title: Energy substrate metabolism among habitually violent alcoholic offenders having antisocial personality disorder.
abstract: A large proportion of violent offences in Western countries are attributable to antisocial personality disorder (APD). Several studies have shown abnormal lipid, carbohydrate and low cerebrospinal fluid (CSF) monoamine metabolite levels in habitually violent alcoholic offenders with APD, but it is not clear how these biochemical abnormalities are related to each other in this disorder. We aimed to study energy substrate metabolism among habitually violent offenders with APD. Insulin sensitivity (euglycemic insulin clamp), basal energy expenditure (indirect calorimetry), and CSF 5-hydroxyindoleacetic acid (5-HIAA) measurements were performed on 96 habitually violent antisocial male alcoholic offenders and on 40 normal male controls. Habitually violent, incarcerated offenders with APD had significantly lower non-oxidative glucose metabolism, basal glucagon, and free fatty acids when compared with normal controls, but glucose oxidation and CSF 5-HIAA did not differ markedly between these groups. The effect sizes for lower non-oxidative glucose metabolism among incarcerated and non-incarcerated APD subjects were 0.73 and 0.51, respectively, when compared with controls, indicating that this finding was not explained by incarceration. Habitually violent offenders with APD have markedly lower glucagon and non-oxidative glucose metabolism when compared with healthy controls, and these findings were more strongly associated with habitual violent offending than low CSF 5-HIAA levels, a well-established marker for impulsive violent behavior. Follow-up studies are needed to confirm if abnormal glucose and lipid metabolism can be used to predict violent offending over the course of the APD offender's life span.
authors.affiliation: Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Virkkunen
authors.forename: Aila
authors.initials: A
authors.lastname: Rissanen
authors.forename: Hannu
authors.initials: H
authors.lastname: Naukkarinen
authors.forename: Anja
authors.initials: A
authors.lastname: Franssila-Kallunki
authors.forename: Markku
authors.initials: M
authors.lastname: Linnoila
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000378:metabolism*; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D002151:Calorimetry; D002241:Carbohydrates / Q000097:blood; D002784:Cholesterol / Q000378:metabolism; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005949:Glucose Oxidase / Q000097:blood; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D007328:Insulin; D015227:Lipid Peroxidation; D008297:Male; D008995:Monoamine Oxidase / Q000134:cerebrospinal fluid; D011584:Psychology; D012008:Recurrence; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D002241:Carbohydrates; D007328:Insulin; D006897:Hydroxyindoleacetic Acid; D002784:Cholesterol; D005949:Glucose Oxidase; D008995:Monoamine Oxidase