[Role of the orbitofrontal cortex in moral judgment]

The neural substrates of moral judgments have recently been advocated to consist of widely distributed brain networks including the orbitofrontal cortex (OFC), anterior temporal lobe and superior temporal gyrus. Moral judgments could be regarded as a conflict between the top-down rational/logical processes and the bottom-up irrational/emotional processes. Individuals with OFC damage are usually difficult to inhibit emotionally-driven outrages, thereby demonstrating severe impairment of moral judgments despite their well-preserved moral knowledge. Individuals with OFC damage frequently present with anti-social less moral behaviors. However, clinical observation indicates that some OFC patients may show "hypermoral" tendency in the sense that they are too strict to overlook other person's offense. Two representative cases with OFC damage were reported, both presented with extreme rage against others' offensive behaviors. To further elucidate the "hypermorality" of OFC patients, an experiment was performed in which patients with OFC damage and healthy control participants were asked to determine punishments for other's fictitious crimes that varied in perpetrator responsibility and crime severity. Individuals with OFC damage punished more strictly than healthy controls those persons for mitigating circumstances. The results are consistent with clinical observation of OFC patients' highly rigid and inflexible behaviors against third person's offense.

An experimental 'dissection' of the septal syndrome

I present evidence from several different lines of investigation (including partial lesions, intraseptal and intrahippocampal drug injections, and surgical transections of the major fibre systems that enter, leave, or traverse the area) which indicates that individual components of the septal syndrome in the rat and cat reflect an interruption of different neural elements. The 'disinhibitory' effects of septal lesions on behaviour that is suppressed as a consequence of non-reward are due to an interruption of septo-hippocampal (or hippocampo-septal) connections that do not have a cholinergic synapse in the septum but do have one in the hippocampus. The inhibitory effects of punishment are not mediated by the same pathways but involve amygdalo-septal (no directionality intended) projections that have a cholinergic synapse in the septal area. This component of the septum may communicate with the hippocampus via entorhinal and periamygdaloid projections. This pathway does not appear to have a cholinergic synapse in the hippocampus. The effects of septal lesions on active avoidance are related to an interruption of at least two pathways. The facilitated shuttle box conditioned avoidance response acquisition is related mainly to an interruption of ventral connections of the septum with the lower brainstem. The impaired acquisition of most other avoidance problems seems to be due to an interruption of components of the stria medullaris. Both pathways have a cholinergic synapse in the septal area. The hyperdipsia, finickiness, and sudden weight loss are related to an interruption of pathways that interconnect the septum with the lower brainstem.

Role of IL-1 beta and 5-HT2 receptors in midbrain periaqueductal gray (PAG) in potentiating defensive rage behavior in cat

Feline defensive rage, a form of aggressive behavior that occurs in response to a threat can be elicited by electrical stimulation of the medial hypothalamus or midbrain periaqueductal gray (PAG). Our laboratory has recently begun a systematic examination of the role of cytokines in the regulation of rage and aggressive behavior. It was shown that the cytokine, interleukin-2 (IL-2), differentially modulates defensive rage when microinjected into the medial hypothalamus and PAG by acting through separate neurotransmitter systems. The present study sought to determine whether a similar relationship exists with respect to interleukin 1-beta (IL-1 beta), whose receptor activation in the medial hypothalamus potentiates defensive rage. Thus, the present study identified the effects of administration of IL-1 beta into the PAG upon defensive rage elicited from the medial hypothalamus. Microinjections of IL-1 beta into the dorsal PAG significantly facilitated defensive rage behavior elicited from the medial hypothalamus in a dose and time dependent manner. In addition, the facilitative effects of IL-1 beta were blocked by pre-treatment with anti-IL-1 beta receptor antibody, while IL-1 beta administration into the PAG had no effect upon predatory attack elicited from the lateral hypothalamus. The findings further demonstrated that IL-1 beta's effects were mediated through 5-HT(2) receptors since pretreatment with a 5-HT(2C) receptors antagonist blocked the facilitating effects of IL-1 beta. An extensive pattern of labeling of IL-1 beta and 5-HT(2C) receptors in the dorsal PAG supported these findings. The present study demonstrates that IL-beta in the dorsal PAG, similar to the medial hypothalamus, potentiates defensive rage behavior and is mediated through a 5-HT(2C) receptor mechanism.

