Platelet serotonin measures in adolescents with conduct disorder

Serotonin 5-HT2A receptor polymorphisms are associated with irritability and aggression in conduct disorder

In childhood and adolescence, overt antisocial and aggressive manifestations are typically diagnosed as conduct disorder (CD). Given that the emerging research has pointed to the influence of 5-HT_2A receptors in the ontogeny of aggression, we aimed to analyze the association of its genetic polymorphisms with CD. The study included 228 male adolescent subjects (120 with and 108 without CD). CD was diagnosed according to Structured Clinical Interview for DSM-IV criteria, while evaluations of aggressive/dissociative behaviors were performed using psychometric questionnaires including the PCL-YV, OAS-M, KADS, and CBCL. Platelet 5-HT concentration was determined by spectrophotofluorometry. Genotyping of 5-HT_2A receptor polymorphisms rs2070040, rs9534511, rs4142900, rs9534512 was performed using TaqMan SNP Genotyping Assays. Subjective irritability, physical aggression toward others, and antisocial behavior were strongly associated with the G allele of rs2070040 and rs4142900, and the C allele of rs9534511 and rs9534512. A significantly increased platelet 5-HT concentration in CD subjects, compared to controls, was lost after the correction according to the smoking status. Our results indicate an association of the studied HTR2A polymorphisms and their haplotypes with irritability and impulsivity traits, which may contribute to the aggressive and antisocial behavior in male adolescents with CD.

Serotonin and aggressive behaviour in children and adolescents: a systematic review

OBJECTIVE

The role of serotonin (5-HT) in human aggression has been the subject of a large number of studies, mostly with adults. Meta-analyses indicate a small but significant inverse relationship between central nervous 5-HT availability and aggression, but genetically informed studies suggest two pathways: one to reactive aggression and the other to proactive aggression.

METHOD

We conducted a systemic review on central nervous 5-HT function in children and adolescents, with attention to the function of aggression.

RESULTS

In total, 675 articles were screened for relevance, with 45 reviewed. These included blood assays (e.g. plasma, 5-HIAA; platelet 5-HTR_2A ), epigenetic studies, retrospective PET studies and 5-HT challenge paradigms (e.g. tryptophan depletion). Overall, findings were mixed, with support both for negative and for positive associations of central nervous 5-HT function with aggression in children and adolescents.

CONCLUSION

We propose factors that may be blurring the picture, including problems in the conceptualization and measurement of aggression in young people, the lack of prospective designs and the bias towards clinical samples of boys. Research needs to account for variance in the both motivation for and implementation of aggression, and look to the behavioural economics literature to consider the roles of reward, vengeance and self-control more clearly.

Anger Emotional Stress Influences VEGF/VEGFR2 and Its Induced PI3K/AKT/mTOR Signaling Pathway

Objective. We discuss the influence of anger emotional stress upon VEGF/VEGFR2 and its induced PI3K/AKT/mTOR signal pathway. Methods. We created a rat model of induced anger (anger-out and anger-in) emotional response using social isolation and resident-intruder paradigms and assessed changes in hippocampus' VEGF content, neuroplasticity, and the PI3K/AKT/mTOR signaling pathway. Results. The resident-intruder method successfully generated anger-out and anger-in models that differed significantly in composite aggression score, aggression incubation, open field behavior, sucrose preference, and weight gain. Anger emotional stress decreased synaptic connections and VEGFR2 expression. Anger emotional stress led to abnormal expression of VEGF/VEGFR2 mRNA and protein and disorderly expression of key factors in the PI3K/AKT/mTOR signal pathway. Fluoxetine administration ameliorated behavioral abnormalities and damage to hippocampal neurons caused by anger emotional stress, as well as abnormal expression of some proteins in VEGF/VEGFR2 and its induced PI3K/AKT/mTOR signal pathway. Conclusion. This research provides a detailed classification of anger emotion and verifies its influence upon VEGF and the VEGF-induced signaling pathway, thus providing circumstantial evidence of mechanisms by which anger emotion damages neurogenesis. As VEGFR2 can promote neurogenesis and vasculogenesis in the hippocampus and frontal lobe, these results suggest that anger emotional stress can result in decreased neurogenesis.

An exploration of the serotonin system in antisocial boys with high levels of callous-unemotional traits

BACKGROUND

The serotonin system is thought to play a role in the aetiology of antisocial and aggressive behaviour in both adults and children however previous findings have been inconsistent. Recently, research has suggested that the function of the serotonin system may be specifically altered in a sub-set of antisocial populations - those with psychopathic (callous-unemotional) personality traits. We explored the relationships between callous-unemotional traits and functional polymorphisms of selected serotonin-system genes, and tested the association between callous-unemotional traits and serum serotonin levels independently of antisocial and aggressive behaviour.

METHOD

Participants were boys with antisocial behaviour problems aged 3-16 years referred to University of New South Wales Child Behaviour Research Clinics. Participants volunteered either a blood or saliva sample from which levels of serum serotonin (N = 66) and/or serotonin-system single nucleotide polymorphisms (N = 157) were assayed.

RESULTS

Functional single nucleotide polymorphisms from the serotonin 1b receptor gene (HTR1B) and 2a receptor gene (HTR2A) were found to be associated with callous-unemotional traits. Serum serotonin level was a significant predictor of callous-unemotional traits; levels were significantly lower in boys with high callous-unemotional traits than in boys with low callous-unemotional traits.

CONCLUSION

Results provide support to the emerging literature that argues for a genetically-driven system-wide alteration in serotonin function in the aetiology of callous-unemotional traits. The findings should be interpreted as preliminary and future research that aims to replicate and further investigate these results is required.

