Liu FengJu, Shao Yang, Li Xin, Liu Li, Zhao Rong, Xie Bin, Qiao Yi
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.
Front Psychiatry. 2020 Aug 28;11:788. doi: 10.3389/fpsyt.2020.00788. eCollection 2020.
In recent years, neuroimaging has been used increasingly to explore the biological underpinnings of violence carried out by schizophrenia patients (SPs). Studies have focused mostly on patients with a history of carrying out severe physical assaults, or comorbid with substance abuse/personality disorder (SA/PD). As a result, participants were unrepresentative and the interpretation of brain-structure changes was confusing. Here, we concentrated on SPs on a general psychiatric ward with a history of relatively lower violence, and individuals comorbid with SA or PD were excluded. We expected to identify the characteristics of brain morphometry in this population, and to explore whether the morphometric changes were universal.
Forty-eight violent schizophrenia patients (VSPs), twenty-seven non-VSPs (nVSPs) and 28 nonviolent healthy controls (HCs) were investigated. Voxel-based morphometry was used to evaluate the gray matter volume (GMV) of all study participants. Whole-brain analyses were used to reveal group effects and differences between any two groups. Correlation analyses were undertaken between significant brain regions and behavioral measurements in the VSP group.
Patients showed a significantly smaller GMV in widespread frontal, temporal, and limbic regions compared with HCs. No region was found in which the two patient groups had significantly larger volumes compared with that in HCs. A significant decrease in the GMV of the right fusiform gyrus was found in the VSP group compared with that in the nVSP group (p = 0.004), where the GMV of this region had a negative correlation with the Physical Aggression [subscale of the Modified Overt Aggression Scale (MOAS)] or Hostility score. The VSP group showed a trend of GMV decrease in the left middle temporal cortex compared with that in the nVSP group (p = 0.077). Negative correlation was also found between the GMV of left inferior temporal gyrus/left Superior frontal gyrus, medial and the Hostility score.
Our results provide initial evidence demonstrating the generalizability of GMV abnormalities in SPs engaged in varying levels of violence, even when SA or PD have not been implicated. GMV reduction was correlated with only the Physical Aggression subscale score of the MOAS, suggesting that this change in brain morphology may be dependent upon different types of violent actions.
近年来，神经影像学越来越多地被用于探究精神分裂症患者（SPs）实施暴力行为的生物学基础。研究主要集中在有严重身体攻击史或合并物质滥用/人格障碍（SA/PD）的患者身上。因此，研究参与者缺乏代表性，对脑结构变化的解释也令人困惑。在此，我们聚焦于普通精神科病房中暴力程度相对较低的精神分裂症患者，并排除合并SA或PD的个体。我们期望确定这一人群的脑形态测量特征，并探讨形态测量变化是否具有普遍性。
对48名暴力型精神分裂症患者（VSPs）、27名非暴力型精神分裂症患者（nVSPs）和28名非暴力健康对照者（HCs）进行了研究。基于体素的形态测量法用于评估所有研究参与者的灰质体积（GMV）。全脑分析用于揭示组间效应以及任意两组之间的差异。对VSP组中显著脑区与行为测量指标进行了相关性分析。
与HCs相比，患者在广泛的额叶、颞叶和边缘区域的GMV显著更小。未发现两个患者组在任何区域的体积比HCs显著更大。与nVSP组相比，VSP组右侧梭状回的GMV显著降低（p = 0.004），该区域的GMV与身体攻击行为[改良外显攻击量表（MOAS）的子量表]或敌意得分呈负相关。与nVSP组相比，VSP组左侧颞中皮质的GMV有降低趋势（p = 0.077）。左侧颞下回/左侧额上回中部的GMV与敌意得分之间也呈负相关。
我们的结果提供了初步证据，表明GMV异常在不同暴力程度的精神分裂症患者中具有普遍性，即使不存在SA或PD。GMV降低仅与MOAS的身体攻击行为子量表得分相关，这表明脑形态的这种变化可能取决于不同类型的暴力行为。
