Psychopathy and Functional Magnetic Resonance Imaging Blood Oxygenation Level-Dependent Responses to Emotional Faces in Violent Patients with Schizophrenia

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.