Cerebrospinal fluid glutamate concentration correlates with impulsive aggression in human subjects.

Neurochemical studies have pointed to a modulatory role in human aggression for various central neurotransmitters. Some (e.g., serotonin) appear to play an inhibitory role, while others appear to play a facilitator role. While recent animal studies of glutaminergic activity suggest a facilitator role for central glutamate in the modulation of aggression, no human studies of central glutaminergic indices have yet been reported regarding aggression. Basal lumbar cerebrospinal fluid (CSF) was obtained from 38 physically healthy subjects with DSM-IV Personality Disorder (PD: n = 28) and from Healthy Volunteers (HV: n = 10) and assayed for glutamate, and other neurotransmitters, in CSF and correlated with measures of aggression and impulsivity. CSF Glutamate levels did not differ between the PD and HC subjects but did directly correlate with composite measures of both aggression and impulsivity and a composite measure of impulsive aggression in both groups. These data suggest a positive relationship between CSF Glutamate levels and measures of impulsive aggression in human subjects. Thus, glutamate function may contribute to the complex central neuromodulation of impulsive aggression in human subjects.

Cerebrospinal fluid neuropeptide Y-like immunoreactivity correlates with impulsive aggression in human subjects.

BACKGROUND: Neurochemical studies have pointed to a modulatory role in human aggression for a number of central neurotransmitters; some (e.g., serotonin) appear to play an inhibitory role, while others (e.g., vasopressin) appear to play a facilitator role in the modulation of aggression. While recent animal studies of neuropeptide Y (NPY) have suggested a facilitator role for central NPY in the modulation of aggression, no human studies of central NPY have yet been reported regarding aggression. METHODS: Basal lumbar cerebrospinal fluid (CSF) was obtained from 60 physically healthy subjects with personality disorder (PD) (n=40) and from healthy volunteers (n=20). These samples were then assessed for CSF NPY-like immunoreactivity (NPY-LI) and other neurotransmitter-related species in CSF and correlated with measures of aggression and impulsivity. RESULTS: Cerebrospinal fluid NPY-LI was higher in PD subjects compared with healthy volunteers and in subjects with intermittent explosive disorder compared with those without intermittent explosive disorder. In PD subjects, CSF NPY-LI was directly correlated with composite measures of aggression and impulsivity and a composite measure of impulsive aggression. Group differences in CSF NPY-LI concentration were accounted for by measures of impulsive aggression. CONCLUSIONS: These data suggest a direct relationship between CSF NPY-immunoreactivity concentration and measures of impulsive aggression in human subjects. This adds to the complex picture of the central neuromodulatory role of impulsive aggression in human subjects.

Cerebrospinal fluid 5-hydroxyindolacetic acid and homovanillic acid: reciprocal relationships with impulsive aggression in human subjects.

While the relationship between cerebrospinal fluid 5-HIAA (CSF 5-HIAA) and aggression is typically reported as inverse, studies of some groups of aggressive individuals demonstrate a positive (or no) relationship, between these two variables. It is possible that simultaneous examination of both CSF 5-HIAA and CSF homovanillic acid (HVA), which co-vary in human subjects may clarify differences in reported findings in different groups of aggressive individuals. CSF 5-HIAA and CSF HVA concentrations were simultaneously examined in 60 healthy human subjects (40 with personality disorder and 20 healthy controls) and were correlated with measures of aggression and impulsivity. CSF 5-HIAA concentrations correlated positively, and CSF HVA concentrations correlated inversely, with a composite measure of impulsive aggression in all subjects as well as in the personality disordered subjects. The CSF 5-HIAA findings are consistent with those demonstrating reduced post-synaptic 5-HT receptor responsiveness to 5-HT agent challenge and suggest differences in the pathophysiology between different groups of subjects with aggressive behavior, particularly with regard to severity of aggressive behavior.

Cerebrospinal fluid oxytocin, life history of aggression, and personality disorder.

