Abstract
Several structural brain abnormalities have been associated with aggression in patients with schizophrenia. However, little is known about shared and distinct abnormalities underlying aggression in these subjects and non-psychotic violent individuals. We applied a region-of-interest volumetric analysis of the amygdala, hippocampus, and thalamus bilaterally, as well as whole brain and ventricular volumes to investigate violent (n = 37) and non-violent chronic patients (n = 26) with schizophrenia, non-psychotic violent (n = 24) as well as healthy control subjects (n = 24). Shared and distinct volumetric abnormalities were probed by analysis of variance with the factors violence (non-violent versus violent) and diagnosis (non-psychotic versus psychotic), adjusted for substance abuse, age, academic achievement and negative psychotic symptoms. Patients showed elevated vCSF volume, smaller left hippocampus and smaller left thalamus volumes. This was particularly the case for non-violent individuals diagnosed with schizophrenia. Furthermore, patients had reduction in right thalamus size. With regard to left amygdala, we found an interaction between violence and diagnosis. More specifically, we report a double dissociation with smaller amygdala size linked to violence in non-psychotic individuals, while for psychotic patients smaller size was linked to non-violence. Importantly, the double dissociation appeared to be mostly driven by substance abuse. Overall, we found widespread morphometric abnormalities in subcortical regions in schizophrenia. No evidence for shared volumetric abnormalities in individuals with a history of violence was found. Finally, left amygdala abnormalities in non-psychotic violent individuals were largely accounted for by substance abuse. This might be an indication that the association between amygdala reduction and violence is mediated by substance abuse. Our results indicate the importance of structural abnormalities in aggressive individuals.
Highlights
There is a growing interest to further our understanding of violence and aggression in patients with severe mental illness
We investigate brain structures associated with emotional regulation comparing schizophrenia patients with (VS) and without a history of violence (NVS) as well as non-psychotic violent individuals (NPV) to delineate neuroanatomical abnormalities linked to psychosis and aggression
There was a significant difference in age among groups (F3,107 = 2.94, p = .036), with non-violent patients with schizophrenia (NVS), older compared to healthy control participants (HC), violent patients with schizophrenia (VS), and NPV
Summary
There is a growing interest to further our understanding of violence and aggression in patients with severe mental illness. Violent behavior is a public health concern, and there is evidence of increased rates of violence in patients with schizophrenia [1,2,3]. Violence is determined by multiple factors, emerging evidence suggests that emotional regulation, the ability to modulate one’s state or behavior in a given situation plays an important role in aggressive behavior [4,5,6]. We investigate brain structures associated with emotional regulation comparing schizophrenia patients with (VS) and without a history of violence (NVS) as well as non-psychotic violent individuals (NPV) to delineate neuroanatomical abnormalities linked to psychosis and aggression. Along with perceived urgency and difficulties in self-regulation associated with prefrontal cortex dysfunction increase the risk of violence [15,16,17,18]
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