Cardiovascular reactivity of patients with essential and renal hypertension in an emotion-triggering interview

Blood pressure reactivity to mental stress in hypertensives is much higher than in normotensives. The authors' aim in this study was to examine whether different cardiovascular responses can be induced by various stimuli in hypertensive subgroups. The authors matched 10 essential hypertensives (EHs), 10 renal hypertensives (RHs), and 10 normotensives (Ns) according to age and gender examined them during an emotion-stimulating interview, and measured blood pressure (BP) and heart rate (HR) during the phases of the interview. They observed differences in BP reactivity between EHs/RHs and Ns under some stimuli but not between EHs and RHs, as well as a marked difference in the product of systolic BP (SBP) and HR between both hypertensive groups in the anger/rage phase (p = .028) and the baseline 2 (p = .02). This shows a higher cardiovascular activation under mental stress and a lower recovery in EHs and more sensitivity to perturbation or higher central tension compared with RHs.

The neurobiology of aggression and rage: role of cytokines

Recent studies have suggested an important relationship linking cytokines, immunity and aggressive behavior. Clinical reports describe increasing levels of hostility, anger, and irritability in patients who receive cytokine immunotherapy, and there are reports of a positive correlation between cytokine levels and aggressive behavior in non-patient populations. On the basis of these reports and others describing the presence or actions of different cytokines in regions of the brain associated with aggressive behavior, our laboratory embarked upon a program of research designed to identify and characterize the role of IL-1 and IL-2 in the hypothalamus and midbrain periaqueductal gray (PAG)--two regions functionally linked through reciprocal anatomical connections--in the regulation of feline defensive rage. A paradigm involved cytokine microinjections into either medial hypothalamus and elicitation of defensive rage behavior from the PAG or vice versa. These studies have revealed that both cytokines have potent effects in modulating defensive rage behavior. With respect to IL-1, this cytokine facilitates defensive rage when microinjected into either the medial hypothalamus or PAG and these potentiating effects are mediated through 5-HT2 receptors. In contrast, the effects of IL-2 are dependent upon the anatomical locus. IL-2 microinjected into the medial hypothalamus suppresses defensive rage and this suppression is mediated through GABA(A) receptors, while microinjections of IL-2 in the PAG potentiate defensive rage, in which these effects are mediated through NK-1 receptors. Present research is designed to further delineate the roles of cytokines in aggressive behavior and to begin to unravel the possible signaling pathways involved this process.

Psychological presentations without hepatic involvement in Wilson disease

Wilson disease is an autosomal recessive inborn error of copper metabolism that leads to neurologic symptoms and variable degrees of hepatic damage. The most common characteristic signs clinically are liver disease, psychiatric disease, neurologic disease, or a combination of these. Early recognition by means of clinical signs and an early initiation of therapy using chelators or zinc-salts are essential for a good outcome and prognosis. This report describes a male suffering from Wilson disease who exhibited an unusual presentation that included psychological manifestations without hepatic involvement. He was initially treated for attention-deficit hyperactivity disorder and a seizure disorder until brain imaging established the diagnosis of Wilson disease.

