The Neurobiology of Violence in a Psychosis-Risk Cohort

R01MH113861-01-Girgis 研究表明，暴力在精神病患者中并不常见，当它确实发生时，精神病患者往往是受害者，而不是肇事者。虽然已经确定了暴力的风险因素，如未经治疗的症状和药物使用，但仍存在巨大的知识差距。我们对精神病中的暴力风险缺乏了解，特别是在精神病的减弱和早期阶段，反映出先前的研究是在已经患有精神病的个人中进行的，和/或没有纵向组成部分。此外，在大多数研究中，VB的假定前置因素(即暴力思维[VI])没有被测量。这些因素使VB和精神病症状之间的联系变得复杂，并排除了从VI到VB的时间进程的检查。了解暴力和精神病之间的关系对于制定旨在降低精神病患者暴力风险的干预措施至关重要。为了满足这一需求，我们最近进行了一项初步研究，在该研究中，我们使用精神病风险综合征(SiPS)结构化访谈对200名CHR个体进行了VI和VB的纵向评估，并根据麦克阿瑟社区暴力类别对这些人进行了评级。我们发现VI是相对常见的，在基线时VI和VB都能很好地预测随访期间的VB以及向精神病的转化，独立于所有的临床和人口统计学变量。此外，没有通过直接询问VI来获得关于VI的信息，而是通过SIPs上的具体提示获得的，该SIPs与暴力无关，但与对精神病思维的询问有关。此外，我们对其中71人进行了初步的表面形态测量分析，发现杏仁核形态测量和基线VI之间的关系。这些数据支持早期精神病和VB之间的神经生物学和现象学联系的可能性，并暗示了识别一组暴力风险较高的患者的可能性，这可能受益于更密切的监测和快速治疗干预。需要复制和阐述这些重要结果，因为它们对制定旨在减少精神病患者暴力风险的干预措施具有重要影响。在这项拨款申请中，我们将重点放在VI上。为此，我们将在基线时对VI、症状和临床措施(例如精神病、犯罪史)进行全面评估，并进行跟踪，直到转化为完全精神病或两年，以先发生者为准，以获得转化为精神病和结果VB的信息。我们还将在基线和转化为完全精神病或两年后(以最先发生的为准)进行核磁共振检查。

R01MH113861-01 – Girgis Research suggests that violence is uncommon in individuals with psychosis, and when it does happen, individuals with psychosis are more often the victims rather than the perpetrators. While risk factors for violence have been identified, such as untreated symptoms and substance use, huge knowledge gaps remain. Our lack of understanding of violence risk in psychosis, particularly during attenuated and early phases of psychosis, reflects that prior studies were performed in already psychotic individuals and/or did not possess longitudinal components. Additionally, the presumed antecedents of VB (i.e., violent ideation [VI]) were not measured in the majority of studies. These factors complicate the disentangling of links between VB and psychotic symptoms, and preclude an examination of the temporal progression from VI to VB. An understanding of the relationship between violence and psychosis is critical for developing interventions aimed at reducing the risk of violence in psychotic individuals. In order to address this need, we recently performed a preliminary study in which we longitudinally assessed 200 CHR individuals for VI and VB using the Structured Interview for Psychosis-Risk Syndromes (SIPS), and rated these according to MacArthur Community Violence categories. We found that VI was relatively common, and that both VI and VB at baseline strongly predicted VB during follow-up as well as conversion to psychosis, independent of all clinical and demographic variables. Additionally, no information about VI was obtained by directly asking about VI, but instead by specific prompts on the SIPS unrelated to violence but related to inquiry about psychotic thinking. In addition, we performed preliminary surface based morphometric analyses of 71 of these individuals and found relationships between amygdalar morphometry and baseline VI. These data support the potential for neurobiological and phenomenological links between incipient psychosis and VB and suggest the possibility of identification of a group of patients at elevated risk for violence that might benefit from closer monitoring and rapid treatment interventions. These important results need to be replicated and expounded upon as they have critical implications for the development of interventions aimed at reducing the risk of violence in psychotic individuals. In this grant application, we will focus on VI. To do so we will perform comprehensive assessments of VI, symptoms, and clinical measures that were not measured in the pilot study (e.g., psychopathy, criminal history) at baseline and follow them until conversion to full blown psychosis or two years, whichever comes first, to obtain information on conversion to psychosis and outcome VB. We will also obtain MRI at baseline and upon conversion to full blown psychosis or two years, whichever comes first.