Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls

Abstract

There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience

“…A recent Greek study suggested that a distinction should be done between aggressivity related to the core positive symptoms of schizophrenia and that emerging from independent antisocial personality traits, along with alcohol consumption [74].…”

Psychotically driven aggression is associated with greater mentalizing challenges in psychotic spectrum disorders

“…Several studies have examined social cognition in schizophrenia and aggression. No differences were found in faux pas tests of cognitive social cognition [19,31] or in an empathic accuracy test [31] between those with schizophrenia with and without aggression. However, the studies did not differentiate different forms of aggression nor include cognitive measures.…”

“…While only few studies have examined social cognition in individuals with schizophrenia with a history of aggression [14,17,18], these suggest that aggression per se is coupled with impaired social cognition. However, not all studies have found that social cognition is more impaired in those with schizophrenia who have been aggressive compared with those who have not [19], possibly related to the recognition that aggression in those with schizophrenia broadly separates into that which begins early with a history of conduct disorder and impulsivity and that which has a later debut which is often regarded to be more intimately connected with psychotic content [20]. Yet clinically it is well known that even young persons with schizophrenia may have an early debut into violence which is driven by their psychotic experiences and which occurs without a history of conduct disorder.…”

Theory of Mind in Offending: A Systematic Review

“…Advanced ToM results. Among the 22 studies, seven did not find differences in advanced ToM between the offenders and nonoffenders (Kristof et al, 2018;Mayer et al, 2018;Mundy, 2004;Nentjes, Bernstein, Arntz, Slaats, & Hannemann, 2015;Nentjes, Bernstein, Arntz, van Breukelen, & Slaats, 2015;Winter et al, 2017;Woodbury-Smith et al, 2005), whereas nine studies found deficits in advanced ToM in offenders (Castellino et al, 2011;Engelstad et al, 2019;Mariano et al, 2017;Milojevic ´& Dimitrijevic ´, 2014;Newbury-Helps et al, 2017;Romero-Martínez et al, 2013;Schuler et al, 2019;Spenser, 2017;Spenser et al, 2015). Additionally, six studies reported inconsistent patterns of impairment, depending on the task that was assessed.…”