Impulsivity in Male Patients with Treatment- Resistant Schizophrenia Is Associated with Lower Total Cholesterol Levels

Impulsivity in Male Patients with Treatment- Resistant Schizophrenia Is Associated with Lower Total Cholesterol Levels | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impulsivity in Male Patients with Treatment- Resistant Schizophrenia Is Associated with Lower Total Cholesterol Levels Zhenkuo Li, Cheng Yang, Peng Xie, Zhuoning Liu, Hongli Song, Wei Yi, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5877512/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Treatment-Resistant Schizophrenia (TRS) in males with impulsive and violent behavior poses a clinical challenge. The pathophysiological mechanisms of impulsivity in Male TRS remain unclear. This study explores these mechanisms and investigates potential biomarkers for impulsivity. Method 180 Male TRS patients and 100 healthy controls were enrolled. Psychiatric symptoms and impulsivity were assessed using the Positive and Negative Syndrome Scale 5-factor model (PANSS-5F) and the PANSS-Excited Component (PANSS-EC). Patients were divided into Male TRS with impulsivity (n = 80) and without impulsivity (n = 100). Demographic data and lipid profiles (triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein) were collected for both groups. Statistical analyses assessed the relationship between lipid profiles and impulsivity. Results A negative correlation was found between total cholesterol (TC) levels and impulsivity in Male TRS. Those with impulsivity had worse educational and marital status and more severe cognitive impairment. TC levels and hypercholesterolemia were higher in Male TRS compared to healthy controls. Conclusions Lower TC levels in Male TRS with impulsivity are associated with higher impulsivity risk. TC may be a potential biomarker for impulsivity in this population. Male Treatment-Resistant Schizophrenia Impulsivity Biological Markers Lipid Profile Total Cholesterol PANSS-EC 1. Introduction Schizophrenia is a disease characterized by multifaceted impairment of cognitive, affective, behavioral, and volitional activities, with a prolonged course and a high rate of disease recurrence, which can lead to varying degrees of impaired social functioning. As one of the ten most disabling disorders in the world, schizophrenia frequently results in severe adverse outcomes and imposes a heavy burden of illness on patients’ families[ 1 ]. Impulsive and violent behavior is a common symptom of schizophrenia, with a much higher risk of impulsivity observed in this population compared to the general population[ 2 ]. A study published in The Lancet Psychiatry found that the incidence of impulsive behaviors over a 5–10 years period was much higher in schizophrenia than in other psychiatric disorders[ 3 ]. Moreover, impulsive and violent behaviors were much more frequent in men with schizophrenia than in women[ 4 – 6 ], often characterized by recklessness, cruelty, and overt perpetration[ 7 ]. Impulsive and violent behavior in men with schizophrenia has attracted widespread social attention and has created a significant economic burden and safety risks for families and society [ 8 ]. Treatment-Resistant Schizophrenia (TRS) is a special group of patients with schizophrenia, accounting for approximately 20%-50% of patients[ 9 ]. TRS is defined as the lack of response to a number of antipsychotic agents, which causes the patients to be actively symptomatic and to not gain symptom remission and functional recovery[ 10 ]. Compared to non-refractory schizophrenia (non-TRS), TRS is more severe[ 11 ] and social functioning is more significantly impaired[ 12 ]. Clozapine is currently recognized worldwide as an effective antipsychotic for TRS[ 13 ], and clozapine reduces impulsive behaviors in patients with schizophrenia[ 14 ], but only about 40%-70% of TRS patients respond effectively to clozapine[ 15 ], which leads to impulsive behaviors being more difficult to control in TRS patients. The study of impulsive behavior in patients with psychiatric disorders has always been a hot clinical research topic. However, so far the mechanism of impulsive behavior in patients with schizophrenia is still not completely clear, and even fewer studies have been conducted on impulsive behavior in TRS. Some studies have found a correlation between lipid profiles such as low-density lipoprotein, total cholesterol, and Triglyceride and impulsive, violent, and even suicidal behaviors in patients with schizophrenia[ 16 – 18 ]. One main hypothesis of a possible biological mechanism which might explain the association is that low cholesterol levels in the central nervous system (CNS) may contribute to reduced transportation of serotonin through cholesterol-containing cell membranes. This may result in low levels of serotonin in the CNS and insufficient top-down control from the prefrontal cortex to the limbic structures of the brain, resulting in increased risk of affective and impulsive aggression[ 19 – 21 ]. However, there is a lack of consistency in the findings of studies on correlates of impulsive behaviors in people with mental disorders, with several studies not finding similar positive results or gender differences in positive results[ 22 ]. The inconsistency in the findings of these studies also suggests that there may be a more complex biological link between lipid profiles and impulsive behaviors that still needs to be explored and explained by many clinical studies. Male patients with refractory schizophrenia with concomitant impulsivity have received attention for their poorer outcomes and more difficult impulse control. Still, research evidence on the biological mechanisms of impulsivity in this population remains insufficient. In summary, there has been increasing evidence suggesting that the lipid profile has the potential to be a biological marker of impulsive and violent behavior in patients with psychiatric disorders, so the present study aimed to explore the biological relationship between lipid profile levels and impulsive and violent behavior in male refractory schizophrenia patients with concomitant impulsivity, as well as between male refractory schizophrenia patients with and without concomitant impulsivity in terms of lipid profile differences. This study seeks to identify reliable biological markers of impulsive and violent behavior that may assist in the identification, evaluation, and treatment of men with refractory schizophrenia who are at high risk for impulsivity in clinical practice. 2. Methods 2.1 Study design and participants This was a single-center cross-sectional study. Our study included 180 Male Treatment-Resistant Schizophrenia (Male TRS, n = 180) hospitalized in the Fifth People's Hospital of Xiangtan City from September 1, 2022, to August 31, 2023, who met the following inclusion and exclusion criteria. Inclusion criteria for Male TRS: 1. meet the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). 2. male, aged 18–65 years, without major physical illness. 3. duration of disease < 15 years. 4. Meet the criteria for TRS[ 23 ]. Exclusion criteria: 1. Severe physical illness and other organic brain diseases. 2. Comorbid substance abuse. 3. Comorbid mental retardation. We referred to several clinical studies on impulsive behavior in patients with schizophrenia and used the definitions of impulsivity from these studies: Scores of ≥ 60 on the Positive and Negative Syndrome Scale 5-factor model (PANSS-5F) and ≥ 14 on the PANSS- Excited Component (PANSS-EC), with a score of ≥ 4 on at least one of the five items[ 24 , 25 ]. Male TRS (n = 180) was categorized into Male Treatment-Resistant Schizophrenia with Impulsivity (Male TRS with Impulsivity, n = 80) and Male Treatment-Resistant Schizophrenia without Impulsivity (Male TRS without Impulsivity, n = 100). This study also recruited 100 men who underwent a physical examination at the hospital's health center during the same period as Healthy controls (HCs, n = 100). General demographic information and blood test parameters of HCs were obtained from the hospital's health screening system. HCs had to meet the following inclusion criteria as well as exclusion criteria. Inclusion criteria: (a) Male, no mental illness, and no family history of mental illness. (b) Be between 18 and 65 years of age. (c) Volunteer to participate in the study and sign an informed consent form. Exclusion criteria: (a) Psychoactive substance abusers. (b) Severe physical illness. (c) Comorbid mental retardation. This study received approval from the Ethics Committee of the Fifth People’s Hospital of Xiangtan City (approval number: 2022003) and was conducted with no conflicts of interest, adhering strictly to the Declaration of Helsinki. Detailed information about the study was provided to all participants, who then voluntarily signed informed consent forms, ensuring their cooperation and the protection of their privacy rights throughout the research process. Clinical trial registration: chictr.org.cn, identifier: ChiCTR2200063407, registration date: 6 September 2022. 2.2 Outcome measures Researchers collected general demographic information (Age, Education, Marital status, Employed Status, Household Registration, etc.) and general clinical information (Age of Onset, Duration of Illness, Number of Hospitalizations, etc.) from the Male TRS group (n = 180) using a self-administered scale. The PANSS 5-factor model (PANSS-5F) was used to assess clinical psychiatric symptoms of patients. Blood samples from patients were collected between 06:00 and 07:00 AM after an overnight fast. Triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were detected. TG was measured by the GPO–PAP method. TC was measured by the CHOD–POD method. HDL-C and LDL-C were measured by the terminal method. 2.3 Primary outcomes Agitation or impulsivity was assessed by the PANSS-EC, TC lab results were obtained from blood samples drawn in the fasting state, and the PANSS-EC score and TC metrics were set as the primary endpoint. The PANSS-EC is a subscale of the PANSS, which has been extensively used to measure agitation or impulsivity in clinical pharmacotherapy trials[ 26 , 27 ]. The PANSS-EC consists of five individual PANSS items: hostility, uncooperativeness, impulsivity, tension, and excitability. The severity of each item is rated from 1 = nonexistent to 7 = extreme. Higher scores on the PANSS-EC indicate greater severity of agitation or impulsivity.TC is a biomarker of hotspots in the relationship between impulsivity and lipid profiles and has been used as a focal point of research in many studies[ 28 ], so this study also used TC as a primary observation. 2.4 Secondary outcomes PANSS-5F, PANSS-Negative Component (PANSS-Ne), PANSS-Cognitive Component (PANSS-Co), PANSS-Depressive/ Anxiety Component (PANSS-DA), PANSS- Positive Component (PANSS-Po) scores and other members of the lipid profile family (including TG, HDL, LDL, and hypercholesterolemia prevalence[ 29 ] were set as secondary outcomes. The PANSS-5F scores indicate overall psychiatric symptom severity, with higher scores indicating greater severity of the condition. Similarly, the PANSS-Ne, PANSS-Co, PANSS-DA, and PANSS-Po scores indicate the severity of the patient's negative, cognitive impairment, anxiety-depression, and positive symptoms, respectively, with higher scores indicating a more severe condition. In studies of patients with schizophrenia with impulsivity, it has been shown that the PANSS-5F model can better characterize the patient's condition in a multidimensional way [ 30 – 32 ], so we applied the PANSS-5F model to assess the psychiatric symptoms of the enrolled patients. 3. Statistical Analysis Data were analyzed using IBM SPSS Statistics 25.0 categorical variables were described by rate (%), and continuous variables were described by Mean ± SD or median (IQR) depending on whether they conformed to a normal distribution. Chi-square tests, independent samples t-tests, or Mann-Whitney U tests were performed between groups. In the Male TRS group, whether or not the impulses were accompanied was used as the dependent variable, the unaccompanied impulses group was assigned the value of 0 and the accompanied impulses group was assigned the value of 1. The results of these analyses were analyzed using logistic regression analyses for factors associated with impulsivity in the Male TRS group and calculated the odds ratio (OR) and 95% confidence interval (95% CI). Uncorrected models tested only demographic variables totaling 6 items (Age, Education, Marital status, Employed Status, Household Registration, Positive family history of schizophrenia). Model 1 tested demographic variables with clinical variables (Age of Onset, Duration of Illness, Number of Hospitalizations, olanzapine equivalent dose) totaling 10 items. Model 2 tested Model 1 + scale-related variables (PANSS-Po, PANSS-Ne, PANSS-Co, PANSS-DA) totaling 14 items and excluded PANSS-5F and PANSS-EC because grouping in the Male TRS was based on the PANSS-EC, which was also directly involved in the composition of the total score of the PANSS-5F. Model 3 tested Model 1 + Model 2 + lipid-related variables (TG, TC, HDL, LDL) totaling 18 items. All statistical results were considered statistically significant at p < 0. 05 (2-tailed). 4. Results 4.1 Comparison of general information and lipid profile levels in Healthy controls and Male TRS Group The mean age of the Male TRS group (42.52 ± 8.33) years and the mean age of the Healthy control group (43.32 ± 9.43) years were not statistically significant. No statistically significant difference found in Employed Status, Household Registration of Male TRS and HCs groups. The mean years of education of the Male TRS group (9.22 ± 1.85) years was significantly lower than that of the HCs group. The mean years of education in the TRS group (9.22 ± 1.85) was significantly lower than the mean years of education in the HCs group (11.89 ± 2.03), and the difference was statistically significant ( p < 0.001). Marital status was statistically different between the two groups ( p < 0.005). The married rate was significantly higher in HCs (83%) than in Male TRS (66.7%), and the single rate (5%) and the divorce rate (12%) were lower in HCs group than in Male TRS group (16.7%,16.7%), respectively. The TC level in the Male TRS group (4.41 ± 0.85) and prevalence of hypercholesterolemia (67.2%) were higher in the Male TRS group (3.17 ± 1.01, 34%) than in the HCs group (3.17 ± 1.01, 34%), respectively, and the differences were statistically significant (all p < 0.001). No statistical differences were found between TG, LDL, and HDL in the two groups. See Table 1 . Table 1 Comparison of socio-demographic information and clinical characteristics of the healthy control group and Male TRS group. Variables Healthy Controls (n = 100) Male TRS (n = 180) Statistics X 2 / t / Z P Age (year) 43.32 ± 9.43 42.52 ± 8.33 0.71 0.48 Education (year) 11.89 ± 2.03 9.22 ± 1.85 10.88 <0.001 Marital status 7.8 <0.005 Married 83(83%) 120(66.7%) Single 5(5%) 30(16.7%) Divorced 12(12%) 30(16.7%) Employed Status 77(77%) 130(72.2%) 0.53 0.47 Household Registration 0.02 0.89 Local Resident 55(55%) 96(53.3%) Non-local Resident 45(45%) 84(46.7%) Positive family history of schizophrenia 16(8.9%) Age of Onset (years) 31.40 ± 5.062 Duration of Illness(months) 86.79 ± 43.18 Number of Hospitalizations 5.04 ± 1.50 Olanzapine equivalent dose (mg) 11.29 ± 4.75 PANSS-5F 96.77 ± 10.55 PANSS-EC 13.84 ± 3.61 PANSS-Po 20.01 ± 1.81 PANSS-Ne 18.87 ± 2.07 PANSS-Co 18.07 ± 1.25 PANSS-DA 20.98 ± 3.11 Prevalence of hypercholesterolaemia(%) 34(34%) 121(67.2%) 27.38 <0.001 TG(mmol/L) 0.99 ± 0.45 1.09 ± 0.30 -1.77 0.077 TC(mmol/L) 3.17 ± 1.01 4.41 ± 0.85 -10.4 <0.001 HDL(mmol/L) 1.24 ± 0.21 1.21 ± 0.32 0.94 0.346 LDL(mmol/L) 2.77 ± 6.42 2.97 ± 8.65 -0.22 0.826 n: sample size; P : probability; %:percent; PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA: Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein. 4.2 Comparison of General Demographic Data and General Clinical Data Between Male TRS with Impulsivity and Male TRS without Impulsivity No significant statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of Age, Education, Marital Status, Employment Status, and Household Registration. Additionally, there were no significant statistical differences between the two groups regarding Age of Onset, Duration of Illness, Number of Hospitalizations, Olanzapine Equivalent Dose, or Positive Family History of Schizophrenia. See Table 2 . Table 2 Comparison of sociodemographic information and clinical characteristics between Male TRS with Impulsivity and Male TRS without Impulsivity. Variables Male TRS without Impulsivity (n = 100) Male TRS with Impulsivity (n = 80) Statistics X 2 / t / Z P Age (year) 42.04 ± 7.58 43.11 ± 9.18 -0.858 0.392 Education (year) 9.35 ± 1.77 9.05 ± 1.96 1.08 0.282 Marital status 0.349 0.84 Married 65(65%) 55(68.8%) Single 18(18%) 12(15%) Divorced 17(17%) 13(16.3%) Employed Status 70(70%) 60(75%) 0.554 0.457 Household Registration 0.04 0.841 Local Resident 54(54%) 42(52.5) Non-local Resident 46(46%) 38(47.5%) Positive family history of schizophrenia 10(10%) 6(7.5%) 0.343 0.558 Age of Onset (years) 31.54 ± 5.09 31.23 ± 5.06 0.414 0.679 Duration of Illness (months) 87.65 ± 42.72 85.71 ± 44.01 0.298 0.766 Number of Hospitalizations 5.19 ± 1.43 4.86 ± 1.57 1.462 0.145 Olanzapine equivalent dose (mg) 8.61 ± 3.15 8.39 ± 1.58 0.531 0.595 PANSS-5F 92.12 ± 11.33 102.59 ± 5.47 -7.584 <0.001 PANSS-EC 10.97 ± 1.35 17.43 ± 1.97 -26.031 <0.001 PANSS-Po 19.95 ± 1.83 20.08 ± 1.80 -0.458 0.647 PANSS-Ne 18.93 ± 2.09 18.79 ± 2.07 0.457 0.648 PANSS-Co 18.19 ± 1.25 17.93 ± 1.23 1.421 0.157 PANSS-DA 21.03 ± 3.13 20.91 ± 3.12 0.251 0.802 TG 1.10 ± 0.29 1.08 ± 0.31 0.521 0.603 TC 4.68 ± 0.78 4.08 ± 0.82 4.963 <0.001 HDL 1.21 ± 0.34 1.22 ± 0.28 -0.309 0.757 LDL 2.29 ± 0.66 2.35 ± 0.72 -0.576 0.566 n: sample size; P : probability; %:percent; PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA, Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein. 4.3 Comparison of the PANSS-5F Model Between Male TRS with Impulsivity and Male TRS without Impulsivity No statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of PANSS-Ne, PANSS-Po, PANSS-DA, and PANSS-Co. Compared with Male TRS without Impulsivity, Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores, and the difference was statistically significant (all p < 0.001). 4.4 Comparison of Lipid Profile Levels Between Male TRS with Impulsivity and Male TRS without Impulsivity No statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of LDL, HDL, and TG. Compared with Male TRS without Impulsivity, Male TRS with Impulsivity had lower TC levels, and the difference was statistically significant ( p < 0.001). 4.5 Correlations Between TC Levels of Male TRS and Factors of the PANSS-5F Model As can be seen in Table 3 , Pearson correlation analysis in the Male TRS group showed a negative correlation between TC levels and PANSS-5F (r=-0.246, p = 0.001), PANSS-EC (r=-0.326, p < 0.001), and PANSS-Co (r=-0.203, p = 0.016). The correlation between TG, HDL, and LDL was not found to be correlated with the factors of the PANSS-5F model, and the results were not statistically significant. Table 3 Pearson Correlation Coefficients (r) Between the PANSS-5F Model and Lipid Profile in Male TRS. Variables PANSS-5F PANSS-Ec PANSS-Po PANSS-Ne PANSS-Co PANSS-DA TG -0.079 -0.028 -0.084 -0.044 -0.001 0.186 TC -0.246** -0.326** -0.008 0.022 -0.203** -0.129 HDL -0.06 0.023 -0.09 0.113 -0.072 0.103 LDL 0.011 -0.005 -0.049 0.023 0.103 -0.06 *: P <0.05; **: P <0.01. PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA, Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein. 4.6 Factors Associated with Impulsivity In a multi-model regression analysis based on binary logistic regression, we did not obtain positive results in the uncorrected model. In the 3 models, we found that the risk of impulsivity was lower with more hospitalizations (model 1: OR = 0.68, 95% Cl = 0.47–0.98, P = 0.036; model 2: OR = 0.58, 95% Cl = 0.35–0.86, P = 0.028; model 3: OR = 0.77, 95% Cl = 0.61–0.99, P = 0.041). In addition, in Model 3, we found that the lower the level of TC, the higher the risk of impulsivity (OR = 0.47, 95% Cl = 0.23–0.95, P = 0.023). (Table 4 ) Table 4 Multi-model regression analysis of factors associated with impulsivity in the Male TRS OR (95% CI) Uncorrected model Mode 1 Mode 2 Mode 3 Number of Hospitalizations 0.68(0.47–0.98)* 0.66(0.45–0.96)* 0.77(0.61–0.99)* TC 0.47(0.23–0.95)* *: P <0.05; **: P <0.01. TC: total choles. The uncorrected model included 6 variables: Age + Education + Marital status + Employed Status + Household Registration + Positive family history of schizophrenia Model 1 included 10 variables: uncorrected model + Age of Onset + Duration of Illness + Number of Hospitalizations + olanzapine equivalent dose. Model 2 included 14 variables: model 1 + PANSS-Po + PANSS-Ne + PANSS-Co + PANSS-DA. Model 3 included Model 2 + TG + TC + HDL + LDL. 5. Discussion The findings of this study validated our suspicions, and the main findings were as follows. First, compared to healthy controls, Male TRS had poorer mean education and marital status, and Male TRS had higher TC levels. Second, compared to Male TRS without Impulsivity, Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores, and lower TC levels. Third, in Male TRS, TC levels were negatively correlated with PANSS-5F, PANSS-EC, and PANSS-Co, respectively. And more hospitalizations were found to be a protective factor for impulsivity and lower TC levels were found to be a risk factor for impulsivity in the multi-model regression analysis of binary logistic regression. In our study, Male TRS were found to be less educated than the healthy population and had similarly poorer marital status than the healthy population (Table 1 ). Several review studies have mentioned that the schizophrenia population is generally poorly educated[ 33 , 34 ], but none of these studies have delved into whether there are differences in educational attainment between subtypes of schizophrenia, such as TRS. The current state of poor educational attainment in Male TRS may be related to a variety of factors. One study found that women with schizophrenia typically have a later age of onset than men and that positive and negative symptoms contribute to decreased learning ability and social regression in both male and female patients[ 35 ]. Early onset of schizophrenia and exposure to psychotic symptoms puts male patients' schooling at risk, coupled with a more severe risk of violence than female patients[ 4 – 6 ] and disease characteristics of poorer efficacy of TRS[ 11 ], all of which may contribute to the inability of schools to accept these male patients and thus deprive them of the opportunity to continue their education. So it is not difficult to explain why Male TRS have a lower level of education, especially compared to the healthy population. In addition, a comparison of general demographic information revealed that the marital status of Male TRS was worse compared to healthy controls (Table 1 ). The above potential influences on the differences in educational attainment between the two groups may equally influence their marital status. The higher risk of violence, lower social functioning, and especially poorer clinical outcomes in refractory schizophrenia in men with schizophrenia are all undesirable factors that may have a hindering effect on the choice of spouse in Male TRS. A review study described that the marital status of patients with schizophrenia is often dismal, and even those who form families have difficulty in obtaining family support from the couple relationship which eventually leads to marital breakdown[ 36 ]. More recently, a study from China found that stigma was a serious problem for people with mental disorders and their family relationships and that they were almost reluctant to disclose information about their illnesses because of stigma[ 37 ]. Stigma about mental illness is indeed prevalent in China[ 38 ], and excessive stigma may cause people with mental illness to avoid contact with the opposite sex and even lose the opportunity to form a family, which may be an important factor contributing to the poorer marital status of people with Male TRS than the healthy population. In Table 1 we also found a statistically significant difference in the prevalence of hypercholesterolemia and TC levels between Male TRS and the healthy population, with Male TRS having a much higher prevalence of hypercholesterolemia and TC levels than the healthy population. Regarding these two findings, they are consistent with the conclusions of some studies[ 39 , 40 ], which have pointed out that long-term use of antipsychotics can cause disorders of glucose-lipid metabolism and even the development of metabolic syndrome, so it is not difficult to explain the fact that Male TRS has a higher prevalence of hypercholesterolemia and TC levels. Compared with Male TRS without Impulsivity, our study found that Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores (Table 2 ). We used the PANSS-EC definition of impulsivity to group the included Male TRS, so Male TRS with Impulsivity had higher PANSS-EC scores as a result of the grouping requirement. A cross-sectional study by the team of Yi et al. exploring the clinical characteristics of schizophrenics with violence in China[ 41 ] found that patients in the violent group had higher total PANSS scores than those in the nonviolent group, which is consistent with our findings and implies that the population of patients with impulsivity or violence has more severe psychiatric symptoms. Yi's study also used the PANSS-5F model to assess patients' psychiatric symptoms and also found that the violent group had higher PANSS-EC scores and PANSS-Po scores, but did not find Male TRS with Impulsivity to have higher PANSS-Po scores in our study. In contrast to our study, Yi's study used a self-administered questionnaire to define violent behavior, which lacked quantifiable indicators, and the definition of “violence” was not comprehensive enough, ignoring verbal violence and violence against oneself, such as self-inflicted suicide. It is possible that the difference between Yi's team's definition of “violence” and the definition of “impulsivity” in our study influenced the grouping results and led to partially different positive results in the PANSS-5F model. The relationship between lipid profile levels and impulsivity has been a hot topic, and many studies have been based on the classic cholesterol-serotonin attack hypothesis proposed by Kaplan et al. that low levels of TC lead to attack by altering the serotonergic system[ 16 , 20 ]. In Table (2), it can be found that the TC level of Male TRS with Impulsivity is significantly lower than that of Male TRS without Impulsivity, and a negative correlation between TC level and PANSS-EC scores was found in Male TRS (Table 3 ), a finding that suggests that there is an underlying biological link, with lower TC levels potentially implying higher impulsivity. A cross-sectional study by Kavoor[ 42 ] et al. found a negative correlation between TC levels and severity of impulsivity, a finding that is consistent with the findings of our study, in addition, they found a similarly negative correlation between TC levels and propensity for suicidal impulsivity. Unlike our study, Kavoor's team included drug-naïve/drug-free patients of schizophrenia, whereas our study was conducted on TRS patients on long-term antipsychotic medications or even multi-drug combinations, and similar findings were obtained in different study populations, suggesting that the relationship between impulsivity and TC levels may persist and persist throughout a schizophrenic patient's illness, perhaps having little to do with whether or not they have been treated with antipsychotic medication. Studies by Roaldset [ 20 ] and Hillbrand[ 43 ] likewise came to similar conclusions, verifying the relationship between TC and impulsivity. In addition, a relationship between low TC and high risk of impulsivity has also been found in violent offenders without mental disorders [ 44 , 45 ], and this research evidence suggests that the relationship between lipid profiles and impulsivity is not limited to mentally challenged populations, but also exists in impulsive healthy populations, particularly violent offenders. This may help to identify potentially high-risk violent populations at an early stage and reduce the incidence of violent crime. There are also prospective studies confirming the negative correlation between TC levels and impulsive behavior in patients with mental disorders[ 16 ]. Lower TC implying a high risk of suicidal impulsivity has been found not only in the field of schizophrenia research but also in studies related to suicidal impulsivity in patients with major depression[ 46 ]. Suicidal ideation and violent suicidal behavior were found to correlate with TC and leptin levels in a study on suicide attempts in patients with mental disorders[ 47 ]. It has been shown that there is an interaction between the leptinergic and serotonergic systems in the CNS[ 48 ], and leptin has been observed to stimulate serotonin turnover[ 49 ]. In turn, levels of TC in the central nervous system can influence the metabolism of the serotonergic system to induce impulsive and aggressive behaviors[ 21 ], so there appears to be an even more complex biological connection between TC, leptin, and serotonin, but research on the relationship between the three is lacking. Perhaps it is because of this complex interplay of influences that some studies have come to inconsistent conclusions. A study by Eriksen et al. found no significant association between TC levels and impulsivity, but there was a significant negative correlation between HDL levels and the severity of impulsivity during hospitalization and even follow-up, and this relationship was only found in male patients with acute-phase psychiatric disorders[ 17 ]. Unlike the results of Eriksen et al.'s study, we did not find a correlational relationship between impulsivity and HDL, although our study included the same all-male patients and the difference in sample size could be a potential factor for the inconsistent results. In addition, Eriksen's study included almost all acute-onset psychiatric disorders, including schizophrenia, bipolar disorder, depressive disorders, and even personality disorders, and the difference in sample size may have also contributed to the variability in results. Not to be overlooked, some studies report no association between TC and impulsivity [ 50 ]. In Table (3), it can be seen that there is a negative correlation between TC levels and PANSS-Co scores in Male TRS, which implies that patients with lower TC levels may have more severely impaired cognitive function. Similar conclusions were reached in a clinical study from China on cognitive functioning in patients with chronic schizophrenia, which found that elevated serum TC levels may be associated with improved cognitive functioning, especially that of immediate memory[ 51 ]. Pang's study[ 52 ] found that higher TC levels in older adults > 60 years of age were protective of cognitive function in older women, an association that was not found in older men. Pang's findings also suggest that there may be age and gender differences in the relationship between TC levels and cognitive function. Thorvaldsson's study[ 53 ] similarly found an association between lower TC levels were associated with poorer cognitive function, and those with a significant trend of declining TC levels over time had a similarly prominent rate of cognitive decline and were more likely to develop dementia. In addition, Huan's study[ 54 ] found that elevated serum TC may be a potential factor in preventing or mitigating cognitive dysfunction within the normal range of serum TC in a population of healthy older adults, but there were racial differences in this association. The findings of the above studies support our findings, but there is a lack of consistency in the findings of current clinical studies on the relationship between TC and cognitive function. For example, both research teams of Zhao[ 55 ] and Jia[ 56 ] found higher TC levels to be a risk factor for cognitive impairment. In addition to this, several clinical studies have explored the relationship between cognitive deficits and impulsive behavior in patients with psychiatric disorders. Ahmed et al. found that schizophrenic patients with violent offenses showed more severe impairments in most of the cognitive domains, and Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states[ 57 ]. A study from China found[ 58 ] that patients with violent behavior had lower RBANS language, semantic fluency, and total subscale scores. These studies verified that psychotic patients with impulsive behavior have worse cognitive functioning, and laterally support the negative correlation between serum TC and impulsivity. Perhaps cognitive impairment plays a mediating role between serum TC and impulsivity, but this still needs to be verified by clinical studies, and our next study will also focus on this. Furthermore, in Table 3 , a negative correlation was found between PANSS-5F scores and serum TC, implying that Male TRS with lower levels of serum TC had more severe psychiatric symptoms. On this point, the study found that it is not difficult to explain that more severe cognitive impairment and impulsivity are a reflection of the severity of psychiatric symptoms. In addition, the relationship between the positive results in Table 3 can be synthesized and analyzed to conclude that PANSS-EC and PANSS-Co may be the main reason for the negative correlation between PANSS-5F total score and TC. A multi-model regression analysis of Male TRS found that a higher number of hospitalizations implied a lower risk of impulsivity in all three models (Table 4 ). This finding may be related to the unbalanced allocation of healthcare resources and inadequate community psychiatric rehabilitation systems in developing countries. The lack of timely access to quality community-based psychiatric rehabilitation services for discharged patients with mental disorders, coupled with the fact that the condition of TRS patients is more difficult to control, contributes to the high rate of relapse and recurrent hospitalization of patients with schizophrenia. One study found an extremely high risk of re-hospitalization in the first 60 days after discharge [ 59 ]. Therefore, timely hospitalization during acute episodes of psychiatric symptoms may be the most effective way for patients with mental disorders in developing countries to receive specialized psychiatric care. More hospitalizations mean more healthcare resources are available, and systematic antipsychotic treatment will inevitably reduce the severity of psychiatric symptoms, especially impulsivity, which is more easily observed clinically. However, repeated hospitalization imposes a heavy economic burden on society and also takes up a large amount of medical resources[ 60 ], so it is particularly important to establish a comprehensive community-based psychiatric rehabilitation system[ 61 , 62 ]. In addition, lower TC levels can be found as a risk factor for impulsivity in Table 4 , implying that the risk of impulsivity is more severe in Male TRS with low TC levels. Regarding this point of conclusion, the correlation relationship between lipid profile and impulsivity has been validated in Table 3 . In addition, the inclusion of 18 variables in Model 3 for binary logistic regression analysis yielded positive results that shed even more light on the biological link between serum TC levels and patient impulsivity. Returning to our findings and combining them with the previously listed studies that are consistent with our findings, we can prove the negative correlation between TC and impulsivity in Male TRS. However, we cannot ignore the studies that are inconsistent with our conclusions and have to pay more attention to them, because these inconsistent conclusions also reflect a more complex relationship between lipid profile and impulsivity from the side. This relationship may not be fully explained by the simple cholesterol-serotonin attack hypothesis, and this relationship may involve more complex metabolic and transport mechanisms, as well as more biological substances, such as leptin. In addition, we found that some of the existing studies on the correlation between lipid profiles and impulsivity included mixed samples, and the sample populations often included multiple psychiatric disorders, which suggests that less stringent sample inclusion and exclusion criteria may also have had an impact on the reliability and consistency of the findings. Therefore, more scientific, rigorous, and comprehensive studies are still needed to further substantiate the follow-up. In this study, there are several limitations: 1) Sample Size and Generalizability: The study's small sample size and single-center design limit the generalizability of the findings. 2) Gender Considerations: The trial exclusively included male patients with schizophrenia, overlooking potential gender differences in impulsive behavior. 3) Assessment Tools: Reliance on a single psychiatric assessment scale may not fully capture the complexity of the clinical symptoms. These limitations suggest the need for further research with larger, multi-center trials that include both male and female patients and utilize a broader range of neurophysiological markers and psychiatric assessment tools. 6. Conclusion In summary, our study found a negative correlation between TC levels and impulsivity in male patients with Treatment-Resistant Schizophrenia (TRS). Male TRS patients exhibiting impulsivity were found to have less favorable educational and marital status, along with more severe cognitive impairments, compared to those without impulsivity. In addition, TC levels and the prevalence of hypercholesterolemia were significantly higher in Male TRS than in healthy controls. Our study demonstrated an association between lipid profile and impulsivity, and both existing findings and our findings support the potential of TC as a biological marker associated with impulsivity in male patients with Treatment-Resistant Schizophrenia with concomitant impulsivity. Our findings facilitate the early clinical identification of impulsivity risk in men with impulsive refractory schizophrenia and guide early prevention and intervention of impulsive or violent behaviors, or even reduction of violent crime in this group of patients. The study also provides direction and theoretical basis for further exploration of the mechanism of impulsivity in the future. Declarations Acknowledgements The authors would like to thank all of the participants in this study. Authors’ contributions Zhenkuo Li ：Writing – original draft, Writing – review & editing, Visualization, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Cheng Yang ： Writing – review & editing, Project administration, Formal analysis, Data curation. Peng Xie ： Conceptualization, Formal analysis, Software, Writing – original draft, Writing – review & editing. Zhuoning Liu ： Writing – review & editing, Methodology, Data curation. Hongli Song : Writing – review & editing, Methodology, Formal analysis. Wei Yi: Writing – review & editing, Methodology, Data curation. Bo Sun ： Writing – review & editing. Gan Wang ： Writing – review & editing, Methodology, Data curation. Ling Ma ： Data curation. Xi Chen ： Data curation. Yinghan Tian ： Writing – review & editing, Methodology, Formal analysis. Lei Xia ： Writing – review & editing, Writing – original draft, Methodology, Data curation, Conceptualization. Huanzhong Liu : Writing – review & editing, Supervision, Project administration, Methodology, Data curation, Conceptualization. Funding This study was supported by the Scientific Research Fund of the Xiangtan City Medical Association in Hunan Province, China (2022-xtyx-59). Data availability The authors declare that all relevant data from this study are available within the article or from the corresponding author upon reasonable request. Ethics approval and consent to participate This study received approval from the Ethics Committee of the Fifth People’s Hospital of Xiangtan City (approval number: 2022003) and was conducted with no conflicts of interest, adhering strictly to the Declaration of Helsinki. Detailed information about the study was provided to all participants, who then voluntarily signed informed consent forms, ensuring their cooperation and the protection of their privacy rights throughout the research process. Clinical trial registration: chictr.org.cn, identifier: ChiCTR2200063407, registration date: 6 September 2022. Consent for publication The authors declare no conficts of interest and agree to publish. Competing interests The authors declare no competing interests. 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Mazereel V, Detraux J, Vancampfort D, van Winkel R, De Hert M. Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness. Front Endocrinol (Lausanne). 2020;11:573479. Penninx BWJH, Lange SMM. Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues Clin Neurosci. 2018;20:63–73. Yi Y, Huang Y, Chen Q, Yang H, Li H, Feng Y, et al. Violence, neurocognitive function and clinical correlates in patients with schizophrenia. Front Psychiatry. 2022;13:1087372. Kavoor AR, Mitra S, Kumar S, Sisodia AK, Jain R. Lipids, aggression, suicidality and impulsivity in drug-naïve/drug-free patients of schizophrenia. Asian J Psychiatr. 2017;27:129–36. Hillbrand M, Waite BM, Miller DS, Spitz RT, Lingswiler VM. Serum cholesterol concentrations and mood states in violent psychiatric patients: an experience sampling study. J Behav Med. 2000;23:519–29. Chakrabarti N, Sinha VK. 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No correlation of serum cholesterol levels with measures of violence in patients with schizophrenia and non-psychotic disorders. Eur Psychiatry. 1999;14:346–8. Zhang G, Ye X, Wang X, Lin Y, Zhu C, Pan J, et al. Serum total cholesterol levels associated with immediate memory performance in patients with chronic schizophrenia. Schizophr Res. 2023;255:256–60. Pang K, Liu C, Tong J, Ouyang W, Hu S, Tang Y. Higher Total Cholesterol Concentration May Be Associated with Better Cognitive Performance among Elderly Females. Nutrients. 2022;14:4198. Thorvaldsson V, Skoog I, Johansson B. Cholesterol and cognitive aging: Between-person and within-person associations in a population-based representative sample not on lipid-lowering medication. Psychol Aging. 2020;35:508–16. Huan S, Liu M, Liu Z, Gao J, Yin G. Association Between Dietary and Serum Cholesterol and Cognitive Function Among the U.S. Elderly from NHANES 2011-2014. J Alzheimers Dis. 2023;95:625–40. Zhao Y, Zhang H, Cheng J, Zou Y, Zhang D, Duan X. Association between Dyslipidaemia and Cognitive Impairment: A Meta-Analysis of Cohort and Case-Control Studies. J Integr Neurosci. 2024;23:40. Jia Q-F, Yang H-X, Zhuang N-N, Yin X-Y, Zhu Z-H, Yuan Y, et al. The role of lipoprotein profile in depression and cognitive performance: a network analysis. Sci Rep. 2020;10:20704. Ahmed AO, Richardson J, Buckner A, Romanoff S, Feder M, Oragunye N, et al. Do cognitive deficits predict negative emotionality and aggression in schizophrenia? Psychiatry Res. 2018;259:350–7. Yi Y, Huang Y, Chen Q, Yang H, Li H, Feng Y, et al. Violence, neurocognitive function and clinical correlates in patients with schizophrenia. Front Psychiatry. 2022;13:1087372. Markowitz M, Karve S, Panish J, Candrilli SD, Alphs L. Antipsychotic adherence patterns and health care utilization and costs among patients discharged after a schizophrenia-related hospitalization. BMC Psychiatry. 2013;13:246. 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05:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5877512/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5877512/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101753998,"identity":"dcd5e758-ee9e-41dc-a42b-3cf8b6e8f2a2","added_by":"auto","created_at":"2026-02-03 10:41:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1189792,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5877512/v1/e1f5b5e2-f572-4330-8c39-85f78ea687d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impulsivity in Male Patients with Treatment- Resistant Schizophrenia Is Associated with Lower Total Cholesterol Levels","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSchizophrenia is a disease characterized by multifaceted impairment of cognitive, affective, behavioral, and volitional activities, with a prolonged course and a high rate of disease recurrence, which can lead to varying degrees of impaired social functioning. As one of the ten most disabling disorders in the world, schizophrenia frequently results in severe adverse outcomes and imposes a heavy burden of illness on patients\u0026rsquo; families[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Impulsive and violent behavior is a common symptom of schizophrenia, with a much higher risk of impulsivity observed in this population compared to the general population[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A study published in \u003cem\u003eThe Lancet Psychiatry\u003c/em\u003e found that the incidence of impulsive behaviors over a 5\u0026ndash;10 years period was much higher in schizophrenia than in other psychiatric disorders[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, impulsive and violent behaviors were much more frequent in men with schizophrenia than in women[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], often characterized by recklessness, cruelty, and overt perpetration[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Impulsive and violent behavior in men with schizophrenia has attracted widespread social attention and has created a significant economic burden and safety risks for families and society [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTreatment-Resistant Schizophrenia (TRS) is a special group of patients with schizophrenia, accounting for approximately 20%-50% of patients[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. TRS is defined as the lack of response to a number of antipsychotic agents, which causes the patients to be actively symptomatic and to not gain symptom remission and functional recovery[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Compared to non-refractory schizophrenia (non-TRS), TRS is more severe[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and social functioning is more significantly impaired[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Clozapine is currently recognized worldwide as an effective antipsychotic for TRS[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and clozapine reduces impulsive behaviors in patients with schizophrenia[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], but only about 40%-70% of TRS patients respond effectively to clozapine[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which leads to impulsive behaviors being more difficult to control in TRS patients. The study of impulsive behavior in patients with psychiatric disorders has always been a hot clinical research topic. However, so far the mechanism of impulsive behavior in patients with schizophrenia is still not completely clear, and even fewer studies have been conducted on impulsive behavior in TRS. Some studies have found a correlation between lipid profiles such as low-density lipoprotein, total cholesterol, and Triglyceride and impulsive, violent, and even suicidal behaviors in patients with schizophrenia[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. One main hypothesis of a possible biological mechanism which might explain the association is that low cholesterol levels in the central nervous system (CNS) may contribute to reduced transportation of serotonin through cholesterol-containing cell membranes. This may result in low levels of serotonin in the CNS and insufficient top-down control from the prefrontal cortex to the limbic structures of the brain, resulting in increased risk of affective and impulsive aggression[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, there is a lack of consistency in the findings of studies on correlates of impulsive behaviors in people with mental disorders, with several studies not finding similar positive results or gender differences in positive results[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The inconsistency in the findings of these studies also suggests that there may be a more complex biological link between lipid profiles and impulsive behaviors that still needs to be explored and explained by many clinical studies. Male patients with refractory schizophrenia with concomitant impulsivity have received attention for their poorer outcomes and more difficult impulse control. Still, research evidence on the biological mechanisms of impulsivity in this population remains insufficient.