Lithium as a Neuroscience/Public Health Approach to Reducing

Antisocial Behaviors

James M. DeCarli, MPH, MPA, CHESUniversity of Southern California

Department of Psychology/Neuroscience

Overview

BackgroundAntisocial BehaviorIneffective Interventions

Gene-Environment Interplay

Anosognosia

Lithium Nutritional SupplimentationPharmocokeneticsPharmacodynamics

ConclusionEfficacy of Lithium supplementation to reduce antisocial behaviors

Background

20% of people experience victimization by perpetrators of violent and nonviolent illegal behavior per year (U.S. Bureau of Justice Statistics, 2002)

Behavioral science needs to achieve an understanding of the causes of ASB to obtain an evidenced-based approach to control and prevent ASB

Only about 12%: shown to reduce juvenile offenders’ recidivism (Lipsey & Wilson, 1998)

ABS has not been shown to be reduced due from even the best of these programs

While programs have not shown to be effective, this review takes a neuroscience approach as lithium supplementation as a potential public health strategy to reduce and control violence.

Background

Heritability

MAO-A

Serotonin (HT5) Norepinephrine

(Neurotransmitter)

Heritability

ABSOutcome

Environmental Risk Factor

Heritability(Genotype)

Neural Substrate

Barrier to Seeking Treatment

Environmental stimuli might be observed as the problem among both the antisocial parent and the childThis becomes a barrier and those are not likely to seek treatment.

Anosognosia

As observed with many mood disorders and antisocial behaviors nonadherence to treatment are common, leading to a barrier to being treated as wellSome common themes of nonadherance include fear of dependency, side effects, discomfort of psychiatric diagnosis and most importantly denial of illness (Byrne, 2006) or anosognosiaBefore one is capable of seeking or accepting treatment they first need conscious self-awareness of their illness.

Antisocial Behaviors: Neurological Effects

Reduce gray matter (amygdala) emotional regulationWhile those with antisocial and violence behaviors exhibit reduced gray matter, specifically among the amygdala in emotional dysregulation, low level of serotonin is also common, resulting in an increased risk of conduct disorder among children.

Pharmacokenetics of Lithium

Oral IngestionAbsorbed

GastrointestinalKidneys

Excreted in breast milk and insignificant amount in perspiration and feces Organs affected: Thyroid, hematopoietic system, kidneys, and heart.

Inhibit inositol phosphatases within the neurons Pathogenesis of Neurotransmitters:

Serotonin (5HT) Norepinephrine

Increases serotonin and norepinephrine,Shown to increase grey matter (Sassi, 2002).

Pharmacodynamics of Lithium

Lithium: Neurological Effects

Antisocial Behavior

Gray Matter(Amygdala) Serotonin (HT5)

Aetiology of AnosognosiaDissociable Interactions and Conscious Experience

(DICE) Model [McGlynn & Schacter,1989]

Language

Conscious Awareness System (CAS)-Inferior Parietal Lobes and Cingulate Cortex

Executive SystemFrontal Lobes

Memory Sensormotor Vision

Lack of awareness of complex impairments in problem solving, retrieving, and integrating information, behaviorally, socially, and personality changes

Efficacy of Lithium

Studies have shown that the incidence of rape, homicide, and suicide were significantly higher in areas where the drinking water contained little or no lithium.This has confirmed that low level dose of lithium has a beneficial effect on human behavior (Schrauzer, 1990).

Conclusion

Nutritional lithium supplement could help close this gap among those with antisocial behaviors who choose not to seek or accept treatment because of their denial and lack of conscious self-awareness of illnessApplication

Water/Food sourceSchools (with high levels of community violence)

Help meet the Health People 2010 leading health objectives to reduce youth violence