Potentiating role of interleukin 2 (IL-2) receptors in the midbrain periaqueductal gray (PAG) upon defensive rage behavior in the cat: role of neurokinin NK(1) receptors

Feline defensive rage is a form of aggression occurring in nature in response to a threatening condition and is elicited under laboratory conditions by electrical stimulation of the medial hypothalamus or midbrain periaqueductal gray (PAG). Since it has recently been shown that cytokines can modulate neurotransmitter release, the present study was designed to determine the effects of administration of interleukin 2 (IL-2) into the PAG upon defensive rage elicited from the medial hypothalamus. Microinjections of relatively low doses of IL-2 into the dorsal PAG significantly facilitated defensive rage behavior elicited from the medial hypothalamus. The specificity of this phenomenon was supported by the following findings: (1) IL-2 induced effects were dose- and time-dependent, (2) the facilitative effects of IL-2 could be completely blocked by pre-treatment of the injection site with either anti-IL-2 or anti-IL-2 receptor antibody and (3) IL-2 administration into the PAG showed no effect upon another form of aggression, namely predatory attack, elicited from the lateral hypothalamus. The findings further demonstrated that the effects of IL-2 were mediated by an NK(1) receptor mechanism since pre-treatment of the PAG with an NK(1) receptor antagonist completely blocked the facilitating effects of IL-2. Immunocytochemical observations supported these findings by demonstrating an extensive pattern of labeling of IL-2Ralpha in the dorsal PAG. The present study thus demonstrates that IL-2 in the dorsal PAG potentiates defensive rage behavior and is mediated through an NK(1) receptor mechanism.

Cytokine modulation of defensive rage behavior in the cat: role of GABAA and interleukin-2 receptors in the medial hypothalamus

Defensive rage behavior is a form of aggressive behavior occurring in nature in response to a threatening stimulus. It is also elicited by stimulation of the medial hypothalamus and midbrain periaqueductal gray (PAG) and mediated through specific neurotransmitter-receptor mechanisms within these regions. Since interleukin (IL)-2 modulates the release of neurotransmitters linked to aggression and rage, we sought to determine whether IL-2 microinjected into the medial hypothalamus would modulate defensive rage. Microinjections of relatively low doses of IL-2 into the medial hypothalamus significantly suppressed defensive rage elicited from the PAG in a dose-dependent manner and in the absence of signs of sickness behavior. Pre-treatment with an antibody directed against IL-2Ralpha or a GABA(A) receptor antagonist blocked IL-2's suppressive effects upon defensive rage. Since the suppression of defensive rage is also mediated by 5-HT(1) receptors in the medial hypothalamus, a 5-HT(1) antagonist was microinjected into this region as a pretreatment for IL-2; however, it did not block IL-2's suppressive effects. Immunocytochemical data provided anatomical support for these findings by revealing extensive labeling of IL-2Ralpha on neurons in the medial hypothalamus. IL-2 microinjected into the medial hypothalamus did not modulate predatory attack elicited from the lateral hypothalamus. In summary, we provide evidence for a novel role for IL-2 in the medial hypothalamus as a potent suppressor of defensive rage behavior. These effects are mediated through an IL-2-GABA(A) receptor mechanism.

Differential effects of NK1 receptors in the midbrain periaqueductal gray upon defensive rage and predatory attack in the cat

This study utilized anatomical and behavioral-pharmacological methods to determine the role of NK(1)-Substance P receptors in the midbrain periaqueductal gray (PAG) in defensive rage behavior in cats. For behavioral pharmacological experiments, monopolar stimulating electrodes were implanted in the medial hypothalamus for elicitation of defensive rage behavior and cannula-electrodes were implanted in the PAG for microinjections of receptor compounds. Microinjections of the NMDA antagonist, AP-7 (2 nmol), into the dorsal PAG blocked defensive rage elicited by medial hypothalamic stimulation, thus establishing the PAG as a synaptic region that receives hypothalamic inputs linked to defensive rage behavior. Microinjections of the NK(1) agonist, GR73632, into the same injection sites facilitated defensive rage in a dose-dependent manner, and also induced spontaneous hissing in five cats. The effects of GR73632 were reduced by pretreatment of the PAG with the NK(1) antagonist, GR82334 (16 nmol), microinjected into the same sites. Microinjections of GR73632 (8 nmol) into the PAG also suppressed predatory attack elicited by stimulation of the lateral hypothalamus. Immunohistochemical methods utilized to detect Substance P and Fos immunoreactivity revealed that neurons in the PAG activated after defensive rage-inducing medial hypothalamic stimulation lie in the same region as Substance-P-immunoreactive processes. Fos immunoreactivity was highest in the dorsomedial aspect of the rostral PAG after medial hypothalamic stimulation. Cats that were unstimulated or that exhibited predatory attack after lateral hypothalamic stimulation had low c-fos expression levels in the PAG. Substance P immunoreactivity was high throughout the dorsal PAG. The results indicate that NK(1) receptors in the PAG potentiate defensive rage and suppress predatory aggression in the cat.

