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Impulsivity and aggression in schizophrenia: a neural circuitry perspective with implications for treatment

Published online by Cambridge University Press:  22 April 2015

Matthew J. Hoptman
Matthew J. Hoptman*
Affiliation:
Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA; Department of Psychiatry, New York University School of Medicine, New York, New York, USA; Department of Psychology, City University of New York, New York, New York, USA
*
*Address for correspondence, Matthew J. Hoptman, PhD, Nathan Kline Institute, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA. (Email: Hoptman@nki.rfmh.org)
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Abstract

Elevations of impulsive behavior have been observed in a number of serious mental illnesses. These phenomena can lead to harmful behaviors, including violence, and thus represent a serious public health concern. Such violence is often a reason for psychiatric hospitalization, and it often leads to prolonged hospital stays, suffering by patients and their victims, and increased stigmatization. Despite the attention paid to violence, little is understood about its neural basis in schizophrenia. On a psychological level, aggression in schizophrenia has been primarily attributed to psychotic symptoms, desires for instrumental gain, or impulsive responses to perceived personal slights. Often, multiple attributions can coexist during a single aggressive incident. In this review, I discuss the neural circuitry associated with impulsivity and aggression in schizophrenia, with an emphasis on implications for treatment. Impulsivity appears to account for a great deal of aggression in schizophrenia, especially in inpatient settings. Urgency, defined as impulsivity in the context of strong emotion, is the primary focus of this article. It is elevated in several psychiatric disorders, and in schizophrenia, it has been related to aggression. Many studies have implicated dysfunctional frontotemporal circuitry in impulsivity and aggression in schizophrenia, and pharmacological treatments may act via that circuitry to reduce urgency and aggressive behaviors; however, more mechanistic studies are critically needed. Recent studies point toward manipulable neurobehavioral targets and suggest that cognitive, pharmacological, neuromodulatory, and neurofeedback treatment approaches can be developed to ameliorate urgency and aggression in schizophrenia. It is hoped that these approaches will improve treatment efficacy.

Keywords

Functional connectivityimpulsivityMRIneuroimagingschizophreniatreatmenturgencyviolenceaggression
Type
Review Articles
Information
CNS Spectrums , Volume 20 , Special Issue 3: Violence in the Psychiatric Setting , June 2015 , pp. 280 - 286
Copyright
© Cambridge University Press 2015 

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Footnotes

I wish to thank Karen A. Nolan, PhD, and Amanda R. McGovern, PhD, for their helpful comments on prior drafts of this article.

This article draws on work supported in part by the National Institute of Mental Health (M.J.H., grant numbers R01MH064783 and R21MH0804031) and NARSAD (M.J.H., Young Investigator Award).

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