The objective of this study is to determine whether violence in psychiatric patients is associated with brain dysfunction independent of substance abuse. Psychiatric inpatients with a history of violent behavior in the community were compared to nonviolent inpatients on several variables related to brain dysfunction. The two groups were similar in terms of demographics and psychiatric diagnosis. No significant differences were found in neuropsychological function, but violent patients were significantly more likely to have co-occurring substance abuse and nearly 4 times more likely to have a history of closed-head injury. Logistic regression revealed that the association between violence and head injury can be explained by comorbid substance abuse.
Adams, J.J., Meloy, J.R., & Moritz, M.S. (1990). Neuropsychological deficits and violent behavior in incarcerated schizophrenics. Journal of Nervous and Mental Disease, 178, 253-256.
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .
3.
Arsenault, L., Tremblay, R.E., Boulerice, B., Seguin, J.R., & Saucier, J.F. (2000). Minor physical anomalies and family adversity as risk factors for violent delinquency in adolescence. American Journal of Psychiatry, 157, 917-923.
4.
Baker, S.C., Frith, C.D., & Dolan, R.J. (1997). The interaction between mood and cognitive function studied with PET. Psychological Medicine, 27, 565-578.
5.
Barkataki, I., Kumari, V., Das, M., Hill, M., Morris, R., O'Connell, P., et al. (2005). Neuropsychological investigation into violence and mental illness. Schizophrenia Research, 74, 1-13.
6.
Barkataki, I., Kumari, V., Das, M., Taylor, P., & Sharma, T. (2006). Volumetric structural brain abnormalities in men with schizophrenia or antisocial personality disorder. Behavior and Brain Research, 169, 239-247.
7.
Barker, E.D., Seguin, J.R., White, H.R., Bates, M.E., Lacourse, E., Carbonneau, R., et al. (2007). Developmental trajectories of male physical violence and theft: Relations to neurocognitive performance. Archives of General Psychiatry, 64, 592-599.
8.
Bechara, A., Dolan, S., Denburg, N., Hindes, A., Anderson, S.W., & Nathan, P.E. (2001). Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers . Neuropsychologia, 39, 376-389.
9.
Best, M., Williams, J.M., & Coccaro, E.F. (2002). Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder. Proceedings of the National Academy of Sciences, USA, 99, 8448-8453.
10.
Blake, P.Y., Pincus, J.H., & Buckner, C. (1995). Neurologic abnormalities in murderers. Neurology, 45, 1641-1647.
11.
Brooks, D., Campsie, L., Symington, C., Beattie, A., & McKinlay, W. (1986). The five year outcome of severe blunt head injury: A relative's view. Journal of Neurology, Neurosurgery, and Psychiatry, 49, 764-770.
12.
Brower, M.C., & Price, B.H. (2001). Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: A critical review. Journal of Neurology, Neurosurgery and Psychiatry, 71, 720-726.
13.
Bryant, E.T., Scott, M.L., Golden, C.J., & Tori, C.D. (1984). Neuropsychological deficits, learning disability, and violent behavior. Journal of Consulting and Clinical Psychology , 52, 323-324.
14.
Convit, A., Czobor, P., & Volavka, J. (1991). Lateralized abnormality in the EEG of persistently violent psychiatric inpatients. Biological Psychiatry, 30, 363-370.
15.
Convit, A., Douyon, R., Yates, K., Smith, G., Czobor, P., de Asis, J., et al. (1996). Frontotemporal abnormalities and violent behavior. In D. M. Stoff & R. B. Cairns (Eds.), Aggression and violence: Genetic, neurobiological, and biosocial perspectives (pp. 169-194). Mahwah, NJ: Lawrence Erlbaum.
16.
Denno, D.J. (1990). Biology and violence: From birth to adulthood . New York: Cambridge University Press.
17.
Dougherty, D.D., Rauch, S.L., Deckersbach, T., Marci, C., Loh, R., Shin, L.M., et al. (2004). Ventromedial prefrontal cortex and amygdala dysfunction during an anger induction positron emission tomography study in patients with major depressive disorder with anger attacks. Archives of General Psychiatry, 61, 795-804.
18.
Dunn, L. (1965). Expanded manual for the Peabody Picture Vocabulary Test. Circle Pines, MN: American Guidance Service.
19.
