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，当暴力发生时，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，例如未经治疗的症状和药物使用，但仍然存在巨大的知识差距。我们缺乏对精神病暴力风险的了解，特别是在精神病的衰减和早期阶段，反映了先前的研究是在已经精神病患者中进行的和/或没有纵向成分。此外，VB的假定前提（即，暴力意念[VI]）在大多数研究中没有测量。这些因素使VB和精神病症状之间联系的解开复杂化，并排除了从VI到VB的时间进展的检查。暴力和精神病之间的关系的理解是至关重要的发展干预措施，旨在减少精神病患者的暴力风险。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，我们纵向评估了200个人的VI和VB使用结构化访谈精神病风险综合征（SIPS），并根据麦克阿瑟社区暴力类别进行评级。我们发现VI是相对常见的，VI和VB在基线强烈预测VB在随访期间以及转换为精神病，独立于所有临床和人口统计学变量。此外，没有通过直接询问VI获得关于VI的信息，而是通过SIPS上与暴力无关但与询问精神病思维有关的具体提示获得。此外，我们进行了初步的表面为基础的形态分析，这些人中的71个，发现杏仁核形态测量和基线VI之间的关系。这些数据支持潜在的神经生物学和现象学的早期精神病和VB之间的联系，并建议一组患者的暴力，可能会受益于更密切的监测和快速治疗干预的风险升高的识别的可能性。这些重要的结果需要复制和阐述，因为它们对旨在减少精神病患者暴力风险的干预措施的发展具有重要意义。在这次申请中，我们将重点关注VI。为此，我们将对VI、症状和临床指标进行全面评估，这些指标在试点研究中没有测量（例如，精神病，犯罪史），并跟踪他们，直到转化为全面爆发的精神病或两年，以先到者为准，以获得关于转化为精神病和结果VB的信息。我们还将在基线和转换为全面精神病或两年时（以先到者为准）进行MRI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.