White matter integrity in the fronto-striatal accumbofrontal tract predicts impulsivity

Neural Correlates of Trait Impulsivity among Adult Healthy Individuals

Objective

: Impulsivity can be observed in individuals with or without mental illness. The discovery of neural correlates responsible for trait impulsivity can therefore help to understand the severity of psychiatric symptoms, personality characteristics and social adjustment. In this study, we aimed to identify the gray matter substrates of trait impulsivity in healthy individuals.

Methods

: Seventy-five healthy individuals were enrolled. At baseline, trait impulsivity was assessed using the Barratt Impulsiveness Scale (BIS) and all participants underwent T1-weighted magnetic resonance imaging scan. Beck Anxiety Inventory (BAI), World Health Organization Quality of Life (WHOQOL-BREF) and Connor-Davidson Resilience Scale (CD-RISC) were also assessed. Mean cortical thickness (CT) and the local gyrification index (LGI) were calculated to perform whole-brain vertex-wise correlation analysis, which were performed to investigate the relationship between BIS scores and CT or LGI in each brain region. We also revealed the relationship between brain regions and psychological measurements.

Results

: Total BIS scores were significantly and negatively correlated with mean CT values in the left lateral occipital cortex (OC) and LGIs in the inferior frontal gyrus (IFG). Correlation analyses revealed that the lateral OC's mean CT values were negatively correlated with BAI scores and positively correlated with WHOQOL-BREF scores, while LGI in the IFG was positively correlated with CD-RISC scores.

Conclusion

: Our study showed that trait impulsivity might be associated with the lateral OC and IFG in healthy individuals. Understanding the neural correlates of trait impulsivity could provide ways to expect high impulsivity, anxiety, and poor resilience in healthy adults.

A detailed spatio-temporal atlas of the white matter tracts for the fetal brain

This study presents the construction of a comprehensive spatiotemporal atlas detailing the development of white matter tracts in the fetal brain using diffusion magnetic resonance imaging (dMRI). Our research leverages data collected from fetal MRI scans conducted between 22 and 37 weeks of gestation, capturing the dynamic changes in the brain's microstructure during this critical period. The atlas includes 60 distinct white matter tracts, including commissural, projection, and association fibers. We employed advanced fetal dMRI processing techniques and tractography to map and characterize the developmental trajectories of these tracts. Our findings reveal that the development of these tracts is characterized by complex patterns of fractional anisotropy (FA) and mean diffusivity (MD), reflecting key neurodevelopmental processes such as axonal growth, involution of the radial-glial scaffolding, and synaptic pruning. This atlas can serve as a useful resource for neuroscience research and clinical practice, improving our understanding of the fetal brain and potentially aiding in the early diagnosis of neurodevelopmental disorders. By detailing the normal progression of white matter tract development, the atlas can be used as a benchmark for identifying deviations that may indicate neurological anomalies or predispositions to disorders.

Sensation seeking correlates with increased white matter integrity of structures associated with visuospatial processing in healthy adults

Introduction

The ability to process sensory information is an essential adaptive function, and hyper- or hypo-sensitive maladaptive profiles of responses to environmental stimuli generate sensory processing disorders linked to cognitive, affective, and behavioral alterations. Consequently, assessing sensory processing profiles might help research the vulnerability and resilience to mental disorders. The research on neuroradiological correlates of the sensory processing profiles is mainly limited to the young-age population or neurodevelopmental disorders. So, this study aims to examine the structural MRI correlates of sensory profiles in a sample of typically developed adults.

Methods

We investigated structural cortical thickness (CT) and white matter integrity, through Diffusion Tensor Imaging (DTI), correlates of Adolescent/Adult Sensory Profile (AASP) questionnaire subscales in 57 typical developing subjects (34F; mean age: 32.7 ± 9.3).

Results

We found significant results only for the sensation seeking (STS) subscale. Positive and negative correlations emerged with fractional anisotropy (FA) and radial diffusivity (RD) in anterior thalamic radiation, optic radiation, superior longitudinal fasciculus, corpus callosum, and the cingulum bundle. No correlation between sensation seeking and whole brain cortical thickness was found.

Discussion

Overall, our results suggest a positive correlation between sensation seeking and higher white matter structural integrity in those tracts mainly involved in visuospatial processing but no correlation with gray matter structure. The enhanced structural integrity associated with sensation seeking may reflect a neurobiological substrate linked to active research of sensory stimuli and resilience to major psychiatric disorders like schizophrenia, bipolar disorder, and depression.

