Prospective cohort study of the relationship between neuro-cognition, social cognition and violence in forensic patients with schizophrenia and schizoaffective disorder

BMC Psychiatry

Harry G Kennedy²  Zareena Abidin²  Ronan Mullaney²  Mary Davoren²  Elizabeth Owens²  Louise Brennan²  Elizabeth Watts²  Yvette Ennis²  Lasairiona McGuinness²  Tracey McDonagh²  Mairead Losty²  Arann Rowe²  Danny O’Sullivan²  Ciaran Coyle²  Gary Donohoe¹  Ken O’Reilly² 

[1] Department of Psychiatry, Trinity College Dublin, Dublin, Ireland;National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland

关键词: Function;    Reasoning HCR-20;    Social cognition;    Neurocognition;    MSCEIT;    MATRICS;    Mediation;    Violence;    Schizophrenia;   

Others  :  1218934
DOI  :  10.1186/s12888-015-0548-0

 received in 2015-02-17, accepted in 2015-06-30,  发布年份 2015

【 摘 要 】

Background

There is a broad literature suggesting that cognitive difficulties are associated with violence across a variety of groups. Although neurocognitive and social cognitive deficits are core features of schizophrenia, evidence of a relationship between cognitive impairments and violence within this patient population has been mixed.

Methods

We prospectively examined whether neurocognition and social cognition predicted inpatient violence amongst patients with schizophrenia and schizoaffective disorder (n = 89; 10 violent) over a 12 month period. Neurocognition and social cognition were assessed using the MATRICS Consensus Cognitive Battery (MCCB).

Results

Using multivariate analysis neurocognition and social cognition variables could account for 34 % of the variance in violent incidents after controlling for age and gender. Scores on a social cognitive reasoning task (MSCEIT) were significantly lower for the violent compared to nonviolent group and produced the largest effect size. Mediation analysis showed that the relationship between neurocognition and violence was completely mediated by each of the following variables independently: social cognition (MSCEIT), symptoms (PANSS Total Score), social functioning (SOFAS) and violence proneness (HCR-20 Total Score). There was no evidence of a serial pathway between neurocognition and multiple mediators and violence, and only social cognition and violence proneness operated in parallel as significant mediators accounting for 46 % of the variance in violent incidents. There was also no evidence that neurocogniton mediated the relationship between any of these variables and violence.

Conclusions

Of all the predictors examined, neurocognition was the only variable whose effects on violence consistently showed evidence of mediation. Neurocognition operates as a distal risk factor mediated through more proximal factors. Social cognition in contrast has a direct effect on violence independent of neurocognition, violence proneness and symptom severity. The neurocognitive impairment experienced by patients with schizophrenia spectrum disorders may create the foundation for the emergence of a range of risk factors for violence including deficits in social reasoning, symptoms, social functioning, and HCR-20 risk items, which in turn are causally related to violence.

【 授权许可】

   
2015 O'Reilly et al.

【 图 表 】

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