Mapping aggressive behaviors and testosterone among schizophrenia patients in acute stage

Testosterone play an important role in schizophrenia, particularly for impulsive aggressive behaviors. However, there is still unclear how the neurobiological basis and correlates of these risk factors in schizophrenia patients. The schizophrenia patients who visited psychiatric emergency departments (PED) with an acute stage and received an evaluation of aggression and psychotic symptoms by the Positive and Negative Syndrome Scale (PANSS) were included. Blood samples were collected for plasma testosterone measurement. The network analysis and network comparison test were conducted to construct and evaluate whether network characteristics differed by gender. The prevalence of level Ⅱ aggression was 41.4%, level Ⅲ aggression was 33.3%, and level Ⅳ aggression was 8.8% in the SCZ patients visited in PED, respectively. The total score of PANSS, the average level of testosterone, and the proportion of males in the aggressive group were higher than those in the non-aggressive group, respectively. Network analysis identified "Guilt feelings", "Poor impulse control" and "Difficulty in abstract thinking" as the most influential symptoms. "Poor impulse control" appeared to be the bridge symptom linking psychotic symptoms to aggressive behavior. Concurrently, "Poor impulse control" stand as critical bridge symptoms between psychotic symptoms to aggressive behaviors. Moreover, "Blunted affect" exhibited the strongest positive correlation with testosterone levels among SCZ patients in the acute stage. The findings highlight the complex interplay between testosterone and psychotic symptoms of schizophrenia patients, emphasizing the importance of targeting influential symptoms in psychiatric emergency care. The identification of central and bridge symptoms suggests potential pathways for individual interventions for SCZ patients.