1 medical issues and criminogenic risk medical issues and criminogenic risk edward pontius md...

1

Medical Issues and Medical Issues and Criminogenic RiskCriminogenic Risk

Edward Pontius MDEdward Pontius MD

Medical Director, Crisis & Medical Director, Crisis & CounselingCounseling

11/12/0911/12/09

2

Medical Issues and Criminogenic RiskMedical Issues and Criminogenic Risk

Theories of CriminogenesisTheories of Criminogenesis

3


Theories of CriminogenesisTheories of Criminogenesis

Principles of Biological TreatmentPrinciples of Biological Treatment

7

What Is Crime?What Is Crime?

Definitions:Definitions: CRIME: The breach of one or more rules or CRIME: The breach of one or more rules or

laws for which some for which some governing authority, via , via mechanisms such as mechanisms such as police power, may , may ultimately prescribe a ultimately prescribe a conviction. .

OFFENCE: a violation of the OFFENCE: a violation of the penal law. An . An offence can range from a simple offence can range from a simple misdemeanour (e.g. a traffic violation) to a (e.g. a traffic violation) to a felony (e.g. capital murder). In common law (e.g. capital murder). In common law usage, 'offence' differs from 'crime' in that usage, 'offence' differs from 'crime' in that there is typically no victim, but the action there is typically no victim, but the action remains prohibited by statute. remains prohibited by statute.

8

Who Is A Criminal?Who Is A Criminal? Legal Institutions, Media and Society use Legal Institutions, Media and Society use

different standards to determine who is a different standards to determine who is a ‘criminal’. ‘criminal’.

Under the idea of “innocent until proved Under the idea of “innocent until proved guilty,” successful prosecution is guilty,” successful prosecution is necessary to establish the title of necessary to establish the title of criminalcriminal

White Collar Criminals are not usually White Collar Criminals are not usually called criminals until their offense gains called criminals until their offense gains national notoriety.national notoriety.

People who make a lifestyle of People who make a lifestyle of committing significant crimes are committing significant crimes are criminals.criminals.

((see see http://socyberty.com))

9

Criminal behavior…

10

Criminal behavior… Is not always viewed as part of a deviant lifestyle…

13

2007 Crime Rate for 2007 Crime Rate for MaineMaine

The crime rate in Maine is about 32% lower than the national average rate. Property crimes account for around 95.4% of the crime rate in Maine

which is 26% lower than the national rate. The remaining 3.2% are violent crimes and are about 75% lower than other states.

The following graph shows how Maine compared to the rest of the states.

State Crime Rates (Per 100,000 People)

Maine National Avg.

Crime Rates (2007) 2,547 3,731

Violent Crimes 118 467

Property Crimes 2,429 3,264

14

2004 Corrections 2004 Corrections PopulationPopulation

Maine has 12,852 adults under correctional supervision (prisons, jails, probation, and parole).

The supervision rate (number of offenders per 100,000 people) is about 48% lower than the national rate.

State Population Rates (Per 100,000 People)

Maine National Avg.

Population Rate (2004) 1,341 2,572

15

2007 Incarceration 2007 Incarceration InformationInformation

Maine has a rate 64% lower than the national average of incarcerated adults per 100,000.

Incarceration Rate (Per 100,000)(Place your mouse over a bar for details, or click on a bar to view that state's profile.)

Maine National Avg.

Incarceration Rate (2007) 159 447

16

2008 Corrections Percentage 2008 Corrections Percentage of Total State Government of Total State Government

ExpendituresExpenditures

Taxpayers paid 27% lower than than the national average in 2008.

Maine National Avg.

% Spent on Corrections (2008) 4.9% 6.7%

Most recent Maine data from http://www.nicic.org/features/statestats/?State=ME accessed 11/11/09. Original Data Sources:The PEW Center on the States

Federal Bureau of Investigation, U.S. Dept. of Justice Bureau of Justice Statistics, U.S. Dept. of Justice

American Jail Assoc. American Correctional Assoc.

State Government Data and Websites.

17

How Does Psychiatric How Does Psychiatric Illness Impact Criminal riskIllness Impact Criminal risk Psychiatric illness is associated with risk of Psychiatric illness is associated with risk of

both criminal behavior and violent crimeboth criminal behavior and violent crime Illnesses associated with criminality include Illnesses associated with criminality include

substance use disorders, conduct disorder, substance use disorders, conduct disorder, antisocial personality disorder, borderline antisocial personality disorder, borderline personality disorder, bipolar disorder, personality disorder, bipolar disorder, schizophrenia, organic brain syndromes.schizophrenia, organic brain syndromes.