Psychiatric aspects of patients with hypothalamic hamartoma and epilepsy

Uncontrolled rage, while long associated with hypothalamic hamartoma, has not been as extensively studied as the epilepsy. Rage can be more detrimental to quality of life than seizures. It is now realized that behavior and aggression improve after a complete resection of the hypothalamic hamartoma correlating with a good seizure control post-surgically. We report on the longitudinal psychiatric history of a patient with hypothalamic hamartoma and rage whose severe and refractory epilepsy was ultimately treated by thalamic and intrahamartoma chronic stimulation. Our patient did not exhibit sham rage typical of hypothalamic lesions, but rather multifactorial aggressive bouts typical of challenging behaviors seen with mental retardation. The anxious and social features of the aggression suggest that psychiatric interventions, which have been neglected as the emphasis has been on seizure control, are worthwhile in the overall management of this difficult case.

Interleukin-1 beta in the hypothalamus potentiates feline defensive rage: role of serotonin-2 receptors

The neurochemistry of aggression and rage has largely focused on the roles played by neurotransmitters and their receptor mechanisms. In contrast, little attention has been given to the possible functions of other substances. Interleukin-1beta is an immune and brain-derived cytokine that is present in the hypothalamus. Functionally, interleukin-1 has been shown to induce the release of serotonin (5-HT), a neurotransmitter known to potently affect aggression and rage behavior. Thus, the goal of the present study was to test the hypothesis that interleukin-1beta in the medial hypothalamus could modulate defensive rage behavior in the cat. In the first experiment, electrical stimulation of sites in the medial hypothalamus from which defensive rage could be elicited and where microinjections of specific compounds were later placed, facilitated defensive rage elicited from the periaqueductal gray (PAG), thus demonstrating the functional relationship between these two regions. In the second experiment, microinjections of relatively low doses of interleukin-1beta into the medial hypothalamus potentiated defensive rage behavior elicited from the midbrain periaqueductal gray in a dose-related manner. In the third experiment, pretreatment with a selective 5-HT2 receptor antagonist, LY-53857, blocked the facilitating effects of interleukin-1beta upon defensive rage. These findings reveal for the first time that brain cytokines can dramatically alter aggressive behavior. In particular, interleukin-1beta in the medial hypothalamus potentiates defensive rage behavior elicited from the periaqueductal gray in the cat, and the potentiating effects of interleukin-1beta on this form of emotional behavior are mediated via a 5-HT2 receptor mechanism.

Differential modulation of feline defensive rage behavior in the medial hypothalamus by 5-HT1A and 5-HT2 receptors

