Fluoxetine increases relative metabolic rate in prefrontal cortex in impulsive aggression.
BACKGROUND
Impulsive aggressive personality disordered patients have been shown to have decreased relative glucose metabolism in orbito-frontal cortex and anterior cingulate gyrus compared with normal subjects. In addition, patients with impulsive aggression have an attenuation of symptoms with selective serotonin reuptake inhibitor (SSRI) treatment.


OBJECTIVE
The goals of the present study were to attempt to replicate the finding of improvement in impulsive aggression in borderline personality disorder with SSRIs and to investigate the specific cortical areas modified by medication, which might underlie the observed clinical improvement using (18)FDG-PET.


METHODS
Ten impulsive aggressive patients with borderline personality disorder were imaged with (18)F-deoxyglucose positron emission tomography at baseline and after receiving fluoxetine at 20 mg/day for 12 weeks. Anatomical MRIs were coregistered to PET and relative metabolic rates were obtained in 39 Brodmann areas.


RESULTS
Brodmann areas 11 and 12 in the orbito-frontal cortex showed significant increases in relative metabolic rate. Significant clinical improvement was also observed as assessed by the Overt Aggression Scale-Modified.


CONCLUSIONS
These changes are consistent with a normalizing effect of fluoxetine on prefrontal cortex metabolism in impulsive aggressive disorder.
New
Antonia S
AS
Psychiatry Service-Mount Sinai School of Medicine and the Bronx VA Medical Center, 130 West Kingsbridge Road, PO Box 1168, Bronx, NY 10468, USA. antonia.new@mssm.edu
Buchsbaum
Monte S
MS
Hazlett
Erin A
EA
Goodman
Marianne
M
Koenigsberg
Harold W
HW
Lo
Jenni
J
Iskander
Lisa
L
Newmark
Randall
R
Brand
Jesse
J
O'Flynn
Karen
K
Siever
Larry J
LJ
D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000502:physiology* / Q000523:psychology; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D019788:Fluorodeoxyglucose F18; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007175:Impulsive Behavior / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*; D011569:Psychiatric Status Rating Scales; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D018687:Antidepressive Agents, Second-Generation; D019275:Radiopharmaceuticals; D005473:Fluoxetine; D019788:Fluorodeoxyglucose F18