Puri, Treasaden, and colleagues conducted a cerebral 31-phosphorus magnetic resonance spectroscopy study of 15 male patients with schizophrenia who had violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic and a control group of 13 age-matched healthy male control subjects.2 Spectra were obtained from 70 × 70 × 70 mm3 voxels in the brain using an image-selected in vivo spectroscopy pulse sequence. Following initial truncation of the signal to remove the broad component, seven sets of peaks were modeled using Lorentzians (Figure 5.1). The area (and therefore the cerebral concentration) of β-nucleotide triphosphate (βNTP) was lower, and the γNTP higher, in the violent schizophrenia group compared with the control group. βNTP indexes adenosine triphosphate (ATP), the majority of adenosine diphosphate (ADP) is nuclear magnetic resonance-invisible, and the γNTP signal overlaps with signals from βADP, although the signal of γNTP is much stronger.3 Therefore, these results are consistent with increased
cerebral energy metabolism in the forensic patient group.2 Furthermore, there was a strong negative correlation between the inorganic phosphate concentration (labeled Pi in Figure 5.1) and the volumetric niacin response; the latter is a non-invasive niacin-based measure of phospholipid signal transduction.4,5 Hence these further results suggest that patients with schizophrenia who have violently offended and who have poor phospholipid-related signal transduction may have higher levels of cerebral energy metabolism.