BACKGROUND: Data from animal studies have identified oxytocin as an important modulator of social aggression. We have previously reported on a relationship between cerebrospinal fluid (CSF) levels of vasopressin and life history of aggressive behavior, a finding that is consistent with animal data. We hypothesized that CSF Oxytocin levels would be inversely related to dimensional measures of lifetime aggression. METHODS: Lumbar CSF for morning basal levels of oxytocin was obtained from 58 consenting subjects with and without DSM-IV personality disorders. Aggression was assessed dimensionally using an interview instrument (Life History of Aggression (LHA)). The primary analysis was conducted using a linear regression model predicting variance in CSF Oxytocin concentration, including the predictors of LHA score, Sex, Height, and the presence or absence of personality disorder. RESULTS: The model predicting variance in CSF Oxytocin concentration including LHA score was statistically significant, after removal of a single multivariate outlier. Inclusion of the outlier resulted in a most likely spurious interaction between Sex and LHA score. Presence or absence of personality disorder was not associated with variance in CSF Oxytocin levels. Exploratory analyses revealed a possible inverse relationship between CSF Oxytocin level and history of suicidal behavior. CONCLUSIONS: As hypothesized, CSF Oxytocin levels were inversely correlated with life history of aggression. This represents the first such report of a relationship between oxytocin levels and aggression. The correlational, cross-sectional study design precludes causal inferences, but the data are consistent with the known effects of oxytocin on aggressive behavior in animals.

Cerebrospinal fluid GABA concentration: relationship with impulsivity and history of suicidal behavior, but not aggression, in human subjects.

The objective of this study was to assess the relationship between cerebrospinal fluid concentrations of the neurotransmitter gamma-aminobutyric acid (GABA) and measures of impulsivity and related behaviors (aggression and suicidality) in healthy volunteer and personality disordered subjects. CSF GABA levels, and measures of impulsivity, aggression, and history of suicidal behavior were obtained by morning lumbar puncture in 57 healthy volunteer subjects and in subjects with personality disorder. CSF GABA levels were not found to correlate with measures of aggression but were found to correlate directly with measures of impulsivity; e.g., a composite measure of impulsivity in all subjects (r=0.35, df=46, P=0.015) and in personality disordered subjects examined separately (r=0.39, df=30, P=0.029). In the personality disorder group, CSF GABA levels were higher among subjects with a history of suicidal behavior compared with those without this history. These data suggest that central GABAergic function correlates directly with impulsiveness and history of suicidal behavior, but not aggressiveness, in personality disordered subjects. This may be consistent with observations that high doses of benzodiazepines can lead to "behavioral disinhibition" in human subjects. Further work assessing this and other aspects of the central GABA system in personality disordered subjects are warranted.

Neurobiology of suicidal behavior. An integration of biological and clinical findings.

Suicide is among the top ten leading causes of death in individuals of all ages. An explanatory model for suicidal behavior that links clinical and psychological risk factors or endophenotypes, to the underlying neurobiological abnormalities associated with suicidal behavior may enhance prediction, help identify treatment options and have heuristic value. Our explanatory model proposes that developmental factors that are biological (genetics) and psychological or clinical (early childhood adversity) may have causal relevance to the disturbances found in subjects with suicidal behavior. In this way, our model integrates findings from several perspectives in suicidology and attempts to explain the relationship between various neurobiological, genetic, and clinical observations in suicide research, offering a comprehensive hypothesis to facilitate understanding of this complex outcome.

Physiological correlates of aggression and impulsivity in free-ranging female primates.

