Neuropsychological Characteristics of Schizophrenic Patients who Committed Homicide / 신경정신의학

OBJECTIVES: There is a moderate but significant association between schizophrenia and violence. The purpose of this study is to investigate the relationship between violence and brain cognitive functions in schizophrenic patients who have committed homicide using neuropsychological tests. METHODS: The study involved three group of subjects: schizophrenics who have committed homicide (n=51), schizophrenics who have not committed homicide (n=50) and normal control (n=50). Intelligence test (K-WAIS), memory test (Rey-Kim Memory Test) and executive function test (Stroop test, WCST) as well as Positive and Negative Syndrome Scale (PANSS) and Structured Interview for DSM-IV Personality (SIDP) were administered by trained researchers. RESULTS: There were no significant differences in demographic variables among groups. Schizophrenic patients showed overall cognitive deficit in intelligence, memory and executive functions, regardless of homicide behavior. Homicidal schizophrenic group was not significantly different from non-homicidal schizophrenic group in every cognitive domain. There was no significant correlation between index scores of cognitive functions and Life History of Aggression assessment (LHA). However, index scores of cognitive functions were negatively correlated with the PANSS and schizotypal trait scores. CONCLUSION: Cognitive dysfunction is common across both schizophrenic groups. It doesn't significantly correlate with homicidal experience, but it correlates with the schizophrenic symptom domains.

Clinical Characteristics of Schizophrenic Patients who Committed Homicide / 신경정신의학

OBJECTIVES: Recent studies have shown that schizophrenic patients are at increased risk to commit acts of aggression, and aggressive behaviors have severe critical results for the patients and victims. The purpose of the present study is to assess the homicidal behaviors of schizophrenic patients as a extreme case of aggressiveness. METHODS: 93 homicidal schizophrenic patients and 93 non-homicidal schizophrenic patients participated in this study. Diagnostic evaluation was made with SCID (Structured Clinical Interview for DSM-IV), and personality trait was evaluated with SIDP (Structured Interview for DSM-IV Personality Disorders). Symptom evaluation was done with PANSS (Positive And Negative Syndrome Scale), and violent behaviors were assessed with LHA (Life History of Aggression) and OAS (Overt Aggression Scale). RESULTS: There were no significant differences in demographic variables, schizotypal personality trait and antisocial personality trait between two groups. Mean age at homicidal commitment was 34+/-8.9 years and 9.8+/-7.5 years after the onset of illness. The major criminal victims were the parents of the patients(N=49, 53.7%). The aggressiveness was higher in homicidal schizophrenic patients in LHA and OAS scales. There were statistical significances in separate items of the PANSS scale such as excitement (P4), poor rapport (N3), lack of judgement and insight (G12), disturbance of volition (G13), poor impulse control (G14) and active social avoidnance (G16), but not in the positive, negative, general subscales and the total scores of the PANSS scale. CONCLUSION: Excitement and poor impulse control persisted in homicidal schizophrenics, although overt psychotic symptoms decline after proper treatment. Homicidal behavior can be preventive if proper treatment for excitement and poor impulse control are given.