\u003c/p\u003e \u003cp\u003eIn summary, there has been increasing evidence suggesting that the lipid profile has the potential to be a biological marker of impulsive and violent behavior in patients with psychiatric disorders, so the present study aimed to explore the biological relationship between lipid profile levels and impulsive and violent behavior in male refractory schizophrenia patients with concomitant impulsivity, as well as between male refractory schizophrenia patients with and without concomitant impulsivity in terms of lipid profile differences. This study seeks to identify reliable biological markers of impulsive and violent behavior that may assist in the identification, evaluation, and treatment of men with refractory schizophrenia who are at high risk for impulsivity in clinical practice.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eThis was a single-center cross-sectional study. Our study included 180 Male Treatment-Resistant Schizophrenia (Male TRS, n\u0026thinsp;=\u0026thinsp;180) hospitalized in the Fifth People's Hospital of Xiangtan City from September 1, 2022, to August 31, 2023, who met the following inclusion and exclusion criteria.\u003c/p\u003e \u003cp\u003eInclusion criteria for Male TRS: 1. meet the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). 2. male, aged 18\u0026ndash;65 years, without major physical illness. 3. duration of disease\u0026thinsp;\u0026lt;\u0026thinsp;15 years. 4. Meet the criteria for TRS[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Exclusion criteria: 1. Severe physical illness and other organic brain diseases. 2. Comorbid substance abuse. 3. Comorbid mental retardation.\u003c/p\u003e \u003cp\u003eWe referred to several clinical studies on impulsive behavior in patients with schizophrenia and used the definitions of impulsivity from these studies: Scores of \u0026ge;\u0026thinsp;60 on the Positive and Negative Syndrome Scale 5-factor model (PANSS-5F) and \u0026ge;\u0026thinsp;14 on the PANSS- Excited Component (PANSS-EC), with a score of \u0026ge;\u0026thinsp;4 on at least one of the five items[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Male TRS (n\u0026thinsp;=\u0026thinsp;180) was categorized into Male Treatment-Resistant Schizophrenia with Impulsivity (Male TRS with Impulsivity, n\u0026thinsp;=\u0026thinsp;80) and Male Treatment-Resistant Schizophrenia without Impulsivity (Male TRS without Impulsivity, n\u0026thinsp;=\u0026thinsp;100).\u003c/p\u003e \u003cp\u003eThis study also recruited 100 men who underwent a physical examination at the hospital's health center during the same period as Healthy controls (HCs, n\u0026thinsp;=\u0026thinsp;100). General demographic information and blood test parameters of HCs were obtained from the hospital's health screening system. HCs had to meet the following inclusion criteria as well as exclusion criteria. Inclusion criteria: (a) Male, no mental illness, and no family history of mental illness. (b) Be between 18 and 65 years of age. (c) Volunteer to participate in the study and sign an informed consent form. Exclusion criteria: (a) Psychoactive substance abusers. (b) Severe physical illness. (c) Comorbid mental retardation.\u003c/p\u003e \u003cp\u003e This study received approval from the Ethics Committee of the Fifth People\u0026rsquo;s Hospital of Xiangtan City (approval number: 2022003) and was conducted with no conflicts of interest, adhering strictly to the Declaration of Helsinki. Detailed information about the study was provided to all participants, who then voluntarily signed informed consent forms, ensuring their cooperation and the protection of their privacy rights throughout the research process. Clinical trial registration: chictr.org.cn, identifier: ChiCTR2200063407, registration date: 6 September 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Outcome measures\u003c/h2\u003e \u003cp\u003eResearchers collected general demographic information (Age, Education, Marital status, Employed Status, Household Registration, etc.) and general clinical information (Age of Onset, Duration of Illness, Number of Hospitalizations, etc.) from the Male TRS group (n\u0026thinsp;=\u0026thinsp;180) using a self-administered scale. The PANSS 5-factor model (PANSS-5F) was used to assess clinical psychiatric symptoms of patients. Blood samples from patients were collected between 06:00 and 07:00 AM after an overnight fast. Triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were detected. TG was measured by the GPO\u0026ndash;PAP method. TC was measured by the CHOD\u0026ndash;POD method. HDL-C and LDL-C were measured by the terminal method.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Primary outcomes\u003c/h2\u003e \u003cp\u003eAgitation or impulsivity was assessed by the PANSS-EC, TC lab results were obtained from blood samples drawn in the fasting state, and the PANSS-EC score and TC metrics were set as the primary endpoint. The PANSS-EC is a subscale of the PANSS, which has been extensively used to measure agitation or impulsivity in clinical pharmacotherapy trials[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The PANSS-EC consists of five individual PANSS items: hostility, uncooperativeness, impulsivity, tension, and excitability. The severity of each item is rated from 1\u0026thinsp;=\u0026thinsp;nonexistent to 7\u0026thinsp;=\u0026thinsp;extreme. Higher scores on the PANSS-EC indicate greater severity of agitation or impulsivity.TC is a biomarker of hotspots in the relationship between impulsivity and lipid profiles and has been used as a focal point of research in many studies[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], so this study also used TC as a primary observation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Secondary outcomes\u003c/h2\u003e \u003cp\u003ePANSS-5F, PANSS-Negative Component (PANSS-Ne), PANSS-Cognitive Component (PANSS-Co), PANSS-Depressive/ Anxiety Component (PANSS-DA), PANSS- Positive Component (PANSS-Po) scores and other members of the lipid profile family (including TG, HDL, LDL, and hypercholesterolemia prevalence[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] were set as secondary outcomes. The PANSS-5F scores indicate overall psychiatric symptom severity, with higher scores indicating greater severity of the condition. Similarly, the PANSS-Ne, PANSS-Co, PANSS-DA, and PANSS-Po scores indicate the severity of the patient's negative, cognitive impairment, anxiety-depression, and positive symptoms, respectively, with higher scores indicating a more severe condition. In studies of patients with schizophrenia with impulsivity, it has been shown that the PANSS-5F model can better characterize the patient's condition in a multidimensional way [\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], so we applied the PANSS-5F model to assess the psychiatric symptoms of the enrolled patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Statistical Analysis","content":"\u003cp\u003eData were analyzed using IBM SPSS Statistics 25.0 categorical variables were described by rate (%), and continuous variables were described by Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (IQR) depending on whether they conformed to a normal distribution. Chi-square tests, independent samples t-tests, or Mann-Whitney U tests were performed between groups. In the Male TRS group, whether or not the impulses were accompanied was used as the dependent variable, the unaccompanied impulses group was assigned the value of 0 and the accompanied impulses group was assigned the value of 1. The results of these analyses were analyzed using logistic regression analyses for factors associated with impulsivity in the Male TRS group and calculated the odds ratio (OR) and 95% confidence interval (95% CI). Uncorrected models tested only demographic variables totaling 6 items (Age, Education, Marital status, Employed Status, Household Registration, Positive family history of schizophrenia). Model 1 tested demographic variables with clinical variables (Age of Onset, Duration of Illness, Number of Hospitalizations, olanzapine equivalent dose) totaling 10 items. Model 2 tested Model 1\u0026thinsp;+\u0026thinsp;scale-related variables (PANSS-Po, PANSS-Ne, PANSS-Co, PANSS-DA) totaling 14 items and excluded PANSS-5F and PANSS-EC because grouping in the Male TRS was based on the PANSS-EC, which was also directly involved in the composition of the total score of the PANSS-5F. Model 3 tested Model 1\u0026thinsp;+\u0026thinsp;Model 2\u0026thinsp;+\u0026thinsp;lipid-related variables (TG, TC, HDL, LDL) totaling 18 items. All statistical results were considered statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0. 05 (2-tailed).\u003c/p\u003e"},{"header":"4. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Comparison of general information and lipid profile levels in Healthy controls and Male TRS Group\u003c/h2\u003e \u003cp\u003eThe mean age of the Male TRS group (42.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33) years and the mean age of the Healthy control group (43.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43) years were not statistically significant. No statistically significant difference found in Employed Status, Household Registration of Male TRS and HCs groups. The mean years of education of the Male TRS group (9.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85) years was significantly lower than that of the HCs group. The mean years of education in the TRS group (9.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85) was significantly lower than the mean years of education in the HCs group (11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03), and the difference was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Marital status was statistically different between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.005). The married rate was significantly higher in HCs (83%) than in Male TRS (66.7%), and the single rate (5%) and the divorce rate (12%) were lower in HCs group than in Male TRS group (16.7%,16.7%), respectively. The TC level in the Male TRS group (4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85) and prevalence of hypercholesterolemia (67.2%) were higher in the Male TRS group (3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01, 34%) than in the HCs group (3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01, 34%), respectively, and the differences were statistically significant (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No statistical differences were found between TG, LDL, and HDL in the two groups. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of socio-demographic information and clinical characteristics of the healthy control group and Male TRS group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealthy Controls (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMale TRS (n\u0026thinsp;=\u0026thinsp;180)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e / t / Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130(72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Registration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96(53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-local Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84(46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive family history\u003c/p\u003e \u003cp\u003eof schizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of Onset (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Illness(months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.79\u0026thinsp;\u0026plusmn;\u0026thinsp;43.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlanzapine equivalent dose (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-5F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.77\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-EC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Po\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Ne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Co\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-DA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevalence of hypercholesterolaemia(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(67.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;8.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003en: sample size; \u003cem\u003eP\u003c/em\u003e: probability; %:percent; PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA: Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2 Comparison of General Demographic Data and General Clinical Data Between Male TRS with Impulsivity and Male TRS without Impulsivity\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNo significant statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of Age, Education, Marital Status, Employment Status, and Household Registration. Additionally, there were no significant statistical differences between the two groups regarding Age of Onset, Duration of Illness, Number of Hospitalizations, Olanzapine Equivalent Dose, or Positive Family History of Schizophrenia. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of sociodemographic information and clinical characteristics between Male TRS with Impulsivity and Male TRS without Impulsivity.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMale TRS without Impulsivity\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMale TRS with Impulsivity\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e / t / Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.04\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(68.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Registration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-local Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive family history\u003c/p\u003e \u003cp\u003eof schizophrenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of Onset (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Illness (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.65\u0026thinsp;\u0026plusmn;\u0026thinsp;42.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.71\u0026thinsp;\u0026plusmn;\u0026thinsp;44.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlanzapine equivalent dose (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-5F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.12\u0026thinsp;\u0026plusmn;\u0026thinsp;11.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-EC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-26.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Po\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Ne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-Co\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS-DA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003en: sample size; \u003cem\u003eP\u003c/em\u003e: probability; %:percent; PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA, Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Comparison of the PANSS-5F Model Between Male TRS with Impulsivity and Male TRS without Impulsivity\u003c/h2\u003e \u003cp\u003eNo statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of PANSS-Ne, PANSS-Po, PANSS-DA, and PANSS-Co. Compared with Male TRS without Impulsivity, Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores, and the difference was statistically significant (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Comparison of Lipid Profile Levels Between Male TRS with Impulsivity and Male TRS without Impulsivity\u003c/h2\u003e \u003cp\u003eNo statistical differences were found between Male TRS with Impulsivity and Male TRS without Impulsivity in terms of LDL, HDL, and TG. Compared with Male TRS without Impulsivity, Male TRS with Impulsivity had lower TC levels, and the difference was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Correlations Between TC Levels of Male TRS and Factors of the PANSS-5F Model\u003c/h2\u003e \u003cp\u003eAs can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Pearson correlation analysis in the Male TRS group showed a negative correlation between TC levels and PANSS-5F (r=-0.246, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), PANSS-EC (r=-0.326, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and PANSS-Co (r=-0.203, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016). The correlation between TG, HDL, and LDL was not found to be correlated with the factors of the PANSS-5F model, and the results were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson Correlation Coefficients (r) Between the PANSS-5F Model and Lipid Profile in Male TRS.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePANSS-5F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePANSS-Ec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePANSS-Po\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePANSS-Ne\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePANSS-Co\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePANSS-DA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.246**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.326**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.203**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*:\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; **:\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01. PANSS-5F: Positive and Negative Syndrome Scale five-factor; PANSS-EC: Positive and Negative Syndrome Scale-Excited Component; PANSS-Po: Positive and Negative Syndrome Scale-Positive Component; PANSS-Co: Positive and Negative Syndrome Scale-Cognitive Component; PANSS-DA, Positive and Negative Syndrome Scale-Depressive/Anxiety Component; TG: triglyceride; TC: total choles; HDL: high-density lipoprotein; LDL: low-density lipoprotein.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Factors Associated with Impulsivity\u003c/h2\u003e \u003cp\u003eIn a multi-model regression analysis based on binary logistic regression, we did not obtain positive results in the uncorrected model. In the 3 models, we found that the risk of impulsivity was lower with more hospitalizations (model 1: OR\u0026thinsp;=\u0026thinsp;0.68, 95% Cl\u0026thinsp;=\u0026thinsp;0.47\u0026ndash;0.98, P\u0026thinsp;=\u0026thinsp;0.036; model 2: OR\u0026thinsp;=\u0026thinsp;0.58, 95% Cl\u0026thinsp;=\u0026thinsp;0.35\u0026ndash;0.86, P\u0026thinsp;=\u0026thinsp;0.028; model 3: OR\u0026thinsp;=\u0026thinsp;0.77, 95% Cl\u0026thinsp;=\u0026thinsp;0.61\u0026ndash;0.99, P\u0026thinsp;=\u0026thinsp;0.041). In addition, in Model 3, we found that the lower the level of TC, the higher the risk of impulsivity (OR\u0026thinsp;=\u0026thinsp;0.47, 95% Cl\u0026thinsp;=\u0026thinsp;0.23\u0026ndash;0.95, P\u0026thinsp;=\u0026thinsp;0.023). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMulti-model regression analysis of factors associated with impulsivity in the Male TRS OR (95% CI)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncorrected model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMode 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMode 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMode 3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Hospitalizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68(0.47\u0026ndash;0.98)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66(0.45\u0026ndash;0.96)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77(0.61\u0026ndash;0.99)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47(0.23\u0026ndash;0.95)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*:\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; **:\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01. TC: total choles.\u003c/p\u003e \u003cp\u003eThe uncorrected model included 6 variables: Age\u0026thinsp;+\u0026thinsp;Education\u0026thinsp;+\u0026thinsp;Marital status\u0026thinsp;+\u0026thinsp;Employed Status\u0026thinsp;+\u0026thinsp;Household Registration\u0026thinsp;+\u0026thinsp;Positive family history of schizophrenia\u003c/p\u003e \u003cp\u003eModel 1 included 10 variables: uncorrected model\u0026thinsp;+\u0026thinsp;Age of Onset\u0026thinsp;+\u0026thinsp;Duration of Illness\u0026thinsp;+\u0026thinsp;Number of Hospitalizations\u0026thinsp;+\u0026thinsp;olanzapine equivalent dose.\u003c/p\u003e \u003cp\u003eModel 2 included 14 variables: model 1\u0026thinsp;+\u0026thinsp;PANSS-Po\u0026thinsp;+\u0026thinsp;PANSS-Ne\u0026thinsp;+\u0026thinsp;PANSS-Co\u0026thinsp;+\u0026thinsp;PANSS-DA.\u003c/p\u003e \u003cp\u003eModel 3 included Model 2\u0026thinsp;+\u0026thinsp;TG\u0026thinsp;+\u0026thinsp;TC\u0026thinsp;+\u0026thinsp;HDL\u0026thinsp;+\u0026thinsp;LDL.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThe findings of this study validated our suspicions, and the main findings were as follows. First, compared to healthy controls, Male TRS had poorer mean education and marital status, and Male TRS had higher TC levels. Second, compared to Male TRS without Impulsivity, Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores, and lower TC levels. Third, in Male TRS, TC levels were negatively correlated with PANSS-5F, PANSS-EC, and PANSS-Co, respectively. And more hospitalizations were found to be a protective factor for impulsivity and lower TC levels were found to be a risk factor for impulsivity in the multi-model regression analysis of binary logistic regression.