We examined the relations among cerebrospinal fluid (CSF) monoamine metabolite concentrations, plasma hormone concentrations, aggression, and impulsive risk-taking behavior in a free-ranging population of female rhesus macaques. We selected 44 juvenile female rhesus macaques as subjects from a population of approximately 3000 macaques that inhabit a 475-acre Sea Island. We obtained CSF and blood samples, and recorded behavioral observations over a subsequent 18-month period. Our results indicate an inverse correlation between CSF concentrations of the major serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), and the frequency of low-intensity restrained aggression typically associated with matrilineal defense of social status. In contrast, previous research with males has shown an inverse correlation between CSF 5-HIAA concentrations and levels of violent unstrained aggression typically associated with traumatic injury and death. We also noted a negative correlation between plasma concentrations of the stress hormone cortisol and the frequency of low-intensity aggressive acts, a finding not reported in our previous studies with males. Further examination revealed a negative correlation between CSF 5-HIAA concentrations and the rate of long dangerous leaps through the forest canopy, suggesting that the relation between low serotonergic functioning and impulsivity may generalize to both female and male primates. These results indicate that females with low CSF 5-HIAA concentrations, like their male counterparts, are at increased risk for impulsive temperament, but that unlike males, females may be buffered from this risk through intersexual differences in life history patterns and social affiliation.

Biological markers for suicidal behavior in alcohol dependence.

Alcohol-dependent populations have a high lifetime suicide rate (between 7 and 15%, relative risk = 7), and alcoholism is one of the two psychiatric disorders most frequently found in suicidal cases (between 15 and 25%). Biological factors that would detect patients at risk could thus be of value. Carbohydrate-deficient transferrin, monoamine oxidase B, soluble interleukin-2 receptor and cholesterol have been proposed as markers of suicidal risk in alcohol-dependent patients, although nonspecific and with low predictive value. On the other hand, there is large and convergent data stressing the importance of serotonin dysregulation as increasing the risk for aggressive behaviour toward the self, although it is not clear whether serotonin is involved through the altered behavior inhibition system, enhancement of anxiety and depression, or association with specific subtypes of alcohol-dependence, such as early-onset type II alcoholism. Considering the complex but significant impact of alcohol on serotonin metabolism and turnover, it is likely that serotonin mediates a large part of the proneness of ethanol to commit impulsive-aggressive behavior.

CSF studies in violent offenders. II. Blood-brain barrier dysfunction without concurrent inflammation or structure degeneration.

Cerebral dysfunction without corresponding structural pathology has been reported in brain imaging studies of violent offenders. Biochemical markers in the CSF reflect various types of CNS pathology, such as blood-brain barrier dysfunction (CSF/S albumin ratio), infectious or inflammatory processes (IgG and IgM indices), neuronal or axonal degeneration (CSF-tau protein) and synaptic de- or regeneration (CSF-growth associated protein-43 (GAP-43)). We compared these CSF markers in 19 non-psychotic perpetrators of severe violent crimes undergoing pretrial forensic psychiatric investigation and 19 age- and sex-matched controls. Index subjects had significantly higher albumin ratios (p = 0.002), indicating abnormal vascular permeability as part of the complex CNS dysfunction previously reported in violent offenders. Axis I disorders, including substance abuse or current medication, did not explain this finding. Since Ig-indices, CSF-tau protein or CSF-GAP-43 were not increased, there was no support for inflammation or neuronal/synaptic degeneration as etiological factors to CNS dysfunction in this category of subjects.

Association of aggressive behavior with altered serotonergic function in patients who are not suicidal.

OBJECTIVE: The purpose of this study was to determine whether aggression and serotonergic dysfunction are related in the absence of a history of suicidal behavior. Although serotonergic dysfunction has been implicated in aggressive and impulsive behavior, most studies of such behavior have included individuals with a history of suicide attempts. Low concentrations of CSF 5-hydroxyindoleacetic acid (5-HIAA) have been consistently associated with suicidal behavior, presenting a potential confound in the link between aggression and serotonergic dysfunction. METHOD: The authors examined the association between aggression and CSF 5-HIAA concentrations in a group of 64 patients who had different DSM-III-R axis I diagnoses and no past suicidal behavior. Aggressive (N=35) and nonaggressive (N=29) groups were defined by a median split on a six-item history of adulthood aggressive behavior. RESULTS: The aggressive group had significantly lower CSF 5-HIAA concentrations than the nonaggressive group. Aggressive individuals also scored significantly higher on self-report measures of hostility, impulsiveness, and sensation seeking. CSF 5-HIAA concentrations, however, did not correlate with self-reported hostility and impulsivity. CONCLUSIONS: There is an association between aggressive behavior and serotonergic dysfunction independent of suicidal behavior in patients with axis I disorders who exhibit relatively milder forms of aggressive behavior. Analogous to findings with suicidal behavior, a low concentration of CSF 5-HIAA is related to aggressive behavior but does not show the same relationship to the continuum of aggressive feelings and thoughts.

