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Summary Task 2 - Acquired brain injury & criminality

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Summary of Task 2 of Neuropsychology & Law

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  • September 27, 2023
  • 13
  • 2023/2024
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TASK 2: ACQUIRED BRAIN INJURY &
CRIMINALITY
THE EFFECTS OF ACQUIRED BRAIN INJURY ON CRIMINAL BEHAVIOUR

PATIENT PROFILES OF CRIMINAL BEHAVIOUR IN THE CONTEXT OF TBI (LANE ET AL.)

TBI = an alternation in brain physiology / anatomy caused by an external force

 Glasgow Coma Scale (GCS) – determines severity of TBI
 15-point scale measuring best motor, verbal, eye-opening responses immediately
after TBI
 13-15: mild, 9-12: moderate, 8 or below: severe
 Aggression is a major complication of TBI BUT no concrete definition of aggression in
TBI research
 Aggressive behaviours post-TBI reported in 11-96% of the cases
 Aggression = verbal outbursts & physical violence toward objects & others
 Various studies reported wide range (25-87%) of inmates having history of TBI – 8.5%
in general population
 Possible association between TBI & criminal behaviour


Methods  Retrospective chart review of patients currently / previously enrolled in
Neuropsychological program
 Case selection: age ≥ 18, history of severe TBI, frontal lobe injury, post-TBI
criminal / aggressive behaviour resulting in police intervention /
incarceration

CASE SERIES

Case 1 Case 2

 37 year old male  37 year old male
 History of nonpenetrating TBI at age  History of nonpenetrating TBI at age
22 20
 Initial GCS = 5, coma > 2 weeks  Initial GCS = 4, coma > 3 weeks
 Polysubstance abuse prior to TBI  ADHD prior to TBI
 1 arrest on drug-related charges  Complex & strained upbringing

After TBI: After TBI:

 Damage to left frontal lobes, left  Bilateral dorsomedial frontal & PF
temporo-parietal lobes contusion
 Personality change with chronic  Diffuse atrophy of corpus callosum
aggression  Personality change with rigidity &
 Cognitive disorder not otherwise oppositionalism, chronic aggression,

, specified (NOS) with nonfluent impulsivity, dementia
expressive aphasia  Multiple police interventions following
 Adjustment disorder with depressed verbal & physical aggression directed
mood toward staff & peers
 3 arrests due to assault + parole
violation

DISCUSSION

 Pre-TBI factors influenced post-TBI behaviour  every patient experienced worsening
aggression after TBI


Risk factors  Specific TBI-related & unrelated risk factors for aggression post TBI: (1)
for injury severity, (2) history of multiple TBIs with loss of consciousness,
aggression (3) aggressive traits pre-TBI, (4) history of substance abuse, (5) history
of comorbid depressive & anxiety disorders

TBI as risk  Clear association between TBI involving frontal lobe & aggressive
factor for behaviour
incarceration  Recent meta-analysis: 51% of incarcerated subjects had history of TBI
 Risk factors for incarceration (similar to those for TBI): (1) low
socioeconomic status, (2) low education, (3) male gender, (4) history of
substance abuse, (5) psychiatric disorders, (6) general propensity to
engage in risky behaviour
 Risk factors may lead to TBI, which may then lead to aggression
 Aggressive behaviour can predate, be caused by, or exacerbated by
TBI

Legal  Effects of TBI on behaviour may go unnoticed – people may attribute
implications blame onto individual rather than injury
 Essential to have experts who are well versed in TBI
 Experts need to relay knowledge to jury members, so they can
make educated decision about defendants behaviour

Clinical  When individual has TBI + trouble with the law  possible reason for
implications behaviour must be determined in an individualised manner
 Precise & practical definition of aggression necessary to establish
guidelines to documenting aggressive behaviour

A FORENSIC NEUROPSYCHIATRIC APPROACH TO TBI, AGGRESSION AND SUICIDE (WORTZEL)

 Types & severities of symptoms that follow TBI vary widely between & within individuals
as they recover

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