Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder

Huber, Christian G.; Hochstrasser, Lisa; Meister, Klara; Schimmelmann, Benno G.; Lambert, Martin

doi:10.1016/j.schres.2016.04.027

Cited by 32 publications

(20 citation statements)

References 48 publications

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“…Persons with psychoses are at increased risks for violent behavior ( 4 – 6 ) even in the first episode of illness ( 7 – 10 ) and in at-risk mental states ( 11 ), although more than 90% of violent acts in society are committed by persons without psychoses ( 12 ). Brekke et al ( 13 ) even found that people with schizophrenia are at a greater risk of becoming victims of violence than of being an offender.…”

Section: Introductionmentioning

confidence: 99%

Structural Magnetic Resonance Imaging Correlates of Aggression in Psychosis: A Systematic Review and Effect Size Analysis

et al. 2018

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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.

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Section: Introductionmentioning

confidence: 99%

Structural Magnetic Resonance Imaging Correlates of Aggression in Psychosis: A Systematic Review and Effect Size Analysis

et al. 2018

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“…In order to identify factors contributing to violence in schizophrenia, phenomena beyond the disease itself should also be considered. Violent actions take place in special social and ecological contexts which include among others the patient with their own history, health status, condition and environmental effects (Swanson et al, 2013;Teasdale, 2009), comorbid substance abuse (Elbogen and Johnson, 2009;Fazel et al, 2009;Richard-Devantoy et al, 2013;Short et al, 2013;Slijepcevic et al, 2014;Van Dorn et al, 2012), antisocial personality disorder (Abu-Akel et al, 2015;Huber et al, 2016;Nolan et al, 1999;Sedgwick et al, 2017), and treatment status (and adherence to treatment) (Fazel et al, 2014;Witt et al, 2013). Whilst these studies provide valuable data for the understanding of violent behaviour in schizophrenia, research so far has not given much emphasis to such processes and capacities as mentalization and empathy, which are relevant both to violence and schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls

Kristof

Kresznerits

Olah³

et al. 2018

Psychiatry Research

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There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.

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“…However, PANSS-EC subscales comprising the five items poor impulse control , tension , hostility , uncooperativeness , and excitement have also been repeatedly identified 2 . In analogy, BPRS-EC subscales have been constructed encompassing the items excitement , hostility , and uncooperativeness with 4 or without the item tension 5 . In the current study, to ensure comparability with previous studies in patients with ARMS and recent onset psychosis, we assessed subjects using the BPRS-EC containing the items excitement , hostility , uncooperativeness and tension 3 .…”

Section: Methodsmentioning

confidence: 99%

“…We showed earlier that an agitated-aggressive syndrome was already present in at-risk mental state (ARMS) for psychosis and first-episode psychosis (FEP) 4 . Also, there is evidence for an agitated-aggressive syndrome in early-onset psychosis 5 . However, it is not clear whether this agitated-aggressive syndrome is associated with structural brain abnormalities in early stages of psychosis.…”

Section: Introductionmentioning

confidence: 99%

Voxel-Based Morphometry Correlates of an Agitated-Aggressive Syndrome in the At-Risk Mental State for Psychosis and First Episode Psychosis

Huber

Widmayer

Smieskova

et al. 2018

Sci Rep

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There are mixed reports on structural neuroimaging correlates of aggression in schizophrenia with weak evidence due to cohort overlaps and lack of replications. To our knowledge, no study examined volumetric neuroimaging correlates of aggression in early stages of psychosis. An agitated-aggressive syndrome is present in at-risk mental state (ARMS) and in first-episode psychosis (FEP) – it is unclear whether this syndrome is associated with structural brain abnormalities in early stages of psychosis. Using three-dimensional magnetic resonance imaging and a whole brain voxel-based morphometry approach, we examined 56 ARMS patients, 55 FEP patients and 25 healthy controls. We operationalized aggression using the Excited Component of the Brief Psychiatric Rating Scale (BPRS-EC) and dichotomized our patient group by median split into “BPRS-EC high” (n = 49) and “BPRS-EC low” groups (n = 62). The “BPRS-EC high” group had significantly smaller left lingual gyrus volume than HC. This finding was not present in the “BPRS-EC low” group. In addition, grey matter volume in the left lingual gyrus showed a negative linear correlation with BPRS-EC over all subjects (ρ = −0.318; p = 0.0001) and in the patient group (ρ = −0.202; p = 0.033). These findings provide first hints on structural brain abnormalities associated with an agitated-aggressive syndrome in ARMS and FEP patients.

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Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder

Cited by 32 publications

References 48 publications

Structural Magnetic Resonance Imaging Correlates of Aggression in Psychosis: A Systematic Review and Effect Size Analysis

Structural Magnetic Resonance Imaging Correlates of Aggression in Psychosis: A Systematic Review and Effect Size Analysis

Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls

Voxel-Based Morphometry Correlates of an Agitated-Aggressive Syndrome in the At-Risk Mental State for Psychosis and First Episode Psychosis

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