The neurobiology of oppositional defiant disorder and conduct disorder: altered functioning in three mental domains

This review discusses neurobiological studies of oppositional defiant disorder and conduct disorder within the conceptual framework of three interrelated mental domains: punishment processing, reward processing, and cognitive control. First, impaired fear conditioning, reduced cortisol reactivity to stress, amygdala hyporeactivity to negative stimuli, and altered serotonin and noradrenaline neurotransmission suggest low punishment sensitivity, which may compromise the ability of children and adolescents to make associations between inappropriate behaviors and forthcoming punishments. Second, sympathetic nervous system hyporeactivity to incentives, low basal heart rate associated with sensation seeking, orbitofrontal cortex hyporeactiviy to reward, and altered dopamine functioning suggest a hyposensitivity to reward. The associated unpleasant emotional state may make children and adolescents prone to sensation-seeking behavior such as rule breaking, delinquency, and substance abuse. Third, impairments in executive functions, especially when motivational factors are involved, as well as structural deficits and impaired functioning of the paralimbic system encompassing the orbitofrontal and cingulate cortex, suggest impaired cognitive control over emotional behavior. In the discussion we argue that more insight into the neurobiology of oppositional defiance disorder and conduct disorder may be obtained by studying these disorders separately and by paying attention to the heterogeneity of symptoms within each disorder.

Inter-relationship between different platelet measures of 5-HT and their relationship to aggression in human subjects

The objective of this study was to explore the inter-relationship of three platelet measures of serotonergic function (5-HT): 5-HT Transporter Binding, 5-HT-2 Receptor Binding and 5-HT Content and to explore their inter-relationship with measures of aggression and impulsivity. 58 male subjects with personality disorder were studied. Numbers of platelet 5-HT Transporter and 5-HT-2 Receptor sites were assessed by examining the Bmax of ³H-Paroxetine Binding and the Bmax of ¹²⁵I-LSD Binding to the blood platelet; 5-HT Content was assessed by measuring the amount of 5-HT in the platelet material. Life history of aggression was assessed by Life History of Aggression. Impulsivity was assessed by the Impulsivity Scale of the Eysenck Personality Questionnaire-II. Platelet 5-HT Transporter Binding correlated with both 5-HT-2 Receptor Binding and 5-HT Content; the latter two variables did not correlate with each other. Only Platelet 5-HT Transporter binding correlated significantly with LHA Aggression. These data suggest that while Platelet 5-HT Transporter binding correlates with both 5-HT-2 Receptor Binding and with 5-HT Content, that only 5-HT Transporter Binding represents a correlate of aggression in male personality disordered subjects.

Epigenetics in Developmental Disorder: ADHD and Endophenotypes

Heterogeneity in attention-deficit/hyperactivity disorder (ADHD), with complex interactive operations of genetic and environmental factors, is expressed in a variety of disorder manifestations: severity, co-morbidities of symptoms, and the effects of genes on phenotypes. Neurodevelopmental influences of genomic imprinting have set the stage for the structural-physiological variations that modulate the cognitive, affective, and pathophysiological domains of ADHD. The relative contributions of genetic and environmental factors provide rapidly proliferating insights into the developmental trajectory of the condition, both structurally and functionally. Parent-of-origin effects seem to support the notion that genetic risks for disease process debut often interact with the social environment, i.e., the parental environment in infants and young children. The notion of endophenotypes, markers of an underlying liability to the disorder, may facilitate detection of genetic risks relative to a complex clinical disorder. Simple genetic association has proven insufficient to explain the spectrum of ADHD. At a primary level of analysis, the consideration of epigenetic regulation of brain signalling mechanisms, dopamine, serotonin, and noradrenaline is examined. Neurotrophic factors that participate in the neurogenesis, survival, and functional maintenance of brain systems, are involved in neuroplasticity alterations underlying brain disorders, and are implicated in the genetic predisposition to ADHD, but not obviously, nor in a simple or straightforward fashion. In the context of intervention, genetic linkage studies of ADHD pharmacological intervention have demonstrated that associations have fitted the "drug response phenotype," rather than the disorder diagnosis. Despite conflicting evidence for the existence, or not, of genetic associations between disorder diagnosis and genes regulating the structure and function of neurotransmitters and brain-derived neurotrophic factor (BDNF), associations between symptoms-profiles endophenotypes and single nucleotide polymorphisms appear reassuring.

Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents

Epidemiological and clinical data show frequent associations between adverse childhood experiences (ACEs) and substance abuse susceptibility particularly in adolescents. A large body of evidences suggests that the possible dysregulation of neuroendocrine responses as well as neurotransmitters function induced by childhood traumatic experiences and emotional neglect could constitute one of the essential biological changes implementing substance abuse vulnerability. Moreover, genotype variables and its environment interactions have been associated with an increased risk for early onset substance abuse. In this paper we present several data that support the hypothesis of the involvement of hypothalamus-pituitary-adrenal (HPA) axis in mediating the combined effect of early adverse experiences and gene variants affecting neurotransmission. The presented data also confirm the relationship between basal plasma levels of cortisol and ACTH, on the one hand, and retrospective measures of neglect during childhood on the other hand: the higher the mother and father neglect (CECA-Q) scores are, the higher the plasma levels of the two HPA hormones are. Furthermore, such positive relationship has been proved to be particularly effective and important when associated with the "S" promoter polymorphism of the gene encoding the 5-HTT transporter, both in homozygote and heterozygote individuals.

Inverse relationship between numbers of 5-HT transporter binding sites and life history of aggression and intermittent explosive disorder

The objective of this study was to determine if platelet 5-HT transporter (5-HTT) sites vary as a function of aggression, and/or impulsiveness, and differ as a function of Intermittent Explosive Disorder (IED). Accordingly, the number of platelet 5-HTT sites was assessed in 100 personality disordered (PD) individuals with varying degrees of aggressiveness. The number of platelet 5-HTT sites was assessed by examining the Bmax of H(3)-Paroxetine Binding to the blood platelet. Life history of aggression was assessed by Life History of Aggression. Impulsivity was assessed by the Barratt Impulsiveness Scale. Diagnoses of IED were made by both DSM-IV and Research Criteria. Examination of the data revealed that Bmax, but not Kd, values of Platelet H(3)-Paroxetine Binding correlated inversely with the LHA Aggression score (r=-.42 n=87, p<.001) but not with the BIS-11 Impulsivity score (r=.03, n=77, p=.777). PD subjects meeting Research Criteria for IED demonstrated a significant reduction in Bmax values for Platelet H(3)-Paroxetine Binding. These results were similar after accounting for the effect of lifetime history of depressive mood disorder on Bmax values for Platelet H(3)-Paroxetine Binding. These data indicate a significant inverse relationship between platelet 5-HTT and aggression, though not impulsivity, as a dimensional variable in personality disordered individuals. Results from the examination of IED as a categorical aggression variable suggest that Research, rather than DSM-IV, criteria better identify individuals with reduced numbers of platelet 5-HTT sites.