Association is not proof of causalityAssociation is not proof of causality Patients with psychiatric illness are more likely Patients with psychiatric illness are more likely

to be VICTIMS of crime than perpetratorsto be VICTIMS of crime than perpetrators Patients with Psychotic Illness are more likely Patients with Psychotic Illness are more likely

to be perpetrators if comorbid with SUD’sto be perpetrators if comorbid with SUD’s

18

General CriteriaGeneral CriteriaDSM-IV TR Personality DSM-IV TR Personality

DisordersDisorders General diagnostic criteriaGeneral diagnostic criteria

According to DSM-IV-TR (see page 689)According to DSM-IV-TR (see page 689)[7], the diagnosis of a , the diagnosis of a personality disorder must satisfy the following general criteria, in personality disorder must satisfy the following general criteria, in addition to the specific criteria listed under the specific personality addition to the specific criteria listed under the specific personality disorder under consideration.disorder under consideration.

A.A. An enduring pattern of inner experience and behavior deviating markedly An enduring pattern of inner experience and behavior deviating markedly from the expectations of the individual's culture. This pattern is manifested from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:in two (or more) of the following areas:

cognition (perception and interpretation of self, others and events) (perception and interpretation of self, others and events) affect (the range, intensity, (the range, intensity, lability and appropriateness of and appropriateness of emotional

response) response) interpersonal functioninginterpersonal functioning impulse control

B.B. The enduring pattern is inflexible and pervasive across a broad range of The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.personal and social situations.

C.C. The enduring pattern leads to clinically significant distress or impairment The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.in social, occupational or other important areas of functioning.

D.D. The pattern is stable and of long duration and its onset can be traced The pattern is stable and of long duration and its onset can be traced back at least to back at least to adolescence or early or early adulthood..

E.E. The enduring pattern is not better accounted for as a manifestation or The enduring pattern is not better accounted for as a manifestation or consequence of another consequence of another mental disorder..

F.F. The enduring pattern is not due to the direct physiological effects of a The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).condition (e.g., head trauma).

19

General CriteriaGeneral CriteriaDSM-IV TR Personality DSM-IV TR Personality

DisordersDisorders Cluster A (odd or eccentric Cluster A (odd or eccentric

disorders)disorders)

Cluster B (dramatic, Cluster B (dramatic, emotional or erratic emotional or erratic disorders)disorders)

Cluster C (anxious or fearful Cluster C (anxious or fearful disorders)disorders)

20

Cluster B Cluster B (dramatic, emotional or erratic (dramatic, emotional or erratic

disorders)disorders) Cluster B (dramatic, emotional or erratic Cluster B (dramatic, emotional or erratic

disorders)disorders) Antisocial personality disorder Antisocial personality disorder

(DSM-IV code 301.7):(DSM-IV code 301.7): a pervasive disregard for the law a pervasive disregard for the law and the rights of others.and the rights of others.

Borderline personality disorder Borderline personality disorder (DSM-IV code 301.83):(DSM-IV code 301.83): extreme "black and white" extreme "black and white"

thinking, instability in relationships, self-image, identity thinking, instability in relationships, self-image, identity and behavior.and behavior.

Histrionic personality disorder Histrionic personality disorder (DSM-IV code 301.50):(DSM-IV code 301.50): pervasive attention-seeking pervasive attention-seeking

behavior including inappropriate sexual seductiveness behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions.and shallow or exaggerated emotions.

Narcissistic personality disorder Narcissistic personality disorder (DSM-IV code 301.81):(DSM-IV code 301.81): a pervasive pattern of grandiosity, a pervasive pattern of grandiosity,

need for admiration, and a lack of empathy.need for admiration, and a lack of empathy.

21

DSM-IV TR CriteriaDSM-IV TR CriteriaAntisocial Personality Antisocial Personality

DisorderDisorder A) There is a pervasive pattern of disregard for and the rights of others A) There is a pervasive pattern of disregard for and the rights of others

occurring since the age of 15, as indicated by three (or more) of the occurring since the age of 15, as indicated by three (or more) of the following:[1]following:[1]

failure to conform to social norms with respect to lawful behaviors as indicated by failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;repeatedly performing acts that are grounds for arrest;

deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;personal profit or pleasure;

impulsivity or failure to plan ahead;impulsivity or failure to plan ahead; irritability and aggressiveness, as indicated by repeated physical fights or assaults;irritability and aggressiveness, as indicated by repeated physical fights or assaults; reckless disregard for safety of self or others;reckless disregard for safety of self or others; consistent irresponsibility, as indicated by repeated failure to sustain consistent work consistent irresponsibility, as indicated by repeated failure to sustain consistent work