CSF monoamines, age and impulsivity in wild grivet monkeys (Cercopithecus aethiops aethiops).

Brain monoaminergic activity has been associated with behaviors, such as impulsive risk-taking, that tend to peak during adolescence in humans and nonhuman primates. This study was designed to assess natural variation in monoamine neurotransmitter metabolism in relation to age and behavioral impulsivity in grivet monkeys (Cercopithecus aethiops aethiops) living in their native habitat and subject to natural ecological pressures. Cisternal cerebrospinal fluid, collected from 22 animals living in the Awash National Park, Ethiopia, was assayed for the major metabolites of serotonin (5-hydroxyindoleacetic acid, 5-HIAA), dopamine (homovanillic acid, HVA) and norepinephrine (3-methoxy-4-hydroxyphenylglycol, MHPG). Concentrations of HVA declined significantly from one year of age to older adulthood. Further, a significant curvilinear relationship was identified between age and the 5-HIAA/HVA ratio, with the trough coinciding with the period of adolescence. Finally, behavioral impulsivity, as measured by re-entering baited traps a second time after the animal had already been captured and sampled for CSF, was related to lower levels of MHPG. The results suggest that normal variation in central monoaminergic activity may have functional consequences in wild populations.

The neurobiology of suicide risk: a review for the clinician.

Suicidal behavior has neurobiological determinants independent of the psychiatric illnesses with which it is associated. We have found that some patients with major depression are vulnerable to acting on suicidal impulses. This vulnerability results from the interaction between triggers or precipitants and the threshold for suicidal behavior. An important factor in setting an individual's threshold for acting on suicidal impulses is brain serotonergic function. Serotonin function has been shown to be lower in suicide attempters by studies measuring serotonin metabolites in cerebrospinal fluid and studies of prolactin response to fenfluramine. Postmortem studies of suicide victims also reveal decreased serotonin activity in the ventrolateral prefrontal cortex. New neuroimaging paradigms, such as positron emission tomography (PET), offer an opportunity to visualize serotonin function in vivo in a more direct way than has previously been available. This technology may provide the possibility of timely therapeutic intervention in patients at high risk for suicide.

A replication study of violent and nonviolent subjects: cerebrospinal fluid metabolites of serotonin and dopamine are predicted by plasma essential fatty acids.

BACKGROUND: Among an independent group of subjects selected for their history of violent, impulsive behaviors and nonviolent control subjects, we attempted to replicate the finding that plasma docosahexaenoic acid concentrations were negatively correlated with cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) concentrations. METHODS: CSF 5-HIAA and homovanillic acid (HVA), fasting total cholesterol, and plasma fatty acid concentrations were examined in violent and nonviolent subjects matched for their severity of alcohol dependence. RESULTS: Violent subjects had significantly higher lifetime violence and hostility ratings and lower concentrations of CSF 5-HIAA than nonviolent subjects. Plasma docosahexaenoic acid was negatively correlated with CSF 5-HIAA only among violent subjects. CONCLUSIONS: This observational study suggests that dietary essential fatty acids may change neurotransmitter concentrations. Prospective dietary intervention trials will be required to determine if increasing dietary intake of docosahexaenoic acid will increase or decrease either CSF 5-HIAA concentrations or impulsive and violent behaviors.

Low central nervous system serotonergic activity is traitlike and correlates with impulsive behavior. A nonhuman primate model investigating genetic and environmental influences on neurotransmission.