Elliott, F. (1982). Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome. Journal of Nervous and Mental Disease, 170, 680-687.
20.
Elliott, F. (1990). Neurology of aggression and episodic dyscontrol . Seminars in Neurology, 10, 303-312.
21.
Elliott, F. (1992). Violence. The neurologic contribution: An overview . Archives of Neurology, 49, 595-603.
22.
Erkiran, M., Ozunalan, H., Evren, C., Aytaclar, S., Kirisci, L., & Tarter, R. (2006). Substance abuse amplifies the risk for violence in schizophrenia spectrum disorder. Addictive Behaviors, 31, 1797-1805.
23.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician . Journal of Psychiatric Research, 12, 189-198.
24.
Fulwiler, C., Eckstine, J., & Kalsy, S. (2005). Impulsive-aggressive traits, serotonin function, and alcohol-enhanced aggression. Journal of Clinical Pharmacology , 45, 94-100.
25.
Fulwiler, C., Grossman, H., Forbes, C., & Ruthazer, R. (1997). Early-onset substance abuse and community violence by outpatients with chronic mental illness. Psychiatric Services , 48, 1181-1185.
26.
Fulwiler, C., & Ruthazer, R. (1999). Premorbid risk factors for violence in adult mental illness. Comprehensive Psychiatry, 40, 96-100.
27.
Grafman, J., Schwab, K., Warden, D., Pridgen, A., Brown, H.R., & Salazar, A.M. (1996). Frontal lobe injuries, violence, and aggression: A report of the Vietnam Head Injury Study. Neurology, 46, 1231-1238.
28.
Grant, S., Contoreggi, C., & London, E.D. (2000). Drug abusers show impaired performance in a laboratory test of decision-making. Neuropsychologia, 38, 1180-1187.
29.
Halperin, J.M., Wolf, L., Greenblatt, E.R., & Young, G. (1991). Subtype analysis of commission errors on the continuous performance test in children. Developmental Neuropsychology , 7, 207-217.
30.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50-55.
31.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology , Neurosurgery, and Psychiatry, 23, 56-62.
32.
Harmon-Jones, E., Barratt, E.S., & Wigg, C. (1997). Impulsiveness, aggression, reading, and the P300 of the event-related potential. Personality and Individual Differences, 22, 439-445.
33.
Heaton, R. (1981). Wisconsin Card Sorting Test manual. Odessa, FL: Psychological Assessment Resources.
34.
Heinrichs, R. (1989). Frontal cerebral lesions and violent incidents in chronic neuropsychiatric patients. Biological Psychiatry , 25, 174-178.
35.
Hien, D., Zimberg, S., Weisman, S., First, M., & Ackerman, S. (1997). Dual diagnosis subtypes in urban substance abuse and mental health clinics. Psychiatric Services, 48, 1058-1063.
36.
Hodgins, S. (1992). Mental disorder, intellectual deficiency, and crime. Archives of General Psychiatry, 49, 476-483.
37.
Hodgins, S., Kratzer, L., & McNeil, T.F. (2002). Obstetrical complications, parenting practices and risk of criminal behaviour among persons who develop major mental disorders. Acta Psychiatrica Scandinavica, 105, 179-188.
38.
Jastak, S., & Wilkinson, G. (1984). Wide Range Achievement Test-Revised. Wilmington, DE: Jastak Associates.
39.
Kandel, E., Brennan, P.A., Mednick, S.A., & Michelson, N.M. (1989). Minor physical anomalies and recidivistic adult violent criminal behavior. Acta Psychiatrica Scandinavica, 79, 103-107.
40.
Krakowski, M., Convit, A., Jaeger, J., Lin, S., & Volavka, J. (1989). Neurological impairment in violent schizophrenic inpatients. American Journal of Psychiatry, 146, 849-853.
41.
Krakowski, M., Czobor, P., Carpenter, M.D., Libiger, J., Kunz, M., Papezova, H., et al. (1997). Community violence and inpatient assaults: Neurobiological deficits. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 549-555.
42.
Kreutzer, J.S., Marwitz, J.H., & Witol, A.D. (1995). Interrelationships between crime, substance abuse, and aggressive behaviours among persons with traumatic brain injury. Brain Injury, 9, 757-768.
43.
