Neural and behavioural responses to threat in men with a history of serious violence and schizophrenia or antisocial personality disorder Veena Kumari a,b, ⁎, Mrigendra Das c,d , Pamela J. Taylor e , Ian Barkataki c , Christopher Andrew f , Alexander Sumich a,f , Steven C.R. Williams f , Dominic H. ffytche f a Department of Psychology, Institute of Psychiatry, King's College London, London, UK b NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK c Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London, UK d Broadmoor Special Hospital, Crowthorne, Berkshire, UK e Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK f Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK article info abstract Article history: Received 18 August 2008 Received in revised form 7 January 2009 Accepted 10 January 2009 Available online 20 February 2009 Background7 Contemporary theories and evidence implicate defective emotion regulation in violent behaviour. The two psychiatric illnesses most implicated in violence are schizophrenia and antisocial personality disorder (APD). This study examined behavioural and brain abnormalities in violent men with schizophrenia or APD during anticipatory fear. Method7 Fifty-three men [14 non-violent healthy controls, 13 with schizophrenia and a history of serious violence (VSZ), 13 with schizophrenia without a history of violence (SZ), 13 with APD and a history of serious violence] underwent blood-oxygenation-level-dependent fMRI during an experiment involving repeated presentations of ‘safe’ and ‘threat of electric shock’ conditions and provided ratings of shock anticipation and fear. Schizophrenia patients did not have co-morbid APD. Results7 VSZ participants reported the highest, and APD participants the lowest, level of shock anticipation and fear, with intermediate ratings by SZ and healthy participants. The violent, relative to non-violent, groups showed altered activity modulation in occipital and temporal regions, from early to latter parts of threat periods. Additionally, VSZ patients displayed exaggerated whereas APD patients showed attenuated thalamic-striatal activity during latter threat periods. Conclusions7 Aberrant activity in occipital and temporal regions when exposed to sustained visual threat cues is associated with a predisposition to violence in both schizophrenia and APD. This common biological deficit, however, appears to arise from dissimilar behavioural mechanisms related to differences in the strength of aversive conditioning and behavioural response to sustained threat cues (enhanced in VSZ; attenuated in APD), also reflected in opposite patterns of alternations in thalamic-striatal activity, in these two disorders. © 2009 Elsevier B.V. All rights reserved. Keywords: Schizophrenia fMRI Fear Threat Serious violence Antisocial personality disorder 1. Introduction Violent behaviour is associated with certain mental disorders, most markedly schizophrenia (Arseneault et al., 2000) and antisocial personality disorder (APD) (Hodgins, 1992). Although positive symptoms may drive inpatient violence, several other factors contribute on their own or in interaction with symptoms to persistent violence in the community shown by schizophrenia patients (Krakowski, 2005). Dysfunction within a neural circuit implicated in emotion regulation is considered to constitute the neural substrates of violence (Davidson et al., 2000). This circuit includes several Schizophrenia Research 110 (2009) 47–58 ⁎ Corresponding author. PO78, Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel.: +44 207 848 0233; fax: +44 207 848 0860. E-mail address: v.kumari@iop.kcl.ac.uk (V. Kumari). 0920-9964/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2009.01.009 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres