Distinct neural responses to punishment anticipation in violent and non-violent individuals with schizophrenia

Evidence suggests an increased risk of violence in individuals with schizophrenia. While violent behavior in non-psychotic populations has been associated with reduced sensitivity to punishment, the neural mechanisms underlying reward and punishment processing in violent individuals with schizophrenia have yet to be investigated. Thus, this study aims to examine the neural responses to reward and punishment processing in this population. Ninety-four participants were divided into three groups: schizophrenia with violent behaviors (SZ + V, n = 31), schizophrenia without violent behavior (SZ-V, n = 31), and healthy controls (HC, n = 32). All participants performed a monetary incentive delay task during a functional magnetic resonance imaging session. Compared to SZ-V and HC groups, the SZ + V group showed alterations in the lingual gyrus, the dorsal anterior cingulate cortex, and the supplementary motor area during punishment anticipation. The SZ + V group also demonstrated alterations in the fusiform gyrus during reward anticipation, as well as in the inferior temporal gyrus during punishment avoidance. Both SZ + V and SZ-V groups exhibited alterations in the ventrolateral prefrontal cortex during reward outcome, in the dorsolateral prefrontal cortex during no reward outcome, and in the lateral and dorsolateral prefrontal cortex during punishment outcome, compared to the HC group. Mainly, we found that violence in schizophrenia is associated with increased activation in brain regions involved in salience and attentional processing, as well as in motor preparation during punishment processing.