A neuropsychological investigation into violence and mental illness

Abstract

Previous research has reported cognitive impairment in patients with schizophrenia and antisocial personality disorder (APD), the two psychiatric illnesses most implicated in violent behaviour. Previous studies have focused on either group exclusively, and have been criticized for procedural inadequacies and sample heterogeneity. The authors investigated and compared neuropsychological profiles of individuals with APD and violent and nonviolent individuals with schizophrenia in a single investigation. The study involved four groups of subjects: (i) individuals with a history of serious violence and a diagnosis of APD, (ii) individuals with a history of violence and schizophrenia, (iii) individuals with schizophrenia without a history of violent behaviour and (iv) healthy control subjects. All study groups were compared on a neuropsychological battery designed to assess general intellectual function, executive function, attention, and processing speed. Cognitive deficits were more widespread among individuals with schizophrenia regardless of history of violence, compared with those with APD. Significant impairment in patients with APD was limited to processing speed. Violent individuals with schizophrenia demonstrated poorer performance than their nonviolent schizophrenia peers on a measure of executive function. Different cognitive impairments are manifested by individuals with APD and schizophrenia with violent behaviours, suggesting differences in underlying pathology. Furthermore, cognitive impairment appears to be more a feature of schizophrenia than of violent behaviour, although there is evidence that a combination of schizophrenia and violent behaviour is associated with greater cognitive deficits.