Prostaglandins, Leukotrienes and Essential Fatty Acids 70 (2004) 409–411 Cerebral metabolism in male patients with schizophrenia who have seriously and dangerously violently offended: a 31 P magnetic resonance spectroscopy study B.K. Puri a , S.J. Counsell a , G. Hamilton a , M.G. Bustos b,c , D.F. Horrobin d,{ , A.J. Richardson e,f , I.H. Treasaden b,c, * a MRI Unit, MRC Clinical Sciences Centre, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK b Three Bridges Medium Secure Unit, West London Mental Health NHS Trust, Uxbridge Road, Middlesex UB1 3EU, UK c Imperial College School of Medicine, St Mary’s Campus, London, UK d Laxdale Research, Kings Park House, Laurelhill Business Park, Stirling, Scotland FK7 9JQ, UK e Mansfield College, University of Oxford, Oxford OX1 3TF, UK f University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, UK Accepted 18 December 2003 Abstract There is biochemical evidence to suggest that membrane phospholipid metabolism may be impaired in some patients with schizophrenia. The aim of this study was to test the hypothesis that patients with schizophrenia who have violently offended while psychotic suffer from changes in cerebral phospholipid metabolism. Cerebral 31-phosphorus magnetic resonance spectroscopy was carried out in 15 male patients with schizophrenia who had violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic and in a control group of 13 age-matched healthy male control subjects. Spectra were obtained from 70  70  70mm 3 voxels in the brain using an image-selected in vivo spectroscopy pulse sequence. bNTP was lower (Po0:04) and gNTP was higher (Po0:04) in the patient group compared with the normal control group. Our results are suggestive of increased cerebral energy metabolism taking place in the forensic patients. r 2004 Elsevier Ltd. All rights reserved. 1. Background There is biochemical evidence to suggest that mem- brane phospholipid metabolism may be impaired in some patients with schizophrenia. Reduced levels of highly unsaturated fatty acids have been reported in erythrocyte membranes and the brain [1–4] in patients with this disorder. Furthermore, increased levels of the phospholipase A 2 group of enzymes, which catalyze the removal of highly unsaturated fatty acids from the Sn2 position of membrane phospholipid molecules, have been found in the plasma [5,6] and platelets [7] of patients with schizophrenia. Moreover, the response to the niacin flush test, which indirectly indexes membrane phospholipid metabolism, has been found to be impaired in schizophrenia [8], including in its quantita- tive measurement form as the volumetric niacin response [9]. Indeed, some of this evidence has given rise to a membrane hypothesis of schizophrenia [10]. Fatty acid analyses of blood samples from individuals convicted of violent crimes have shown reduced levels of highly unsaturated fatty acids in both plasma and erythrocytes [11]. On the basis of these findings, we hypothesized that the subgroup of patients with schizophrenia who are violent offenders may suffer from abnormal membrane phospholipid metabolism. Our aim was to test this hypothesis by carrying out the first investigation of cerebral phospholipid metabolism in patients with schizophrenia, who have seriously and violently of- fended while psychotic, using phosphorus-31 magnetic resonance spectroscopy ( 31 P MRS). ARTICLE IN PRESS *Corresponding author. Three Bridges Medium Secure Unit, West London Mental Health NHS Trust, Uxbridge Road, London UB1 3EU, UK. Tel.: +44-20-8354-8086; fax: +44-20-8571-9796. E-mail address: ian.treasaden@wlmht.nhs.uk (I.H. Treasaden). { Deceased. 0952-3278/$-see front matter r 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.plefa.2003.12.017