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John Stratton, MS, MA, is a Graduate Student, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Kent A. Kiehl, PhD, is the Executive Science Officer and Director, Mobile Imaging Core and Clinical Cognitive Neuroscience; Professor of Translational Neuroscience, The Mind Research Network; and a Professor, Department of Psychology, Neuroscience and Law, University of New Mexico. Robert E. Hanlon, PhD, ABPP, is an Associate Professor, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; and a Clinical Neuropsychologist, Neuropsychological Associates of Chicago.
Disclosure: The authors have no relevant financial relationships to disclose.
The construct of psychopathy is highly influential in both legal and clinical settings and has the potential for significant public policy implications. The modern conceptualization of psychopathy is derived from the work of psychiatrist Hervey Cleckley,1 who identified 16 qualities that exemplify the disorder. Psychopathy is characterized by both emotional dysfunction (ie, diminished capacity for empathy and guilt, callousness, shallowness, and superficiality) and interpersonal difficulties (ie, poor behavioral control, impulsivity, nomadism). Using Cleckleyâ[euro](TM)s characterization of psychopathy, Hare2 operationalized the qualities classically associated with the construct, creating the Hare Psychopathy Checklist2 and the Hare Psychopathy Checklist-Revised (PCL-R).3,4 The PCL-R is the most widely validated and accepted diagnostic instrument for assessing psychopathy across numerous populations, including forensic, psychiatric, and substance abuse patients, as well as incarcerated offenders.4,5
Recent advances in neuroscience have highlighted structural and functional neural abnormalities among individuals with psychopathy and elucidated the role of neurocognitive dysfunction in the condition. A number of neurobiological and neurocognitive models of psychopathy have been proposed that provide conceptual frameworks for understanding and synthesizing research findings. These models, and the relevant neuropsychological and neuroimaging literatures, are reviewed below and followed by a discussion of potential treatment interventions. Importantly, recent reviews have highlighted discrepancies within the neuroimaging literature, noting that methodological issues (ie, varying assessment instruments and clinical cutoffs, improper PCL-R administration, psychopathy subtypes, differing samples, redundant samples) likely account for disparate findings (for a detailed review, see Koeings et al.6 and Anderson and Kiehl7). This review will primarily consider studies utilizing the PCL-R, although other clinical and self-report measures of psychopathy will be included.
<bold>Neurocognitive Models</bold>
Using data from cognitive neuroscience, neurocognitive models have proposed that attention plays a central role...