Introduction

Frontal lobes are structures located at the front-most part of the cerebral cortex, in front of the central fissure and over the Sylvian fissure. Anatomically speaking, they account for a third part of the human brain and are divided into three areas: orbitofrontal, medial frontal and dorsolateral (Figure 1).

Figure 1 Frontal lobe 

It is the most developed area in the phylogenetic scale and is the center of the human person, responsible for managing the identity of an individual. Thanks to this area, thoughts are transformed into decisions, plans and actions (dorsolateral area), emotions are regulated (medial frontal area) and, particularly, our darkest impulses are inhibited (orbitofrontal area).

Orbitofrontal syndrome is known for disinhibition, impulsiveness and transgression of social norms. Therefore, it is associated with the development of criminal behavior. It occurs particularly in adolescence, a phase when the brain has not yet been fully developed and is characterized by poor adaptive coping skills ¹.

Clinical case

Male aged 18 years (16 at the time of the transgression), voluntarily participating in the study, born in Lima, righthanded with complete secondary studies, facing a socioeducational penalty at Centro Juvenil de Diagnóstico y Rehabilitación de Lima (CJDR Lima - Juvenile Diagnostic and Detention Center Lima) for aggravated kidnapping, rape and death of a minor.

Concerning the transgression, the young man told that while drunk on his way home from a party in his neighborhood, he ran into three minors. He approached them and invited them to buy something in a store, and when the girls were distracted, he carried one of them (4 years old) and took her with him to his brother’s house. There he abused her, fell asleep, and when he woke up, he realized that she was unconscious, took a tool and hit her in the head, and so he allegedly killed her.

Subsequently, he put the corpse into a sack, left it in a vacant land and fled. However, the municipality cameras in the neighborhood were examined, the images were broadcasted on television, and he was captured some hours later.

The research subject did not have any records of previous legal transgressions or a significant medical or psychological history. He had completed elementary school but not high school. He had worked as a loader in a market since he was 10 years old and mentioned that he did not have many friends. He said that he did not use drugs but occasionally consumed alcohol since he was 13 years old. Concerning his sexual activity, he started at 13 (heterosexual).

He came from a single-parent household with an unloving mother and strict parenting style: when he did not obey the family rules, he was physically punished (with a belt). Moreover, he never met his father. In the last few years, he moved into his stepbrother’s place because it was the closest to his job (loader).

After the research subject voluntarily signed the informed consent, anamnesis, behavioral observation and clinical interview were carried out; he declared his infringing behavior; and data was collected using the following instruments: Eysenck personality questionnaire, which assesses personality (validity and reliability of 0.68 measured with correlation coefficient and test-retest method, respectively) ²; Raven’s progressive matrices (RPM), aimed to examine intellectual ability (reliability of 0.89 and validity of 0.86 measured with split-halves method) ³; Rey-Osterrieth complex figure, which evaluates perceptual organization and visual memory (reliability of 0.83 and validity of 0.78) ⁴; Differences perception test (FACES-R), which determines attention skills and impulsiveness control (validity of 0.81 and reliability of 0.88 measured with Cronbach’s alpha coefficient) ⁵; Stroop color and word test (SCWT), which assesses self-regulation and executive function disorders (validity and reliability of 0.78 measured by analyzing the main components and intraclass correlation coefficient, respectively) ⁶; Mini-Mental state examination (MMSE), which diagnoses dementia (validity of 0.80 and reliability of 0.89) ⁷; and Anger, irritability and aggression (CIA) questionnaire, an instrument that assesses susceptibility to anger, irritability and aggression (content validity and reliability of 0.94 measured by expert opinion and Cronbach’s alpha coefficient, respectively) ⁸.

Hence, the results showed age-appropriate speech, language and vocabulary. He did not present apparent organic disorders and/or physical problems. He had error awareness, took responsibility on his actions and expressed remorse. He had a higher-than-average intelligence quotient and showed argumentation skills with an adequate level of understanding and analysis. Moreover, he showed melancholic temperament with depressive thoughts, introverted personality with low environmental sensitivity, poor social skills, self-absorption and avoidance. Additionally, he showed perfectionist tendencies, sudden emotional changes, difficulty changing behavioral patterns and impulsiveness. At neuropsychological level, he was oriented to person, time and space. He did not show attention, language (but, at prosodic level, he had poor intonation and expression when speaking), writing, reading, praxis, calculation, perception or memory disorders (Table 1).

Discussion

The neuropsychological evaluations (Table 1) showed that the research subject suffered from orbitofrontal syndrome due to the high rate of impulsiveness, disinhibition and difficulty changing behavioral patterns: elements that are associated with an antisocial behavior ⁹.

Regarding the family dynamics, he said that he was the fourth of five siblings (from three different relationships) and had never lived with his father. In this regard, Morales et al. ⁹ state that, in a father-son relationship, father rejection and absence lead to disruptive behaviors aimed to punish parents as a response to their flat affect.

He was not a victim of sexual abuse as a child, so a history of preexisting rape and repetition of a behavioral pattern cannot be considered. He also stated not using psychoactive substances, except for alcohol (occasionally). He mentioned being drunk when he committed the offense; however, it is difficult to determine whether alcohol is the only trigger of violent reactions ^10,11.

In this case, there was no evidence of marked psychological disorders, so it is not always possible to establish specific psychopathological characteristics among prison populations ¹².

As to the neuropsychological profile, there is evidence of impulsiveness, possibly related to a poor frontal lobe function, which may become crucial in the rehabilitation process of incarcerated offenders ¹³.

It is important to consider that besides being a predictive factor of sociopathic behavior, age includes two groups: “indulgent” and “lacking.” ¹ This case corresponds to the latter because the research subject was raised with lack of affection and economic deprivation. It should be noted that during adolescence the brain has not yet been fully developed and is characterized by poor adaptive coping skills ¹. Regardless of his high intellectual level, the research subject showed impulsiveness and limited cognitive flexibility.

Sophisticated assessment devices were not used since bringing these materials to prisons and the time allowed with the research subject were restricted for security reasons; therefore, simple and quick tests were administered. Furthermore, it should be mentioned that, although an orbitofrontal syndrome may explain, to some extent, the offences committed by the research subject, it is not intended to justify or diminish the defendant’s responsibilities.

Finally, this research highlights the use of psychometric tests and neuropsychological evaluations for the diagnosis and assessment of orbitofrontal syndrome ^14,15 since they are necessary for the proper management of offenders incarcerated in prisons and/or detention centers who do not have access to neuroimaging.