CWL

Psychopaths are typically considered untreatable, but brain scans could change that

Dangerous, manipulative and, above all, untreatable. The traditional picture of the psychopath is one that everyone, from psychiatrists to members of a jury, seems to share.

But although this picture encourages a “lock them up and throw away the key” mentality, surprisingly little is really known about how, or if, rehabilitation is possible for psychopaths. Now, brain scans of children with psychopathy-like conditions suggests objective ways to diagnose psychopathy, new targets for therapy - and techniques for settling the question of whether or not psychopaths can be successfully treated and released.

For 15 years, psychiatrists have relied on the Hare psychopathy checklist to diagnose the condition. The revised version - the PCL-R - consists of a formal interview and an analysis of an individual’s past behaviour, which is scored for indicators including superficial charm, pathological lying, a grandiose sense of self-worth, and a lack of guilt or empathy. The PCL-R is generally accepted as the best available way to diagnose psychopathy, but such interview-based methods are vulnerable to subjective scoring, and clever individuals can learn how to pass them.

“Psychopaths by their nature are deceitful and cunning, so they can pick up on what authorities want to hear,” says Michael Koenigs, a neuroscientist at the University of Wisconsin, Madison.

Looking for the signs of psychopathy in brain scans could sidestep such problems, but with every new glimpse into the psychopathic brain, the picture seems to become more confused.

For instance, initial studies of brain activity as psychopaths were presented with photographs of negative emotional scenes showed abnormally high activity in the cerebellum, fusiform gyrus and postcentral gyrus, suggesting these brain regions are involved in the condition. But a repeat run of the experiment in different psychopaths revealed different foci of abnormal activity: the medial temporal lobe, and occipital and parietal cortices (Molecular Psychiatry, DOI: 10.1038/mp.2010.124).