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

Arch Gen Psychiatry. 1994;51(1):28-33.

Abstract
Background
Based on clinical observations in a series of studies on Finnish alcoholic, violent offenders, we asserted that the impulsive offenders represented an extreme group of type 2 alcoholics. We also observed that these subjects were vulnerable to hypoglycemia after the administration of oral glucose load. Furthermore, we believe that while being hypoglycemic, the impulsive offenders are particularly irritable and aggressive. In the present study, we addressed these issues by studying psychological trait and state variables in a new group of violent offenders and fire setters, and age- and sex-matched healthy volunteers.

Methods
Fifty-eight alcoholic, violent offenders and impulsive fire setters and 21 healthy volunteers were administered the Karolinska scales of personality and the Rosenzweig picture frustration test after an oral aspartame and glucose challenge.

Results
The psychological test results and the criminal histories of the offenders, together with biochemical measurements, suggest that a low 5-hydroxyindoleacetic acid concentration in cerebrospinal fluid in the alcoholic offenders is associated with irritability and impaired impulse control, and a high free testosterone concentration in cerebrospinal fluid is associated with increased aggressiveness, monotony avoidance, sensation seeking, suspiciousness, and reduced socialization.

Conclusion
Finnish alcoholic, impulsive offenders have personality profiles characteristic of Scandinavian earlyonset male alcoholics with antisocial traits, who have been also referred to as type 2 alcoholics.

Author Affiliations
From the Departments of Psychiatry (Drs Virkkunen, Kallio, and Tokola) and Clinical Chemistry (Dr Karonen), University of Helsinki (Finland); Laboratory of Clinical Studies, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md (Mr Rawlings and Dr Linnoila); Division of Biological Psychiatry, Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, Calif (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, National Institute of Mental Health, Bethesda (Dr Kalogeras).

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