Abstract
Schizophrenia (SCZ) is associated with an increased risk of violence compared to the general population. Previous studies have indicated smaller hippocampal and amygdala volumes in violent than non-violent psychotic patients. However, little is known about volumetric differences at the subdivision level of these structures. In the present study, hippocampal subfields and amygdala nuclei volumes were estimated with FreeSurfer from 3 T MRI of SCZ patients with (SCZ-V, n = 24) and without (SCZ-NV, n = 51) a history of severe violence and 90 healthy controls (HC). Volumetric differences between groups were explored with a general linear model covarying for confounders, in addition to follow-up analyses in patient groups controlling for clinical characteristics such as antipsychotic medication, duration of illness and illicit substance use. SCZ-V had smaller total hippocampal volume and smaller CA1, HATA, fimbria, and molecular layer of DG volumes compared to HC. Total amygdala volume together with basal nucleus, accessory basal nucleus, CTA, and paralaminar nucleus volumes were smaller in SCZ-V compared to HC. In SCZ-NV, compared to HC, the observed smaller volumes were limited to basal and paralaminar nucleus. There were no significant differences in hippocampal subfield and amygdala nuclei volumes between SCZ-V and SCZ-NV. Follow-up analyses showed that the results in patient groups were not affected by clinical characteristics. The results suggest that smaller hippocampal subfield and amygdala nuclei volumes may be relevant to violence risk in SCZ. However, the neurobiological signature of violence in SCZ should be further investigated in larger cohorts.
Highlights
Violence in persons with schizophrenia (SCZ) constitutes a significant public health concern and contributes to the major stigma associated with mental illness
All statistical analyses of volumetric MRI data were performed with R. 12 hippocampal subfields and 9 nuclei of the amygdala were included in the subsequent analyses
We found that CA1 (p = 0.009, d = − 0.712), hippocampal–amygdaloid transition area (HATA) (p = 0.009, d = − 0.803), fimbria (p = 0.009, d = − 0.711), and molecular layer (p = 0.025, d = − 0.635) were significantly smaller, whereas hippocampal fissure (p = 0.009, d = 0.793) was significantly larger in SCZ patients with a history of violence (SCZ-V) compared to healthy controls (HC)
Summary
Violence in persons with schizophrenia (SCZ) constitutes a significant public health concern and contributes to the major stigma associated with mental illness. Epidemiological studies indicate that SCZ patients are at an increased risk of committing violent acts compared to the general population [1,2,3,4]. A large population-based study from Sweden estimated that one of ten male SCZ patients will be convicted for a violent offence within 5 years from the initial diagnosis [5]. Aggression and violence in SCZ are associated with different, though phenomenologically correlated factors including low socio-economic status, substance abuse and other psychopathological comorbidities [6]. Violent behavior in SCZ has been associated with exacerbating delusions during the states of acute psychosis [8, 9]. Bearing in mind the complexity of violence in SCZ, mapping its neurobiological signature represents an indispensable step towards improvement in therapeutic strategies and preventive measures
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