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Cognition and violent behavior in psychotic disorders: A nationwide case-control study
Jelle Lamsma1,2, Wiepke Cahn2, Seena Fazel1
1Department of Psychiatry, University of Oxford, Oxford, UK.
Schizophrenia Research. Cognition
|December 14, 2019
Summary
Violent patients with psychotic disorders showed deficits in executive functions and theory of mind. However, these impairments are unlikely to be useful for predicting or intervening in violent behavior.
Area of Science:
- Psychiatry
- Neuroscience
- Psychology
Background:
- Psychotic disorders are associated with an increased risk of violence.
- Executive functions (EFs) and theory of mind (ToM) impairments may contribute to this risk.
- Previous research was limited by composite measures and small sample sizes.
Purpose of the Study:
- To investigate the relationship between specific executive functions, theory of mind abilities, and lifetime violence in a large sample of patients with psychotic disorders.
- To determine if specific cognitive deficits are associated with violent behavior in this population.
Main Methods:
- Utilized data from the Genetic Risk and Outcome of Psychosis (GROUP) study, including 891 patients with psychotic disorders.
- Administered a battery of neuropsychological tests targeting inhibition, cognitive flexibility, fluid intelligence, planning, affective ToM, and cognitive ToM.
- Assessed lifetime violence through medical records and patient interviews, using ANCOVA to compare violent and nonviolent groups.
Main Results:
- Violent patients exhibited significantly worse performance on tests of fluid intelligence (WAIS-III Block Design), planning (NAB Mazes Test), and cognitive ToM (Hinting Task).
- No significant differences were found for tests of inhibition, cognitive flexibility, or affective ToM.
- Violent behavior accounted for less than 1% of the variance in performance on the tested cognitive functions.
Conclusions:
- Specific impairments in executive functions (fluid intelligence, planning) and cognitive theory of mind are associated with violence in psychotic disorders.
- These specific cognitive deficits do not appear to be strong predictors or targets for intervention for violent behavior in this population.
- The findings suggest that current measures of EFs and ToM may not be clinically useful for risk assessment or intervention in violent behavior associated with psychotic disorders.
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