Oct 16, 2019
Kent A. Kiehl, PhD, joins host Lorenzo
Norris, MD on the MDedge Psychcast to discuss the use of MRI
scans to provide information about the brains of people who exhibit
antisocial behaviors. The goals are to use the information to treat
patients and prevent violent crimes.
- This week in Psychiatry (00:33)
- Meet the guest (03:35)
- Interview (04:25)
- Credits (54:10)
Kiehl is professor of psychology, neuroscience, and law at the
University of New Mexico, Albuquerque. He also codirects a
nonprofit mental health research institute called the Mind Research Network, also in
Albuquerque. He also helps run a for-profit consulting firm that
helps attorneys do better science, called MINDSET.
This week in Psychiatry:
Suicide attempts up in black
by Randy Dotinga
Overall rates of suicide dipped from 1991 to 2017, according to
research published in Pediatrics. However, the rate of suicide
attempts grew slightly in black adolescents during that
SOURCE: Lindsey MA et al, Pediatrics. 2019;144(5): e20191187,
Show notes by Jacqueline Posada, MD, consultation-liaison
psychiatry fellow with the Inova Fairfax Hospital/George Washington
University program in Falls Church, Va.
Brain imaging can support diagnoses
- Dr. Kiehl works with cutting-edge technology using noninvasive
structural and functional brain imaging; machine learning, such as
artificial intelligence; and algorithms to evaluate forensic
patients and understand psychopathology, predict outcomes, and
measure the impact of interventions. Dr. Kiehl and his team travel
to prisons across the country with two mobile MRI units imaging
incarcerated individuals and forensic patients.
- More and more, brain imaging is considered in capital cases,
because MRI provides valuable information for defense attorneys and
prosecutors. For example, a man was charged with murder and his MRI
supported a diagnosis of frontotemporal dementia with a behavioral
variant, so he was able to plead not criminally responsible based
on his illness – and was sent to a state mental hospital rather
than to death row. The case of
John W. Hinckley Jr., who
shot former President Ronald Reagan and his press secretary,
James Brady in 1981, was an initial case in which neuroscience
and imaging influenced the verdict. The shooter’s brain imaging
showed enlarged ventricles and cortical atrophy, which supported a
diagnosis of schizophrenia – particularly when compared with the
imaging of age-matched controls.
- Structural and functional MRI is an adjunct to
neuropsychological tests. Neuroscientists are elucidating patterns
through artificial intelligence and algorithms that can be useful
to civil and criminal cases.
- For example, age is considered a strong predictor of antisocial
behaviors. To enhance accuracy, Dr. Kiehl’s team has developed a
neuroprediction model in which MRI quantifies brain age, which
correlates closely with cognitive testing scores. So, brain age
might be more useful for predicting behavior than chronological
age. This study used more than 1,000 imaging studies of inmates.
The data were analyzed using an algorithm called independent
component analysis, which evaluates distinct neural circuits to
identify components that predict age. In the next step of analysis,
the algorithm identifies patterns associated with reoffending.
Younger brain age in the anterior temporal lobe and orbitofrontal
cortex – brain areas associated with decision making – accurately
estimates the risk of reoffending better than just chronological
- Based on an understanding of brain plasticity, dogma suggesting
that people who commit violent crimes cannot be changed should be
challenged. A group at the University of Wisconsin, Madison, was
asked to create an evidence-based, multimodal treatment program for
the hardest-to-treat violent juvenile offenders. The program, which
includes interventions such as multisystemic family therapy and
positive reinforcement contingency treatment, resulted in a
decrease in reoffending and violent crimes in participants who
received 10 months of treatment. Dr. Kiehl’s group followed up with
those juvenile boys using MRI to evaluate what had changed in their
brains, how much treatment is required, and how or whether those
brain changes can be reinforced. Reduction in incarceration costs
is a return on investment for the states that fund those types of
- If scientists can identify useful interventions and identify
brain changes though imaging, perhaps science can affect outcomes
such as societal violence and incarceration rates.
- Implementation is the primary short-term obstacle. This type of
research needs more funding and institutional change to identify
programs that work.
- The brain has an incredible amount of plasticity, which
translates into opportunities for change.
The Mind Research
The Psychopath Whisperer: The Science of Those Without
Conscience. Random House, 2014.
Kiehl KA et al. Age of gray matters: Neuroprediction of
recidivism. Neuroimage Clin.
Steele VR et al. Machine learning of structural magnetic
resonance imaging predicts psychopathic traits in adolescent
offenders. Neuroimage. 2017 Jan
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