Psychobiology of violent behavior.
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Biomedical subjects
Publications and source records attributed to M Virkkunen.
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The present study is a follow-up of a sample of 348 men convicted of manslaughter, attempted manslaughter, or arson who were released from incarceration. Multiple factors assessed at the time of incarceration, including demographic, behavioral, family history, and biochemical variables, and psychiatric diagnoses were used in an attempt to discriminate between those who became recidivists during the follow-up period and those who did not. Violent recidivism was most strongly associated (sensitivity of 90%) with impulsivity of the original crime in killers and attempted killers; for arsonists, having made a suicide attempt was the strongest predictor (68% sensitivity). For predictive purposes, both single factor associations and multiple entries into discriminant analysis produced too many false-positives, i.e., the high rate of false designation as recidivist remained a problem.
If a genetic association between the D2 dopamine receptor genotype and alcoholism is mediated by altered dopamine function, then a stronger association might be found in alcoholics who are deviant in indices of dopamine function and by comparing alcoholics to nonalcoholics matched for ethnic origin. Therefore, we evaluated the D2/TaqI polymorphism in 29 impulsive violent alcoholic Finns, 17 nonimpulsive violent alcoholic Finns and 36 Finnish controls free of mental disorders, alcoholism and substance abuse. In 37 of the alcoholics, we measured cerebrospinal fluid (CSF) homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol. There was no relationship between D2/Taq 1 genotype and concentrations of these monoamine metabolites in this group, which exhibits lower CSF HVA and 5-HIAA as compared to controls. There was also no genotypic difference between Finnish alcoholics and nonalcoholic controls. The lack of relationship between D2/Taq1 genotype and HVA concentration was replicated in 24 Caucasian alcoholics in the United States.
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Studies from several countries, representing diverse cultures, have reported an association between violent suicide attempts by patients with unipolar depression and personality disorders and low concentrations of the major serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF). Related investigations have documented a similar inverse correlation between impulsive, externally directed aggressive behavior and CSF 5-HIAA in a subgroup of violent offenders. In these individuals, low CSF 5-HIAA concentrations are also associated with a predisposition to mild hypoglycemia, a history of early-onset alcohol and substance abuse, a family history of type II alcoholism, and disturbances in diurnal activity rhythm. These data are discussed in the context of a proposed model for the pathophysiology of a postulated "low serotonin syndrome."
Several lines of evidence suggest that abnormal brain serotonin metabolism may occur in early onset, type 2 alcoholism in men. Low cerebrospinal fluid 5-hydroxy-indoleacetic acid concentration has been found to be associated with a history of paternal alcoholism, and abnormal oral glucose tolerance tests (tendency to low blood glucose nadir) in subjects who are prone to exhibit impulsive, aggressive behaviour under the influence of alcohol. Moreover, a low ratio of the concentrations of tryptophan and other large neutral amino acids in plasma seems to correlate with early onset alcohol abuse and violent tendencies. More knowledge is required about neurochemical changes in homogenous subgroups of alcoholics such as the putative type 2 so as to understand which of the relationships are causative and to provide treatment strategies for alcoholism and its complications.
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 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.
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.
We had studied cerebrospinal fluid monoamine metabolite concentrations and glucose metabolism in 58 violent offenders and impulsive fire setters in the early 1980s. We performed a follow-up study investigating recidivist crimes after release from prison and histories of suicide attempts using behavioral, diagnostic, and biochemical variables to discriminate subjects with recidivism and suicide attempts from subjects without recidivism and suicide attempts. Biochemical variables discriminated significantly between the groups.
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The evidence is reviewed that violent and suicidal behavior is associated with a deficiency of the serotonin system and that individuals with poor impulse control tend to become hypoglycemic during an oral glucose tolerance test, and have low levels of 5-hydroxyindole acetic acid in the cerebrospinal fluid. It is postulated that serotonergic deficits may predispose individuals to poor impulse control, disturbance of glucose metabolism, alcohol abuse, violent behavior and suicide.
Cerebrospinal fluid (CSF) monoamine metabolite levels were studied in 20 arsonists, 20 habitually violent offenders, and ten healthy inpatient volunteers. The arsonists and violent offenders had been in prison an average of six months before the study. Both the raw data and data adjusted by analysis of covariance for group differences in age, height, sex, and season of the lumbar puncture showed significantly lower concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG) and 5-hydroxyindoleacetic acid (5-HIAA) in the arsonists than in the other groups. The finding remained the same when arsonists with violent suicide attempts were excluded from the analysis. Although CSF concentrations of MHPG or 5-HIAA did not correlate with the severity of repeated fire-setting behavior, low blood glucose nadir in the oral glucose tolerance test (a measure of the tendency toward hypoglycemia) did. These results support the hypothesis that poor impulse control in criminal offenders is associated with low levels of certain CSF monoamine metabolites and with a hypoglycemic tendency.
We review cerebrospinal fluid (CSF) studies suggesting on association between low CSF levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAAA) and suicidal and impulsive behaviour and alcoholism. Relatively high percentages of alcoholics attempt and commit suicide and have impulsive antisocial personality disorder. Therefore, we suggest that there may be a sizable subgroup of alcoholics who have a reduced central serotonin turnover.
Insulin activity in plasma and the concentrations of tryptophan and serotonin were measured during the glucose tolerance test (GTT) in habitually violent and impulsive male offenders and in psychiatric personnel as controls. Insulin was enhanced in the intermittent explosive disorder; at the same time the concentration of plasma tryptophan and the ratio of tryptophan to large neutral amino acids were on a high level and tryptophan even increased in many cases during GTT. Serotonin values did not differ. Many offenders with enhanced insulin secretion displayed abnormal neuroglycopenic symptoms during GTT.
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