Background
Comorbidity between schizophrenia and psychopathy has been noted in violent patients
in forensic settings. Both disorders are characterized by deficits in processing sad
and fearful emotions, but there have been no imaging studies examining the impact
of comorbid psychopathic traits on emotional information processing in violent patients
with schizophrenia. We tested the hypothesis that violent patients with schizophrenia
who had high psychopathy scores would show attenuated amygdala responses to emotional
(particularly fearful) faces compared with those with low psychopathy scores.
Methods
Twenty-four violent male patients with schizophrenia were categorized as high/low
scorers based on the Psychopathy Checklist: Screening Version. Participants underwent
functional magnetic resonance imaging during a block-designed implicit face affect
processing task. In a region of interest approach, responses in the amygdala and prefrontal
cortex were examined with contrasts between sad/fearful/angry/disgusted faces and
neutral faces.
Results
High psychopathy scorers exhibited reduced blood oxygenation level-dependent (BOLD)
responses in the amygdala during exposure to fearful faces. Psychopathy scores, particularly
the affective facets, correlated negatively with amygdala responses. The BOLD responses
in the orbitofrontal cortex were negatively correlated with the lifestyle and antisocial
facets of psychopathy during exposure to sad faces. Psychopathy scores were positively
correlated with neural activation in amygdala and inferior prefrontal regions for
disgust but negatively correlated for anger.
Conclusions
Patients with schizophrenia and high levels of psychopathic traits appear to have
blunted amygdala responses to fearful faces. At a dimensional level, psychopathy subfacets
show a differential relationship to functioning in amygdala-prefrontal circuitry.
Key Words
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Article info
Publication history
Published online: May 18, 2009
Accepted:
March 27,
2009
Received in revised form:
March 25,
2009
Received:
December 15,
2008
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
