d,l-fenfluramine Response in Impulsive Personality Disorder Assessed with [18F]fluorodeoxyglucose Positron Emission Tomography

• Published in: Neuropsychopharmacology (New York, N.Y.) Vol. 20; no. 5; pp. 413 - 423
• Main Authors: Siever, Larry J, Buchsbaum, Monte S, New, Antonia S, Spiegel-Cohen, Jacqueline, Wei, Tsechung, Hazlett, Erin A, Sevin, Elizabeth, Nunn, Melissa, Mitropoulou, Vivian
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1999; Nature Publishing
• Subjects: Adult; Adult and adolescent clinical studies; Aggression; Aggression - drug effects; Biological and medical sciences; Brain Chemistry - drug effects; Brain Mapping; Female; Fenfluramine - therapeutic use; Fluorodeoxyglucose F18; Glucose metabolic rate; Humans; Image Processing, Computer-Assisted; Magnetic resonance imaging; Male; Medical sciences; Orbital cortex; Personality disorders; Personality Disorders - diagnostic imaging; Personality Disorders - drug therapy; Personality Disorders - psychology; Prolactin; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Radiopharmaceuticals; Serotonin; Serotonin - metabolism; Serotonin Uptake Inhibitors - therapeutic use; Tomography, Emission-Computed; Orbital cortex; Serotonin; Magnetic resonance imaging; Aggression; Prolactin; Glucose metabolic rate; Radionuclide study; Human; Impulsivity; Pathophysiology; Central nervous system; Glucose; Metabolism; Personality disorder; Tomography; Aggressiveness; Brain (vertebrata); Positron; Emission tomography
• ISSN: 0893-133X; 1740-634X
• DOI: 10.1016/S0893-133X(98)00111-0

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.