Abstract
BackgroundThe excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients. MethodsData were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex. ResultsViolent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test. ConclusionImpairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.
Highlights
People with psychotic disorders are at increased risk of violent behavior compared with the general population (Fazel et al, 2009; Large and Nielssen, 2011)
To address the limitations of previous studies, we have investigated the association between neuropsychological test performance and a sensitive marker of violent behavior for a comprehensive set of executive functions (EFs) and affective and cognitive theory of mind (ToM) in a large nationwide sample of people with psychotic disorders
In a nationwide sample of 891 patients with psychotic disorders, we have investigated the association between neuropsychological test performance and lifetime violence for a comprehensive range of executive functions and affective and cognitive theory of mind
Summary
People with psychotic disorders are at increased risk of violent behavior compared with the general population (Fazel et al, 2009; Large and Nielssen, 2011). Important, but rarely studied, are impairments in executive functions (EFs) and theory of mind (ToM). The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Conclusion: Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions
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