Neuroeconomics in the Clinic and Courtroom. Michael Koenigs, PhD Associate Professor Department of Psychiatry University of Wisconsin-Madison

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1 Neuroeconomics in the Clinic and Courtroom Michael Koenigs, PhD Associate Professor Department of Psychiatry University of Wisconsin-Madison

2 Outline Overview of brain regions Applications in psychiatry Applications in criminal justice

3 Overview of brain regions ventral striatum ventromedial prefrontal cortex (vmpfc) Data from neurosynth.org

4

5 Outline Overview of brain regions Applications in psychiatry Applications in criminal justice

6 Applications in psychiatry

7 National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC)

8 National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC)

9 National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC)

10 National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) Traditional diagnostic categories of mental disorders are not conducive to treatment development because they do not correspond to discrete biological or psychological mechanisms Heterogeneity within diagnoses Co-morbidity across diagnoses Need a more precise system of diagnosis based on pathophysiology Mental disorders are brain disorders Identify measurable dimensions of psychological and neurobiological function that are critical for mental health and adaptive behavior Cuthbert & Insel, 2013; Insel, 2014

11 RDoC matrix

12

13 Applications in psychiatry 1. Objective diagnosis of specific functions 2. Anatomical targets for intervention 3. Predictors of treatment response 4. Markers of treatment efficacy 5. Subtyping

14 1. Objective diagnosis of specific functions

15 1. Objective diagnosis of specific functions Test of Loss Aversion Test of Risk Aversion Charpentier et al., 2017 Biological Psychiatry

16 1. Objective diagnosis of specific functions Charpentier et al., 2017 Biological Psychiatry

17 1. Objective diagnosis of specific functions

18 1. Objective diagnosis of specific functions Heller et al., 2015 Journal of Neuroscience

19 2. Anatomical targets for intervention Zheng et al., 2016 Frontiers in Psychology

20 2. Anatomical targets for intervention Zheng et al., 2016 Frontiers in Psychology

21 2. Anatomical targets for intervention Zheng et al., 2016 Frontiers in Psychology

22 2. Anatomical targets for intervention

23 2. Anatomical targets for intervention Fox et al., Biological Psychiatry, 2012

24 2. Anatomical targets for intervention Berlim et al., Journal of Affective Disorders, 2014

25 3. Predictors of treatment response Siegle et al., American Journal of Psychiatry, 2006

26 3. Predictors of treatment response Downar et al., Biological Psychiatry, 2014

27 3. Predictors of treatment response Riva-Posse et al., Biological Psychiatry, 2014

28 4. Markers of treatment efficacy Kennedy et al., American Journal of Psychiatry, 2007

29 4. Markers of treatment efficacy Dichter et al., Biological Psychiatry, 2014

30 5. Subtyping Drysdale et al., 2017 Nature Medicine

31 5. Subtyping Drysdale et al., 2017 Nature Medicine

32 Outline Overview of brain regions Applications in psychiatry Applications in criminal justice

33 Applications in criminal justice 1. Prediction of future offense 2. Prospects for rehabilitation 3. Evaluating mens rea 4. Mitigation in sentencing

34 1. Prediction of future offense

35 1. Prediction of future offense Kiehl & Hoffman, 2011

36 1. Prediction of future offense General U.S. population U.S. jail and prison population 1% 20%

37 1. Prediction of future offense Despite his excellent rational powers, the psychopath continues to show the most execrable judgment about attaining what one might presume to be his ends This exercise of execrable judgment is not particularly modified by experience, however chastening his experiences may be It is my opinion that no punishment is likely to make the psychopath change his ways. -Hervey Cleckley, Mask of Sanity

38 1. Prediction of future offense Baskin-Sommers et al., PNAS, 2017

39 1. Prediction of future offense Baskin-Sommers et al., PNAS, 2017

40 1. Prediction of future offense Buckholtz et al., Neuron, 2017

41 1. Prediction of future offense Aharoni et al., PNAS, 2013

42 2. Prospects for rehabilitation Downar et al., Biological Psychiatry, 2014 Siegle et al., American Journal of Psychiatry, 2006 Riva-Posse et al., Biological Psychiatry, 2014

43 3. Evaluating mens rea 2 conditions for criminal liability: Actus reus: guilty act Mens rea: guilty mind Moral Penal Code standard: a defendant is not responsible for criminal conduct "if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law."?

44 3. Evaluating mens rea Motzkin et al., Journal of Neuroscience, 2011

45 4. Mitigation in sentencing

46 4. Mitigation in sentencing

47 4. Mitigation in sentencing Aspinwall et al., Science, 2012

48 4. Mitigation in sentencing

49 4. Mitigation in sentencing Aggravating factor Longer sentence e.g., future danger, lack of remorse Mitigating factor Shorter sentence e.g., history of abuse, emotional problems, remorse

50 4. Mitigation in sentencing Aspinwall et al., Science, 2012

51 Summary vmpfc-ventral striatum circuit is critical biological substrate for reward, value, and decision-making Underlies key aspects of mental health and criminal behavior Behavioral economics combined with neuroimaging offers novel ways to characterize this circuit In psychiatry, may be applied to develop more specific, objective, quantitative, and biologically-based strategies for diagnosis and treatment of mental illness In criminal justice, may be applied to the culpability, penalty, and treatment of offenders

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