The Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, USA.
Schizophr Res. 2012 Nov;141(2-3):228-33. doi: 10.1016/j.schres.2012.08.037. Epub 2012 Sep 23.
There is no literature investigating denial of aggression in schizophrenia. Our goal was to study this phenomenon and to determine what deficits are associated with it.
102 inpatients with schizophrenia were divided into three groups: (1) patients with a documented history of violent crime who denied it on extensive interviews ("deniers"); (2) those with such a history who admitted to it; and (3) those without violent crime. Patients were administered a psychometrically validated self-report scale of aggression, the Buss-Perry Aggression Questionnaire (BPAQ), the Positive and Negative Syndrome Scale and a comprehensive neurocognitive battery. They were followed for twelve weeks during which all violent incidents were recorded.
The deniers were significantly more impaired in executive function, but not in any other cognitive domain. They did not evidence more severe psychotic symptoms or greater lack of insight in their psychosis, but this lack of insight was strongly related to hostility and suspiciousness. Their denial of aggression was also evidenced in a significantly lower self-reported BPAQ aggression score. In the patients who admitted to violent crimes, baseline BPAQ aggression score predicted subsequent aggression; in the deniers, it was negatively related to subsequent aggression.
Denial of aggression is associated with executive dysfunction which facilitates a misappraisal of the surrounding world as threatening and hostile. For those who admit to crimes, self-reported aggression predicts future aggression. In contrast, in the deniers, the extent of denial is related to future aggression. The denial itself is a marker of greater aggressive tendencies.
目前尚无关于精神分裂症患者否认攻击行为的文献。我们的目的是研究这一现象，并确定与之相关的缺陷。
将 102 名住院精神分裂症患者分为三组：（1）有明确暴力犯罪史但在广泛访谈中否认的患者（“否认者”）；（2）有此类病史且承认的患者；（3）无暴力犯罪的患者。对患者进行了一项经心理测量验证的攻击性自评量表，即 Buss-Perry 攻击性问卷（BPAQ）、阳性和阴性综合征量表以及全面的神经认知测试。在接下来的 12 周内，对他们进行随访，记录所有暴力事件。
否认者在执行功能方面的损伤明显更严重，但在其他认知领域没有损伤。他们的精神病症状没有更严重，也没有对自己的精神病缺乏洞察力，但这种缺乏洞察力与敌意和多疑密切相关。他们对攻击性的否认也表现在自我报告的 BPAQ 攻击性评分明显较低。在承认暴力犯罪的患者中，基线 BPAQ 攻击性评分预测了随后的攻击行为；而在否认者中，它与随后的攻击行为呈负相关。
否认攻击行为与执行功能障碍有关，这会导致对周围世界的错误评估，认为其具有威胁性和敌意。对于那些承认犯罪的人来说，自我报告的攻击性预测未来的攻击行为。相比之下，在否认者中，否认的程度与未来的攻击行为有关。否认本身就是更具攻击性倾向的标志。