Waiting impulsivity in progressive supranuclear palsy-Richardson's syndrome

Background

Waiting impulsivity in progressive supranuclear palsy-Richardson's syndrome (PSP-RS) is difficult to assess, and its regulation is known to involve nucleus accumbens (NAc) subregions. We investigated waiting impulsivity using the "jumping the gun" (JTG) sign, which is defined as premature initiation of clapping before the start signal in the three-clap test and compared clinical features of PSP-RS patients with and without the sign and analyzed neural connectivity and microstructural changes in NAc subregions.

Materials and methods

A positive JTG sign was defined as the participant starting to clap before the start sign in the three-clap test. We classified participants into the JTG positive (JTG +) and JTG negative (JTG-) groups and compared their clinical features, microstructural changes, and connectivity between NAc subregions using diffusion tension imaging. The NAc was parcellated into core and shell subregions using data-driven connectivity-based methods.

Results

Seventy-seven patients with PSP-RS were recruited, and the JTG + group had worse frontal lobe battery (FAB) scores, more frequent falls, and more occurrence of the applause sign than the JTG- group. A logistic regression analysis revealed that FAB scores were associated with a positive JTG sign. The mean fiber density between the right NAc core and right medial orbitofrontal gyrus was higher in the JTG + group than the JTG- group.

Discussion

We show that the JTG sign is a surrogate marker of waiting impulsivity in PSP-RS patients. Our findings enrich the current literature by deepening our understanding of waiting impulsivity in PSP patients and introducing a novel method for its evaluation.

Adolescent Neurodevelopment Within the Context of Impulsivity and Substance Use

Purpose of Review

The aim of the present review is to provide an update on recent studies examining adolescent neurodevelopment in the context of impulsivity and substance use. We provide a review of the neurodevelopmental changes in brain structure and function related to impulsivity, substance use, and their intersection.

Recent Findings

When examining brain structure, smaller gray matter volume coupled with lower white matter integrity is associated with greater impulsivity across three components: trait impulsivity, choice impulsivity, and response inhibition. Altered functional connectivity in networks including the inhibitory control network and reward processing network confers risk for greater impulsivity and substance use.

Summary

Across brain structure and function, there is evidence to suggest that overlapping areas involved in the rise in impulsivity during adolescence contribute to early substance use initiation and escalation. These overlapping neurodevelopmental correlates have promising implications for prevention and early intervention efforts for adolescent substance use.

Disrupted white matter microstructure correlates with impulsivity in children and adolescents with bipolar disorder

Altered white matter (WM) microstructure likely occurs in children with bipolar disorder (BD) with impulsivity representing one of the core features. However, altered WM microstructures and their age-related trendlines in children with BD and those at high-risk of developing BD, as well as correlations of WM microstructures with impulsivity, have been poorly investigated. In this study, diffusion MRI, cognitive, and impulsivity assessments were obtained from children/adolescents diagnosed with BD, offspring of individuals with BD (high-risk BD) and age-matched healthy controls. A novel atlas-based WM skeleton measurement approach was used to quantify WM microstructural integrity with all diffusion-tensor-imaging (DTI) metrics including fractional anisotropy, axial, mean and radial diffusivity to survey entire WM tracts and ameliorate partial volume effects. Among all DTI-derived metric measures, radial diffusivity quantifying WM myelination was found significantly higher primarily in corpus callosum and in the corona radiata in children with BD compared to controls. Distinguished from age-related progressively decreasing diffusivities and increasing fractional anisotropy in healthy controls, flattened age-related trendlines were found in BD group, and intermediate developmental rates were observed in high-risk group. Larger radial diffusivity in the corpus callosum and corona radiata significantly correlated with shorter response times to affective words that indicate higher impulsivity in the BD group, whereas no such correlation was found in the healthy control group. This work corroborates the progressive nature of pediatric BD and suggests that WM microstructural disruption involved in affective regulation and sensitive to impulsivity may serve as a biomarker of pediatric BD progression.

