Neural and behavioural responses to threat in men with a history of serious violence and schizophrenia or antisocial personality disorder.
BACKGROUND
Contemporary theories and evidence implicate defective emotion regulation in violent behaviour. The two psychiatric illnesses most implicated in violence are schizophrenia and antisocial personality disorder (APD). This study examined behavioural and brain abnormalities in violent men with schizophrenia or APD during anticipatory fear.


METHODS
Fifty-three men [14 non-violent healthy controls, 13 with schizophrenia and a history of serious violence (VSZ), 13 with schizophrenia without a history of violence (SZ), 13 with APD and a history of serious violence] underwent blood-oxygenation-level-dependent fMRI during an experiment involving repeated presentations of 'safe' and 'threat of electric shock' conditions and provided ratings of shock anticipation and fear. Schizophrenia patients did not have co-morbid APD.


RESULTS
VSZ participants reported the highest, and APD participants the lowest, level of shock anticipation and fear, with intermediate ratings by SZ and healthy participants. The violent, relative to non-violent, groups showed altered activity modulation in occipital and temporal regions, from early to latter parts of threat periods. Additionally, VSZ patients displayed exaggerated whereas APD patients showed attenuated thalamic-striatal activity during latter threat periods.


CONCLUSIONS
Aberrant activity in occipital and temporal regions when exposed to sustained visual threat cues is associated with a predisposition to violence in both schizophrenia and APD. This common biological deficit, however, appears to arise from dissimilar behavioural mechanisms related to differences in the strength of aversive conditioning and behavioural response to sustained threat cues (enhanced in VSZ; attenuated in APD), also reflected in opposite patterns of alternations in thalamic-striatal activity, in these two disorders.
Kumari
Veena
V
Department of Psychology, Institute of Psychiatry, King's College London, London, UK. v.kumari@iop.kcl.ac.uk
Das
Mrigendra
M
Taylor
Pamela J
PJ
Barkataki
Ian
I
Andrew
Christopher
C
Sumich
Alexander
A
Williams
Steven C R
SC
Ffytche
Dominic H
DH
D000328:Adult; D000704:Analysis of Variance; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology*; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D001931:Brain Mapping; D044707:Forensic Sciences; D006801:Humans; D055809:Illness Behavior / Q000502:physiology*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D014754:Violence / Q000523:psychology*; D055815:Young Adult
D010100:Oxygen