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      Prediction of recidivism in a long-term follow-up of forensic psychiatric patients: Incremental effects of neuroimaging data

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          Abstract

          One of the primary objectives in forensic psychiatry, distinguishing it from other psychiatric disciplines, is risk management. Assessments of the risk of criminal recidivism are performed on a routine basis, as a baseline for risk management for populations involved in the criminal justice system. However, the risk assessment tools available to clinical practice are limited in their ability to predict recidivism. Recently, the prospect of incorporating neuroimaging data to improve the prediction of criminal behavior has received increased attention. In this study we investigated the feasibility of including neuroimaging data in the prediction of recidivism by studying whether the inclusion of resting-state regional cerebral blood flow measurements leads to an incremental increase in predictive performance over traditional risk factors. A subsample ( N = 44) from a cohort of forensic psychiatric patients who underwent single-photon emission computed tomography neuroimaging and clinical psychiatric assessment during their court-ordered forensic psychiatric investigation were included in a long-term (ten year average time at risk) follow-up. A Baseline model with eight empirically established risk factors, and an Extended model which also included resting-state regional cerebral blood flow measurements from eight brain regions were estimated using random forest classification and compared using several predictive performance metrics. Including neuroimaging data in the Extended model increased the area under the receiver operating characteristic curve (AUC) from .69 to .81, increased accuracy from .64 to .82 and increased the scaled Brier score from .08 to .25, supporting the feasibility of including neuroimaging data in the prediction of recidivism in forensic psychiatric patients. Although our results hint at potential benefits in the domain of risk assessment, several limitations and ethical challenges are discussed. Further studies with larger, carefully characterized clinical samples utilizing higher-resolution neuroimaging techniques are warranted.

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          Choosing Prediction Over Explanation in Psychology: Lessons From Machine Learning.

          Psychology has historically been concerned, first and foremost, with explaining the causal mechanisms that give rise to behavior. Randomized, tightly controlled experiments are enshrined as the gold standard of psychological research, and there are endless investigations of the various mediating and moderating variables that govern various behaviors. We argue that psychology's near-total focus on explaining the causes of behavior has led much of the field to be populated by research programs that provide intricate theories of psychological mechanism but that have little (or unknown) ability to predict future behaviors with any appreciable accuracy. We propose that principles and techniques from the field of machine learning can help psychology become a more predictive science. We review some of the fundamental concepts and tools of machine learning and point out examples where these concepts have been used to conduct interesting and important psychological research that focuses on predictive research questions. We suggest that an increased focus on prediction, rather than explanation, can ultimately lead us to greater understanding of behavior.
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            Age and the Explanation of Crime

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              Individual differences in executive functions are almost entirely genetic in origin.

              Recent psychological and neuropsychological research suggests that executive functions--the cognitive control processes that regulate thought and action--are multifaceted and that different types of executive functions are correlated but separable. The present multivariate twin study of 3 executive functions (inhibiting dominant responses, updating working memory representations, and shifting between task sets), measured as latent variables, examined why people vary in these executive control abilities and why these abilities are correlated but separable from a behavioral genetic perspective. Results indicated that executive functions are correlated because they are influenced by a highly heritable (99%) common factor that goes beyond general intelligence or perceptual speed, and they are separable because of additional genetic influences unique to particular executive functions. This combination of general and specific genetic influences places executive functions among the most heritable psychological traits. These results highlight the potential of genetic approaches for uncovering the biological underpinnings of executive functions and suggest a need for examining multiple types of executive functions to distinguish different levels of genetic influences. (c) 2008 APA, all rights reserved
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 May 2019
                2019
                : 14
                : 5
                : e0217127
                Affiliations
                [1 ] Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
                [2 ] Regional Forensic Psychiatric Clinic, Växjö, Sweden
                [3 ] Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden
                [4 ] Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
                [5 ] Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
                [6 ] Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden
                [7 ] Division of Forensic Psychiatry, Region Skåne, Trelleborg, Sweden
                Medical University of Vienna, AUSTRIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-4827-7650
                Article
                PONE-D-18-11503
                10.1371/journal.pone.0217127
                6522126
                31095633
                47ae57a4-e068-4a88-b081-63403b4e4761
                © 2019 Delfin et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 May 2018
                : 4 May 2019
                Page count
                Figures: 3, Tables: 1, Pages: 21
                Funding
                The work was supported by the Regional Forensic Psychiatric Clinic in Växjö, grants from Region Skåne, Region Kronoberg, Södra sjukvårdsregionen, Stiftelsen Lindhaga, and through the regional agreement on medical training and clinical research (ALF) between the Region Skåne and Lund University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Clinical Laboratory Sciences
                Forensics
                Social Sciences
                Law and Legal Sciences
                Forensics
                Research and Analysis Methods
                Imaging Techniques
                Neuroimaging
                Biology and Life Sciences
                Neuroscience
                Neuroimaging
                Social Sciences
                Sociology
                Criminology
                Crime
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Biology and Life Sciences
                Anatomy
                Brain
                Cerebral Cortex
                Parietal Lobe
                Medicine and Health Sciences
                Anatomy
                Brain
                Cerebral Cortex
                Parietal Lobe
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Personality Disorders
                Research and Analysis Methods
                Imaging Techniques
                Neuroimaging
                Single Photon Emission Computed Tomography
                Biology and Life Sciences
                Neuroscience
                Neuroimaging
                Single Photon Emission Computed Tomography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Tomography
                Single Photon Emission Computed Tomography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Tomography
                Single Photon Emission Computed Tomography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Tomography
                Single Photon Emission Computed Tomography
                Biology and Life Sciences
                Anatomy
                Brain
                Cerebral Cortex
                Temporal Lobe
                Medicine and Health Sciences
                Anatomy
                Brain
                Cerebral Cortex
                Temporal Lobe
                Custom metadata
                Data cannot be made publicly available for ethical reasons, as public availability would compromise patient confidentiality and/or participant privacy. The study was approved by the Regional Ethics Committee with the condition that individual data is not made publicly available. The data contains sensitive information, such as detailed descriptions of crimes, mental disorders, and illicit drug use, details about forensic psychiatric treatment including date of admittance and date of discharge, dates of death and deportation, and data on regional brain function, which could be used to identify individuals. The data is permanently stored on secured hard drives. Researchers may request the data by contacting bjorn.hofvander@ 123456med.lu.se (co-author) or ase.holl@ 123456gu.se (research secretary). Contact information to the Regional Ethics Committee who approved the study: registrator@ 123456epn.lu.se , reference number 2007/64 and 2014/911.

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