\u003c/p\u003e \u003cp\u003eIn our study, Male TRS were found to be less educated than the healthy population and had similarly poorer marital status than the healthy population (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Several review studies have mentioned that the schizophrenia population is generally poorly educated[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], but none of these studies have delved into whether there are differences in educational attainment between subtypes of schizophrenia, such as TRS. The current state of poor educational attainment in Male TRS may be related to a variety of factors. One study found that women with schizophrenia typically have a later age of onset than men and that positive and negative symptoms contribute to decreased learning ability and social regression in both male and female patients[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Early onset of schizophrenia and exposure to psychotic symptoms puts male patients' schooling at risk, coupled with a more severe risk of violence than female patients[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and disease characteristics of poorer efficacy of TRS[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], all of which may contribute to the inability of schools to accept these male patients and thus deprive them of the opportunity to continue their education. So it is not difficult to explain why Male TRS have a lower level of education, especially compared to the healthy population. In addition, a comparison of general demographic information revealed that the marital status of Male TRS was worse compared to healthy controls (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The above potential influences on the differences in educational attainment between the two groups may equally influence their marital status. The higher risk of violence, lower social functioning, and especially poorer clinical outcomes in refractory schizophrenia in men with schizophrenia are all undesirable factors that may have a hindering effect on the choice of spouse in Male TRS. A review study described that the marital status of patients with schizophrenia is often dismal, and even those who form families have difficulty in obtaining family support from the couple relationship which eventually leads to marital breakdown[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. More recently, a study from China found that stigma was a serious problem for people with mental disorders and their family relationships and that they were almost reluctant to disclose information about their illnesses because of stigma[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Stigma about mental illness is indeed prevalent in China[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and excessive stigma may cause people with mental illness to avoid contact with the opposite sex and even lose the opportunity to form a family, which may be an important factor contributing to the poorer marital status of people with Male TRS than the healthy population. In Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e we also found a statistically significant difference in the prevalence of hypercholesterolemia and TC levels between Male TRS and the healthy population, with Male TRS having a much higher prevalence of hypercholesterolemia and TC levels than the healthy population. Regarding these two findings, they are consistent with the conclusions of some studies[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], which have pointed out that long-term use of antipsychotics can cause disorders of glucose-lipid metabolism and even the development of metabolic syndrome, so it is not difficult to explain the fact that Male TRS has a higher prevalence of hypercholesterolemia and TC levels.\u003c/p\u003e \u003cp\u003eCompared with Male TRS without Impulsivity, our study found that Male TRS with Impulsivity had higher PANSS-5F and PANSS-EC scores (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We used the PANSS-EC definition of impulsivity to group the included Male TRS, so Male TRS with Impulsivity had higher PANSS-EC scores as a result of the grouping requirement. A cross-sectional study by the team of Yi et al. exploring the clinical characteristics of schizophrenics with violence in China[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] found that patients in the violent group had higher total PANSS scores than those in the nonviolent group, which is consistent with our findings and implies that the population of patients with impulsivity or violence has more severe psychiatric symptoms. Yi's study also used the PANSS-5F model to assess patients' psychiatric symptoms and also found that the violent group had higher PANSS-EC scores and PANSS-Po scores, but did not find Male TRS with Impulsivity to have higher PANSS-Po scores in our study. In contrast to our study, Yi's study used a self-administered questionnaire to define violent behavior, which lacked quantifiable indicators, and the definition of \u0026ldquo;violence\u0026rdquo; was not comprehensive enough, ignoring verbal violence and violence against oneself, such as self-inflicted suicide. It is possible that the difference between Yi's team's definition of \u0026ldquo;violence\u0026rdquo; and the definition of \u0026ldquo;impulsivity\u0026rdquo; in our study influenced the grouping results and led to partially different positive results in the PANSS-5F model.\u003c/p\u003e \u003cp\u003eThe relationship between lipid profile levels and impulsivity has been a hot topic, and many studies have been based on the classic cholesterol-serotonin attack hypothesis proposed by Kaplan et al. that low levels of TC lead to attack by altering the serotonergic system[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In Table\u0026nbsp;(2), it can be found that the TC level of Male TRS with Impulsivity is significantly lower than that of Male TRS without Impulsivity, and a negative correlation between TC level and PANSS-EC scores was found in Male TRS (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), a finding that suggests that there is an underlying biological link, with lower TC levels potentially implying higher impulsivity. A cross-sectional study by Kavoor[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] et al. found a negative correlation between TC levels and severity of impulsivity, a finding that is consistent with the findings of our study, in addition, they found a similarly negative correlation between TC levels and propensity for suicidal impulsivity. Unlike our study, Kavoor's team included drug-na\u0026iuml;ve/drug-free patients of schizophrenia, whereas our study was conducted on TRS patients on long-term antipsychotic medications or even multi-drug combinations, and similar findings were obtained in different study populations, suggesting that the relationship between impulsivity and TC levels may persist and persist throughout a schizophrenic patient's illness, perhaps having little to do with whether or not they have been treated with antipsychotic medication. Studies by Roaldset [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and Hillbrand[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] likewise came to similar conclusions, verifying the relationship between TC and impulsivity. In addition, a relationship between low TC and high risk of impulsivity has also been found in violent offenders without mental disorders [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and this research evidence suggests that the relationship between lipid profiles and impulsivity is not limited to mentally challenged populations, but also exists in impulsive healthy populations, particularly violent offenders. This may help to identify potentially high-risk violent populations at an early stage and reduce the incidence of violent crime. There are also prospective studies confirming the negative correlation between TC levels and impulsive behavior in patients with mental disorders[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Lower TC implying a high risk of suicidal impulsivity has been found not only in the field of schizophrenia research but also in studies related to suicidal impulsivity in patients with major depression[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Suicidal ideation and violent suicidal behavior were found to correlate with TC and leptin levels in a study on suicide attempts in patients with mental disorders[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. It has been shown that there is an interaction between the leptinergic and serotonergic systems in the CNS[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and leptin has been observed to stimulate serotonin turnover[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. In turn, levels of TC in the central nervous system can influence the metabolism of the serotonergic system to induce impulsive and aggressive behaviors[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], so there appears to be an even more complex biological connection between TC, leptin, and serotonin, but research on the relationship between the three is lacking. Perhaps it is because of this complex interplay of influences that some studies have come to inconsistent conclusions. A study by Eriksen et al. found no significant association between TC levels and impulsivity, but there was a significant negative correlation between HDL levels and the severity of impulsivity during hospitalization and even follow-up, and this relationship was only found in male patients with acute-phase psychiatric disorders[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Unlike the results of Eriksen et al.'s study, we did not find a correlational relationship between impulsivity and HDL, although our study included the same all-male patients and the difference in sample size could be a potential factor for the inconsistent results. In addition, Eriksen's study included almost all acute-onset psychiatric disorders, including schizophrenia, bipolar disorder, depressive disorders, and even personality disorders, and the difference in sample size may have also contributed to the variability in results. Not to be overlooked, some studies report no association between TC and impulsivity [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;(3), it can be seen that there is a negative correlation between TC levels and PANSS-Co scores in Male TRS, which implies that patients with lower TC levels may have more severely impaired cognitive function. Similar conclusions were reached in a clinical study from China on cognitive functioning in patients with chronic schizophrenia, which found that elevated serum TC levels may be associated with improved cognitive functioning, especially that of immediate memory[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Pang's study[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] found that higher TC levels in older adults\u0026thinsp;\u0026gt;\u0026thinsp;60 years of age were protective of cognitive function in older women, an association that was not found in older men. Pang's findings also suggest that there may be age and gender differences in the relationship between TC levels and cognitive function. Thorvaldsson's study[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] similarly found an association between lower TC levels were associated with poorer cognitive function, and those with a significant trend of declining TC levels over time had a similarly prominent rate of cognitive decline and were more likely to develop dementia. In addition, Huan's study[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] found that elevated serum TC may be a potential factor in preventing or mitigating cognitive dysfunction within the normal range of serum TC in a population of healthy older adults, but there were racial differences in this association. The findings of the above studies support our findings, but there is a lack of consistency in the findings of current clinical studies on the relationship between TC and cognitive function. For example, both research teams of Zhao[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e] and Jia[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] found higher TC levels to be a risk factor for cognitive impairment. In addition to this, several clinical studies have explored the relationship between cognitive deficits and impulsive behavior in patients with psychiatric disorders. Ahmed et al. found that schizophrenic patients with violent offenses showed more severe impairments in most of the cognitive domains, and Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. A study from China found[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] that patients with violent behavior had lower RBANS language, semantic fluency, and total subscale scores. These studies verified that psychotic patients with impulsive behavior have worse cognitive functioning, and laterally support the negative correlation between serum TC and impulsivity. Perhaps cognitive impairment plays a mediating role between serum TC and impulsivity, but this still needs to be verified by clinical studies, and our next study will also focus on this. Furthermore, in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, a negative correlation was found between PANSS-5F scores and serum TC, implying that Male TRS with lower levels of serum TC had more severe psychiatric symptoms. On this point, the study found that it is not difficult to explain that more severe cognitive impairment and impulsivity are a reflection of the severity of psychiatric symptoms. In addition, the relationship between the positive results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e can be synthesized and analyzed to conclude that PANSS-EC and PANSS-Co may be the main reason for the negative correlation between PANSS-5F total score and TC.\u003c/p\u003e \u003cp\u003eA multi-model regression analysis of Male TRS found that a higher number of hospitalizations implied a lower risk of impulsivity in all three models (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This finding may be related to the unbalanced allocation of healthcare resources and inadequate community psychiatric rehabilitation systems in developing countries. The lack of timely access to quality community-based psychiatric rehabilitation services for discharged patients with mental disorders, coupled with the fact that the condition of TRS patients is more difficult to control, contributes to the high rate of relapse and recurrent hospitalization of patients with schizophrenia. One study found an extremely high risk of re-hospitalization in the first 60 days after discharge [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Therefore, timely hospitalization during acute episodes of psychiatric symptoms may be the most effective way for patients with mental disorders in developing countries to receive specialized psychiatric care. More hospitalizations mean more healthcare resources are available, and systematic antipsychotic treatment will inevitably reduce the severity of psychiatric symptoms, especially impulsivity, which is more easily observed clinically. However, repeated hospitalization imposes a heavy economic burden on society and also takes up a large amount of medical resources[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], so it is particularly important to establish a comprehensive community-based psychiatric rehabilitation system[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. In addition, lower TC levels can be found as a risk factor for impulsivity in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, implying that the risk of impulsivity is more severe in Male TRS with low TC levels. Regarding this point of conclusion, the correlation relationship between lipid profile and impulsivity has been validated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In addition, the inclusion of 18 variables in Model 3 for binary logistic regression analysis yielded positive results that shed even more light on the biological link between serum TC levels and patient impulsivity.\u003c/p\u003e \u003cp\u003eReturning to our findings and combining them with the previously listed studies that are consistent with our findings, we can prove the negative correlation between TC and impulsivity in Male TRS. However, we cannot ignore the studies that are inconsistent with our conclusions and have to pay more attention to them, because these inconsistent conclusions also reflect a more complex relationship between lipid profile and impulsivity from the side. This relationship may not be fully explained by the simple cholesterol-serotonin attack hypothesis, and this relationship may involve more complex metabolic and transport mechanisms, as well as more biological substances, such as leptin. In addition, we found that some of the existing studies on the correlation between lipid profiles and impulsivity included mixed samples, and the sample populations often included multiple psychiatric disorders, which suggests that less stringent sample inclusion and exclusion criteria may also have had an impact on the reliability and consistency of the findings. Therefore, more scientific, rigorous, and comprehensive studies are still needed to further substantiate the follow-up.\u003c/p\u003e \u003cp\u003eIn this study, there are several limitations: 1) Sample Size and Generalizability: The study's small sample size and single-center design limit the generalizability of the findings. 2) Gender Considerations: The trial exclusively included male patients with schizophrenia, overlooking potential gender differences in impulsive behavior. 3) Assessment Tools: Reliance on a single psychiatric assessment scale may not fully capture the complexity of the clinical symptoms. These limitations suggest the need for further research with larger, multi-center trials that include both male and female patients and utilize a broader range of neurophysiological markers and psychiatric assessment tools.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eIn summary, our study found a negative correlation between TC levels and impulsivity in male patients with Treatment-Resistant Schizophrenia (TRS). Male TRS patients exhibiting impulsivity were found to have less favorable educational and marital status, along with more severe cognitive impairments, compared to those without impulsivity. In addition, TC levels and the prevalence of hypercholesterolemia were significantly higher in Male TRS than in healthy controls. Our study demonstrated an association between lipid profile and impulsivity, and both existing findings and our findings support the potential of TC as a biological marker associated with impulsivity in male patients with Treatment-Resistant Schizophrenia with concomitant impulsivity. Our findings facilitate the early clinical identification of impulsivity risk in men with impulsive refractory schizophrenia and guide early prevention and intervention of impulsive or violent behaviors, or even reduction of violent crime in this group of patients. The study also provides direction and theoretical basis for further exploration of the mechanism of impulsivity in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all of the participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZhenkuo Li\u003c/strong\u003e：Writing – original draft, Writing – review \u0026amp; editing, Visualization, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization.\u003cstrong\u003e\u0026nbsp;Cheng Yang\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing, Project administration, Formal analysis, Data curation.\u003cstrong\u003e\u0026nbsp;Peng Xie\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eConceptualization, Formal analysis, Software, Writing – original draft, Writing – review \u0026amp; editing.\u003cstrong\u003e\u0026nbsp;Zhuoning Liu\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing, Methodology, Data curation.\u003cstrong\u003e\u0026nbsp;Hongli Song\u003c/strong\u003e:\u0026nbsp;Writing – review \u0026amp; editing, Methodology, Formal analysis.\u003cstrong\u003e\u0026nbsp;Wei Yi:\u003c/strong\u003eWriting – review \u0026amp; editing, Methodology, Data curation.\u003cstrong\u003e\u0026nbsp;Bo Sun\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing.\u003cstrong\u003e\u0026nbsp;Gan Wang\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing, Methodology, Data curation.\u003cstrong\u003e\u0026nbsp;Ling Ma\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eData curation.\u003cstrong\u003e\u0026nbsp;Xi Chen\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eData curation.\u003cstrong\u003e\u0026nbsp;Yinghan Tian\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing, Methodology, Formal analysis. \u003cstrong\u003eLei Xia\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWriting – review \u0026amp; editing, Writing – original draft, Methodology, Data curation, Conceptualization.\u003cstrong\u003e\u0026nbsp;Huanzhong Liu\u003c/strong\u003e:\u0026nbsp;Writing – review \u0026amp; editing, Supervision, Project administration, Methodology, Data curation, Conceptualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Scientific Research Fund of the Xiangtan City Medical Association in Hunan Province, China (2022-xtyx-59).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that all relevant data from this study are available within the article or from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Ethics Committee of the Fifth People’s Hospital of Xiangtan City (approval number: 2022003) and was conducted with no conflicts of interest, adhering strictly to the Declaration of Helsinki. Detailed information about the study was provided to all participants, who then voluntarily signed informed consent forms, ensuring their cooperation and the protection of their privacy rights throughout the research process.\u0026nbsp;Clinical trial registration:\u0026nbsp;chictr.org.cn, identifier: ChiCTR2200063407, registration date: 6 September 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conficts of interest and agree to publish.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003eDepartment of Psychiatry, The Fifth People’s Hospital of Xiangtan City, Xiangtan 411100, China.\u003cstrong\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eDepartment of Psychiatry, The Fourth People's Hospital of Wuhu ,Wuhu 241000,Anhui,China.\u003cstrong\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003eSchool of Accounting, Tianjin University of Commerce, Tianjin300000 ,China.\u003cstrong\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China.\u003cstrong\u003e\u003csup\u003e5\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003eDepartment of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei230022, Anhui, China.\u003cstrong\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003eDepartment of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, Anhui, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMarder SR, Cannon TD. 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Int J Ment Health Syst. 2024;18:6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Male, Treatment-Resistant Schizophrenia, Impulsivity, Biological Markers, Lipid Profile, Total Cholesterol, PANSS-EC","lastPublishedDoi":"10.21203/rs.3.rs-5877512/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5877512/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTreatment-Resistant Schizophrenia (TRS) in males with impulsive and violent behavior poses a clinical challenge. The pathophysiological mechanisms of impulsivity in Male TRS remain unclear. This study explores these mechanisms and investigates potential biomarkers for impulsivity.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e180 Male TRS patients and 100 healthy controls were enrolled. Psychiatric symptoms and impulsivity were assessed using the Positive and Negative Syndrome Scale 5-factor model (PANSS-5F) and the PANSS-Excited Component (PANSS-EC). Patients were divided into Male TRS with impulsivity (n\u0026thinsp;=\u0026thinsp;80) and without impulsivity (n\u0026thinsp;=\u0026thinsp;100). Demographic data and lipid profiles (triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein) were collected for both groups. Statistical analyses assessed the relationship between lipid profiles and impulsivity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA negative correlation was found between total cholesterol (TC) levels and impulsivity in Male TRS. Those with impulsivity had worse educational and marital status and more severe cognitive impairment. TC levels and hypercholesterolemia were higher in Male TRS compared to healthy controls.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLower TC levels in Male TRS with impulsivity are associated with higher impulsivity risk. TC may be a potential biomarker for impulsivity in this population.\u003c/p\u003e","manuscriptTitle":"Impulsivity in Male Patients with Treatment- Resistant Schizophrenia Is Associated with Lower Total Cholesterol Levels","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 10:59:56","doi":"10.21203/rs.3.rs-5877512/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6eec2672-88da-49d6-abc5-d45ee2f72fb4","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T04:25:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-29 10:59:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5877512","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5877512","identity":"rs-5877512","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}