BACKGROUND People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence. METHOD We investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence. RESULTS Psychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence. CONCLUSIONS Moral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

中文翻译：

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道德认知，精神病症状与暴力行为之间缺少的联系：一项全国性的法医队列研究。

背景技术精神分裂症患者的凶杀可能性是普通人群的十倍。精神分裂症的症状与暴力行为之间的关系尚不清楚。关于如何确定暴力的严重性和形式（例如反应性或工具性暴力）的研究也很有限。道德认知在精神分裂症患者的暴力行为中可能起反常作用。由精神病症状引起的具有道德内涵的思想可能是造成严重暴力的原因。方法我们采用横断面全国法证研究队列（n = 55）调查了暴力行为发生时的精神病症状和道德认知是否与暴力行为相关。我们检查了在控制神经认知和暴力倾向时，道德认知是否与暴力相关。我们探讨了在发生暴力行为时出现的所有精神病症状，被判断为与暴力行为有关的精神病症状与当时存在的道德认知之间的关联。使用调解分析，我们检查了道德认知是否是症状与暴力症状的相关性之间缺少的联系。我们还调查了特定的道德认知是否介导了特定的精神病症状，暴力的严重性（包括凶杀）和暴力形式之间的关系。结果精神病症状通常与严重程度或暴力形式无关。但是，即使在控制神经认知和暴力倾向时，特定的道德认知也与暴力的严重性和形式相关。特定的道德认知与出现的，与暴力有关的特定精神病症状有关。道德认知介导了特定精神病症状的存在与其与暴力，凶杀，暴力的严重性和暴力形式的相关性之间的关系。结论道德认知包括减轻痛苦，对不公正或背叛行为作出反应，遵守权威的愿望或惩罚不纯正或令人恶心的行为的愿望，可能是解释精神病症状与性行为之间关系的关键中介者。暴力。我们的发现可能对风险评估，治疗和暴力预防具有重要意义。道德认知介导了特定精神病症状的存在与其与暴力，凶杀，暴力的严重性和暴力形式的相关性之间的关系。结论道德认知包括减轻痛苦，对不公正或背叛行为作出反应，遵守权威的愿望或惩罚不纯正或令人恶心的行为的愿望，可能是解释精神病症状与性行为之间关系的关键中介者。暴力。我们的发现可能对风险评估，治疗和暴力预防具有重要意义。道德认知介导了特定精神病症状的存在与其与暴力，凶杀，暴力的严重性和暴力形式的相关性之间的关系。结论道德认知包括减轻痛苦，对不公正或背叛行为作出反应，遵守权威的愿望或惩罚不纯正或令人恶心的行为的愿望，可能是解释精神病症状与性行为之间关系的关键中介者。暴力。我们的发现可能对风险评估，治疗和暴力预防具有重要意义。或希望惩罚不洁或令人作呕的行为，可能是解释精神病症状与暴力行为之间关系的主要调解人。我们的发现可能对风险评估，治疗和暴力预防具有重要意义。或希望惩罚不洁或令人作呕的行为，可能是解释精神病症状与暴力行为之间关系的主要调解人。我们的发现可能对风险评估，治疗和暴力预防具有重要意义。