive neurodegenerative disorder
-> onset age: late 50s
