Urgency breeds aggression in schizophrenia patients

By Eleanor McDermid, Senior medwireNews Reporter

Increased urgency is a major contributor to aggression in patients with schizophrenia, suggests research published in The American Journal of Psychiatry.

Both positive and negative urgency were significantly increased in schizophrenia patients versus mentally healthy controls and accounted for up to 18% of the variance in aggression over and above what was explained by being in the patient versus control group.

Editorialist Philip Szeszko (The Feinstein Institute for Medical Research, Manhasset, New York, USA) says the study “highlights the underappreciated role of urgency in aggression among individuals with schizophrenia and the concomitant underlying neural circuits that may mediate this relationship.”

He adds: “For clinicians treating individuals with schizophrenia, it is a reminder that impulsivity and urgency may be risk factors for aggressive behavior.”

The researchers assessed the study participants’ aggression on the Buss-Perry Aggression Questionnaire and positive and negative urgency on the Urgency, Premeditation, Perseverance, and Sensation-Seeking scale. Other subfactors of the urgency scale – lack of premeditation, lack of perseverance and sensation seeking – did not significantly differ between the 32 patients and 30 controls.

Study author Matthew Hoptman (Nathan S Kline Institute for Psychiatric Research, Orangeburg, New York, USA) and colleagues also looked at the participants’ brain structure and function, which Szeszko describes as a “major strength” of the study.

The team found that, in patients but not controls, increased negative urgency was associated with reduced cortical thickness at the right frontal pole and the right medial orbitofrontal cortex, while increased positive urgency correlated with reduced left rostral anterior cingulate and right frontal pole thickness.

Urgency was also associated with altered functional connectivity between these areas, being associated with reduced connectivity between ventral prefrontal and limbic/cognitive control regions and increased connectivity between sensory regions, including the middle occipital gyrus.

“This is important given that these regions have been linked to response inhibition, cognitive control, and conflict monitoring”, says Szeszko.

“It is also particularly noteworthy that many of the networks that associated positively or negatively with urgency were themselves inversely correlated, suggesting that different networks ‘compete’ to regulate behavioral variability related to urgency in schizophrenia”, he adds.

“It is therefore conceivable that an inability to differentially engage these networks, as well as difficulty modulating their interaction, could contribute to increased urgency and aggression in schizophrenia.”

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