تشخیص احساسات و صورت در اختلالات شخصیت ضد اجتماعی مردان با یا بدون اختلال بیش فعالی با کمبود توجه بزرگسالان

Abstract Objective We aimed to investigate facial emotion recognition abilities in violent individuals with antisocial personality disorder who have comorbid attention deficient hyperactivity disorder (ADHD) or not. Method The photos of happy, surprised, fearful, sad, angry, disgust, and neutral facial expressions and Wender Utah Rating Scale have been performed in all groups. Results The mean ages were as follows: in antisocial personality disorder with ADHD 22.0 ± 1.59, in pure antisocial individuals 21.90 ± 1.80 and in controls 22.97 ± 2.85 (p > 0.05). The mean score in Wender Utah Rating Scale was significantly different between groups (p < 0.001). The mean accurate responses to each facial emotion between groups were insignificant (p > 0.05) excluding disgust faces which was significantly impaired in ASPD + ADHD and pure ASPD groups. Antisocial individuals with attention deficient and hyperactivity had spent significantly more time to each facial emotion than healthy controls (p < 0.05) while pure antisocial individual had more time to recognize disgust and neutral faces than healthy controls (p < 0.05). Conclusion Study of complex social cognitive abilities in adults with ADHD and violent behaviors is lacking. This study is the first, investigating the differences according to social cognition cues in violent individual that revealed no significance within pure antisocial individuals and antisocial individuals with ADHD.

1. Introduction As a continuous process, prospective studies in attention deficit hyperactivity disorder (ADHD) have often reported that it is predictive for severe unwanted outcomes in forensic psychiatry [1]. Significantly higher arrest rates as adults [2], more court referrals in late adolescence [3], and association between ADHD in adults and antisocial behaviors [4] have been reported in the literature. The processing of facial emotion recognition is essential for normal socialization and personal interaction and antisocial behaviors such as aggression may be consequences of failure to be appropriately guided by the social cues of other peoples [5]. Distress related cues, especially fearful and sad expressions have been shown to play an important role in inhibiting antisocial behavior [5]. Thus, facial emotion recognition seems to have an important place in modulating interpersonal behavior. Alongside inattentiveness, impulsivity and hyperactivity in patients with ADHD, failure in recognition of social cues may be considered as an independent risk factor for interpersonal troubles in ADHD [6]. However, the emotion recognition abilities of adult ASPD with ADHD patients with violent behavior are lacking in the literature. Thus, the current study was designed to investigate facial emotion recognition abilities in violent patients with ASPD + ADHD and violent individuals with pure antisocial personality disorder (ASPD). In this study, we have three hypothesis: i) there should be more impairment in identifying facial emotions in ASPD + ADHD than in pure ASPD, ii) patients with a history of violent acts should have more misidentification rates of facial emotions than healthy controls, iii) the required reaction time for recognizing facial emotions should be more impaired in ASPD + ADHD than in pure ASPD and both of them should be more impaired than healthy controls.

