Four trajectory classes for schizophrenia inpatients’ violent behavior are identified, and baseline clinical features — particularly lower level of total cholesterol (TC) and triglyceride (TG) — are associated with higher level of violence in the trajectories, according to a prospective study led by researchers at National Taiwan University College of Public Health. The study has been published in the 2015 July-August issue of Journal of Psychiatric Research.
The study was based on a cohort established by Dr. Shing-Chia Chen, the first author and assistant professor of School of Nursing, College of Medicine. According to Dr. Wei J. Chen, the corresponding author and Taiwan professor, patients with schizophrenia are more likely to be violent than the general population, but whether patients’ violence is associated with biochemical characteristics remains largely unexplored.
“Cholesterol is necessary for optimal brain function,” said Ms. Ni-Hsuan Chu, Taiwan master’s graduate, who made the proposition of the link of lipid levels with violence in these patients and contributed equally to this work. “Low total cholesterol (TC) can cause reduced central serotonin activity, which is robustly linked to increased suicide and aggression in the general population. Our study sought to examine the relationship between lipid levels and the longitudinal pattern of violence in schizophrenia inpatients.”
The researchers rated repeatedly patients’ violent behavior using Violence Scale and collected information on clinical features from medical chart in a cohort of 107 inpatients in acute care settings from 2002 to 2003; they also took blood samples for determining lipid profile, including the level of TC, TG, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)..
When trajectory analysis was applied to the weekly violence ratings, four classes were identified: class 1 (no violence, 37.4 percent), class 2 (low-leveling off, 39.2 percent), class 3 (high-falling sharply, 10.3 percent), and class 4 (high-falling slowly, 13.1 percent). They find that patients with more violent trajectories were significantly associated with more positive symptoms, less negative symptoms, a longer length of hospitalization, lower level of TC and TG. Besides, female inpatients showed higher prevalence of violence, mainly verbal aggression.
“These findings provide important insight about longitudinal course of violent behaviors in schizophrenia,” Dr. Wei J. Chen said. “It may be useful for directing the level of vigilance and caution when those violent trajectories are emerging in clinical care.”