Serper Mark, Beech Danielle R, Harvey Philip D, Dill Charles
Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
J Clin Exp Neuropsychol. 2008 Aug;30(6):700-9. doi: 10.1080/13803390701684554. Epub 2008 Jan 22.
Neuropsychological assessment of executive dysfunction may identify psychiatric patients who may be at high risk for aggressive behavior because impairment of the prefrontal cortex has been indicated as a possible anatomical correlate of aggression. No consensus, however, has been reached on the extent that executive dysfunction contributes to the formation of psychopathology and to aggressive behavior in psychiatric inpatients. We hypothesized a mediating model wherein patients' executive-functioning deficits contribute to the formation of psychopathological symptoms, which then underlies aggressive behavior. To test this model, we examined the relationship between executive functioning, psychiatric symptomatology, and aggressive behavior in 85 psychiatric inpatients presenting over an acute hospital admission using structure equation modeling techniques. The results revealed that psychiatric inpatients' executive function impairment significantly predicted the formation of psychiatric symptomatology, which in turn significantly contributed to the manifestation of aggressive behavior. Executive dysfunction also directly predicted inpatient aggressive behavior. Combining the indirect and direct effects, 59% of our inpatient aggression measure factor variance was accounted for by our measures of executive dysfunction and clinical symptom severity. These findings suggest that neurocognitive deficits underlie both psychiatric symptom formation and aggression. Patients with executive dysfunction may not possess the behavioral inhibition skills needed to cope with the presence of symptoms and other stressful events that accompany acute psychosis and hospitalization that may result, consequently, in increased manifestations of aggressive behavior.
对执行功能障碍进行神经心理学评估，可能会识别出有攻击行为高风险的精神科患者，因为前额叶皮质受损已被指出可能是攻击行为的解剖学相关因素。然而，对于执行功能障碍在多大程度上导致精神病理学的形成以及精神科住院患者的攻击行为，尚未达成共识。我们假设了一个中介模型，即患者的执行功能缺陷导致精神病理症状的形成，进而成为攻击行为的基础。为了验证这个模型，我们使用结构方程建模技术，研究了85名急性入院的精神科住院患者的执行功能、精神症状学和攻击行为之间的关系。结果显示，精神科住院患者的执行功能损害显著预测了精神病理症状的形成，而这反过来又显著促成了攻击行为的表现。执行功能障碍也直接预测了住院患者的攻击行为。综合间接和直接效应，我们对住院患者攻击行为测量的因素方差中有59%可由执行功能障碍和临床症状严重程度的测量来解释。这些发现表明，神经认知缺陷是精神症状形成和攻击行为的基础。执行功能障碍的患者可能不具备应对急性精神病和住院所伴随的症状及其他应激事件所需的行为抑制技能，因此可能导致攻击行为的更多表现。