The heterogeneity of disruptive behavior disorders - implications for neurobiological research and treatment

Disruptive behavior disorders (DBDs) are reflected by a great variety of symptoms ranging from impulsive-hot-tempered quarrels to purposeful and goal-directed acts of cruelty. A growing body of data indicates that there are neurobiological factors that increase the risk for developing DBDs. In this review, we give a broad overview of recent studies investigating physiological, neural, genetic factors, and specific neurotransmitter systems. We also discuss the impact of psychosocial risk and consider the effects of gene-environment interactions. Due to the heterogeneity of DBDs, it is concluded that specific subtypes of disruptive behavior should be considered both in terms their biological basis and in regard to specific treatment needs.

Platelet poor plasma serotonin level in delinquent adolescents diagnosed with conduct disorder

OBJECTIVE

Accumulating data indicate the involvement of the serotonergic system in adolescent aggression. The aim of this study was to examine the platelet-poor plasma (PPP) serotonin (5-HT) levels among delinquent adolescent boys with conduct disorder (CD) in comparison with normal controls.

METHOD

PPP 5-HT levels were measured in 16 male delinquent CD adolescents from a correctional facility and in 14 normal male adolescent controls. Severity of aggressive behavior was assessed by the Child Behavior Checklist (CBCL) and the Overt Aggression Scale (OAS).

RESULTS

Delinquent CD adolescents had higher PPP 5-HT levels (about 3-fold) than the normal controls (27.68+/-32.29 vs. 7.76+/-4.23 ng/ml, respectively, p=0.027). In the delinquent CD adolescents a significant correlation was found between the PPP 5-HT levels and the CBCL and OAS aggressive scores (r=0.68, p=0.0034 and r=0.59, p=0.016, respectively).

CONCLUSIONS

Juvenile delinquency is associated with high PPP 5-HT levels. Modulation of 5-HT neurotransmission may have a role in the symptomatology and treatment of severe adolescent CD.

Contextualizing the neurobiology of conduct disorder in an emotion dysregulation framework

Conduct disorder (CD) represents the most common childhood psychiatric disorder found in community and mental health clinics. This paper provides a comprehensive review of the neurobiology of CD; specifically, neurological and neurochemical correlates. Converging evidence suggests that neurological profiles of individuals with CD, compared to peers, are characterized by reduced P300 brain wave amplitude, deactivation of the anterior cingulated cortex and reduced activation in the left amygdala in response to negative stimuli, and reduced right temporal lobe volume. The neurochemical profiles of individuals with CD are characterized by reduced serotonin and cortisol levels (i.e., decreased HPA axis function), as well as attenuated autonomic nervous system functioning. Popular theoretical frameworks cited within the CD literature are limited in their ability to explain and consolidate the neurological and neurochemical findings. We believe that emotion dysregulation theory, though not often used within CD research, may provide the most comprehensive and inclusive framework for understanding neurobiological aspects of this disorder. Limitations within the literature, future directions for research, and implications of the findings will be discussed.

Psychometric testing methods for children's social skills

Social skill excesses and deficits have garnered considerable attention from researchers and clinicians over the last three decades. This trend is undoubtedly due to the central role these problems play in psychopathology and the general adjustment of children of all ages. Not surprisingly, these concerns and attention to such problems have also fostered a substantial literature on scaling methods specifically designed to help define and identify social skill deficits as well as track treatment progress. In this paper, for example, we identified 48 scales and related testing methods specifically designed for this purpose. Our goal here was to critically review the psychometric properties and patterns of research with existing social skill tests for children. Current strengths and weaknesses along with future directions for research are considered for this highly researched topic.

Behavioral and neurobiological characteristics influencing social hierarchy formation in female cynomolgus monkeys

Socially housed monkeys have been used as a model to study human diseases. The present study examined behavioral, physiological and neurochemical measures as predictors of social rank in 16 experimentally naïve, individually housed female cynomolgus monkeys (Macaca fascicularis). The two behavioral measures examined were novel object reactivity (NOR), as determined by latency to touch an opaque acrylic box placed in the home cage, and locomotor activity assessed in a novel open-field apparatus. Serum cortisol concentrations were evaluated three times per week for four consecutive weeks, and stress reactivity was assessed on one occasion by evaluating the cortisol response to adrenocorticotropic hormone (ACTH) following dexamethasone suppression. Measures of serotonin (5-HT) function included whole blood 5-HT (WBS) concentrations, cerebrospinal fluid (CSF) concentrations of the 5-HT metabolite 5-hydroxyindoleacetic acid (5-HIAA) and brain 5-HT transporter (SERT) availability obtained using positron emission tomography (PET). After baseline measures were obtained, monkeys were assigned to four social groups of four monkeys per group. The two measures that correlated with eventual social rank were CSF 5-HIAA concentrations, which were significantly higher in the animals who eventually became subordinate, and latency to touch the novel object, which was significantly lower in eventual subordinate monkeys. Measures of 5-HT function did not change as a consequence of social rank. These data suggest that levels of central 5-HIAA and measures of novel object reactivity may be trait markers that influence eventual social rank in female macaques.

The influence of serotonin- and other genes on impulsive behavioral aggression and cognitive impulsivity in children with attention-deficit/hyperactivity disorder (ADHD): Findings from a family-based association test (FBAT) analysis

BACKGROUND

Low serotonergic (5-HT) activity correlates with increased impulsive-aggressive behavior, while the opposite association may apply to cognitive impulsiveness. Both types of impulsivity are associated with attention-deficit/hyperactivity disorder (ADHD), and genes of functional significance for the 5-HT system are implicated in this disorder. Here we demonstrate the separation of aggressive and cognitive components of impulsivity from symptom ratings and test their association with 5-HT and functionally related genes using a family-based association test (FBAT-PC).