Adolescent reinforcement-learning trajectories predict cocaine-taking behaviors in adult male and female rats

The anatomical, structural, and functional adaptations that occur in the brain during adolescence are thought to facilitate improvements in decision-making functions that are known to occur during this stage of development. The mechanisms that underlie these neural adaptations are not known, but deviations in developmental trajectories have been proposed to contribute to the emergence of mental illness, including addiction. Direct evidence supporting this hypothesis, however, has been limited. Here, we used a recently developed reversal-learning protocol to investigate the predictive relationship between adolescent decision-making trajectories and cocaine-taking behaviors in adulthood. Decision-making functions in the reversal-learning task were assessed throughout adolescence and into adulthood in male and female Long-Evans rats. Trial-by-trial choice data was fitted with a reinforcement-learning model to quantify the degree to which choice behavior of individual rats was influenced by rewarded (e.g., ∆₊ parameter) and unrewarded (e.g., ∆₀ parameter) outcomes. We report that reversal-learning performance improved during adolescence and that this was due to an increase in value updating for rewarded outcomes (e.g., ∆₊ parameter). Furthermore, the rate of change in the ∆₊ parameter predicted individual differences in the ∆₊ parameter and, notably, cocaine-taking behaviors in adulthood: Rats that had a shallower adolescent trajectory were found to have a lower ∆₊ parameter and greater cocaine self-administration in adulthood. These data indicate that adolescent development plays a critical role in drug use susceptibility. Future studies aimed at understanding the neurobiological mechanisms that underlie these age-related changes in decision-making could provide new insights into the biobehavioral mechanisms mediating addiction susceptibility.

Predation Stress Causes Excessive Aggression in Female Mice with Partial Genetic Inactivation of Tryptophan Hydroxylase-2: Evidence for Altered Myelination-Related Processes

The interaction between brain serotonin (5-HT) deficiency and environmental adversity may predispose females to excessive aggression. Specifically, complete inactivation of the gene encoding tryptophan hydroxylase-2 (Tph2) results in the absence of neuronal 5-HT synthesis and excessive aggressiveness in both male and female null mutant (Tph2-/-) mice. In heterozygous male mice (Tph2+/-), there is a moderate reduction in brain 5-HT levels, and when they are exposed to stress, they exhibit increased aggression. Here, we exposed female Tph2+/- mice to a five-day rat predation stress paradigm and assessed their emotionality and social interaction/aggression-like behaviors. Tph2+/- females exhibited excessive aggression and increased dominant behavior. Stressed mutants displayed altered gene expression of the 5-HT receptors Htr1a and Htr2a, glycogen synthase kinase-3 β (GSK-3β), and c-fos as well as myelination-related transcripts in the prefrontal cortex: myelin basic protein (Mbp), proteolipid protein 1 (Plp1), myelin-associated glycoprotein (Mag), and myelin oligodendrocyte glycoprotein (Mog). The expression of the plasticity markers synaptophysin (Syp) and cAMP response element binding protein (Creb), but not AMPA receptor subunit A2 (GluA2), were affected by genotype. Moreover, in a separate experiment, naïve female Tph2+/- mice showed signs of enhanced stress resilience in the modified swim test with repeated swimming sessions. Taken together, the combination of a moderate reduction in brain 5-HT with environmental challenges results in behavioral changes in female mice that resemble the aggression-related behavior and resilience seen in stressed male mutants; additionally, the combination is comparable to the phenotype of null mutants lacking neuronal 5-HT. Changes in myelination-associated processes are suspected to underpin the molecular mechanisms leading to aggressive behavior.

Impulsive trait mediates the relationship between white matter integrity of prefrontal-striatal circuits and the severity of dependence in alcoholism

BACKGROUND

Alcohol dependence (AD) remains one of the major public health concerns. Impulsivity plays a central role in the transfer from recreational alcohol use to dependence and relapse. White matter dysfunction has been implicated in alcohol addiction behaviors and impulsivity. However, little is known about the role of systematic striatal structural connections underlying the mechanism of impulsive traits in AD.

METHODS

In our study, we used seed-based classification by probabilistic tractography with five target masks of striatal circuits to explore the differences in white matter integrity (fractional anisotropy, FA) in AD male patients (N = 51) and healthy controls (N = 27). We mainly explored the correlation between FA of the striatal circuits and impulsive traits (Barratt Impulsiveness Scale, BIS-11), and the mediation role of impulsivity in white matter integrity and the severity of alcohol dependence.

RESULTS

Compared with healthy controls, AD showed much lower FA in the left and right striatum-supplementary motor area (SMA) and left striatum-amygdala. We also found the decreased FA of right striatum-vlPFC was correlated with higher impulsivity. Besides, the relationship between reduced FA of right striatum-vlPFC and severity of dependence could be mediated by impulsivity.