. Results The mean ages were as follows: in ASPD with ADHD 22.0 ± 1.59, in pure ASPD 21.90 ± 1.80 and in controls 22.97 ± 2.85 and there was no significant difference between groups (F = 2.43 and p = 0.093). There were no significance differences between the three groups according to education level (X2 = 14.92 and p = 0.063), marital status (X2 = 2.39 and p = 0.301) and types of crimes between ASPD + ADHD and pure ASPD (X2 = 0.156 and p = 0.989). The violent acts of the patients are summarized in Table 1. Table 1. The features of crimes in violent patients. Type of violence in patients1 ASPD + ADHD n = 34 Pure ASPD n = 21 • Murder 4 3 X2 = 0.156, df = 1, p = 0.989 • Grievous bodily harm by using weapon and/or instrument 8 5 • Actual bodily harm 5 3 • Rape 3 2 • Robbery, pick pocketing 3 2 • Sexual assault 2 1 • Embezzlement, forgery 2 1 • Multiple violence (≥2 types) 7 4 1 Chi square test was used. Table options The mean ADHD score according to the Wender Utah Rating Scale was significantly different within groups (F = 110.29 and p < 0.001). The mean ADHD score in ASPD + ADHD was 67.11 ± 13.19 points, 31.66 ± 12.51 in the pure ASPD group (p < 0.001) and 22.97 ± 2.85 points in healthy controls (p < 0.001). In addition, the mean ADHD score was significantly higher in pure ASPD than healthy controls (p = 0.004). The findings according to mean accurate responses to each facial emotion between groups after Bonferroni correction were as follows: for sad faces (F = 0.315 and p = 0.731), for happy faces (F = 0.596 and p = 0.553), for surprised faces (F = 0.703 and p = 0.498), performed with one way ANOVA; for neutral faces (X2 = 3.84 and p = 0.146), for fearful faces (X2 = 1.22 and p = 0.544), for disgusted faces (X2 = 6.77 and p = 0.034) and for angry faces (X2 = 1.03 and p = 0.597), performed with Kruskal Wallis. Thus, excluding disgusted faces, the mean accurate responses to each facial emotion between groups were insignificant. With Mann Whitney U test, the mean accurate response to disgusted facial emotion in pure individuals with ASPD was significantly lower than patients with ASPD + ADHD (p = 0.017) and healthy controls (p = 0.034). In addition, individuals with pure ASPD were significantly more inaccurate than healthy controls in identifying neutral faces (p = 0.045) (Table 2). Table 2. The mean accurate responses of participants towards emotional expressions. Accuracy mean ± SD Happy⁎ Sad⁎ Fear⁎⁎ Disgust⁎⁎ Angry⁎⁎ Surprised⁎ Neutral⁎⁎ ASPD + ADHD n = 34 6.9 ± 0.2 4.6 ± 1.5 2.5 ± 1.7 4.6 ± 1.9 4.6 ± 2.0 5.0 ± 2.0 4.7 ± 2.2 Pure ASPD n = 21 6.9 ± 0.3 4.4 ± 1.9 2.4 ± 1.6 3.6 ± 1.9 4.5 ± 1.9 4.9 ± 2.0 4.5 ± 2.0 Control n = 39 6.9 ± 0.5 4.3 ± 1.6 2.8 ± 1.7 4.4 ± 1.8 4.5 ± 1.7 5.4 ± 1.8 5.3 ± 2.0 P1 0.935 0.918 0.626 0.017⁎ 0.384 0.961 0.299 P2 0.528 0.709 0.489 0.411 0.551 0.635 0.367 P3 0.832 0.957 0.295 0.034⁎ 0.463 0.539 0.045⁎ P1: ASPD + ADHD vs pure ASPD; P2: ASPD + ADHD vs controls, P3: pure ASPD vs controls. ⁎ Compared with one way ANOVA, Bonferroni correction was made. ⁎⁎ Compared with Mann Whitney U test. Table options The mean reaction times to facial emotions while recognizing were as follows: for neutral faces (F = 8.158 and p = 0.001), for disgusted faces (F = 12.756 and p < 0.001), for surprised faces (F = 4.287 and p = 0.017), for sad faces (F = 3.396 and p = 0.038), for fear faces (F = 6.008 and p = 0.004), for angry faces (F = 5.367 and p = 0.006) and for happy faces (F = 5.746 and p = 0.004). However, the mean response times to each facial emotion between ASPD + ADHD and pure ASPD were not significantly different. Thus, patients with ASPD + ADHD spent significantly more time for each facial emotion than healthy controls while pure ASPD used significantly more time for recognizing disgusted and neutral faces than healthy controls (Table 3). Table 3. The response time of participants towards emotional expressions. Response time milliseconds Happy Sad Fear Disgust Angry Surprised Neutral ASPD + ADHD n = 34 2.5 ± 0.9 3.5 ± 2.7 3.4 ± 1.2 3.5 ± 1.5 3.4 ± 1.5 3.2 ± 1.7 3.0 ± 1.1 Pure ASPD n = 21 2.3 ± 0.5 3.0 ± 0.7 3.0 ± 0.8 3.0 ± 0.7 3.0 ± 0.7 2.8 ± 0.7 3.1 ± 1.2 Control n = 39 2.0 ± 0.0 2.4 ± 0.7 2.6 ± 0.5 2.4 ± 0.4 2.6 ± 0.6 2.5 ± 0.7 2.3 ± 0.6 P1 0.987 0.943 0.586 0.212 0.529 0.452 0.951 P2 0.004⁎⁎ 0.013⁎ 0.003⁎⁎ 0.001⁎⁎ 0.005⁎⁎ 0.013⁎ 0.002⁎ P3 0.140 0.681 0.303 0.014⁎ 0.325 0.890 0.004⁎ Compared with one way ANOVA, Bonferroni correction was made; P1: ASPD + ADHD vs pure ASPD; P2: ASPD + ADHD vs controls, P3: pure ASPD vs controls. ⁎ p < 0.05. ⁎⁎ p < 0.01. Table options While searching for a relation between accuracy rate and ADHD scores according to WURS: the only significance was in the pure ASPD group, and the attention deficiency and hyperactivity scores were negatively correlated with mean accurate recognitions of sad faces (r = −0.456 and p = 0.038). Nevertheless, while searching for a relation between mean response time and ADHD scores according to WURS: the response time to neutral faces was positively correlated with ADHD scores in patients with ASPD + ADHD (r = 0.374 and p = 0.029).