Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Aug 19, 2025; 15(8): 109280
Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.109280
Neural correlates of aggression in schizophrenia: An event-related potential study using the competitive reaction time task
Lin Zhang, Qian Mei, Jia-Zhao Zhang, Li-Min Chen, Xiao-Hong Liu, Zhen-He Zhou, Hong-Liang Zhou
Lin Zhang, Zhen-He Zhou, Department of Psychiatry, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi 214151, Jiangsu Province, China
Qian Mei, School of Humanities and Management Science, Wannan Medical College, Wuhu 241000, Anhui Province, China
Jia-Zhao Zhang, Li-Min Chen, Xiao-Hong Liu, Zhen-He Zhou, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Hong-Liang Zhou, Department of Psychology, The Affiliated Hospital of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Co-first authors: Lin Zhang and Qian Mei.
Co-corresponding authors: Zhen-He Zhou and Hong-Liang Zhou.
Author contributions: Zhou ZH and Zhou HL designed the study and contributed equally to this work as co-corresponding authors; Zhang L, Mei Q, Liu XH, Chen LM, and Zhang JZ recruited the participants and collected the data; Zhang L and Mei Q contributed equally to this work as co-first authors; Zhang L, Mei Q, Zhou ZH, and Zhou HL analyzed the data and drafted the manuscript; all the authors contributed to the interpretation of the results and manuscript revision, and approved the final version of the manuscript.
Supported by Wuxi Municipal Health Commission Major Project, No. Z202107; and Wuxi Taihu Talent Project, No. WXTTP 2021.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Wuxi Mental Health Center (Approval No. WXMHCIRB2025 LLky020).
Informed consent statement: All participants enrolled into this study provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data used in this study can be available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-He Zhou, Department of Psychiatry, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, No. 156 Qianhu Road, Binhu District, Wuxi 214151, Jiangsu Province, China. zhouzh@njmu.edu.cn
Received: May 8, 2025
Revised: June 3, 2025
Accepted: July 2, 2025
Published online: August 19, 2025
Processing time: 93 Days and 1.1 Hours
Abstract
BACKGROUND

The neural mechanisms underlying aggressive behavior in schizophrenia (SCZ) remain poorly understood. To date, no studies have reported on the event-related potential (ERP) characteristics of aggression in SCZ using the competitive reaction time task (CRTT). Further investigation into the ERP correlates of aggression in SCZ would provide valuable insights into the neural processes involved.

AIM

To explore the neural mechanism of aggressive behavior in SCZ.

METHODS

Participants of this study included 40 SCZ patients and 42 healthy controls (HCs). The Reactive Proactive Aggression Questionnaire was used to assess trait of aggression. The Barratt Impulsiveness Scale 11 was used to measure impulsiveness. The Positive and Negative Symptom Scale (PANSS) was used to evaluate psychopathological features and disease severity. All participants were measured with ERP while performing the CRTT. Data of behavior, ERP components (P2, N2, and P3), and feedback-related negativity (FRN) were analyzed.

RESULTS

Analysis of the behavioral data revealed that compared with HCs, SCZ patients exhibited higher punishment choices. Analysis of ERP components showed that compared with HCs, SCZ patients exhibited higher N2 amplitudes and P2 amplitudes during the decision phase of the CRTT; however, SCZ patients exhibited lower FRN amplitudes and lower P3 amplitudes during the outcome phase of the CRTT. The N2 amplitudes evoked by high-intensity provocation were positively related to PANSS-P scores. And the P3 amplitudes evoked in the winning trials were negatively correlated with the PANSS-G scores.

CONCLUSION

SCZ patients exhibit abnormal ERP characteristics evoked by the CRTT, which suggests the neural correlates of aggressive behavior in SCZ.

Keywords: Schizophrenia; Event-related potential; Aggressive behavior; Competitive reaction time task; Neural mechanism

Core Tip: This study represents the first investigation employing the competitive reaction time task paradigm to examine the neurocognitive mechanisms underlying aggressive behavior in schizophrenia (SCZ) patients. Our findings demonstrate a complex interplay among positive psychotic symptoms, theory of mind deficits, and negative affect dysregulation in mediating aggression in SCZ. These findings provide valuable insights into the understanding of the neural mechanisms of aggression and may guide targeted interventions in SCZ.