METHODS

Our sample consisted of 1180 offspring from 607 families from the International Multicenter ADHD Genetics (IMAGE) study. Impulsive symptoms were assessed using the long forms of the Conners and the Strengths and Difficulties parent and teacher questionnaires. Factor analysis showed that the symptoms aggregated into parent- and teacher-rated behavioral and cognitive impulsivity. We then selected 582 single nucleotide polymorphisms (SNPs) from 14 genes directly or indirectly related to 5-HT function. Associations between these SNPs and the behavioral/cognitive groupings of impulsive symptoms were evaluated using the FBAT-PC approach.

RESULTS

In the FBAT-PC analysis for cognitive impulsivity 2 SNPs from the gene encoding phenylethanolamine N-methyltransferase (PNMT, the rate-limiting enzyme for adrenalin synthesis) attained corrected gene-wide significance. Nominal significance was shown for 12 SNPs from BDNF, DRD1, HTR1E, HTR2A, HTR3B, DAT1/SLC6A3, and TPH2 genes replicating reported associations with ADHD. For overt aggressive impulsivity nominal significance was shown for 6 SNPs from BDNF, DRD4, HTR1E, PNMT, and TPH2 genes that have also been reported to be associated with ADHD. Associations for cognitive impulsivity with a SERT/SLC6A4 variant (STin2: 12 repeats) and aggressive behavioral impulsivity with a DRD4 variant (exon 3: 3 repeats) are also described.

DISCUSSION

A genetic influence on monoaminergic involvement in impulsivity shown by children with ADHD was found. There were trends for separate and overlapping influences on impulsive-aggressive behavior and cognitive impulsivity, where an association with PNMT (and arousal mechanisms affected by its activity) was more clearly involved in the latter. Serotonergic and dopaminergic mechanisms were implicated in both forms of impulsivity with a wider range of serotonergic mechanisms (each with a small effect) potentially influencing cognitive impulsivity. These preliminary results should be followed up with an examination of environmental influences and associations with performance on tests of impulsivity in the laboratory.

How can the study of biological processes help design new interventions for children with severe antisocial behavior?

Children with severe antisocial behavior have an increased risk of showing violently aggressive and other forms of problem behavior in adolescence and adulthood. It is well established that both biological and social factors are involved in the development of antisocial behavior. The primary aim of this paper is to discuss the evidence that specific neurobiological systems are involved in the etiology of childhood-onset antisocial behavior. These factors are responsible for the severity of the behavioral problems observed in antisocial children, but they also play a role in their persistence, because they influence children's interactions with their environment. We will discuss the possible causes of disruptions in neurobiological systems in childhood antisocial behavior and point out the implications of these findings for theory and clinical practice. We will argue that familial factors (e.g., genetic influences, early childhood adversity) are linked to negative behavioral outcomes (e.g., antisocial behavior problems) through the mediating and transactional interplay with neurobiological deficits. An investigation of neurobiological functioning in antisocial children might not only indicate which children are most likely to persist in engaging in severe antisocial behavior, but also guide the development of new interventions.

Serotonergic mediation of aggression in high and low aggressive chicken strains

Serotonin (5-HT) regulates aggressive behavior via binding to its receptors, such as 5-HT1A and 1B, in humans and rodents. Here we investigate the heritable components of 5-HT regulation of aggressiveness in chickens, utilizing 3 distinct genetic strains. In this study, we used 2 divergently selected strains (high and low group productivity and survivability, respectively; HGPS and LGPS) and a third strain, Dekalb XL (DXL), an aggressive out-group. Hens were paired within the same strain. At 24 wk of age, the subordinate of each pair received a daily i.p. injection of NAN-190 (0.5 mg/kg, a 5-HT1A antagonist), GR-127935 (0.5 mg/kg, a 5-HT1B antagonist), or saline (control) for 5 consecutive days. Frequency of aggressive behaviors was increased in the hens of DXL and LGPS treated with 5-HT1A antagonist and in the HGPS hens treated with 5-HT1B antagonist. The 5-HT1B antagonist-treated HGPS hens and 5-HT1A antagonist-treated LGPS hens also displayed increased feather pecking, but neither antagonist had an effect on feather pecking of DXL hens. This may suggest that multiple mediating factors alter feather pecking behaviors. Among the controls, LGPS hens have higher epinephrine levels than HGPS or DXL hens, indicative of the inferior stress-coping ability of LGPS hens. Treatment with 5-HT1B antagonist reduced epinephrine in LGPS hens but not in DXL or HGPS hens, suggesting a role of 5-HT1B in stress regulation in LGPS hens. The results provide evidence for different heritable serotonergic mediation of aggressive behaviors and stress coping in chickens.

Influence of rapid tryptophan depletion on laboratory-provoked aggression in children with ADHD

BACKGROUND

The present study investigated the effects of rapid tryptophan depletion (RTD), and the ensuing reduction of central nervous system levels of serotonin (5-HT), upon reactive aggression in patients with attention deficit/hyperactivity disorder (ADHD). Furthermore, it was asked whether the relation between 5-HT function and behavioural aggression in patients is influenced by their age, the intensity of their attention problems or their comorbid symptoms.

METHODS

The study employed a double-blind, within-subject crossover design. On day 1, 22 male adolescent patients with ADHD were subjected to RTD and the subsequent reduction of central 5-HT levels. On day 2, they received a tryptophan-balanced amino acid mixture (BAL), which acted as a placebo. On both days, 4.5 h after the intake of the RTD/BAL amino acids, reactive aggressive behaviour was provoked using a competitive reaction time game, which consisted of both high and low provocation conditions.

RESULTS

The number of aggressive responses was significantly higher after low provocation during acute tryptophan depletion, in comparison to the placebo. Furthermore, this study provides evidence that neither age nor the intensity of attention symptoms in ADHD patients had an impact on the relation between 5-HT and reactive aggression.

CONCLUSION

This study indicates that in children with ADHD, there is an inverse relationship between 5-HT and aggression.

