Dysfunctional striatal-temporal connectivity is associated with a higher risk for violence in patients with schizophrenia.

Patients with schizophrenia (SZ) exhibit an elevated risk of violence compared to the general population. However, the neural mechanisms of violence in SZ are still unclear. This study examined the neural correlates linked to violence in SZ and determine whether the brain abnormalities were associated with psychotic symptoms of severe delusions. We performed resting-state functional magnetic resonance imaging and assessed the severity of clinical symptoms and personality traits in 140 male participants, aged 18 to 50 years, comprising 39 violent patients with schizophrenia (VSZ), 45 non-violent patients with schizophrenia (NVSZ), and 56 healthy controls (HC). The results showed increased functional connectivity (FC) in the VSZ group in the right insula - middle frontal gyrus coupling(p < 0.001) and right fusiform gyrus (FFG) - left caudate (CAU) coupling (p < 0.001) as well as decreased FC in the right nucleus accumbens (NAcc) - FFG coupling (p = 0.002), compared to the NVSZ and HC groups. Correlation analysis revealed a negative association between affective deficit and FC of the right NAcc - FFG coupling in the VSZ group only (r = -0.350, p = 0.029). Additionally, suspiciousness correlated negatively with the FC value of the right CAU - left middle temporal gyrus coupling in the VSZ (r = -0.387, p = 0.029) and all-patient groups (r = -0.304, p = 0.023). Our findings suggested that aberrant connections between the cortex and subcortical nuclei, especially the striatal-temporal circuit, might be involved in the neurobiological mechanisms of violence in SZ; at the same time, dysfunction of the CAU might be linked to the disease per se. This study highlighting a specific association between violence and psychopathy rather than symptoms of SZ.