Lafayette, J., Frankle, W., Pollock, A., Dyer, K., & Goff, D. (2003). Clinical characteristics, cognitive functioning, and criminal histories of outpatients with schizophrenia. Psychiatric Services, 54, 1635-1640.
44.
Lapierre, D., Braun, C.M., Hodgins, S., Toupin, J., Leveillee, S., & Constantineau, C. (1995). Neuropsychological correlates of violence in schizophrenia. Schizophrenia Bulletin, 21, 253-262.
45.
León-Carrión, J., & Ramos, F.J. (2003). Blows to the head during development can predispose to violent criminal behaviour: Rehabilitation of consequences of head injury is a measure for crime prevention. Brain Injury, 17, 207-216.
46.
Lewis, D.O., Moy, E., Jackson, L.D., Aaronson, R., Restifo, N., Serra, S., et al. (1985). Biopsychosocial characteristics of children who later murder: A prospective study. American Journal of Psychiatry, 142, 1161-1167.
47.
Lindqvist, P., & Allebeck, P. (1989). Schizophrenia and assaultive behaviour: The role of alcohol and drug abuse. Acta Psychiatrica Scandinavica , 82, 191-195.
48.
Link, B., Andrews, H., & Cullen, F. (1992). The violent and illegal behavior of mental patients reconsidered. American Sociological Review, 57, 275-292.
49.
Lipsey, M.W., Wilson, D.B., Cohen, M.A., & Derzon, J.H. (1997). Is there a causal relationship between alcohol use and violence? A synthesis of evidence. Recent Developments in Alcoholism, 13, 245-282.
50.
Maiuro, R., Vitaliano, P., & Cahn, T. (1987). A brief measure for the assessment of anger and aggression. Journal of Interpersonal Violence, 2, 166-178.
51.
Mannuzza, S., Klein, R., Konig, P., & Giampino, T. (1989). Hyperactive boys almost grown up. IV. Criminality and its relationship to psychiatric status. Archives of General Psychiatry, 46, 1073-1079.
52.
Max, J., Castillo, C., Lindgren, S., & Arndt, S. (1998). The Neuropsychiatric Rating Schedule: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 297-304.
53.
Max, J., Robertson, B., & Lansing, A. (2001). The phenomenology of personality change due to traumatic brain injury in children and adolescents. Journal of Neuropsychiatry & Clinical Neurosciences, 13, 161-170.
54.
McAllister, T.W. (1992). Neuropsychiatric sequelae of head injuries. Psychiatric Clinics of North America, 15, 395-413.
55.
McKinlay, W., Brooks, D., Bond, M., Martinage, D., & Marshall, M. (1981). The short-term outcome of severe blunt head injury as reported by relatives of the injured persons. Journal of Neurology, Neurosurgery, and Psychiatry, 44, 527-533.
56.
Miczek, K., DeBold, J., Haney, M., Tidey, J., Vivian, J., & Weerts, E. (1994). Alcohol, drugs of abuse, aggression, and violence . In A. Reiss & J. Roth (Eds.), Understanding and preventing violence. Volume 3: Social influences (pp. 377-507). Washington, DC: National Academy Press.
57.
Miller, L. (1992). Neuropsychology, personality, and substance abuse in the head injury case: Clinical and forensic issues. International Journal of Law and Psychiatry, 15, 303-316.
58.
Modestin, J., & Ammann, R. (1996). Mental disorder and criminality: Male schizophrenia . Schizophrenia Bulletin, 22, 69-82.
59.
Moffitt, T. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.
60.
Moffitt, T., & Henry, B. (1991). Neuropsychological studies of juvenile delinquency and juvenile violence. In J. S. Milner (Ed.), Neuropsychology of aggression (pp. 67-91). Boston : Kluwer.
61.
Morgan, A.B., & Lilienfeld, S.O. (2000). A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function. Clinical Psychology Review, 20, 113-156.
62.
Mungas, D. (1983). An empirical analysis of specific syndromes of violent behavior. Journal of Nervous and Mental Disease, 171, 354-361.
63.
Mungas, D. (1988). Psychometric correlates of episodic violent behaviour. A multidimensional neuropsychological approach. British Journal of Psychiatry, 152, 180-187.
64.
Naudts, K., & Hodgins, S. (2006). Neurobiological correlates of violent behavior among persons with schizophrenia. Schizophrenia Bulletin, 32, 562-572.