Neuroendocrine and neurotransmitter correlates in children with antisocial behavior

When antisocial behavior becomes a persistent pattern that affects diverse domains of children's functioning, psychiatrists refer to oppositional defiant disorder (ODD) or conduct disorder (CD). The term disruptive behavior disorder (DBD) covers both ODD and CD. Research shows that in the absence of effective interventions, the prognosis for DBD children is relatively unfavorable: their disorder can extend into adolescence, manifest itself in delinquency, and convert into other psychiatric symptoms, such as addiction or personality disorders. Although environmental factors have traditionally attracted most attention in explaining the origin and persistence of DBDs, it is important not to overlook the vulnerability of the child in the development of antisocial behavior. Relatively few studies have been conducted on the neurobiological factors involved in the development of DBDs in children. In this paper, we explain how problems in hypothalamic-pituitary-adrenal (HPA) axis and serotonergic system functioning could be important factors in the behavioral problems of DBD children. Low fear of punishment and physiological underactivity may predispose antisocial individuals to seek out stimulation or take risks and may explain poor (social) conditioning and socialization. Findings consistent with this hypothesis are presented. Finally, we explain how stress in general, and adverse early life experiences in particular, could have an impact on the development of the HPA and serotonergic systems. An investigation of the neurobiological factors involved in antisocial behavior disorder might ultimately guide the development of new forms of intervention.

Family-based association test of the 5HTTLPR and aggressive behavior in a general population sample of children

BACKGROUND

A promoter polymorphism in the serotonin transporter (5HTTLPR) has functional effects on an important physiologic process involved in serotonin (5HT) signaling. Despite the fact that variation in the 5HT system has long been implicated in the etiology of aggressive behaviors, only a few association-based studies with mixed results have been reported.

METHODS

We conducted family-based tests of association in a sample of 366 families from which 1187 genotypes of the 5HTTLPR were generated using polymerase chain reaction. Ratings of aggressive behavior were obtained from parents and teachers longitudinally using the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF), instruments widely used in behavioral and psychiatric genetics.

RESULTS

Within-family tests suggest an association between the s-allele of the 5HTTLPR and higher aggressive behavior in middle childhood. The strongest association was at age 9 and for an aggregate measure of teacher-rated aggressive behavior.

CONCLUSIONS

This is the first report of an association analysis of the 5HTTLPR in a general population sample of school-age children. The results provide some support for the hypothesis that the functional effects of the 5HTTLPR s-allele are associated with higher levels of aggressive behavior in middle childhood.

[Reduced serotonin levels in platelet-free plasma of adolescents with externalizing behaviour problems]

OBJECTIVES

A serotonergic dysfunction, in particular a reduced serotonergic neurotransmission in the frontal cortex and limbic brain regions, has been discussed in connection with the aetiology of aggressive and impulsive behaviour. Assessment of the activity in the central serotonergic system in children and adolescents is limited due to its technical complexity and ethical restrictions. Therefore, peripheral serotonergic parameters have been used as a model to obtain deeper insight into central serotonergic functions. The aim of this investigation is to examine the significance of plasma serotonin measurement with regard to behavioural problems in adolescents at risk for psychopathology.

METHODS

Within the framework of a prospective longitudinal study of children at risk, serotonin levels in platelet-free blood plasma were measured in a group of n = 10 adolescents aged 15 years with persistent externalizing behaviour (T-score > or = 60 on the "Externalizing Problems" scale of the CBCL) and in a control group of n = 20 mentally undisturbed adolescents. Groups were matched according to age and gender. Externalizing behaviour was assessed by means of a parent questionnaire, the Achenbach Child Behavior Checklist (CBCL).

RESULTS

Significantly lower levels of plasma serotonin were found in adolescents with persistent behaviour problems than in the control group. Significant negative correlations between serotonin levels and the CBCL scales "Aggressive Behavior" and "Externalizing Problems" were obtained for the total sample.

CONCLUSIONS

Earlier findings that described a serotonergic deficit as a key mechanism in the manifestation of aggressive and antisocial behaviour are confirmed for adolescents at risk taken from a community sample.

Escalated aggressive behavior: Dopamine, serotonin and GABA

The ethical dilemma in aggression research is how to reconcile two divergent objectives, namely to avoid harm and injury as much as possible and, at the same time, how to study behavioral phenomena that validly represent the essence of the neurobiology of aggression. Clinical and preclinical aggression research focuses on different types of aggression. Preclinical studies are usually stimulated by an ethological approach and focus on the phylogeny, ontogeny, survival value and neural mechanisms of ritualized displays and signals. On the other hand, clinical studies focus on violent individuals and pathologically excessive forms of aggressive behavior. This review emphasizes research on escalated forms of aggression in animals and humans and their pharmacotherapy. The current experimental models to generate escalated levels of aggressive behavior in laboratory rely on social instigation, frustrative non-reward and alcohol drinking. These types of aggression are modulated by canonical neurotransmitters like dopamine, serotonin (5-HT) and GABA. It continues to be a main goal of much neurobiological research to find potential targets of pharmacological agents that interact with dopaminergic, GABAergic and serotonergic systems and have high efficacy and selectivity to reduce excessive levels of aggressive and violent behaviors without side-effects. While the mesocorticolimbic dopamine system is implicated in the initiation, execution, termination and consequences of aggressive behavior, drugs with a high affinity for dopamine D2 receptors lack specificity for reducing aggressive behavior. Current investigations point to 5-HT(1B) receptor subtypes as particularly relevant. First, they are differentially expressed in aggression-prone individuals relative to those who are not excessively aggressive. Second, these and also other 5-HT receptor subtypes emerge to be significant targets for anti-aggressive interventions. Positive modulators of GABA(A) receptors with specific subunit configuration may be relevant for heightening aggression, and these sites may be targets for intervention. A prerequisite for rational pharmacotherapies will be adequate characterization of serotonergic and GABAergic receptor regulation in individuals exhibiting escalated aggression.