behavior or honor financial obligations;behavior or honor financial obligations; lack of remorse, as indicated by being indifferent to or rationalizing having hurt, lack of remorse, as indicated by being indifferent to or rationalizing having hurt,

mistreated, or stolen from another.mistreated, or stolen from another. B) The individual is at least 18 years of age.B) The individual is at least 18 years of age. C) There is evidence of Conduct disorder with onset before age 15.C) There is evidence of Conduct disorder with onset before age 15. D) The occurrance of antisocial behavior is not exclusively during the course D) The occurrance of antisocial behavior is not exclusively during the course

of schizophrenia or a manic episode.of schizophrenia or a manic episode. Deceit and manipulation are considered essential features of the Deceit and manipulation are considered essential features of the

disorder. Therefore, it is essential in making the diagnosis to collect disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed.[8]material from sources other than the individual being diagnosed.[8]

It is a requirement of DSM-IV that a diagnosis of any specific It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder personality disorder also satisfies a set of general personality disorder criteria.criteria.

22


a.a. Criminal Classification and Medical Diagnostic ClassificationCriminal Classification and Medical Diagnostic Classification

b.b. Is Criminality An Illness? How is Antisocial Personality Is Criminality An Illness? How is Antisocial Personality Disorder related to Criminality?Disorder related to Criminality?

23



b.b. Is Criminality An Illness? How is Antisocial Personality Is Criminality An Illness? How is Antisocial Personality Disorder related to Criminality? Disorder related to Criminality?

c.c. The Dimensions of the Problem: How Many Criminals Do We The Dimensions of the Problem: How Many Criminals Do We Have In Maine?Have In Maine?

24




c.c. The Dimensions of the Problem: How Many Criminals Are The Dimensions of the Problem: How Many Criminals Are Their In Maine?Their In Maine?

d.d. What Does Criminality and Its Consequences Cost Maine?What Does Criminality and Its Consequences Cost Maine?

25




c.c. The Dimensions of the Problem: How Many Criminals Are The Dimensions of the Problem: How Many Criminals Are Their In Maine?Their In Maine?

d.d. What Does Criminality and Its Consequences Cost Maine?What Does Criminality and Its Consequences Cost Maine?

e.e. Criminality and Incarceration: A Growing Issue for MaineCriminality and Incarceration: A Growing Issue for Maine

27

2.2. Theories of CriminogenesisTheories of Criminogenesis

28


a.a. Racial Theories and the Eugenics MovementRacial Theories and the Eugenics Movement

29

EugenicsEugenics

30

CephalometryCephalometry

32



b.b. Modern Understanding of Gene Action: Behavioral Modern Understanding of Gene Action: Behavioral GeneticsGenetics

a.a. Basic Foundation:Basic Foundation:

a.a. Genes- coded sequences in DNA- both instruct cells in how to Genes- coded sequences in DNA- both instruct cells in how to create proteins and how to function, and serve as basis for create proteins and how to function, and serve as basis for inheritance of genetic inheritanceinheritance of genetic inheritance

b.b. Genes are arranged on large paired structures of DNA and Genes are arranged on large paired structures of DNA and regulatory molecules called CHROMOSOMES.regulatory molecules called CHROMOSOMES.

c.c. Some human genes reside in mitochondria with their own Some human genes reside in mitochondria with their own heritage (maternal only) heritage (maternal only)

33

Human ChromosomesHuman Chromosomes

34

Klinefelter’s Syndrome Klinefelter’s Syndrome (47 XXY)(47 XXY)

35



b.b. Modern Understanding of Gene Action: Modern Understanding of Gene Action: Behavioral GeneticsBehavioral Genetics

c.c. Non-Genetic Biological InfluencesNon-Genetic Biological Influences

d.d. Environmental & Interactive TheoriesEnvironmental & Interactive Theories

36

What Is COMT and Why Does It What Is COMT and Why Does It Matter?Matter?

(Catechol-O-Methyl Transferase)(Catechol-O-Methyl Transferase)

37

What Is COMT and Why Does It What Is COMT and Why Does It Matter?Matter?

