d,l-fenfluramine response in impulsive personality disorder assessed with [18F]fluorodeoxyglucose positron emission tomography.
Reduced serotonergic activity has been associated with impulsive aggression in personality disordered patients in metabolite and pharmacologic challenge studies. This study used positron emission tomography to explore whether reduced serotonergic function occurs in critical brain regions such as orbital frontal and cingulate cortex that, may play a role in modulating aggression. Six impulsive-aggressive patients and five healthy volunteers were evaluated for changes in regional glucose metabolism after administration of the serotonergic releasing agent d,l-fenfluramine (60 mg, p.o.) or placebo. Volunteers demonstrated increases in orbital frontal and adjacent ventral medial frontal cortex, cingulate, and inferior parietal cortex, whereas impulsive-aggressive patients showed no significant increases in glucose metabolism after fenfluramine in any region. Compared with volunteers, patients showed significantly blunted metabolic responses in orbital frontal, adjacent ventral medial and cingulate cortex, but not in inferior parietal lobe. These results are consistent with reduced serotonergic modulation of orbital frontal, ventral medial frontal, and cingulate cortex in patients with impulsive-aggressive personality disorders.
Siever
L J
LJ
Neuroscience PET Laboratory, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
Buchsbaum
M S
MS
New
A S
AS
Spiegel-Cohen
J
J
Wei
T
T
Hazlett
E A
EA
Sevin
E
E
Nunn
M
M
Mitropoulou
V
V
D000328:Adult; D000374:Aggression / Q000187:drug effects; D001923:Brain Chemistry / Q000187:drug effects*; D001931:Brain Mapping; D005260:Female; D005277:Fenfluramine / Q000627:therapeutic use*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D010554:Personality Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D019275:Radiopharmaceuticals; D012701:Serotonin / Q000378:metabolism*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014055:Tomography, Emission-Computed
D005277:Fenfluramine; D019788:Fluorodeoxyglucose F18; D019275:Radiopharmaceuticals; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors