Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Forensic Research Domain, Broadmoor Hospital, West London Mental Health Trust, UK.
Forensic Research Domain, Broadmoor Hospital, West London Mental Health Trust, UK; Centre for Mental Health, Department of Medicine, Imperial College London, UK.
Schizophr Res. 2018 Aug;198:21-27. doi: 10.1016/j.schres.2017.06.045. Epub 2017 Jul 6.
Evidence suggests violence amongst those with psychosis is not aetiologically homogeneous, and that a large proportion of those who engage in violent behaviour have a comorbid antisocial personality disorder. Initial investigations indicate that this subgroup has distinct historical and neuropsychological characteristics, which may indicate diverse treatment needs. This study investigated sensorimotor gating characteristics of violent men with diagnoses of both psychosis and dissocial personality disorder (DPD) (n=21) relative to violent men with psychosis alone (n=12), DPD alone (n=14) and healthy, non-violent male controls (n=27), using the prepulse inhibition (PPI) paradigm. The results indicated that, relative to the psychosis alone and healthy control groups, the comorbid group had lower PPI, especially at 60-ms prepulse-to-pulse interval. The DPD group took an intermediary position and did not differ from any group. Antisocial personality traits (factor two scores of the Psychopathy Checklist - Revised), and greater severity of childhood psychosocial deprivation (including physical and sexual abuse), were significantly correlated with poor PPI across the clinical sample. The findings suggest diverse sensorimotor gating profiles amongst subgroups of violent offenders, with comorbid psychosis and DPD showing most impairment. This is consistent with a 'double dose' of deficit explanation amongst those with both diagnoses, explained at least in part by presence of antisocial personality traits and childhood psychosocial deprivation.
有证据表明,精神病患者之间的暴力行为并非病因学同质的,而且很大一部分从事暴力行为的人都伴有合并的反社会人格障碍。初步研究表明,这一小部分人具有明显的历史和神经心理学特征,这可能表明他们有不同的治疗需求。本研究使用 prepulse inhibition (PPI) 范式,调查了同时患有精神病和反社会人格障碍 (DPD) 的暴力男性(n=21)与仅患有精神病的暴力男性(n=12)、仅患有 DPD 的暴力男性(n=14)和健康、非暴力男性对照组(n=27)的感觉运动门控特征。结果表明,与仅患有精神病组和健康对照组相比,合并组的 PPI 较低,尤其是在 60ms 预备脉冲到脉冲间隔。DPD 组处于中间位置,与任何组都没有差异。反社会人格特征(精神病检查表修订版的因子二得分)和更严重的儿童心理社会剥夺(包括身体和性虐待)与整个临床样本中的 PPI 较差显著相关。研究结果表明,暴力罪犯亚组之间存在不同的感觉运动门控特征,合并有精神病和 DPD 的患者表现出最严重的损伤。这与这两种诊断的“双重缺陷”解释一致,至少部分可以用反社会人格特征和儿童心理社会剥夺的存在来解释。