Méta-analyse des gènes candidats dans le trouble déficit attentionnel avec hyperactivité (TDAH)

Attention-deficit hyperactivity disorder (ADHD) is a common behavioral disorder observed during childhood, detected in 3% to 5% of school-age children. The disorder is characterised by marked inattention, hyperactivity, and impulsiveness. In most cases, symptoms can be treated by catecholamine-releasing drugs, such as methylphenidate. Children with ADHD are at higher risk for substance abuse and oppositional, conduct and mood disorders. Familial and adoption studies shed light on the genetic vulnerability of ADHD. Twin studies estimated the broad heritability to range between 40% and 90%. The mode of transmission is yet unknown, but is likely polygenic. Molecular genetic studies in ADHD should contribute to a greater understanding of the pathophysiology of the disorder (genetics of the vulnerability), and could help to select a more rational type of treatment (pharmacogenetic). Family-based association studies already performed are reviewed in this manuscript. Association studies, using haplotype relative risk (HRR) or transmission disequilibrium test (TDT) have focused on candidate genes which code for proteins potentially involved in the etiopathogenesis of the disorder. Genes involved in dopamine, serotonin, and noradrenalin systems have thus been assessed for their role in core features of ADHD, such as motor overactivity, inattention, and impulsiveness. According to a meta-analysis, the DAT1 gene, an obvious candidate gene in ADHD vulnerability, does not appear to be involved (OR = 1.13, p = 0.21). On the other hand, DRD4 (OR = 1.26, p = 0.01) and DRD5 (OR = 1.4, p = 0.01) are significantly associated to ADHD according to the present meta-analysis, confirming previous ones. Recent studies showed a trend for an association between one allele of the 5-HTT (considering case-control studies) and DBH (OR = 1.27, p = 0.06) genes and ADHD, but these positive findings have to be replicated. ADHD is a complex disorder with potentially many different risk factors. Genetic and phenotypic heterogeneity could explain why some association studies are positive, whereas others are negative. For instance, different developmental pathways are likely to lead to similar clinical outcomes. More clear-cut phenotypes, such as ADHD with conduct disorder, or ADHD with bipolar disorder, could be more homogenous, the genes involved being therefore more easy to detect. These phenotypes are beginning to be specifically studied in molecular genetics. In addition, the development of pharmacogenetics could help to identify predictors of clinical response for a specific type of treatment, which would be clearly helpful in clinical practice.

The UCSD Statin Study: a randomized controlled trial assessing the impact of statins on selected noncardiac outcomes

There has been persistent controversy regarding possible favorable or adverse effects of statins or of cholesterol reduction on cognition, mood and behavior (including aggressive or violent behavior), muscle function, and quality of life. The UCSD Statin Study seeks to ascertain the beneficial or adverse effects of statin cholesterol-lowering drugs on a set of noncardiac endpoints, including cognition, behavior, and serotonin biochemistry. The study will enroll 1000 subjects (minimum 20% female) of mixed ethnicity from San Diego. Subjects must be age 20 and older, postmenopausal if female, without known cardiovascular disease or diabetes, and with LDL-cholesterol between 115 and 190 mg/dl. Subjects will be randomized to a double-blind, placebo-controlled trial with assignment 1/3, 1/3, 1/3 to placebo, simvastatin 20 mg, or pravastatin 40 mg (equipotent LDL-cholesterol-lowering doses for drug arms with simvastatin and pravastatin chosen to represent the extremes of the lipophilicity spectrum) for 6 months of treatment followed by 2 months postcessation follow-up. Primary outcomes are cognition (cognitive battery), irritability/aggression (behavior measure), and serotonin (gauged by whole blood serotonin), assessed as the difference between baseline and 6 months, judging combined statin groups vs. placebo. Secondary outcomes include mood (CES-D and Wakefield depression inventory), quality of life (SF-12V), sleep (Leeds sleep scale, modified), and secondary aggression measures (Conflict Tactics Scale; Overt Aggression Scale, Modified). Cardiovascular reactivity will be examined in a 10% subset. As additional secondary endpoints, primary and selected secondary outcomes will be assessed by statin assignment (lipophilic simvastatin vs. hydrophilic pravastatin). "Reversibility" of changes, if any, at 2 months postcessation will be determined. If effects (favorable or unfavorable) are identified, we will seek to ascertain whether there are baseline variables that predict who will be most susceptible to these favorable or adverse noncardiac effects (i.e., effect modification).

Platelet serotonin content correlates inversely with life history of aggression in personality-disordered subjects

The objective of this study was to test the hypothesis that platelet serotonin (5-hydroxytryptamine, 5-HT) content is correlated with measures of aggression in healthy human subjects. Platelet 5-HT content (ng/mg protein) was measured in personality-disordered (PD) and normal control (NC) subjects. Aggression was assessed with the Life History of Aggression (LHA), the Buss-Durkee Hostility Inventory (BDHI), and the Motor Aggression and Research Criteria for Intermittent Explosive Disorder (IED-IR); impulsivity was assessed with the Eysenck Personality Questionnaire II (EPQII) and the Barratt Impulsiveness Scale (BIS-11). LHA Aggression, but not impulsivity, scores showed significant inverse correlations with platelet 5-HT content in all subjects or in PD subjects alone. The findings in PD subjects remained significant after co-varying for race. PD subjects with IED-IR had lower platelet 5-HT content compared with PD subjects who did not have IED-IR, although this finding only approached significance after controlling for race. This study demonstrates an association between reduced platelet 5-HT content and aggression in PD subjects. Similar to other studies of platelet 5-HT markers, these data suggest that platelet 5-HT content may also reflect central 5-HT alterations and may be used as a biological marker in appropriate patient samples.

Recent trends in the pharmacotherapy of personality disorders

This article reviews pharmacologic trials conducted between 2000 and 2003 directed at the treatment of borderline personality disorder, antisocial personality disorder, and schizotypal personality disorder. Atypical antipsychotics, antiepileptics, selective serotonin reuptake inhibitors, omega fatty acids, and opioid antagonists have all been studied in the treatment of borderline personality disorder with positive results. Atypical antipsychotics have been studied in both schizotypal personality disorder and antisocial personality disorder, again with encouraging outcome reports. Implications of personality changes in response to pharmacologic treatment are discussed. Based on the prevalence of these disorders and the burden they cause to afflicted individuals and society, further trials are unequivocally indicated.

Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II

OBJECTIVE

To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD).

METHOD

Selected summaries of the literature over the past decade are presented.

RESULTS

Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains.

CONCLUSIONS

Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.

