Violence in schizophrenia versus limbic psychotic trigger reaction: Prefrontal aspects of volitional action

Abstract Two basic kinds of violence in psychoses are juxtaposed: In schizophrenia violence is mostly determined by a persisting distortion of the content of thought through delusions and/or hallucinations, while the prefrontal mediation of intentional volition of action behavior is largely intact. Conversely, all prefrontal functions are briefly, but severely impaired by the fronto–limbic imbalance proposed in a subtype of partial limbic seizures, limbic psychotic trigger reaction (LPTR). LPTR is based on the animal model of limbic seizure kindling (through intermittent mild stimuli) in primates, evoking nonconvulsive “behavioral seizures” with indications of visual hallucinations. Additional prefrontal factors contributing to violence both in schizophrenia and most severely in LPTR, concern the inability to appropriately reset a plan of ongoing action upon intervening circumstances, and/or a reduced ability for the cognitive “appreciation” of the consequences and implications of the acts.