Table 3.
Neuroimaging studies on aggression in schizophrenia
| Reference | Country | Sample | Control | Imaging study | Outcome (measured) | Main findings |
|---|---|---|---|---|---|---|
| Kumari et al. (2009) [75] | UK | 38 (24 SCZ) | Healthy control Non-violent SCZ | Structural MRI | Record of serious physical fatal or near fatal violence (≥5 in Gunn and Robertson scale) | ↑ Impulsiveness in violent SCZ which correlated negatively with ↓ hippocampal volume (vs. correlated with ↓ OFC grey matter volume in non-violent SCZ and healthy control) |
| Puri et al. (2008) [76] | UK | 26 | Non-violent SCZ | History of violent offence (homicide, attempted murder, grave bodily harm) | Bilateral ↓ in cerebellar and supramarginal gyrus-associated cerebral cortical grey matter (vs. non-violent SCZ) | |
| Hoptman et al. (2006) [77] | USA | 49 | Total aggression severity score-derived from OAS | ↑ Left caudate volume with higher total aggression score | ||
| Rüsch et al. (2008) [78] | Italy | 110 (55 SCZ) | Healthy controls | Modified OAS | Bilaterally ↑ inferior frontal white matter volume associated with suicidality and self-aggression in schizophrenia | |
| Hoptman et al. (2005) [79] | USA | 49 | OAS | ↑ Left OFC gray matter volumes associated with aggression ↑ Left than right OFC white matter volumes associated with comorbid substance use disorder |
||
| Barkataki et al. (2006) [80] | UK | 43 (30 SCZ) | Healthy Control | History of detainment for violence (e.g., homicide, attempted murder, wounding) | ↓ Whole brain volume (vs. non-violent SCZ and healthy control) | |
| Non-violent SCZ | ↓ Hippocampal volume (vs. healthy control) | |||||
| Hoptman et al. (2002) [81] | USA | 14 | Axial diffusion tensor MRI | Buss Durkee Hostility Inventory | Inferior frontal white matter microstructure is associated with impulsivity and aggression | |
| Life History of Aggression Self-report | ||||||
| Kumari et al. (2009) [82] | UK | 53 (26 SCZ) | Healthy control | fMRI (shock threat) | History of serious violence (≥5 in Gunn and Robertson scale) | Exaggerated thalamic-striatal activity to later threat periods (vs. non-violent SCZ and healthy control) |
| Non-violent SCZ | ||||||
| Dolan et al. (2009) [73] | UK | 24 | Low Psychopathy SCZ | fMRI (facial affect series recognition task) | High psychopathy score (> 18 in PCL:SV) | ↓ BOLD response in right amygdala-prefrontal cue when presented with fearful cue |
| Hoptman et al. (2010) [74] | USA | 46 (21 SCZ) | Healthy controls | fMRI (voxelwise FC analysis) | Buss Perry aggression questionnaire | ↓ Functional connectivity between amygdala and prefrontal cortex (vs. healthy control)(lower functional connectivity associated with higher self-reported aggression in SCZ) |
| Kumari et al. (2006) [83] | England | 48 (25 SCZ) | Healthy control | fMRI (working memory load task) | History of serious violence according to clinical and criminal records (≥4 in Gunn and Robertson scale) | Bilateral activation deficit in the frontal lobe and precuneus compared to the healthy control Activation deficit in the right inferior parietal region when compared to the NVS |
| Non-violent SCZ | ↓ Right inferior parietal region (vs. non-violent SCZ). | |||||
| Joyal et al. (2007) [84] | Canada | 48 (36 SCZ) | Healthy control | fMRI (go/no-go task) | Homicide offense | ↓ Activation of orbital, basal regions of PFC (vs. control and non-criminal SCZ) |
| Non-criminal SCZ | ↑ Activation in motor, premotor anterior cingulate cortex (vs. non-criminal SCZ) | |||||
| Wong et al. (1997) [26] | Australia | 39 | NRVOs with SCZ | MRI, FDG-PET, EEG | Previous history of violent offence (i.e., manslaughter or murder) | Asymmetrical gyral pattern in temporo-parietal region in RVOs (Absent in NRVOs) |
| Not associated with hypometabolism in this area in PET | ||||||
| EEG abnormality localized to temporal side in RVOs | ||||||
| Wong et al. (1997) [85] | Australia | 31 SCZ | NRVOs with SCZ | FDG-PET | Previous history of violent offence (i.e., manslaughter or murder) | ↓ FDG uptake in left anterior-inferior temporal regions (vs. bilateral reduction in NRVOs) |
| Spalletta et al. (2001) [86] | Italy | 15 SCZ | Non-violent SCZ | SPECTa | Hospital records of aggression | ↓ Prefrontal rCBF under neuropsychological stress (NOT at resting state) |
SCZ, schizophrenia; MRI, magnetic resonance imaging; OAS, overt aggression scale; OFC, orbitofrontal cortex; PCL:SV, psychopathy check list: Screening version; BOLD, blood oxygen level-dependent; NVS, non violent schizophrenia; FDG-PET, fluorodeoxyglucose positron emission tomography; EEG, electroencephalogram; RVOs, repetitive violent offenders; NRVOs, non-repetitive violent offenders; SPECT, single photon emission computed tomography; rCBF, regional cerebral blood flow.