The pharmacological treatment of autistic spectrum disorders

What role do medications play in the overall treatment of autistic spectrum disorders? In this review, the decision-making process involving identifying symptoms, initiating a pharmacological intervention, and monitoring that process is discussed. A review of the literature with an emphasis on controlled trials in autistic spectrum disorders is also undertaken.

Serotonin platelet-transporter measures in childhood attention-deficit/hyperactivity disorder (ADHD): clinical versus experimental measures of impulsivity

Impulsivity in terms of aggression, suicide or poor cognitive control has been associated with low synaptic availability of serotonin (5-HT) in adults and children. However, characteristics of the 5-HT transporter have not been studied in children with attention-deficit/hyperactivity disorder (ADHD: combined type), where impulsivity is a core symptom. Here, we explored in 20 children with ADHD the relationship of the density (Bmax) and affinity (Kd) of the platelet 5-HT transporter measured with [3H]paroxetine to both clinical ratings of impulsivity (Conners' Parent Questionnaire), and an experimental measure of impulsivity (the ability to withhold a prepotent response in the "stop-signal" paradigm). Decreases of affinity (increased Kd) correlated with a low probability of response inhibition, but not with the clinical ratings of impulsivity. However, ratings of distractibility and impulsivity correlated with the experimental measure of response-inhibition. In contrast, increased transporter affinity (low Kd) correlated modestly with higher ratings of aggressive and externalising behaviour. Bmax was not associated with any behavioural score. We conclude that the synaptic availability of 5-HT is under the control of the 5-HT transporter binding site affinity and that low affinity may be related to cognitive impulsivity (distractibility). Increased affinity of the transporter may also be related to conduct disturbance.

Biochemical, behavioral, physiologic, and neurodevelopmental changes in mice deficient in monoamine oxidase A or B

The availability of mutant mice that lack either MAO A or MAO B has created unique profiles in the central and peripheral availability of serotonin, norepinephrine, dopamine, and phenylethylamine. This paper summarizes some of the current known phenotypic findings in MAO A knock-out mice and contrast these with those of MAO B knock-out mice. Differences are discussed in relation to the biochemical, behavioral, and physiologic changes investigated to date, as well as the role played by redundancy mechanisms, adaptational responses, and alterations in neurodevelopment.

Antisoziales Verhalten im Jugendalter: Entstehungsbedingungen und Verlaufsformen

Zusammenfassung: Ausmaß und Verbreitung von Gewalt und Delinquenz unter Kindern und Jugendlichen haben in den letzten 15 Jahren kontinuierlich zugenommen. Bei dem Bestreben, dieser Entwicklung entgegenzuwirken, können neuere Erkenntnisse der entwicklungspsychopathologischen und neurobiologischen Forschung wichtige Hilfestellung leisten. In einem Modell von Moffitt werden zwei Entwicklungswege antisozialer Verhaltensprobleme beschrieben, die sich hinsichtlich des Störungsbeginns und -verlaufs unterscheiden: ein Pfad, der durch eine frühzeitig einsetzende und über den Lebenslauf stabile Symptomatik charakterisiert ist (“life-course persistent”), sowie ein Pfad mit einem episodenhaften, auf das Jugendalter begrenzten Auftreten antisozialer Auffälligkeiten (“adolescence-limited”). Während im letzteren Fall die spezifischen Entwicklungsaufgaben und Lebensbedingungen Jugendlicher eine maßgebliche Rolle bei Entstehung und Verlauf spielen, entsteht persistentes antisoziales Verhalten als Resultat eines transaktionalen Prozesses zwischen Kind und Umwelt. Neben psychosozialen Faktoren kommt dabei biologischen Prädispositionen (genetische Belastung) und psychologischen Dispositionen (Temperaments- und Persönlichkeitsmerkmale) eine zentrale Bedeutung zu. Wichtige Aufschlüsse über die zugrunde liegenden Mechanismen versprechen die jüngsten Fortschritte der neurobiologischen und persönlichkeitspsychologischen Forschung. Die Integration beider Ansätze kann dazu beitragen, Maßnahmen der Prävention und Frühintervention zielgruppenorientierter auszurichten und damit wirkungsvoller zu gestalten.

Effects of group selection for productivity and longevity on blood concentrations of serotonin, catecholamines, and corticosterone of laying hens

Selection of a line of White Leghorn chickens for high group productivity and longevity resulted in reducing cannibalism and flightiness in multiple-hen cages. Improvements in survival might have been due to changes of physiological homeostasis. The objective of the present study was to test the hypothesis that genetic selection for high (HGPS) and low (LGPS) group productivity and survivability also altered regulation of neuroendocrine homeostasis. Hens were randomly assigned to individual cages at 17 wk of age. At 21 wk of age, blood concentrations of dopamine, epinephrine, norepinephrine, and serotonin were measured using HPLC assay. Blood concentrations of corticosterone were measured using radioimmunoassay. The LGPS hens had greater blood concentrations of dopamine and epinephrine than the HGPS hens (P < 0.01). The blood concentration of norepinephrine was not significantly different between the lines, but the ratio of epinephrine to norepinephrine was greater in the LGPS hens (P < 0.01). The blood concentrations of serotonin were also higher in the LGPS hens compared to those in the HGPS hens (P < 0.01). Although the HGPS hens tended to have a higher level of blood corticosterone, the difference was not significant (1.87 +/- 0.19 vs. 1.49 +/- 0.21 ng/mL; P = 0.08). The results suggest that selection for group productivity and survivability alters the chickens' neuroendocrine homeostasis, and these changes may correlate with its line-unique coping ability to domestic environments and survivability.

Relationship between impulsivity and platelet serotonin content in adolescents

The relationship between impulsivity and serotonin function was explored in impulsive and non-depressed adolescents. Platelet serotonin content was chosen as a peripheral indicator of central serotonin function. Impulsivity was assessed with a questionnaire. All measures were performed once a week over a 6-week period for all subjects. Subjects comprised eight adolescent inpatients who were hospitalized as a result of their impulsive acts and eight healthy age- and sex-matched control subjects. Mean platelet serotonin concentration was significantly higher in the impulsive group than in the control group. Platelet serotonin concentration was positively correlated with the intensity of impulsivity in the patient group.