CONCLUSION

In our study, we found disrupted white matter integrity in systematic striatal circuits in AD and the decreased FA of right striatum-vlPFC was correlated with higher impulsivity in AD. Our main findings provide evidence for reduced white matter integrity of systematic striatal circuits and the underlying mechanisms of impulsivity in male AD individuals.

Role of White Matter Microstructure in Impulsive Behavior

OBJECTIVE

Increased impulsivity is a hallmark trait of some neuropsychiatric illnesses, including addiction, traumatic brain injury, and externalizing disorders. The authors hypothesized that altered cerebral white matter microstructure may also underwrite normal individual variability in impulsive behaviors and tested this among healthy individuals.

METHODS

Impulsivity and diffusion tensor imaging (DTI) data were collected from 74 healthy adults (32 women; mean age=36.6 years [SD=13.6]). Impulsivity was evaluated using the Barratt Impulsiveness Scale-11, which provides a total score and scores for three subdomains: attentional, motor, and nonplanning impulsiveness. DTI was processed using the Enhancing Neuro Imaging Genetics Through Meta Analysis-DTI analysis pipeline to measure whole-brain and regional white matter fractional anisotropy (FA) values in 24 tracts.

RESULTS

Whole-brain total average FA was inversely correlated with motor impulsiveness (r=-0.32, p=0.007) and positively correlated with nonplanning impulsiveness (r=0.29, p=0.02); these correlations were significant after correction for multiple comparisons. Additional significant correlations were observed for motor impulsiveness and regional FA values for the corticospinal tract (r=-0.29, p=0.01) and for nonplanning impulsiveness and regional FA values for the superior fronto-occipital fasciculus (r=0.32, p=0.008).

CONCLUSIONS

These results provide initial evidence that the motor and nonplanning subdomains of impulsive behavior are linked to specific white matter microstructural connectivity, supporting the notion that impulsivity is in part a network-based construct involving white matter microstructural integrity among otherwise healthy populations.

Accumbofrontal tract integrity is related to early life adversity and feedback learning

Abuse, neglect, exposure to violence, and other forms of early life adversity (ELA) are incredibly common and significantly impact physical and mental development. While important progress has been made in understanding the impacts of ELA on behavior and the brain, the preponderance of past work has primarily centered on threat processing and vigilance while ignoring other potentially critical neurobehavioral processes, such as reward-responsiveness and learning. To advance our understanding of potential mechanisms linking ELA and poor mental health, we center in on structural connectivity of the corticostriatal circuit, specifically accumbofrontal white matter tracts. Here, in a sample of 77 youth (Mean age = 181 months), we leveraged rigorous measures of ELA, strong diffusion neuroimaging methodology, and computational modeling of reward learning. Linking these different forms of data, we hypothesized that higher ELA would be related to lower quantitative anisotropy in accumbofrontal white matter. Furthermore, we predicted that lower accumbofrontal quantitative anisotropy would be related to differences in reward learning. Our primary predictions were confirmed, but similar patterns were not seen in control white matter tracts outside of the corticostriatal circuit. Examined collectively, our work is one of the first projects to connect ELA to neural and behavioral alterations in reward-learning, a critical potential mechanism linking adversity to later developmental challenges. This could potentially provide windows of opportunity to address the effects of ELA through interventions and preventative programming.

Brain gray matter structures associated with trait impulsivity: A systematic review and voxel-based meta-analysis

Trait impulsivity is a multifaceted personality characteristic that contributes to maladaptive life outcomes. Although a growing body of neuroimaging studies have investigated the structural correlates of trait impulsivity, the findings remain highly inconsistent and heterogeneous. Herein, we performed a systematic review to depict an integrated delineation of gray matter (GM) substrates of trait impulsivity and a meta-analysis to examine concurrence across previous whole-brain voxel-based morphometry studies. The systematic review summarized the diverse findings in GM morphometry in the past literature, and the quantitative meta-analysis revealed impulsivity-related volumetric GM alterations in prefrontal, temporal, and parietal cortices. In addition, we identified the modulatory effects of age and gender in impulsivity-GM volume associations. The present study advances understanding of brain GM morphometry features underlying trait impulsivity. The findings may have practical implications in the clinical diagnosis of and intervention for impulsivity-related disorders.

