title: Prefrontal and medial temporal correlates of repetitive violence to self and others.
abstract: BACKGROUND
  The neurobiological basis for violence in humans is poorly understood, yet violent behavior (to self or others) is associated with large social and healthcare costs in some groups of patients (e.g., the mentally retarded). The prefrontal cortex and amygdalo-hippocampal complex (AHC) are implicated in the control aggression, therefore we examined the neural integrity of these regions in violent patients with mild mental retardation and nonviolent control subjects.
  
  
  METHODS
  We used (1)H-magnetic resonance spectroscopy (MRS) to measure 1) concentrations and ratios of N-acetyl aspartate (NAA), creatine phosphocreatine (Cr+PCr), and choline-related compounds (Cho) in prefrontal lobe of 10 violent inpatients and 8 control subjects; 2) ratios of NAA, Cr+PCr, and Cho in the AHC of 13 inpatients and 14 control subjects; and 3) frequency and severity of violence in patients.
  
  
  RESULTS
  Compared to control subjects, violent patients had significantly (p <.05, analysis of covariance-age and IQ as confounding covariates) lower prefrontal concentrations of NAA and Cr+PCr, and a lower ratio of NAA/Cr+PCr in the AHC. Within the violent patient group, frequency of observed violence to others correlated significantly with prefrontal lobe NAA concentration (r = -0.72, p <.05).
  
  
  CONCLUSIONS
  NAA concentration indicates neuronal density, and Cr+PCr concentration high-energy phosphate metabolism. Our findings suggest that violent patients with mild mental retardation have reduced neuronal density, and abnormal phosphate metabolism in prefrontal lobe and AHC compared to nonviolent control subjects. Further studies are needed, however, to determine if these findings are regionally specific, or generalize to other groups of violent individuals.
authors.affiliation: Institute of Psychiatry, London, United Kingdom.
authors.forename: H D
authors.initials: HD
authors.lastname: Critchley
authors.forename: A
authors.initials: A
authors.lastname: Simmons
authors.forename: E M
authors.initials: EM
authors.lastname: Daly
authors.forename: A
authors.initials: A
authors.lastname: Russell
authors.forename: T
authors.initials: T
authors.lastname: van Amelsvoort
authors.forename: D M
authors.initials: DM
authors.lastname: Robertson
authors.forename: A
authors.initials: A
authors.lastname: Glover
authors.forename: D G
authors.initials: DG
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000679:Amygdala / Q000378:metabolism; D001224:Aspartic Acid / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D005260:Female; D006624:Hippocampus / Q000378:metabolism; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis; D007398:Interpersonal Relations; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D010725:Phosphocreatine / Q000378:metabolism; D017397:Prefrontal Cortex / Q000378:metabolism*; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000378:metabolism*; D014754:Violence
chemical_list: D010725:Phosphocreatine; D001224:Aspartic Acid; D002794:Choline