Risk factors for violent crime in patients with schizophrenia: a retrospective study.

Introduction: The relationship between schizophrenia and violence is heterogeneous and complex. The aim of this study was to explore the characteristics and the potential risk factors for violence crime in patients with schizophrenia. Methodology: We conducted a retrospective case-control study at the Judicial Psychiatric Identification Unit of Xiangya Second Hospital of Central South University from January 1, 2013 to December 31, 2016. The case group included violent offenders diagnosed with schizophrenia, while the control group comprised non-violent individuals with the same diagnosis. Results: There were 308 individuals in the violent group [subdivided into the homicide group (n = 155) and the intentional injury group (n = 153)] and 139 individuals in the non-violent group. A risk model showed that a history of violence (odds ratio (OR) = 2.88, 95% CI [1.79-4.64]), persecutory delusions (OR = 2.57, 95% CI [1.63-4.06]), regular treatment in the previous four weeks (OR = 0.29, 95% CI [0.16-0.51]) and insight (OR = 0.30, 95% CI [0.14-0.62]) were independently associated with violence. Conclusion: This study provided useful clinical information to identify risk factors for violence and develop better strategic programs to manage violence in patients with schizophrenia.

Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression.

BACKGROUND: The comorbidity between diabetes mellitus and depression was revealed, and diabetes mellitus increased the prevalence of depressive disorder, which ranked 13th in the leading causes of disability-adjusted life-years. Insulin resistance, which is common in diabetes mellitus, has increased the risk of depressive symptoms in both humans and animals. However, the mechanisms behind the comorbidity are multi-factorial and complicated. There is still no causal chain to explain the comorbidity exactly. Moreover, Selective serotonin reuptake inhibitors, insulin and metformin, which are recommended for treating diabetes mellitus-induced depression, were found to be a risk factor in some complications of diabetes. AIMS: Given these problems, many researchers made remarkable efforts to analyze diabetes complicating depression from different aspects, including insulin resistance, stress and Hypothalamic-Pituitary-Adrenal axis, neurological system, oxidative stress, and inflammation. Drug therapy, such as Hydrogen Sulfide, Cannabidiol, Ascorbic Acid and Hesperidin, are conducive to alleviating diabetes mellitus and depression. Here, we reviewed the exact pathophysiology underlying the comorbidity between depressive disorder and diabetes mellitus and drug therapy. METHODS: The review refers to the available literature in PubMed and Web of Science, searching critical terms related to diabetes mellitus, depression and drug therapy. RESULTS: In this review, we found that brain structure and function, neurogenesis, brain-derived neurotrophic factor and glucose and lipid metabolism were involved in the pathophysiology of the comorbidity. Obesity might lead to diabetes mellitus and depression through reduced adiponectin and increased leptin and resistin. In addition, drug therapy displayed in this review could expand the region of potential therapy. CONCLUSIONS: The review summarizes the mechanisms underlying the comorbidity. It also overviews drug therapy with anti-diabetic and anti-depressant effects.

Hesperidin may improve depressive symptoms by binding NLRP3 and influencing the pyroptosis pathway in a rat model.

OBJECTIVE: Major depressive disorder (MDD) is a debilitating psychiatric disorder which is common and endangers human physical and mental health. Studies have shown that hesperidin could improve the symptoms of depression with unclear mechanisms. METHOD: In this study, hesperidin was administered to chronic unpredictable mild stress (CUMS) depressed mice before behavioral test, network pharmacology analysis, RNA expression microarray analysis, pathway validation and molecular docking experiments. RESULTS: we found that hesperidin intervention could significantly improve the depressive symptoms and downregulate the expression level of pyroptosis pathway including caspase 1 (Casp1), interleukin 18 (IL18), interleukin-1ß (IL-1ß) and NOD-like receptor thermal protein domain associated protein 3 (NLRP3). In addition, we found that hesperidin could possibly bind to NLRP3. CONCLUSIONS: Our study demonstrated that hesperidin had huge potential as anti-depressive neuroprotectant, and may play a role in treating MDD by regulating NLRP3-mediated pyroptosis.

Abnormalities in electroencephalographic microstates among violent patients with schizophrenia.

Schizophrenia is often associated with a remarkably increased risk of violence, which has become a public health concern and brought a great economic burden. Recent studies have reported changes in the electroencephalograms (EEG) of patients with schizophrenia. The evidence for an association between EEG and violence in patients with schizophrenia is not conclusive. This study aimed to investigate EEG microstates in violent patients with schizophrenia. Forty-three violent patients with schizophrenia (the VS group) and 51 non-violent patients with schizophrenia (the NVS group) were included, and their EEG microstates were recorded using 21-Channel EEG recordings. The two groups were compared for differences of four microstate classes (A-D) with regards to three microstate parameters (duration, occurrence, and coverage). Compared with the NVS group, the VS group exhibited increased duration, occurrence, and coverage of microstate class A and decreased occurrence of microstate class B. The VS group also had lower probabilities of transitions from "B to C" and from "C to B", as compared with the NVS group. In addition, the MOAS score was positively correlated with the duration, occurrence, and coverage of microstate A. The present study found an abnormal pattern of EEG microstates in violent patients with schizophrenia, which might help clinicians identify patients with schizophrenia who might engaged in violence as well as develop intervention strategies at an early stage.

The association of childhood adversities and mental health problems with dual-harm in individuals with serious aggressive behaviors.