Cerebral microstructural abnormalities in impulsivity: a magnetic resonance study

Studies that investigated neurobiological parameters subtended to impulsivity trait found their relationship with structural and functional brain alterations. No studies investigated the white matter microstructural attributes of impulsivity in a large sample of healthy subjects. In the present study 1007 subjects from Human Connectome Project public dataset were divided in two groups, impulsive and not impulsive, basing on Delay Discounting task score. For both groups brain morphometric and microstructural characteristics were investigated. A t-test (correct for multiple comparisons) was performed for each brain parcel and impulsivity measure. Magnetic resonance diffusion images were pre-processed and selected to perform a voxelwise analysis on the fractional anisotropy (FA) maps between impulsive and not impulsive groups. Group analysis showed significant differences in morphometric brain data mainly for temporal and frontal lobes. The impulsive group presented higher FA values in four regions: bilateral medial lemniscus and midbrain reticular formation, right superior longitudinal fasciculus, left forceps major, right corticospinal tract. Not impulsive group showed higher FA values in two significant regions: right and left anterior thalamus radiation. Concluding, macroscopic and microstructural brain alterations were assessed, identifying new neuroanatomical substrates for multidimensional impulsivity construct in a large sample of healthy subjects.

Individual Differences in Intertemporal Choice

Intertemporal choice involves deciding between smaller, sooner and larger, later rewards. People tend to prefer smaller rewards that are available earlier to larger rewards available later, a phenomenon referred to as temporal or delay discounting. Despite its ubiquity in human and non-human animals, temporal discounting is subject to considerable individual differences. Here, we provide a critical narrative review of this literature and make suggestions for future work. We conclude that temporal discounting is associated with key socio-economic and health-related variables. Regarding personality, large-scale studies have found steeper temporal discounting to be associated with higher levels of self-reported impulsivity and extraversion; however, effect sizes are small. Temporal discounting correlates negatively with future-oriented cognitive styles and inhibitory control, again with small effect sizes. There are consistent associations between steeper temporal discounting and lower intelligence, with effect sizes exceeding those of personality or cognitive variables, although socio-demographic moderator variables may play a role. Neuroimaging evidence of brain structural and functional correlates is not yet consistent, neither with regard to areas nor directions of effects. Finally, following early candidate gene studies, recent Genome Wide Association Study (GWAS) approaches have revealed the molecular genetic architecture of temporal discounting to be more complex than initially thought. Overall, the study of individual differences in temporal discounting is a maturing field that has produced some replicable findings. Effect sizes are small-to-medium, necessitating future hypothesis-driven work that prioritizes large samples with adequate power calculations. More research is also needed regarding the neural origins of individual differences in temporal discounting as well as the mediating neural mechanisms of associations of temporal discounting with personality and cognitive variables.

Sex differences in pubertal associations with fronto-accumbal white matter morphometry: Implications for understanding sensitivity to reward and punishment

Researchers have reported sex-differentiated maturation of white matter (WM) during puberty. It is not clear, however, whether such distinctions contribute to documented sex differences in sensitivity to reward and punishment during adolescence. Given the role of the orbitofrontal cortex (OFC) and nucleus accumbens (NAcc) in reward and punishment-related behaviors, we tested in a cross-sectional study whether males and females (N = 156, 89 females; ages 9-14 years) differ in the association between pubertal stage and fixel-based morphometry of WM fibers connecting the OFC and NAcc (i.e., the fronto-accumbal tract). Further, we examined whether males and females differ in associations between fronto-accumbal WM measures and self-reported sensitivity to reward and punishment. Pubertal stage was positively associated with fronto-accumbal fiber density and cross-section (FDC) in males, but not in females. Consistent with previous reports, males reported higher reward sensitivity than did females, although fronto-accumbal combined FDC was not related to reward sensitivity in either sex. Meanwhile, only males showed a negative association between fronto-accumbal tract FDC and sensitivity to punishment. Follow-up analyses revealed that fiber cross-section, but not density, was related to pubertal stage and punishment sensitivity in males, as well as to reward sensitivity in all participants. Our findings suggest there are sex differences in puberty-related maturation of the fronto-accumbal tract, and this tract is related to lower punishment sensitivity in adolescent males compared to females.

