Fluoxetine and Impulsive Aggressive Behavior in Personality-Disordered Subjects

Body dysmorphic disorder (BDD) is a relatively common and impairing disorder. However, little is known about non-BDD symptoms and well-being in patients with this disorder. Seventy-five outpatients with DSM-IV BDD completed the Symptom Questionnaire, a validated self-report measure with four scales: depression, anxiety, somatic/somatization, and anger-hostility. Scores were compared to published norms for normal subjects and psychiatric outpatients. Participants in an openlabel fluvoxamine trial completed the Symptom Questionnaire at baseline and endpoint. Compared to normal controls, BDD subjects had markedly elevated scores on all four scales, indicating severe distress and psychopathology. Compared to psychiatric patients, BDD subjects had higher scores on the depression, anxiety, and anger/hostility scales but not on the somatic/somatization scale. Scores on all scales significantly decreased with fluvoxamine. In conclusion, patients with BDD have markedly high levels of distress, are highly symptomatic, and have poor well-being in the domains of depression, anxiety, somatic symptoms, and anger-hostility. All of these symptoms significantly improved with fluvoxamine. Keywordsbody dysmorphic disorder; depression; anxiety; hostility; somatic symptoms Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a distressing and relatively common disorder (1-4). BDD frequently causes impaired functioning, such as social isolation and difficulties in occupational and academic functioning (1,2). Patients with BDD also have notably poor mental health-related quality of life (5) and high lifetime rates of psychiatric hospitalization (48%), suicidal ideation (45%-82%), and suicide attempts (22%-24%) (1,6). However, relatively little is known about non-BDD symptoms and well-being in patients with BDD.Regarding non-BDD symptoms in patients with this disorder, BDD pharmacotherapy studies have reported mild to moderate depressive symptoms on the Hamilton Depression Rating Scale (HAM-D) (7,8) and the MADRS (8). A report of patients who were treated with medication, intensive cognitive behavioral therapy, and rehabilitation in a residential treatment setting found that BDD patients had higher pre-treatment scores on the HAM-D and Hamilton Anxiety (HAM-A) scale than patients with obsessive compulsive disorder (OCD) treated in the same setting (9); BDD patients' HAM-A scores were in the moderate to severe range. In a small open-label BDD fluvoxamine study (n = 12) by Perugi and colleagues, on the self-report Hopkins Symptom Checklist-90, subjects reported that they were distressed by depression "moderately" to "quite a bit" and by anxiety "a little bit" to "moderately" (10). BDD patients also have elevated levels of perceived stress, with scores that are notably higher than those in a large national probability sample and in most normal, medical, and psychiatric samples (11).In this study, we assessed symptoms and well-being in the domains of depression, anxiety, somatic/somatization, and anger-hostility using ...

ABSTRACT-The effect of the malnutrition during suckling on the aggressiveness was investigated in adult rats treated or not with citalopram, a selective serotonin reuptake inhibitor (SSRI). The animals were divided into two groups according to the diet used: nourished group the rats received the control diet with 23% protein during the life; and malnourished group the rats had its mothers submitted to diet with 7.8% protein during suckling. At 120 days of age, each group was sub-divided according to the treatment: acute consisting a single i.p. injection of saline solution or 20-mg/Kg citalopram; chronic consisting the single injections (1 per day during 14 days) of saline or 20 mg/Kg citalopram. The acute or chronic treatment with SSRI reduces aggressive response in nourished rats, but not in malnourished ones. Thus, the malnutrition during the critical period of brain development seems to induce durable alterations in the function of the serotoninergic neurotransmission KEY WORDS: aggressive behavior, malnutrition, serotonin.Ação de inibidor seletivo da recaptação de serotonina sobre comportamento agressivo em rato adulto submetido à desnutrição neonatal RESUMO -O efeito da desnutrição durante a lactação sobre a agressividade foi investigado em ratos adultos tratados ou não com citalopram, um inibidor seletivo da recaptação de serotonina (ISRS). Os animais foram divididos em dois grupos de acordo com a dieta: grupo nutrido ratos que receberam toda a vida dieta controle (23% de proteína); e grupo desnutrido ratos que tiveram suas mães submetidas a dieta com 7,8% de proteína na lactação. Aos 120 dias de idade, cada grupo foi sub-dividido conforme o tratamento: agudo consistindo de injeção única i.p. de solução salina ou 20mg/Kg de citalopram; crônico -consistindo de injeções únicas (1 por dia durante 14 dias) de salina ou 20mg/Kg de citalopram. O tratamento agudo ou crônico com ISRS reduziu a resposta agressiva nos ratos nutridos, mas não nos desnutridos. Assim, a desnutrição durante o período crítico de desenvolvimento do cérebro parece acarretar alterações duradouras na função da neurotransmissão serotoninérgica. PALAVRAS-CHAVE: comportamento agressivo, desnutrição, serotonina.

Abnormal fronto-amygdala circuitry has been implicated in impulsive aggression, a core symptom of borderline personality disorder (BPD). We examined relative glucose metabolic rate (rGMR) at rest and after m-CPP (meta-chloropiperazine) with 18 fluorodeoxyglucose (FDG) with positron emission tomography (PET) in 26 impulsive aggressive (IED)-BPD patients and 24 controls. Brain edges/amygdala were visually traced on MRI scans co-registered to PET scans; rGMR was obtained for ventral and dorsal regions of the amygdala and Brodmann areas within the prefrontal cortex (PFC). Correlation coefficients were calculated between rGMR for dorsal/ventral amygdala regions and PFC. Additionally, amygdala volumes and rGMR were examined in BPD and controls. Correlations PFC/amygdala Placebo: Controls showed significant positive correlations between right orbitofrontal (OFC) and ventral, but not dorsal, amygdala. Patients showed only weak correlations between amygdala and the anterior PFC, with no distinction between dorsal and ventral amygdala. Correlations PFC/amygdala: m-CPP response: Controls showed positive correlations between OFC and amygdala regions, whereas patients showed positive correlations between dorsolateral PFC and amygdala. Group differences between interregional correlational matrices were highly significant. Amygdala volume/metabolism: No group differences were found for amygdala volume, or metabolism in the placebo condition or in response to meta-chloropiperazine (m-CPP). We demonstrated a tight coupling of metabolic activity between right OFC and ventral amygdala in healthy subjects with dorsoventral differences in amygdala circuitry, not present in IED-BPD. We demonstrated no significant differences in amygdala volumes or metabolism between BPD patients and controls.