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Correlates With Suicidal and Impulsive Aggressive Behavior

Emil F. Coccaro, MD; Larry J. Siever, MD; Howard M. Klar, MD; Gail Maurer, PhD; Karen Cochrane, MEd; Thomas B. Cooper, MA; Richard C. Mohs, PhD; Kenneth L. Davis, MD

Arch Gen Psychiatry. 1989;46(7):587-599.

Abstract
• Dysfunction of the central serotonergic system has been variously associated with depression and with suicidal and/or impulsive aggressive behavior. To evaluate central serotonergic function in relation to these variables, prolactin responses to a singledose challenge with fenfluramine hydrochloride (60 mg orally), a serotonin releasing/uptake-inhibiting agent, were examined in 45 male patients with clearly defined major affective (n = 25) and/or personality disorder (n 20) and in 18 normal male control patients. Prolactin responses to fenfluramine among all patients were reduced compared with responses of controls. Reduced prolactin responses to fenfluramine were correlated with history of suicide attempt in all patients but with clinician and selfreported ratings of impulsive aggression in patients with personality disorder only; there was no correlation with depression. These results suggest that reduced central serotonergic function is present in a subgroup of patients with major affective and/or personality disorder and is associated with history of suicide attempt in patients with either disorder, but with impulsive aggression in patients with personality disorder only.

Author Affiliations
From the Psychiatry Service, Bronx Veterans Administration Medical Center, Bronx, NY (Drs Coccaro, Siever, Maurer, Mohs, and Davis, and Ms Cochrane); the Department of Psychiatry, Mount Sinai School of Medicine, New York, NY (Drs Coccaro, Siever, Klar, and Mohs); the Analytic Psychopharmacology Laboratory, Nathan Kline Institute, Orangeburg, NY (Mr Cooper); the New York State Psychiatric Institute, New York (Mr Cooper); and the Departments of Psychiatry and Pharmacology, Mount Sinai School of Medicine, New York, NY (Dr Davis).

Footnotes
Accepted for publication March 9, 1989.

Reprint requests to Department of Psychiatry, Eastern Pennsylvania Psychiatric Institute, Medical College of Pennsylvania, 3200 Henry Ave, Philadelphia, PA 19129 (Dr Coccaro).

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