Individual-level deviations from normative brain morphology in violence, psychosis, and psychopathy

Neuroimaging research has shown brain morphological abnormalities associated with violence and psychosis, but individual differences are substantial and results not consistent across studies. Normative modeling of brain MRI-features facilitates a systematic mapping of individual brain characteristics of complex phenotypes also in small samples but has not yet been applied to forensic psychiatry populations. We explored brain heterogeneity in persons with a history of severe violence with a comorbid schizophrenia spectrum disorder (SSD-V; n = 38), non-violent persons with schizophrenia spectrum disorders (SSD-NV; n = 138), persons with a history of severe violence without comorbid schizophrenia spectrum disorder (nonSSD-V; n = 20), and healthy non-violent participants (HC; n = 196) from lifetime normative trajectories of cortical thickness, surface area, and subcortical volumes. Normative models based on Freesurfer derived regions of interest from 58,836 individuals were used to investigate individual deviances, group differences, and associations to psychopathy traits. We found overall heterogeneous patterns of individual deviations from the norm, which were most prominent for regions within the collateral transverse sulcus, lingual gyrus, and cerebellum among SSD-V, a pattern that differed from SSD-NV (parieto-occipital and suborbital sulci), and nonSSD-V (paracentral and middle frontal regions). We found no significant associations to psychopathy traits. By applying normative modeling, we demonstrate heterogeneous patterns of brain morphometry deviations associated with violence and psychosis. While the results warrant replication, studies addressing individual brain deviations may contribute to improved understanding of the neurobiological underpinnings of comorbid violence and psychosis, which ultimately may have clinical impact on treatment and forensic psychiatric evaluations.