(Catechol-O-Methyl Transferase)(Catechol-O-Methyl Transferase)

Single Amino Acid ChangeFrom val=>met at position 108decreases enzyme effectiveness by 75%Increasing Dopaming, Increasing risk for Schizophrenia, ADHD, Conduct Disorder

39

EpigeneticsEpigenetics epigeneticsepigenetics refers to changes refers to changes

in phenotype (appearance) or in phenotype (appearance) or gene expression caused by gene expression caused by mechanisms other than mechanisms other than changes in the underlying changes in the underlying DNA sequenceDNA sequence

Stress Hormones- Stress Hormones- Environmental PollutantsEnvironmental Pollutants Multigenerational ImpactMultigenerational Impact

40

Pollution now causes the majority Pollution now causes the majority of male fish in some species to of male fish in some species to

become intersex- become intersex- What’s that doing to us?What’s that doing to us?

41

Does Race Matter?Does Race Matter?

42


Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort

Francesca Ducci, M.D., Ph.D., Alec Roy, M.D., Pei-Hong Shen, M.S., Qiaoping Yuan, Ph.D., Nicole P. Yuan, Ph.D.,

Colin A. Hodgkinson, Ph.D., Lynn R. Goldman, M.D., M.P.H., and David Goldman, M.D.

Am J Psychiatry 2009; 166:1031-1040

43

Genetic Ancestry of 864 African American Genetic Ancestry of 864 African American Patients With Substance Dependence and Patients With Substance Dependence and

Comparison SubjectsComparison Subjects

44

Individual and Group Levels of Genetic Individual and Group Levels of Genetic Ancestry From Seven Populations for 407 Ancestry From Seven Populations for 407

African American Patients With Substance African American Patients With Substance Dependence and 457 Comparison SubjectsDependence and 457 Comparison Subjects

45


46


No.

47

What Does Matter?What Does Matter?

What Matters Is ChildhoodAbuse and Neglect

emotional abuse, physical abuse, sexual abuse,

emotional neglect, and physical neglect

48

Abuse and Neglect Is Abuse and Neglect Is NOT Racially DeterminedNOT Racially Determined

Lack of Relationship Between African Ancestry and Scores for Childhood Abuse or Neglect in 310 African American Patients With Substance Dependence

and 180 Comparison Subjects

49

What Matters for Risk of SUD is Nurturing What Matters for Risk of SUD is Nurturing Children and Keeping Them Safe…Children and Keeping Them Safe…

Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort

Francesca Ducci, M.D., Ph.D., Alec Roy, M.D., Pei-Hong Shen, M.S., Qiaoping Yuan, Ph.D., Nicole P. Yuan, Ph.D.,

Colin A. Hodgkinson, Ph.D., Lynn R. Goldman, M.D., M.P.H., and David Goldman, M.D.

Am J Psychiatry 2009; 166:1031-1040

CONCLUSIONS: These results suggest that African genetic heritage does not increase the likelihood of genetic risk for addictions. They highlight the complex interrelation between genetic

ancestry and social, economic, and environmental conditions and the strong relation of those factors to addiction.

50

Principles of Biological TreatmentPrinciples of Biological Treatment

a.a. Where Serious Mental Illness is Present, TreatWhere Serious Mental Illness is Present, Treat

i.i. Psychotic DisordersPsychotic Disorders

ii.ii. Mood DisordersMood Disorders

b.b. Where Drug Problems Are Present, TreatWhere Drug Problems Are Present, Treat

c.c. Future Directions in Modulating Criminogenic FactorsFuture Directions in Modulating Criminogenic Factors

i.i. Can Screening for Criminogenic Risk Be Justified?Can Screening for Criminogenic Risk Be Justified?

ii.ii. Heart Rate as Predictor for Aggressive Trait- Aggression vs. CriminalityHeart Rate as Predictor for Aggressive Trait- Aggression vs. Criminality

iii.iii. Modulating Adrenergic SystemsModulating Adrenergic Systems

iv.iv. Criminogenesis and The Future of Gene TherapyCriminogenesis and The Future of Gene Therapy

d.d. The Most Important Strategy for Today: Prevention & Secondary PreventionThe Most Important Strategy for Today: Prevention & Secondary Prevention

e.e. The Single Most Important Prevention Strategy: Ensuring the Safety of ChildrenThe Single Most Important Prevention Strategy: Ensuring the Safety of Children

51

Medical Issues and Medical Issues and Criminogenic RiskCriminogenic Risk

Edward Pontius MDEdward Pontius MD

Medical Director, Crisis & Medical Director, Crisis & CounselingCounseling

11/12/0911/12/09

1 medical issues and criminogenic risk medical issues and criminogenic risk edward pontius md...

Documents

future criminal behavior

medical diagnosis

law enforcement

penal law

common law usage

nongenetic biological

traffic violation

genetic contributions