BACKGROUND: The coexistence of self-harm and aggression, which is referred to as dual-harm, is commonly seen in forensic population. Self-harm and aggression have often been studied separately, previous studies on risk factors of aggression or self-harm mainly focused on childhood adversities, emotional regulation, impulsivity and psychopathology, given their importance in the two behaviors. However, the factors associated with dual-harm remain unclear. This study aimed to explore potential risk factors associated with co-occurring self-harm among individuals with serious aggressive behaviors. METHODS: This multi-center, cross-sectional case-control study was conducted from May 2013 to January 2016 and involved seven qualified forensic institutes located in seven provinces in China. Participants were individuals with serious aggressive behaviors and were suspected to have mental disorders. Lifetime history of self-harm was obtained by a self-report questionnaire, and serious aggressive behaviors were assessed with the use of participants' forensic archive. Sociodemographic and clinical information were collected using a self-designed standardized data collection form, and childhood adversities was assessed using a clinician-rated scale designed by our research team. The Psychopathy Checklist-Revised (PCL-R) was used to assess psychopathic traits and the Brief Psychiatric Rating Scale (BPRS) was used to assess psychiatric symptoms of the participants. Univariate and multivariate logistic regression analyses were performed to analyze the relevant factors for dual-harm. RESULTS: A total of 423 individuals with serious aggressive behaviors were enrolled in the current study. Of them, 74 (17.5%) with self-harm history assigned into the dual-harm group (D-H) and 349 (82.5%) without self-harm history assigned into the aggression-only group (A-O). According to the binary logistic regression analysis, current diagnosis of mood disorder (OR = 3.2, 95%CI: 1.2-8.5), child abuse (OR = 2.8, 95%CI: 1.3-6.2), parental death (OR = 3.0, 95%CI: 1.2-7.5), and the score of the affective subscale in BPRS (OR = 1.7, 95%CI: 1.3-2.4) were significantly associated with dual-harm. CONCLUSIONS: Our study suggested the necessity of integrated evaluation of self-harm among individuals with serious aggressive behaviors. Childhood adversities and psychiatric symptoms in this population require special attention.

Incomplete homicide-suicide in Hunan China from 2010 to 2019: characteristics of surviving perpetrators.

BACKGROUND: The mental and psychological conditions of the individuals involved in homicide followed by suicide (H-S) are still unclear, especially in China. Information on these aspects cannot be accurately obtained due to the death of perpetrators. This study aims to demonstrate the characteristics of incomplete H-S with surviving perpetrators, which provide the possibility to obtain detailed mental and psychological information. METHODS: This study explores incomplete H-S events occurred in Hunan, China from 2010 to 2019, in which the surviving perpetrators received a forensic psychiatric assessment. Three aspects of information, i.e., the subject's demographic, clinical and criminal information, were recorded and analysed. RESULTS: 125 incomplete H-S incidents involved 166 victims were found in the current study. A total of 112 (89.6%) perpetrators were diagnosed with mental disorders, but only 56 of them had a history of consultation due to mental problems, and only one of them adhered to treatment. In most cases, the motivation is related to the psychopathological states, with the most common diagnosis being major depression, followed by schizophrenia. Gender difference was significant among the subjects: females were more likely to have a suicidal history, to be diagnosed as major depression and to be motivated by delirious altruism and family problems. CONCLUSIONS: This study indicated that psychopathology might be a predisposing factor, which highlighted the importance of mental state assessment for the population involved in incomplete H-S. A clearer understanding of the role of mental disorders might be helpful for the intervention of H-S.

EEG Microstates and Its Relationship With Clinical Symptoms in Patients With Schizophrenia.

Schizophrenia is a complex and devastating disorder with unclear pathogenesis. Electroencephalogram (EEG) microstates have been suggested as a potential endophenotype for this disorder. However, no clear dynamic pattern of microstates has been found. This study aims to identify the dynamics of EEG microstates in schizophrenia and to test whether schizophrenia patients with altered clinical symptoms severity showed different microstates abnormalities compared with healthy controls. Resting-state EEG data in 46 individuals who met the ICD-10 diagnostic criteria for schizophrenia and 39 healthy controls was recorded. The patients with schizophrenia were divided into subgroups based on the level of their negative or positive symptoms assessed using the Positive and Negative Syndrome Scale. Microstate parameters (contribution, occurrence, and duration) of four prototypical microstate classes (A-D) were investigated. Compared with healthy controls, individuals with schizophrenia showed increased duration and contribution of microstate class C, decreased contribution and occurrence of microstate class B. Different microstate patterns were found between subgroups and healthy controls. Results in this study support the consistent observation of abnormal EEG microstates patterns in patients with schizophrenia and highlight the necessity to divide subjects into subgroups according to their clinical symptoms.

Ambient air pollution exposure and risk of depression: A systematic review and meta-analysis of observational studies.

Recent studies have reported an association between air pollution exposure and depression, with inconsistent results. To address this controversy, we conducted a systematic review and meta-analysis of published observational studies that investigated outdoor air pollution and depression. Five electronic databases were searched, and fifteen articles were finally identified. Pooled odds risks were calculated separately based on pollutant type, exposure duration and outcome. Subgroup analyses were conducted based on design, population, important potential confounders, and pollutants levels. We found a significantly increased risk of depression with long-term exposure to PM2.5 and short-term exposure to PM10, NO2, SO2, CO. No evidence was found in the association between exposure to O3 and depression. Besides, exposure to high levels of pollutants indicates a higher risk of depression. Our results highlight the necessity of air pollution control for depression. However, further studies with standardized methods are still required to support the results due to the inconsistent results in stratified analyses and methodological limitations of the included studies.