title: Fluoxetine increases relative metabolic rate in prefrontal cortex in impulsive aggression.
abstract: 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.
authors.affiliation: 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
authors.forename: Antonia S
authors.initials: AS
authors.lastname: New
authors.forename: Monte S
authors.initials: MS
authors.lastname: Buchsbaum
authors.forename: Erin A
authors.initials: EA
authors.lastname: Hazlett
authors.forename: Marianne
authors.initials: M
authors.lastname: Goodman
authors.forename: Harold W
authors.initials: HW
authors.lastname: Koenigsberg
authors.forename: Jenni
authors.initials: J
authors.lastname: Lo
authors.forename: Lisa
authors.initials: L
authors.lastname: Iskander
authors.forename: Randall
authors.initials: R
authors.lastname: Newmark
authors.forename: Jesse
authors.initials: J
authors.lastname: Brand
authors.forename: Karen
authors.initials: K
authors.lastname: O'Flynn
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Siever
mesh_terms: 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
chemical_list: D018687:Antidepressive Agents, Second-Generation; D019275:Radiopharmaceuticals; D005473:Fluoxetine; D019788:Fluorodeoxyglucose F18