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Matti Virkkunen, MD; Robert Rawlings, MS; Riitta Tokola, MD; Russell E. Poland, PhD; Alessandro Guidotti, MD; Charles Nemeroff, MD, PhD; Garth Bissette, PhD; Konstantine Kalogeras, MD; Sirkka-Liisa Karonen, PhD; Markku Linnoila, MD, PhD

Arch Gen Psychiatry. 1994;51(1):20-27.

Abstract
Background
There is an extensive literature describing a central serotonin deficit in alcoholic, impulsive, violent offenders and fire setters. In the present study, we investigated biochemical concomitants of impulsivity and aggressiveness, and the physiological consequences of reduced central serotonin turnover.

Methods
Forty-three impulsive and 15 nonimpulsive alcoholic offenders and 21 healthy volunteers were studied in the forensic psychiatry ward of a university psychiatric department. The subjects underwent lumbar punctures and oral glucose and aspartame challenges, and their diurnal activity rhythm was measured with physical activity monitors. Discriminant function analyses were used to investigate psychophysiological and biochemical concomitants of aggressive and impulsive behaviors.

Results
Alcoholic, impulsive offenders with antisocial personality disorder had low mean cerebrospinal fluid (CSF) 5-hydroxyindoleaceticacid (5-HIAA) and corticotropin levels and high mean CSF testosterone concentrations. Compared with healthy volunteers, they showed increased physical activity during the daytime. Alcoholic, impulsive offenders with intermittent explosive disorder had a low mean CSF 5-HIAA concentration and blood glucose nadir after an oral glucose challenge, and desychronized diuranalactivityrhythm. Healthy volunteers had mean CSF 5-HIAA concentrations that were intermediate between those of alcoholic, impulsive and nonimpulsive offenders. Alcoholic, nonimpulsive offenders had a significantly higher mean CSF 5-HIAA concentration than all the other groups, including healthy volunteers. In the present sample, a low CSF 5-HIAA concentration was primarily associated with impulsivity and high CSF testosterone concentration, with aggressiveness or interpersonal violence.

Conclusions
In the present sample, a low CSF 5-HIAA concentration was primarily associated with impulsivity and high CSF testosterone concentration, with aggressiveness or interpersonal violence.

Author Affiliations
From the Departments of Psychiatry (Drs Virkkunen and Tokola) and Clinical Chemistry (Dr Karonen), University of Helsinki (Finland); Laboratory of Clinical Studies, Division of Intramural Clinical and Biological Research, NIAAA, Bethesda, Md (Mr Rawlings and Dr Linnoila); Division of Biological Psychiatry, Harbor-UCLA Medical Center, Torrance (Dr Poland); Fidia-Georgetown Neuroscience Institute, Washington, DC (Dr Guidotti); Department of Psychiatry, Emory University, Atlanta, Ga (Dr Nemeroff); Department of Psychiatry, Duke University Medical Center, Durham, NC (Dr Bissette); and Clinical Neuroendocrinology Branch, Intramural Research Program, NIMH, Bethesda (Dr Kalogeras).

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