Soggetti psicopatici e socialmente pericolosi: uno studio caso-controllo per valutare i fattori di rischio per la recidiva di comportamento violento

Background Since 2008 people considered Non-Guilty in Reason of Insanity (NGRI) and socially dangerous, are sectioned in the residential forensic units called R.E.M.S (Residences for Execution of Security Measures), exclusively managed by health operators, without policemen support. In judiciary laws, social danger is considered as the risk for a person to commit future crimes in reason of mental disorder. For this reason, the assessment of mental and behavioral parameters is fundamental to connect clinical facets with recidivism and to predict the risk of violence. Violent behavior can occurs in Psychosis and Mood Disorder, often in acute phases, whereas is very common in about 80% of people Personality Disorder, above all Borderline and Antisocial too. Literature suggest that Psychopathy represent the trans-dimentional clinical condition that correlates with longer criminal careers and high level of violent behavior. In fact psychopathic suffer from a profound affective deficit, including shallow emotion and inability to experience empathy, guilt or remorse. Methods We developed a protocol to assess both psychological and biological aspects in patients admitted in R.E.M.S. of Mental Health Department of ASL Rm5 in order to evaluate neurocognitive/psychiatric pathways and to compare differences between psychopathic and non-psychopathic groups. Psychopathy assessment require PCL-r, that is the gold standard reference scale. Case and Control are adults male 20 admitted in REMS since 2016, classified as psychopathic if their PCL-r scores is ≥ 20. All participants underwent clinical evaluation and MRI (Magnetic Resonance Imaging) study with specific sequences to examine possible dysfunction in neural connectivitiy. Results Preliminary results demonstrate that psychopathic participants (7 adults, mean age: 42,71 yo, PCl-r: 23,92) had many lifetime’s criminal records, while non-psychopatic (6 adults, mean age 46,17 yo, PCL-r: 10,35) are admitted in forensic units for the first time in their life. First results suggest that PCL-r total score represent the most important pathway to predict recidivism of violent acts, measured with Harm-FV (Hamilton anatomy of Risk Managent – forensic version), instead of PD (psychopathic deviation) scale of MMPI-II that appears elevated in both groups, without differences between psychopathic and non-psychopathic. Moreover, psychopathic traits may be correlated with different patterns of atypical neural connective activity.