Ultradian rapid cycling in prepubertal and early adolescent bipolarity is not in transmission disequilibrium with val/met COMT alleles

BACKGROUND

Prepubertal children and early adolescents with bipolar disorders (PEA-BP) who participate in the ongoing study "Phenomenology and Course of Pediatric Bipolar Disorders" have a high prevalence of ultradian (within 24-hour periods) rapid cycling. Based on a case-control finding reported in bipolar (BP) adults of an association between rapid and ultradian rapid cycling with the low-activity allele of catechol-O-methyltransferase (l-COMT), study of linkage and linkage disequilibrium of l-COMT in the PEA-BP population seemed warranted.

METHODS

Genotypes on a subset of the larger PEA-BP sample, for whom trio blood collection was complete (i. e., probands and both of their biological parents), were used to perform transmission disequilibrium tests (TDTs). Diagnoses were established from a comprehensive battery that included WASH-U-KSADS (Washington University Kiddie Schedule for Affective Disorders and Schizophrenia) given to both mothers and children and from consensus conferences. Probands with PEA-BP (N = 52) were 10.9 +/- 2.8 years old at index episode; had a mean age of BP onset at 8.0 +/- 3.8 years; were severely impaired, with a mean Children's Global Assessment Scale score of 44.5 +/- 8.9; and manifested the cardinal features of BP (84.6% had euphoric mood, 76.9% had grandiosity, and 57.7% had psychosis). Ultradian rapid cycling occurred in 75%. Genotyping of the single nucleotide polymorphism at COMT was performed using automated capillary electrophoresis single-strand conformational polymorphism with detection by laser-induced fluorescence.

RESULTS

Transmission disequilibrium tests were not significant for preferential transmission of l-COMT for the ultradian rapid-cycling subgroup or for the entire PEA-BP sample.

CONCLUSIONS

The lack of linkage disequilibrium between l-COMT and ultradian rapid cycling in the PEA-BP sample compared to reported findings of an association in case-control studies of adults is discussed in terms of age-specific developmentally relevant phenotypes, anticipatory mechanisms, and heterogeneity. Repeat TDT analyses after these PEA-BP probands reach their adult phenotypes will be informative.

Ketanserin and tetrabenazine abolish aggression in mice lacking monoamine oxidase A

Mice deficient in monoamine oxidase A (MAO A) have elevated brain levels of 5-HT and manifest enhanced aggression. We used these mice as a model to study the role of 5-HT in aggression. Our results show that ketanserin and tetrabenazine (TBZ) strikingly abolished the aggressive behavior of MAO A-deficient mice. The anti-aggressive effect of ketanserin may be primarily mediated by 5-HT(2A) receptors. Another specific 5-HT(2A) antagonist, [R-(+)-a-(2, 3-dimethoxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-piperidine-methan ol (MDL 100907), also blocks the aggression of mutant mice but was less dramatic. Ketanserin and TBZ are both antagonists of the vesicular monoamine transporter (VMAT2). The anti-aggressive effect of TBZ and part of the effect of ketanserin may be mediated by the VMAT2. Using radioligand binding and autoradiography, we also showed that the numbers of VMAT2, 5-HT(1A), 5-HT(2A) and 5-HT(2C) sites are decreased in brains of mutant mice, which may reflect down-regulation by excess 5-HT. This study suggests that ketanserin and TBZ may be developed as novel anti-aggressive agents.

Serotonin transporter gene (HTTLPR) is not in linkage disequilibrium with prepubertal and early adolescent bipolarity

BACKGROUND

As part of an ongoing, larger study, "Phenomenology and Course of Pediatric Bipolarity", a subset of prepubertal and early adolescent onset bipolar (PEA-BP) probands, on whom trio blood collection was complete, were used to study genetic transmission of the serotonin transporter linked promoter region (HTTLPR) short and long alleles using the transmission disequilibrium test(TDT). The HTTLPR alleles were selected based on postulated serotonergic mechanisms for PEA-BP and on the burgeoning number of HTTLPR allele studies in bipolar (BP) adults.

METHODS

There were 46 complete trios of PEA-BP probands and both biological parents. Probands had a mean age of 11.1 +/- 3.0 years and a mean age of onset of PEA-BP of 8.1 +/- 4.0 years. Comprehensive diagnostic assessments included a semi-structured research interview, the WASH-U-KSADS, administered separately to mothers and to children by blind raters. Probands manifested severe impairment (CGAS 43.9 +/- 8.9), elated mood (84.8%), grandiosity (78.3%), rapid cycling (78.3%) and psychosis (63.0%). The HTTLPR length variant was genotyped using fluorescently labeled primers and automated capillary electrophoresis using laser-induced fluorescence.

RESULTS

The TDT was not significant (TDT chi square = .020, df = 1, p = .89).

CONCLUSIONS

This negative result is consistent with the one negative TDT and two negative linkage studies of HTTLPR alleles in bipolar adults in the literature.

Whole blood serotonin relates to violence in an epidemiological study

BACKGROUND

Clinical and animal studies suggest that brain serotonergic systems may regulate aggressive behavior; however, the serotonin/violence hypothesis has not been assessed at the epidemiological level. For study of an epidemiological sample we examined blood serotonin, because certain physiological and behavioral findings suggested that it might serve as an analog marker for serotonergic function.

METHODS

Whole blood serotonin was measured in a representative birth cohort of 781 21-year-old women (47%) and men (53%). Violence was measured using cumulative court conviction records and participants' self-reports. Potential intervening factors addressed were: gender, age, diurnal variation, diet, psychiatric medications, illicit drug history, season of phlebotomy, plasma tryptophan, platelet count, body mass, suicide attempts, psychiatric diagnoses, alcohol, tobacco, socioeconomic status, IQ, and overall criminal offending.

RESULTS

Whole blood serotonin related to violence among men but not women. Violent men's mean blood serotonin level was 0.48 SD above the male population norm and 0.56 SD above the mean of nonviolent men. The finding was specific to violence, as opposed to general crime, and it was robust across two different methods of measuring violence. Together, the intervening variables accounted for 25% of the relation between blood serotonin and violence.

CONCLUSIONS

To our knowledge, this is the first demonstration that an index of serotonergic function is related to violence in the general population.