Comparison of schizophrenic patients with or without A history of violent crime and healthy controls in terms of cognition, social cognition, jumping-to-conclusion bias, and impulsivity

Background and Aim: The fact that some schizophrenic patients show violent and criminal behaviors has led to the need to evaluate these patients in terms of etiological and biopsychosocial factors. In our study, we aimed to compare the schizophrenic patients who have committed violent crimes and those who did not commit violent crimes, and healthy volunteers in terms of the neurocognition, social cognition, jumping-to conclusion bias, insight, impulsivity and aggression, and to examine which of these factors are more closely related to the violent behavior. Materials and Methods: Among patients who applied to Bolu Abant İzzet Baysal Mental Health Hospital General Psychiatry Outpatient Clinic and Forensic Psychiatry Polyclinic between June 2020 and December 2020 for a psychiatric counseling or because of committing a violent crime or were treated as an inpatient in the psychiatry clinic, 25 patients diagnosed with Schizophrenia Spectrum Disorder according to the DSM 5 diagnostic criteria who committed violent crimes (VS), and 25 patients who did not commit a violent crime (NVS) were included in the study. 25 healthy individuals matched for age, gender and education were retrieved as healthy control (HC) group. All participants were between the ages of 18-65. SCID-1 (Structured Clinical Interview for DSM-IV Axis I Disorders) scale for the evaluation of sociodemographic data and comorbid psychiatric diagnoses and Global Assessment Scale for the evaluation of functionality, Wisconsin Card Sorting Test, Stroop test, Trace Making Test, Dokuz Eylül Theory of Mind Scale (DEZİTÖ), Benton Face Recognition Test, Jumping to Conclusion Bias test (JTC), Buss-Perry aggression scale, Barratt impulsivity scales were applied to all groups. Then, PANNS, the 3-components rating scale of Insight, and the Taylor crime rating scale were applied to the schizophrenic patients. xv Results: We found that VS patients had higher unemployment and bachelorism rates (p<0.001), substance abuse history (p=0.002) and hospitalization history (p=0.009), positive psychopathology and disease severity (p=0.018). Trail-making, Stroop, WCST, Benton Face Recognition, DEZİTÖ scores of schizophrenia patients were lower than the HC group, while their JTC ratios were higher (p<0.05). Stroop interference times of VS patients were the longest, tracking difference was the largest, WCST non-perseverative error, the number of cards they used to complete the category and their failure to continue the setup were the highest, and the DEZİTÖ score was the lowest. We determined that JTC+ schizophrenia patients had lower DEZİTÖ scores and worser WCST scores. In the correlation analyzes, we found that the number of hospitalizations tended to increase as the impulsivity increased, the severity of the crime tended to increase as the duration and severity of the illness increased, the patients tended to be more in the VS group as the interference time increased in the Stroop test. The negative psychopathology was correlated with worsening in Tracking and Stroop test performances, the positive psychopathology correlated with worsening of WCST and DEZİTÖ performance and the impairments in face recognition and theory of mind associated with an increase in the disease severity. We determined that JTC tended to increase as WCST, DEZİTÖ, and Benton facial recognition performance decreased. Conclusion: These findings demonstrate that the neuropsychological functions and JTC probably have an effect on the same factor (left prefrontal cortex dysfunction) in patients with schizophrenia. Our study is the first to evaluate JTC data with the clinical data and other scales in schizophrenia patients who have committed and not committed the violent crimes. Our findings expand the existing data on factors influencing the violent crime behaviours in patients with schizophrenia, which is crucial for the development of preventive and therapeutic strategies that could potentially reduce the prevalence of violence in the Turkish population. Keywords: Violent Crime, Schizophrenia, Cognition, Social Cognition, Jumping Bias, Impulsivity