Indices of Serotonin and Glucose Metabolism in Violent Offenders, Arsonists, and Alcoholics

In recent years, there have been several reports of studies on central monoamine metabolites in patients exhibiting suicidal behaviors. The first such report was by Asberg et aL, who found a bimodal distribution of levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the lumbar cerebrospinal fluid (CSF) of 68 depressed patients.‘ Significantly more of the depressed patients in the low CSF 5HIAA mode had attempted suicide in comparison with those in the high mode, leading to the proposal that low CSF 5-HIAA levels may be associated with suicidal behaviors. Since then other studies in personality disordered:” schizophrenic,4.s and depressed patients6” have also reported an association between low levels of CSF 5-HIAA and aggressive and suicidal behaviors, though there have also been some negative reports.8-” It is of note that low CSF 5-HIAA levels have been particularly associated with violent suicide attempts. In fact, in an early study, Traskman et al. reported that CSF 5-HIAA levels were significantly lower only among those patients who had made a violent suicide attempt (hanging, drowning, shooting, gassing, several deep cuts), and that levels were not reduced among those who had made a nonviolent suicide attempt (overdosage).” More recently Banki et al. also found that among 141 female psychiatric patients suffering from depression, schizophrenia, alcoholism, or adjustment disorder, levels of CSF 5-HIAA were significantly lower in the violent suicide attempters in all four diagnostic categofies.’2