title: Prospective cohort study of the relationship between neuro-cognition, social cognition and violence in forensic patients with schizophrenia and schizoaffective disorder.
abstract: BACKGROUND
  There is a broad literature suggesting that cognitive difficulties are associated with violence across a variety of groups. Although neurocognitive and social cognitive deficits are core features of schizophrenia, evidence of a relationship between cognitive impairments and violence within this patient population has been mixed.
  
  
  METHODS
  We prospectively examined whether neurocognition and social cognition predicted inpatient violence amongst patients with schizophrenia and schizoaffective disorder (n = 89; 10 violent) over a 12 month period. Neurocognition and social cognition were assessed using the MATRICS Consensus Cognitive Battery (MCCB).
  
  
  RESULTS
  Using multivariate analysis neurocognition and social cognition variables could account for 34 % of the variance in violent incidents after controlling for age and gender. Scores on a social cognitive reasoning task (MSCEIT) were significantly lower for the violent compared to nonviolent group and produced the largest effect size. Mediation analysis showed that the relationship between neurocognition and violence was completely mediated by each of the following variables independently: social cognition (MSCEIT), symptoms (PANSS Total Score), social functioning (SOFAS) and violence proneness (HCR-20 Total Score). There was no evidence of a serial pathway between neurocognition and multiple mediators and violence, and only social cognition and violence proneness operated in parallel as significant mediators accounting for 46 % of the variance in violent incidents. There was also no evidence that neurocogniton mediated the relationship between any of these variables and violence.
  
  
  CONCLUSIONS
  Of all the predictors examined, neurocognition was the only variable whose effects on violence consistently showed evidence of mediation. Neurocognition operates as a distal risk factor mediated through more proximal factors. Social cognition in contrast has a direct effect on violence independent of neurocognition, violence proneness and symptom severity. The neurocognitive impairment experienced by patients with schizophrenia spectrum disorders may create the foundation for the emergence of a range of risk factors for violence including deficits in social reasoning, symptoms, social functioning, and HCR-20 risk items, which in turn are causally related to violence.
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. oreillk5@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. oreillk5@tcd.ie.
authors.forename: Ken
authors.initials: K
authors.lastname: O'Reilly
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. DONOGHUG@imx1.tcd.ie.
authors.forename: Gary
authors.initials: G
authors.lastname: Donohoe
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. ciaran.coyle@hse.ie.
authors.forename: Ciaran
authors.initials: C
authors.lastname: Coyle
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. danny.osullivan2@hse.ie.
authors.forename: Danny
authors.initials: D
authors.lastname: O'Sullivan
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. arann.rowe@kcl.ac.uk.
authors.forename: Arann
authors.initials: A
authors.lastname: Rowe
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. mlosty@tcd.ie.
authors.forename: Mairead
authors.initials: M
authors.lastname: Losty
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. mcdonagt@tcd.ie.
authors.forename: Tracey
authors.initials: T
authors.lastname: McDonagh
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. lasairiona_mcguinness@hotmail.com.
authors.forename: Lasairiona
authors.initials: L
authors.lastname: McGuinness
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. yvettetennis@eircom.net.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Ennis
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. elizabeth.watts2@hse.ie.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Watts
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. louisepbrennan@eircom.net.
authors.forename: Louise
authors.initials: L
authors.lastname: Brennan
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. owensliz@hotmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Owens
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. davorem@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. davorem@tcd.ie.
authors.forename: Mary
authors.initials: M
authors.lastname: Davoren
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. rmullan@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. rmullan@tcd.ie.
authors.forename: Ronan
authors.initials: R
authors.lastname: Mullaney
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. zareenaabidin@yahoo.ie.
authors.forename: Zareena
authors.initials: Z
authors.lastname: Abidin
authors.affiliation: Department of Psychiatry, Trinity College Dublin, Dublin, Ireland. kennedh@tcd.ie.|National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. kennedh@tcd.ie.
authors.forename: Harry G
authors.initials: HG
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology*; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012919:Social Behavior; D014754:Violence / Q000523:psychology*