Serotonin and Disruptive Behaviour; A Critical Evaluation of the Clinical Data

Abstract

Over the past two decades, several clinical studies have addressed the relationship between aggression, impulsivity and other aspects of disruptive behaviour and indicators of central serotonergic function, particularly hormonal challenge tests and CSF 5-HIAA measurements. Analysis of the 23 studies on CSF 5-HIAA and the 11 studies using challenge tests does not reveal unequivocal support for the serotonin–aggression hypothesis. Taking all the data together, it appears the disturbances in central serotonin neurotransmission, as reflected by lower CSF 5-HIAA levels or blunted prolactin response to a serotonergic challenge compound, may be present in a subgroup of relatively young, male, personality-disordered patients. It is furthermore hypothesized that the functional state of monoaminergic neurotransmission should be studied in relation to the corticosteroid–stress neurobiological systems in order to obtain relevant data about the contribution of genetic, developmental and biological components in the evolvement of aggressive spectrum disorders.