Clinical Psychopharmacology and Neuroscience 2019; 17(4): 475-486  
Biological Aspects of Aggression and Violence in Schizophrenia
WonKyung Cho1, Won-Suk Shin1, Iseul An2,3, Minji Bang3, Doo-Yeoun Cho1, Sang-Hyuk Lee1,3
1Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, 2Clinical Counseling Psychology Graduate School, CHA University, 3Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
Correspondence to: Sang-Hyuk Lee
Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea
E-mail: leesanghyuk@yahoo.com
ORCID: https://orcid.org/0000-0001-7939-3000
Doo-Yeoun Cho
Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea
E-mail: dooycho@cha.ac.kr
ORCID: https://orcid.org/0000-0003-2996-1000
Received: May 7, 2019; Revised: July 1, 2019; Accepted: July 2, 2019; Published online: November 30, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Although the majority of patients with schizophrenia are not actually violent, an increased tendency toward violent behaviors is known to be associated with schizophrenia. There are several factors to consider when identifying the subgroup of patients with schizophrenia who may commit violent or aggressive acts. Comorbidity with substance abuse is the most important clinical indicator of increased aggressive behaviors and crime rates in patients with schizophrenia. Genetic studies have proposed that polymorphisms in the promoter region of the serotonin transporter gene and in the catechol-O-methyltransferase gene are related to aggression. Neuroimaging studies have suggested that fronto-limbic dysfunction may be related to aggression or violence. By identifying specific risk factors, a more efficient treatment plan to prevent violent behavior in schizophrenia will be possible. Management of comorbid substance use disorder may help prevent violent events and overall aggression. Currently, clozapine may be the only effective antipsychotic medication to repress aggressive behavior. With the current medical field moving toward tailored medicine, it is important to identify vulnerable schizophrenia populations and provide efficient treatment.
Keywords: Aggression; Violence; Schizophrenia; Neuroimaging; Antipsychotic agents.


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