Individual differences in accumbofrontal tract integrity relate to risky decisions under stress in adolescents and adults

Psychosocial stress increases risky decision-making (DM). It is widely accepted that individual variation in neural phenotypes underlie variability in this behavioral tendency in adults, but is less examined in adolescents. Our goal was to test the hypothesis that the relation between neural phenotypes and stress-related risky DM is better characterized by individual variation than by age. Using diffusion tensor imaging (DTI) tractography to characterize the accumbofrontal tract, we determined if it uniquely moderated how stress affects risky DM, over and above age. A daily diary design monitored participants’ daily stress for two weeks. Participants completed a DTI scan and performed a task in which decisions varied by expected value, once each on a day when they endorsed feeling higher (and lower) than usual levels of stress. Multilevel logistic regression analyses revealed that all participants were more likely to take risks as expected reward value increased; this behavior was greater under high versus low stress for individuals with low accumbofrontal tract integrity, whereas DM was less influenced by stress for individuals with high accumbofrontal tract integrity, regardless of age. Results suggest that individual differences in brain structure may be more germane to characterizing risky decisions in adolescents, rather than ontogeny.

Relationship between binge eating and associated eating behaviors with subcortical brain volumes and cortical thickness

BACKGROUND

Binge eating disorder (BED) is the most prevalent eating disorder. We examined the presence of binge eating (BE) and three associated eating behaviors in relation to subcortical regional volumes and cortical thickness from brain scans.

METHODS

We processed structural MRI brain scans for 466 individuals from the Nathan Kline Institute Rockland Sample using Freesurfer. We investigated subcortical volumes and cortical thicknesses among those with and without BE and in relation to the scores on dietary restraint, disinhibition, and hunger from the Three-Factor Eating Questionnaire (TFEQ). We conducted a whole-brain analysis and a region of analysis (ROI) using a priori regions associated with BE and with the three eating factors. We also compared scores on the three TFEQ factors for the BE and non-BE.

RESULTS

The BE group had higher scores for dietary restraint (p = .013), disinhibition (p = 1.22E-07), and hunger (p = 5.88E-07). In the whole-brain analysis, no regions survived correction for multiple comparisons (FDR corrected p<0.01) for either BE group or interaction with TFEQ. However, disinhibition scores correlated positively with left nucleus accumbens (NAc) volume (p < 0.01 FDR corrected). In the ROI analysis, those with BE also had greater left NAc volume (p = 0.008, uncorrected) compared to non-BE.

LIMITATIONS

Limitations include potential self-report bias on the EDE-Q and TFEQ.

CONCLUSIONS

The findings show that BE and disinhibition scores were each associated with greater volumes in the left NAc, a reward area, consistent with a greater drive and pleasure for food.

Imaging Violence in Schizophrenia: A Systematic Review and Critical Discussion of the MRI Literature

Background: Persons with schizophrenia have a small but significant increase in risk of violence, which remains after controlling for known environmental risk factors. In vivo MRI-studies may point toward the biological underpinnings of psychotic violence, and neuroimaging has increasingly been used in forensic and legal settings despite unclear relevance. Objectives: (1) To present the first systematic review, following standardized guidelines, of MRI studies of violence with schizophrenia. (2) To critically discuss the promises and pitfalls of using this literature to understand violence in schizophrenia in clinical, forensic, and legal settings. Methods: Following the PRISMA guidelines and literature searches until January 2018, we found 21 original studies that fulfilled the inclusion criteria: (1) Studies of persons with schizophrenia, (2) a history of violence or aggressive behavior, (3) the use of one or more MRI-modalities (sMRI, DTI, fMRI). Results: The most consistent findings from the structural studies were reduced volumes of the hippocampus and the frontal lobe (in particular the orbitofrontal and anterior cingulate cortex) in schizophrenia patients with a history of violence or higher aggression scores. The functional studies mainly showed differences and aggression correlates in the frontal lobe and amygdala. However, the studies were methodologically heterogeneous, with four particular areas of concern: different definitions of violence, region of interest vs. whole-brain studies, small subject samples, and group comparisons in a heterogeneous diagnostic category (schizophrenia). Conclusion: The literature reports subtle, but inconsistent group level differences in brain structure and function associated with violence and aggression with schizophrenia, in particular in areas involved in the formation of psychosis symptoms and affective regulation. Due to methodological challenges the results should be interpreted with caution. In order to come closer to the neurobiological underpinnings of violence in schizophrenia future studies could: (1) address the neurobiological differences of premeditated and reactive violence, (2) use RDoC criteria, for example, or other symptom-based systems to categorize psychosis patients, (3) increase subject cohorts and apply new data driven methods. In this perspective, MRI-studies of violence in schizophrenia have the potential to inform clinical violence prediction and legal evaluations in the future.