• Gabriele Nibbio, Lorenzo Bertoni, Irene Calzavara-Pinton, Nicola Necchini, Stefano Paolini, Antonio Baglioni, Daniela Zardini, Laura Poddighe, Viola Bulgari, Jacopo Lisoni, Giacomo Deste, Stefano Barlati, and Antonio Vita.
• Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy.
• Medicina (Kaunas). 2024 Aug 3; 60 (8).

AbstractCognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, the complex relationship between cognitive impairment and violent behavior is explored, also considering the usefulness of treating cognitive impairment to improve violence-related outcomes. Several studies report that cognitive impairment is linked to violent behavior, but significant differences between domains and conflicting results are also present, leaving the identification of specific cognitive profiles predicting violent behavior in SSD as an important aim for future research. Evidence regarding the effectiveness of treating cognitive impairment to improve violent behavior, while heterogeneous, provides more consistent results: cognition-targeting interventions appear to provide significant benefits also in the prevention of aggression in people living with SSD, and preliminary evidence shows cognition-focused interventions targeting violent behavior improve both cognition- and violence-related outcomes. Implementing these interventions in clinical practice could be of great usefulness, particularly in forensic contexts. Physical exercise, which improves cognitive performance and psychosocial functioning in SSD, appears to reduce violent behavior in healthy individuals, but requires further studies in clinical samples.

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