Risk Factors And Brain Function Of Emotional Processing Of Violence In Male Patients With Schizophrenia

Objectives:1.To investigate the characteristics and risk factors of violence in male patients with schizophrenia in clinical settings.2.To examine neural responses in frontotemporal regions when violent schizophrenia patients are exposed to different emotional stimuli.Methods:A total of 507 male schizophrenia patients were recruited in study 1,including 386 non-violent and 121 violent schizophrenia patients.Sociodemographic and history information were collected.Psychopathological characteristics,personality traits/psychopathy,and risk management-related factors were assessed using the Brief Psychiatric Rating Scale (BPRS),the Modified Manifest Aggressive Behaviour Scale (MOAS),the History of Violence,Clinical,Risk Assessment Scale (HCR-20),the Psychopathy Checklist-Revised (PCL-R) and the Barratt Impulsivity Scale-Eleventh Edition (BIS-11).Differences in these factors were compared between violent and non-violent patients and logistic regression analysis was used to explore risk factors for violence in male schizophrenia patients.Then discriminant functions were constructed using these risk factors.In Study 2,116 male schizophrenia patients completed an emotional task including positive,neutral,and negative emotional stimuli,during which the activity in the frontotemporal regions was recorded using the 52-channel nearinfrared functional brain imaging detection system.Discriminant functions were externally validated and differences in oxyhemoglobin concentration between violent and non-violent patients during different emotional stimuli were identified.Results:1.Violent patients showed lower education level (P=0.029),longer duration of illness (P=0.009),and higher rates of hospitalization (P=0.026),alcohol use (P=0.032),suicide history (P=0.003),as well as higher scores on young age at the first violent incident (P<0.001),relationship instability(P<0.001),employment problems (P=0.012) and early maladjustment(P<0.001) in HCR-20 than non-violent patients.2.Compared to non-violent patients,the violent patients showed higher scores on conceptual disorganization (P=0.007),mannerism and posturing(P=0.015),hostility (P<0.001) and suspiciousness (P<0.001),and lower scores on motor retardation (P=0.019) in BPRS,and higher scores on negative attitudes (P<0.001),impulsivity (P<0.001),and unresponsive to treatment(P<0.001) in HCR-20.3.Violent patients showed higher scores on personality disorder(p<0.001) and prior release or detention failure (p=0.020) in HCR-20,as well as higher scores on total and all subscales of PCL-R (p<0.001).4.Violent patients showed higher scores on risk management,plans lack feasibility,exposure to destabilizers,lack of personal support,noncompliance with remediation attempts,and stress in HCR-20 than non-violent patients(P<0.001).5.Regression analysis showed that suicide history (2.07[1.06-4.05]),antisocial of PCL-R (1.21 [1.01-1.45]),young age at the first violent incident(6.39[4.16-9.84]),impulsivity (1.76[1.20-2.59]),relationship instability(1.60[1.08-2.37]) were risk factors of violence in male schizophrenia patients.6.The discriminant functions were constructed on the basis of risk factors.The correct rates of cross and external validations were 81.26% and 77.42% respectively.7.There was no significant difference in the identification of emotional categories between violent and non-violent schizophrenia patients.8.When exposed to neutral emotional stimuli,violent schizophrenia patients showed higher activation in both the left middle frontal gyrus cortex(P=0.034) and the right postcentral gyrus cortex (P=0.038) than non-violent patients.When exposed to positive emotional stimuli,violent schizophrenia patients showed lower activation in the right dorsolateral superior frontal gyrus (P=0.049),the right precentral gyrus (P=0.049),and the left postcentral gyrus (P=0.009) than non-violent patients.When exposed to negative emotional stimuli,violent schizophrenia patients showed lower activation in the right inferior deltoid frontal gyrus (P=0.021) and right middle frontal gyrus (P=0.049),and higher activation in the right infraorbital superior frontal gyrus (P=0.038) than non-violent patients.Conclusions:1.Male violent schizophrenia patients were characterized by low education level,long duration of illness,high rate of suicide history,severe symptoms such as hostility and suspicion,and high psychopathy scores.2.Suicide history,antisocial of PCL-R,young age at the first violent incident,impulsivity,and relationship instability were risk factors for violence in men with schizophrenia.3.Male violent schizophrenia patients showed abnormal brain activation patterns when dealing with emotions,and their prefrontal emotion regulation is not coordinated:under-regulation of positive/negative emotions and overregulation of neutral emotions.These findings may have implications for the theoretical and clinical understanding of violence in schizophrenia.