65.
New, A.S., Buchsbaum, M.S., Hazlett, E.A., Goodman, M., Koenigsberg, H.W., Lo, J., et al. (2004). Fluoxetine increases relative metabolic rate in prefrontal cortex in impulsive aggression. Psychopharmacology , 176, 451-458.
66.
Nitschke, J.B., Nelson, E.E., Rusch, B.D., Fox, A.S., Oakes, T.R., & Davidson, R.J. (2004). Orbitofrontal cortex tracks positive mood in mothers viewing pictures of their newborn infants. Neuroimage, 21, 583-592.
67.
Nolan, K.A., Czobor, P., Roy, B.B., Platt, M.M., Shope, C.B., Citrome, L.L., et al. (2003). Characteristics of assaultive behavior among psychiatric inpatients. Psychiatric Services, 54, 1012-1016.
68.
Northoff, G., Richter, A., Gessner, M., Schlagenhauf, F., Fell, J., Baumgart, F., et al. (2000). Functional dissociation between medial and lateral prefrontal cortical spatiotemporal activation in negative and positive emotions: A combined fMRI/MEG study. Cerebral Cortex , 10, 93-107.
69.
O'Doherty, J., Kringelbach, M.L., Rolls, E.T., Hornak, J., & Andrews, C. (2001). Abstract reward and punishment representations in the human orbitofrontal cortex. Nature-Neuroscience, 4, 95-102.
70.
Quanbeck, C. (2006). Forensic psychiatric aspects of inpatient violence . Psychiatric Clinics of North America, 29, 743-760.
71.
Raine, A., Brennan, P., & Mednick, S.A. (1994). Birth complications combined with early maternal rejection at age 1 year predispose to violent crime at age 18 years. Archives of General Psychiatry, 51, 984-988.
72.
Raine, A., Brennan, P., & Mednick, S.A. (1997). Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: Specificity to serious, early-onset violence. American Journal of Psychiatry , 154, 1265-1271.
73.
Raine, A., & Buchsbaum, M. (1996). Violence, brain imaging, and neuropsychology. In D. M. Stoff & R. B. Cairns (Eds.), Aggression and violence: Genetic, neurobiological, and biosocial perspectives (pp. 169-194). Mahwah, NJ: Lawrence Erlbaum.
74.
Raine, A., Buchsbaum, M., & LaCasse, L. (1997). Brain abnormalities in murderers indicated by positron emission tomography. Biological Psychiatry, 42, 495-508.
75.
Raine, A., Moffitt, T.E., Caspi, A., Loeber, R., Stouthamer-Loeber, M., & Lynam, D. (2005). Neurocognitive impairments in boys on the life-course persistent antisocial path. Journal of Abnormal Psychology , 114, 38-49.
76.
Rasanen, P., Tiihonen, J., Isohanni, M., Rantakallio, P., Lehtonen, J., & Moring, J. (1998). Schizophrenia, alcohol abuse, and violent behavior: A 26-year follow-up study of an unselected birth cohort. Schizophrenia Bulletin, 24, 437-441.
77.
Raven, J. (1960). Guide to the standard progressive matrices. London: HK Lewis.
78.
Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., Judd, L.L., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. Journal of the American Medical Association, 264, 2511-2518.
79.
Reitan, R., & Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery . Tucson, AZ: Neuropsychology Press .
80.
Rolls, E.T. (1995). A theory of emotion and consciousness, and its application to understanding the neural basis of emotion. In M. S. Gazzaniga (Ed.), The cognitive neurosciences (pp. 325-344). Cambridge, MA: MIT Press.
81.
Rolls, E.T. (1998). The orbitofrontal cortex. In A. C. Roberts, T. W. Robbins , & L. Weiskrantz (Eds.), The prefrontal cortex: Executive and cognitive functions (pp. 67-86). Oxford , UK: Oxford University Press.
82.
Rosenbaum, A., & Hoge, S.K. (1989). Head injury and marital aggression. American Journal of Psychiatry, 146, 1048-1051.
83.
Satterfield, J., & Schell, A. (1997). A prospective study of hyperactive boys with conduct problems and normal boys: Adolescent and adult criminality. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1726-1735.
84.
