Neuroeconomics in the Clinic and Courtroom

Michael Koenigs, PhD Associate Professor

Department of Psychiatry University of Wisconsin-Madison

Outline

• Overview of brain regions • Applications in psychiatry • Applications in criminal justice

Overview of brain regions

ventral striatum ventromedial prefrontal cortex (vmPFC)

Data from neurosynth.org

Outline

• Overview of brain regions • Applications in psychiatry • Applications in criminal justice

Applications in psychiatry

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

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

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

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

“RDoC matrix”

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

1. Objective diagnosis of specific functions

1. Objective diagnosis of specific functions

Charpentier et al., 2017 Biological Psychiatry

Test of Loss Aversion Test of Risk Aversion

1. Objective diagnosis of specific functions

Charpentier et al., 2017 Biological Psychiatry

1. Objective diagnosis of specific functions

1. Objective diagnosis of specific functions

Heller et al., 2015 Journal of Neuroscience

2. Anatomical targets for intervention

Zheng et al., 2016 Frontiers in Psychology

2. Anatomical targets for intervention

Zheng et al., 2016 Frontiers in Psychology

2. Anatomical targets for intervention

Zheng et al., 2016 Frontiers in Psychology

2. Anatomical targets for intervention

2. Anatomical targets for intervention

Fox et al., Biological Psychiatry, 2012

2. Anatomical targets for intervention

Berlim et al., Journal of Affective Disorders, 2014

3. Predictors of treatment response

Siegle et al., American Journal of Psychiatry, 2006

3. Predictors of treatment response

Downar et al., Biological Psychiatry, 2014

3. Predictors of treatment response

Riva-Posse et al., Biological Psychiatry, 2014

4. Markers of treatment efficacy

Kennedy et al., American Journal of Psychiatry, 2007

4. Markers of treatment efficacy

Dichter et al., Biological Psychiatry, 2014

5. Subtyping

Drysdale et al., 2017 Nature Medicine

5. Subtyping

Drysdale et al., 2017 Nature Medicine

Outline

• Overview of brain regions • Applications in psychiatry • Applications in criminal justice

Applications in criminal justice

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

1. Prediction of future offense

1. Prediction of future offense

Kiehl & Hoffman, 2011

1. Prediction of future offense

General U.S. population U.S. jail and prison population

1%

20%

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

1. Prediction of future offense

Baskin-Sommers et al., PNAS, 2017

1. Prediction of future offense

Baskin-Sommers et al., PNAS, 2017

1. Prediction of future offense

Buckholtz et al., Neuron, 2017

Aharoni et al., PNAS, 2013

1. Prediction of future offense

2. Prospects for rehabilitation

Riva-Posse et al., Biological Psychiatry, 2014 Siegle et al., American Journal of Psychiatry, 2006

Downar et al., Biological Psychiatry, 2014

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."

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3. Evaluating mens rea

Motzkin et al., Journal of Neuroscience, 2011

4. Mitigation in sentencing

4. Mitigation in sentencing

Aspinwall et al., Science, 2012

4. Mitigation in sentencing

4. Mitigation in sentencing

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

Aspinwall et al., Science, 2012

4. Mitigation in sentencing

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