Aberrant brain structure in patients with schizophrenia and violence: A meta-analysis

Previous studies have indicated that schizophrenia is associated with an increased risk of violence, which may constitute a public health concern, leading to poor treatment outcomes and stigmatization of patients. Investigating brain structural features of violence in schizophrenia could help us understand its specific pathogenesis and find effective biomarkers. Our study aimed at identifying reliable brain structural changes associated with violence in patients with schizophrenia by conducting a meta-analysis and meta-regression of magnetic resonance imaging studies. Specific brain changes in patients with schizophrenia and violence (VSZ) were studied, compared with patients with schizophrenia and violence (VSZ), patients with non-violent schizophrenia (NVSZ), and individuals with a history of violence only and health controls. Primary outcomes revealed that there was no significant difference of gray matter volume between patients with VSZ and patient with NVSZ. Compared with controls, patients with VSZ exhibited decreased gray matter volume in the insula, the superior temporal gyrus (STG), the left inferior frontal gyrus, the left parahippocampus, and the right putamen. Compared with individuals with a history of violence only, patients with VSZ exhibited decreased volume in the right insula and the right STG. Meta-regression analysis revealed a negative correlation between the duration of schizophrenia and the volume of the right insula in patients with VSZ. These findings may suggest a shared neurobiological basis for both violence and psychiatric symptoms. The impaired frontotemporal-limbic network may serve as a neurobiological basis for higher prevalence of violent behaviour in patients with schizophrenia. However, it is important to note that these changes are not unique to patients with VSZ. Further investigation is needed to explore the neural mechanism that drive the interaction between violent behaviour and specific aggression-related dimensions of schizophrenia.