Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders

Hjell, Gabriela; Mørch-Johnsen, Lynn; Holst, René; Tesli, Natalia; Bell, Christina; Lunding, Synve Hoffart; Rødevand, Linn; Werner, Maren Caroline Frogner; Melle, Ingrid; Andreassen, Ole A.; Lagerberg, Trine Vik; Steen, Nils Eiel; Haukvik, Unn K.

doi:10.1002/brb3.1751

Cited by 6 publications

(9 citation statements)

References 71 publications

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“…This is considered to be the most important result of this study. Our results are not in line with the findings obtained in large groups of patients with schizophrenia and bipolar spectrum disorders, where no significant associations between HDL cholesterol levels and aggression or impulsivity were detected [ 21 ]. The level of HDL cholesterol in subjects with and without aggression was tested for the influence of age, primary dose of therapy, smoking, severity of symptoms of schizophrenia and aggression, and the presence of suicidal behavior, by multiple linear regression.…”

Section: Discussioncontrasting

confidence: 99%

Aggression in Women with Schizophrenia Is Associated with Lower HDL Cholesterol Levels

Herceg

Mímica

Herceg

et al. 2022

IJMS

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This study assessed the association between serum lipid levels and aggression in female patients with schizophrenia. The study included female patients with schizophrenia (N = 120). The participants were subdivided into two groups (aggressive and nonaggressive), with 60 participants in each group. Serum lipids—cholesterol, triglycerides, high-density lipoproteins (HDL cholesterol), and low-density lipoproteins (LDL cholesterol)—were determined. The clinical part of the study included an evaluation using psychiatric scales: the positive and negative syndrome scale (PANSS), the aggression subscale of the PANSS scale (PANSS-AG), and the overt aggression scale (OAS). Significant differences were only observed in HDL cholesterol levels, where aggressive subjects had significantly lower values of HDL cholesterol (t = 2.540; p = 0.012), and the representation of subjects with low cholesterol values was almost three-times higher in the group of subjects with aggression (χ2 = 7.007; p = 0.008) compared to the nonaggressive group. The nominally significant predictor for HDL cholesterol in nonaggressive and aggressive participants was the total value of the PANSS scores. In subjects with aggression, suicidality was not significantly associated with HDL cholesterol levels. Our findings suggest that lower HDL cholesterol is significantly associated with aggression in women with schizophrenia.

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Section: Discussioncontrasting

confidence: 99%

Aggression in Women with Schizophrenia Is Associated with Lower HDL Cholesterol Levels

Herceg

Mímica

Herceg

et al. 2022

IJMS

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“…A total of nine studies ( Cariou et al, 2018 ; Chakrabarti et al, 2004 ; Chen et al, 2015 ; Eriksen et al, 2017 , 2018 ; Hjell et al, 2020 ; Huang and Wu, 2000 ; Repo-Tiihonen et al, 2002 ; Turkoglu et al, 2009 ) explored the link between lipid profile and violence against others, of which six studies found a link. However, there were some variations in the findings.…”

Section: Resultsmentioning

confidence: 99%

“…The studies were again spread over a time period of almost two decades, between 2002 and 2020. Sample sizes varied widely, the largest study with a sample size of 1001 ( Hjell et al, 2020 ), medium level studies with sample sizes of 409 and 348 ( Eriksen et al, 2018 ; Repo-Tiihonen et al, 2002 ) and the smallest with a sample size of 60 patients (Chakrabarti et al, 2009).…”

Section: Resultsmentioning

confidence: 99%

“…The evidence was weaker for the link between TG and violence, with only two studies finding a link, but one with high TG, the other with low TG. It is to be noted that the study with the largest sample size failed to find a link ( Hjell et al, 2020 ). However, one of the issues in this study was the relatively low rate of baseline violence in the study population, thus offering some indication that the link is likely to be more valid in groups where there is a greater prevalence of violence (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies (Hjell et al, 2020;Huang and Wu, 2000) did not find a link between measures of serum cholesterol and violence in schizophrenia patients. Of these, the largest and most recent study (Hjell et al, 2020) had a large sample size (n = 1001) and examined all patients with schizophrenia recruited from inpatient and outpatient clinics of major hospitals in Oslo, Norway, between the years 2002 and 2017. It had 601 patients with schizophrenia spectrum disorders, and the measure of aggression was the PANSS Excited Component (PANSS-EC; Kay et al, 1987).…”

Section: Studies On Aggression Against Othersmentioning

confidence: 96%

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How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review

Sen

Adewusi

Blakemore

et al. 2021

Aust N Z J Psychiatry

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Objectives: Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females. Method: Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal. Results: Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking. Conclusion: There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.

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The Relationship Between CYP46A1 Polymorphism and Suicide Risk: A Preliminary Investigation

Serna-Rodríguez,

Cienfuegos-Jiménez,

Cerda-Flores

et al. 2024

Neuromol Med

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Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 6 publications

References 71 publications

Aggression in Women with Schizophrenia Is Associated with Lower HDL Cholesterol Levels

Aggression in Women with Schizophrenia Is Associated with Lower HDL Cholesterol Levels

How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review

The Relationship Between CYP46A1 Polymorphism and Suicide Risk: A Preliminary Investigation

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