Saykin, A.J., Gur, R.C., Gur, R.E., Mozley, P.D., Mozley, L.H., Resnick, S.M., et al. (1991). Neuropsychological function in schizophrenia: Selective impairment in memory and learning. Archives of General Psychiatry, 48, 618-624.
85.
Seidenwurm, D., Pounds, T.R., Globus, A., & Valk, P.E. (1997). Abnormal temporal lobe metabolism in violent subjects: Correlation of imaging and neuropsychiatric findings. American Journal of Neuroradiology, 18, 625-631.
86.
Shaner, A., Khalsa, M.E., Roberts, L., Wilkins, J., Anglin, D., & Hsieh, S.C. (1993). Unrecognized cocaine use among schizophrenic patients . American Journal of Psychiatry, 150, 758-762.
87.
Shipley, W. (1940). A self-administered scale for measuring intellectual impairment and deterioration. Journal of Psychology, 9, 371-377.
88.
Slaughter, B., Fann, J.R., & Ehde, D. (2003). Traumatic brain injury in a county jail population: Prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury, 17, 731-741.
89.
Soderstrom, H., Tullberg, M., Wikkelso, C., Ekholm, S., & Forsman, A. (2000). Reduced regional cerebral blood flow in non-psychotic violent offenders. Psychiatry Research, 98, 29-41.
90.
Solomon, D.A., & Malloy, P.F. (1992). Alcohol, head injury, and neuropsychological function . Neuropsychology Review, 3, 249-280.
91.
Steadman, H.J., Mulvey, E.P., Monahan, J., Robbins, P.C., Appelbaum, P.S., Grisso, T., et al. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55, 393-401.
92.
Swanson, J.W. (1994). Mental disorder, substance abuse, and community violence: An epidemiologic approach. In J. Monahan & H. Steadman (Eds.), Violence and mental disorder: Developments in risk assessment (pp. 101-136). Chicago: University of Chicago Press.
93.
Swanson, J.W., Holzer, C.E., Ganju, V.K., & Jono, R.T. (1990). Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry, 41, 761-770.
94.
Swartz, M.S., Swanson, J.W., Hiday, V.A., Borum, R., Wagner, H.R., & Burns, B.J. (1998). Violence and severe mental illness: The effects of substance abuse and non-adherence to medication. American Journal of Psychiatry, 155, 226-231.
95.
Tateno, A., Jorge, R., & Robinson, R. (2003). Clinical correlates of aggressive behavior after traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 155-160.
96.
Tonkonogy, J.M. (1991). Violence and temporal lobe lesion: Head CT and MRI data. Journal of Neuropsychiatry and Clinical Neurosciences , 3, 189-196.
97.
Volavka, J. (1987). Electroencephalogram among criminals. In S. Mednick, T. Moffitt, & S. Stack (Eds.), The causes of crime: New biological approaches (pp. 137-145). Cambridge, UK: Cambridge University Press.
98.
Volkow, N.D., & Tancredi, L. (1987). Neural substrates of violent behavior: a preliminary study with positron emission tomography. British Journal of Psychiatry, 151, 668-673.
99.
Volkow, N.D., Tancredi, L.R., Grant, C., Gillespie, H., Valentine, A., Mullani, N., et al. (1995). Brain glucose metabolism in violent psychiatric patients: A preliminary study. Psychiatry Research, 61, 243-253.
100.
Wechsler, D. (1981). Wechsler Adult Intelligence Scale-Revised. San Antonio, TX: Psychological Corporation .
101.
Wildgruber, D., Hertrich, I., Riecker, A., Erb, M., Anders, S., Grodd, W., et al. (2004). Distinct frontal regions subserve evaluation of linguistic and emotional aspects of speech intonation. Cerebral Cortex, 14, 1384-1389.
102.
Wong, M.T., Lumsden, J., Fenton, G.W., & Fenwick, P.B. (1994). Electroencephalography, computed tomography and violence ratings of male patients in a maximum-security mental hospital. Acta Psychiatrica Scandinavica, 90, 97-101.
103.
Yeudall, L.T., & Fromm-Auch, D. (1979). Neuropsychological impairments in various psychopathological populations. In J. Gruzelier & P. Flor-Henry (Eds.), Hemisphere. Asymmetries of function in psychopathology (pp. 341-362). New York: Elsevier/North Holland.
