Abstract
Background: Aggression in psychoses is of high clinical importance, and volumetric MRI techniques have been used to explore its structural brain correlates.Methods: We conducted a systematic review searching EMBASE, ScienceDirect, and PsycINFO through September 2017 using thesauri representing aggression, psychosis, and brain imaging. We calculated effect sizes for each study and mean Hedge's g for whole brain (WB) volume. Methodological quality was established using the PRISMA checklist (PROSPERO: CRD42014014461).Results: Our sample consisted of 12 studies with 470 patients and 155 healthy controls (HC). After subtracting subjects due to cohort overlaps, 314 patients and 96 HC remained. Qualitative analyses showed lower volumes of WB, prefrontal regions, temporal lobe, hippocampus, thalamus and cerebellum, and higher volumes of lateral ventricles, amygdala, and putamen in violent vs. non-violent people with schizophrenia. In quantitative analyses, violent persons with schizophrenia exhibited a significantly lower WB volume than HC (p = 0.004), and also lower than non-violent persons with schizophrenia (p = 0.007).Conclusions: We reviewed evidence for differences in brain volume correlates of aggression in persons with schizophrenia. Our results point toward a reduced whole brain volume in violent as opposed to non-violent persons with schizophrenia. However, considerable sample overlap in the literature, lack of reporting of potential confounding variables, and missing research on affective psychoses limit our explanatory power. To permit stronger conclusions, further studies evaluating structural correlates of aggression in psychotic disorders are needed.
Highlights
Epidemiology and Risk Factors of Aggression in Persons With Psychotic Disorders Persons with psychoses are at increased risks for violent behavior [4,5,6] even in the first episode of illness [7,8,9,10] and in at-risk mental states [11], more than 90% of violent acts in society are committed by persons without psychoses [12]
After subtracting subject overlaps due to the publication of multiple papers using the same cohort, the sample consisted of 314 patients and 96 healthy controls (HC)
The parahippocampal gyrus seems to be involved in emotion processing [62]
Summary
Aggression in Persons With Psychotic DisordersDefining Aggression Aggression, defined as hostile or destructive behavior, can be classified by the target of aggression (self-directed or directed at others), the mode of aggression (physical or verbal), or the cause of aggression [1].We distinguish premeditated vs. impulsive aggression. Premeditated aggression represents a planned behavior while impulsive aggression occurs as a response to provocation or stress [2, 3]. Epidemiology and Risk Factors of Aggression in Persons With Psychotic Disorders Persons with psychoses are at increased risks for violent behavior [4,5,6] even in the first episode of illness [7,8,9,10] and in at-risk mental states [11], more than 90% of violent acts in society are committed by persons without psychoses [12]. Still, according to Wehring and Carpenter [14], a focus on criminal records underestimates the prevalence of aggressive behavior in schizophrenia. Aggression in psychoses is of high clinical importance, and volumetric MRI techniques have been used to explore its structural brain correlates
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