Subtypes of aggression in patients with schizophrenia: the role of psychopathy

Psychopathy is strongly related to aggression in community, forensic psychiatric and offender samples, including in patients with schizophrenia. However, most studies have failed to distinguish between impulsive or premeditated aggression. In a cross-sectional study of 108 patients with schizophrenia and comorbid psychopathy, we investigated if psychopathy measured with the total Psychopathy Checklist-Revised (PCL-R) score and the factors described in the two-factor model and the facets described in the four-factor model are associated with type of aggression in schizophrenia and to explore if the three- and four-factor models are associated with premeditated aggression. Results revealed that PCL-R total score, Factor 1 and 2 of the two-factor model and Facets 1-4 of the four-factor model were related to premeditated aggression and that the four-factor model was better related to premeditated aggression than the three-factor model. These findings delineate the role of psychopathy including antisocial features in the understanding of premeditated aggression in schizophrenia.