We have used nonhuman primates to examine developmental and behavioral correlates of CNS serotonergic activity, as measured by concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF). These studies show that interindividual differences in CNS serotonin turnover rate exhibit traitlike qualities and are stable across time and settings, with interindividual differences in CSF 5-HIAA concentrations showing positive correlations across repeated sampling. Primates with low CNS serotonergic activity exhibit behaviors indicative of impaired impulse control, unrestrained aggression, social isolation, and low social dominance. Maternal and paternal genetic influences play major roles in producing low CNS serotonin functioning, beginning early in life. These genetic influences on serotonin functioning are further influenced by early rearing experiences, particularly parental deprivation.

Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder.

Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale. HVA in CSF was positively correlated with several measures of hyperactivity. The replicability of these findings, as well as possible socioenvironmental effects, and the predictive value of CSF monoamines in prepubertal hyperactivity are the subjects of ongoing study.

Neurobiology of impulsivity and the impulse control disorders.

Clinical impulsivity has been characterized in both dimensional and categorical terms. Whereas DSM-III-R classifies personality disorders characterized by impulsivity and impulse control disorders as discrete entities, impulsive symptoms and traits can also be conceived in terms of an underlying behavioral dimension. The authors review research on impulsivity and the impulse control disorders from a biological perspective. In particular, they critically review evidence that the serotonin neurotransmitter system mediates symptoms and traits of impulsive personality disorders and the impulse control disorders.

MMPI measures of impulsivity and depression correlate with CSF 5-HIAA and HVA in depression but not schizophrenia.

Recent studies have linked impulsivity with CSF concentrations of both 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA). One work found a negative correlation between the MMPI psychopathic deviate (Pd) scale and 5-HIAA in personality disordered men (Brown et al., 1982). We found that the 5-HIAA/Pd correlation extends (P less than 0.05) to unmedicated depressed patients (n = 21). A trend was found between HVA and Pd in depression. There was no relationship between either metabolite and the Pd scale in unmedicated schizophrenics (n = 24). A significant inverse correlation was found between the MMPI depression scale and CSF HVA but not 5-HIAA in the depressed patients.

Relationship of psychobiological variables to recidivism in violent offenders and impulsive fire setters. A follow-up study.

Fifty-eight violent offenders and impulsive fire setters were followed up for an average of 3 years after release from prison. Recidivists who committed a new violent offense or arson had significantly lower cerebrospinal fluid 5-hydroxyindoleacetic acid and homovanillic acid concentrations and blood glucose nadirs after oral glucose challenge than did nonrecidivists. A discriminant analysis, based on the blood glucose nadir and cerebrospinal fluid 5-hydroxyindoleacetic acid concentration, correctly classified 84.2% of the subjects.

Psychobiological concomitants of history of suicide attempts among violent offenders and impulsive fire setters.

Psychobiological data on 58 violent offenders and impulsive fire setters were analyzed for associations with history of suicide attempts. Subjects with a history of suicide attempts serious enough to require an admission to a medical facility had significantly lower mean cerebrospinal fluid 5-hydroxyindoleacetic acid and 3-methoxy-4-hydroxyphenylglycol concentrations than subjects who had not made such attempts. A linear discriminant function analysis based on psychobiological and behavioral variables correctly classified 79% of the subjects according to the suicide attempt history positive and negative outcomes.

Family history of alcoholism in violent offenders and impulsive fire setters.

Fifty-six of 58 violent offenders and impulsive fire setters fulfilled the DSM-III criteria for alcohol abuse. Information necessary for evaluation of family history of alcoholism was obtained on 54 subjects. Forty-four of the 54 subjects had first- or second-degree blood relatives with alcoholism. Thirty-five had alcoholic fathers. Subjects with alcoholic fathers had a lower mean cerebrospinal fluid 5-hydroxyindoleacetic acid concentration and were more often impulsive than subjects without alcoholic fathers.