Previous studies have established that the expression of defensive rage behavior in the cat is mediated over reciprocal pathways that link the medial hypothalamus and the dorsolateral quadrant of the midbrain periaqueductal gray matter (PAG). The present study was designed to determine the roles played by 5-HT(1A) and 5-HT(2C) receptors in the medial hypothalamus on the expression of defensive rage behavior elicited from electrical stimulation of the PAG. Monopolar stimulating electrodes were placed in the midbrain PAG from which defensive rage behavior could be elicited by electrical stimulation. During the course of this study, defensive rage was determined by measuring the latency of the "hissing" component of this behavior. Cannula-electrodes were implanted into sites within the medial hypothalamus from which defensive rage behavior could also be elicited by electrical stimulation in order that serotonergic compounds could be microinjected into behaviorally identifiable regions of the hypothalamus at a later time. Microinjections of the 5-HT(1A) receptor agonist 8-OHDPAT (0.1, 1.0 and 3.0 nmol) into the medial hypothalamus suppressed PAG-elicited hissing in a dose-dependent manner. Administration of the 5-HT(1A) antagonist p-MPPI (3.0 nmol) blocked the suppressive effects of 8-OHDPAT upon hissing. The suppressive effects of 8-OHDPAT were specific to defensive rage behavior because this drug (3 nmol) facilitated quiet biting attack. Microinjections of the 5-HT(2C) receptor agonist (+/-)-DOI hydrochloride into the medial hypothalamus (0.5, 1.0, and 3.0 nmol) facilitated the occurrence of PAG-elicited hissing in a dose-dependent manner. In turn, these facilitating effects were blocked by pretreatment with the selective 5-HT(2) antagonist, LY-53,857, which was microinjected into the same medial hypothalamic site. The findings of this study provide evidence that activation of 5-HT(1A) and 5-HT(2) receptors within the medial hypothalamus exert differential modulatory effects upon defensive rage behavior elicited from the midbrain PAG of the cat.

NK1 receptors in the medial hypothalamus potentiate defensive rage behavior elicited from the midbrain periaqueductal gray of the cat

Defensive rage in the cat occurs naturally in response to a threat and is also elicited by electrical or chemical stimulation over the rostro-caudal extent of the medial hypothalamus and dorsolateral aspect of the periaqueductal gray (PAG). This behavior is mediated over a descending projection from the hypothalamus to the midbrain PAG. The underlying hypothesis for the present study was that medial hypothalamic defensive rage neurons are excited in two ways: by NK(1) receptors and by an ascending input from the PAG. The first aspect of this hypothesis was tested by eliciting defensive rage by electrical stimulation of the PAG and then microinjecting a selective NK(1) agonist and antagonist into the hypothalamus. Microinjections of 16 or 12 nmol/0.25 microl of the NK(1) agonist, GR 73632, resulted in facilitation of defensive rage. These facilitatory effects were then blocked by pretreatment with the NK(1) antagonist, GR 82334. However, microinjections of GR 82334 alone had no effect. The second aspect of the hypothesis was tested by stimulating defensive rage sites in the PAG and using immunohistochemical methods to test for the presence of c-Fos in the hypothalamus. The results revealed the presence of c-Fos immunoreactivity in the medial but not lateral hypothalamus. Overall, the findings indicate that NK(1) receptors in the medial hypothalamus facilitate defensive rage elicited from PAG neurons whose axons project back to the medial hypothalamus. The likely ethological significance of the ascending input is that it allows for potentiation and prolongation of defensive rage in response to a threatening stimulus.

Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children

A micronutrient supplement containing a broad range of dietary minerals and vitamins is being examined for the treatment of mood lability in both adults and children (Kaplan et al. 2001; Popper 2001). During pilot work, two medication-free boys with mood lability and explosive rage were studied in an open-label treatment followed by reversal and retreatment. One child was an 8-year-old with atypical obsessive-compulsive disorder, and the other was a 12-year-old with pervasive developmental delay. Both boys were monitored using the mood and temper items from the Conners Parent Rating Scale, as well as the Child Behavior Checklist. In addition, the boy with atypical obsessive-compulsive disorder was monitored with the child version of the Yale-Brown Obsessive Compulsive Scale. Both boys benefited from the micronutrient supplement when examined in ABAB designs: mood, angry outbursts, and obsessional symptoms improved when initially treated, returned when not taking the supplement, and remitted when the micronutrient supplement was reintroduced. Both boys have been followed and are stable on the nutritional supplement for over 2 years. These cases suggest that mood lability and explosive rage can, in some cases, be managed with a mixture of biologically active minerals and vitamins, without using lithium or other traditional psychopharmacologic agents.

Psychoanalysis in later life

After decades of heeding Freud's admonition against taking patients older than fifty years of age into psychoanalytic treatment, psychoanalysts began to treat them and to report encouraging experiences. This essay is another in a series of case reports that confirms and extends the nature of changes possible in the analytic treatment of elderly patients. In order to demonstrate both specific changes and the possibility of satisfactory terminations with patients of advanced age, the author describes his analytic work with a woman who first consulted him when she was sixty-eight years old.

Serotonin, testosterone and alcohol in the etiology of domestic violence

In a previous study we administered the panicogenic agent sodium lactate to a select group of perpetrators of domestic violence and comparison groups. Results of that study showed that perpetrators exhibited exaggerated lactate-induced fear, panic and rage. In this current study, we compared the cerebral spinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA) and testosterone obtained from perpetrators of domestic violence and a group of healthy comparison subjects. All subjects were assessed for DSM-III-R diagnoses. Perpetrators with alcohol dependence (DV-ALC) (n=13), perpetrators without alcohol dependence (DV-NALC) (n=10) and healthy comparison subjects (HCS) (n=20) were clinically assessed using the Spielberger Trait Anxiety, Brown-Goodwin Aggression Scale, Buss Durkee Hostility Inventory and Straus Conflict Tactics. Following an overnight fast and bed rest, subjects received a lumbar puncture to obtain CSF concentrations of 5-HIAA and testosterone. Perpetrators scored significantly higher on measures of aggression than HCS. DV-NALC had significantly lower concentrations of CSF 5-HIAA and higher Straus Conflict Tactics (CT) physical violence scores than DV-ALC and HCS. DV-ALC had significantly higher concentrations of CSF testosterone than DV-NALC. DV-ALC also had significantly higher Straus CT physical violence scores than HCS. DV-NALC and DV-ALC differed on 5-HIAA concentrations, testosterone concentrations, Straus CT physical violence scores and alcohol dependence. These results suggest that DV-NALC and DV-ALC groups could have different biological mechanisms mediating domestic violence.

Paroxysmal rage as a presenting symptom of the Chiari I malformation. Report of two cases

Signs of meningeal irritation including occipital and cervical pain are common in symptomatic children with the Chiari I malformation. The author reports on two children with Chiari I malformations who presented with a previously undescribed symptom presumably caused by intermittent meningeal irritation: paroxysmal rages. In both cases the rages stopped after decompressive surgery. Evaluation including magnetic resonance imaging should be considered in children with new onset of paroxysmal behavioral disorders.

Cholecystokinin B receptors in the periaqueductal gray potentiate defensive rage behavior elicited from the medial hypothalamus of the cat

Defensive rage behavior is mediated over a descending pathway from the medial hypothalamus to the dorsolateral midbrain periaqueductal gray (PAG) where further integration of this response takes place. The present study sought to determine the roles of CCK-A and CCK-B receptor activation in the PAG in modulating defensive rage behavior. The 'hissing' component of the defensive rage response was used throughout the experiment as the measure of defensive rage behavior. The basic design of the experiment involved placement of monopolar electrodes into the medial hypothalamus from which defensive rage could be elicited and cannula electrodes into the dorsal PAG for purposes of identifying defensive rage sites in this region and for microinjections of CCK compounds into these sites at a later time. Microinjections of the selective CCK-B receptor antagonist, LY288513 (1.05, 4.2, 17.0 nmol/0.25 microliter), into the PAG suppressed the hissing response in a dose- and time-dependent manner. Microinjections of the CCK-B agonist, pentagastrin, (0.5 and 1.0 nmol/0.25 microliter) facilitated the occurrence of defensive rage behavior. Moreover, administration of LY288513 (17 nmol/0.25 microliter) 55 min prior to pentagastrin (1.0 nmol/0.25 microliter) delivery blocked the facilitatory effects of pentagastrin. Administration of the CCK-A antagonist, PD140548 (34 nmol/0.25 microliter), into the PAG failed to alter response latencies for defensive rage behavior. In contrast, microinjections of the CCK-B antagonist, LY288513 (4.2, 17.0 nmol/0.25 microliter), facilitated the occurrence of predatory attack behavior elicited from the lateral hypothalamus. This finding demonstrates the specificity of the effects of CCK-B receptor blockade upon hissing. A combination of immunocytochemical and retrograde tracing procedures using microinjections of Fluoro-Gold (8%, 6 microliters) into the PAG were employed to identify the possible loci of CCK neurons that project to the PAG. The data revealed that neurons labeled for both CCK and Fluoro-Gold were located in the dorsolateral aspect of the midbrain tegmentum, identifying this region as a source of CCK inputs to the PAG. Overall, the findings demonstrate that CCK-B receptors in the PAG potentiate defensive rage behavior and likely suppress predatory attack.

GABA receptor mediated suppression of defensive rage behavior elicited from the medial hypothalamus of the cat: role of the lateral hypothalamus

Recently, our laboratory has demonstrated that predatory attack behavior in the cat, elicited by electrical stimulation of the lateral hypothalamus, is suppressed following activation of the region of the medial hypothalamus from which defensive rage behavior is elicited [Han, Y., Shaikh, M.B., Siegel, A., Medical amygdaloid suppression of predatory attack behavior in the cat: II. Role of a GABAergic pathway from the medial to the lateral hypothalamus, Brain Res., 716 (1996) 72-83.]. The mechanism for this suppression is a direct GABAergic projection from the medial to lateral hypothalamus. The present study tested the hypothesis that the inhibitory relationship between these two regions of hypothalamus is reciprocal, namely, that a GABAergic neuron, which also projects from the lateral to medial hypothalamus, serves to suppress defensive rage elicited from the medial hypothalamus. Monopolar stimulating electrodes were implanted into lateral hypothalamic sites from which predatory attack behavior was elicited. In addition, cannula-electrodes were implanted into the medial hypothalamus for elicitation of defensive rage behavior and for microinjections of GABA compounds. Initially, in the absence of drug administration, the effects of dual stimulation of the lateral and medial hypothalamus upon response latencies were compared with those following single stimulation of the medial hypothalamus alone. Dual stimulation significantly (p<0.01) suppressed defensive rage behavior elicited from the medial hypothalamus. Then, administration of the GABAA receptor antagonist, bicuculline (10-60 pmol), into medial hypothalamic sites from which defensive rage was elicited blocked the suppressive effects of lateral hypothalamic stimulation. The GABAA receptor agonist, muscimol (0.3-30 pmol), microinjected into the medial hypothalamus, suppressed defensive rage elicited by single stimulation of the medial hypothalamus in a dose dependent manner. These suppressive effects of muscimol upon defensive rage were blocked following pretreatment with bicuculline (60 pmol). Administration of muscimol into adjoining regions of the lateral hypothalamus had no effect upon defensive rage, indicating its site specificity. Bicuculline (60 pmol) delivery into the medial hypothalamus had no effect upon defensive rage, suggesting the, presence of a phasic rather than tonic mechanism. A combination of immunocytochemical and retro grade tracing procedures were then employed to determine the origin of the putative GABAergic pathway projecting to the medial hypothalamus. In this experiment, the retrograde tracer, Fluoro-Gold (8%, 0.5 microl), was microinjected through a cannula-electrode in the medial hypothalamus from which defensive rage had been elicited. Following survival periods of 5-6 days, cats were perfused with 4% paraformaldehyde and brain tissue was processed for immunocytochemical staining of GABA neurons. Retrogradely labeled, immunopositively labeled, as well as Fluoro-Gold and GABA labeled cells, were identified in the lateral hypothalamus. Each type of neuron was distributed over wide regions of the lateral hypothalamus, extending from the area immediately caudal to the optic chiasm to the level of the posterior hypothalamus. Together, the behavioral pharmacological and anatomical data provide evidence of a direct inhibitory projection from the lateral to medial hypothalamus whose functions are mediated by GABAA receptors. When coupled with our previous findings, these results reveal the presence of reciprocal GABAergic inhibitory pathways between the medial and lateral hypothalamus. The findings suggest that functions associated with either the lateral or medial hypothalamus, but not both, can be activated at a given time.

Neurotransmitters regulating defensive rage behavior in the cat

This review summarizes recent findings of our laboratory that have been directed at: (1) identifying the neural circuits underlying the expression and modulation of defensive rage behavior in the cat and the neurotransmitters associated with these pathways; and (2) determining which components of the circuitry are affected by alcohol administration and which significantly alter the rage mechanism. The experiments described herein incorporated a number of converging methods, which include brain stimulation, behavioral pharmacology, immunocytochemistry, retrograde tract tracing and receptor binding. For behavioral pharmacological studies, monopolar electrodes and cannula-electrodes were implanted into selected regions along the limbic-midbrain axis for electrical stimulation and local microinfusion of drugs. The findings demonstrated: (1) a direct pathway from the anterior medial hypothalamus to the dorsal periaqueductal gray (PAG) over which this response is mediated. This pathway utilizes excitatory amino acids that act upon NMDA receptors within the midbrain PAG; (2) that the region of the dorsal PAG, from which defensive rage could be elicited, receives other inputs from the basal amygdala that facilitate this response by acting upon NMDA receptors; (3) a pathway from the medial amygdala to the medial hypothalamus that also facilitates defensive rage and whose functions are mediated by substance P receptors within the medial hypothalamus; (4) that the PAG also receives enkephalinergic inputs from the central nucleus of amygdala, which act upon mu receptors, and which powerfully suppress defensive rage; and (5) that recent findings reveal that ethanol administration facilitates defensive rage by virtue of its interactions with the medial hypothalamus, its descending projection to the PAG, and possibly with NMDA receptors within this pathway.

Brain SPECT findings and aggressiveness

Forty adolescents and adults who exhibited aggressive behavior within the six months prior to evaluation by physically attacking another person or destroying property were evaluated with brain SPECT imaging. A control group of 40 psychiatric patients who had never been reported to exhibit aggressive behavior were also studied. The brain SPECT studies were read blind to aggressiveness by nuclear physician on two separate occasions. The interreading reliability was very high. The brain SPECT patterns of the group with aggressive behavior showed significant differences from the control group in several areas of brain. These findings were most often seen in the following combination: decreased activity in the prefrontal cortex, increased activity in the anteromedial portions of the frontal lobes, leftsided increased activity in the basal ganglia and/or limbic system in comparison to the whole brain and focal abnormalities in the left temporal lobe. These findings indicate a possible cerebral perfusion profile for those who exhibit violent or aggressive behavior. Several case studies and the implications for treatment are discussed.

Differential effects of ethanol on feline rage and predatory attack behavior: an underlying neural mechanism

Previous studies have shown that, at certain dose levels, ethanol can exert a powerful, facilitatory effect on aggressive behavior in both animals and humans. In the cat, however, it was discovered that ethanol differentially alters two forms of aggression that are common to this species. Defensive rage behavior is significantly enhanced, whereas predatory attack behavior is suppressed by ethanol administration. One possible mechanism governing alcohol's potentiation of defensive rage behavior is that it acts on the descending pathway from the medial hypothalamus to the midbrain periaqueductal gray (PAG)-an essential pathway for the expression of defensive rage behavior that uses excitatory amino acids as a neurotransmitter. This hypothesis is supported by the finding that the excitatory effects of alcohol on defensive rage behavior are blocked by administration of the N-methyl-D-aspartate antagonist alpha-2-amino-7-phosphoheptanoic acid (AP-7) when microinjected into the periaqueductal gray, a primary neuronal target of descending fibers from the medial hypothalamus that mediate the expression of defensive rage behavior. Thus, the present study establishes for the first time a specific component of the neural circuit for defensive rage behavior over which the potentiating effects of ethanol are mediated.

NMDA receptors in the midbrain periaqueductal gray mediate hypothalamically evoked hissing behavior in the cat

The present study was designed to test the hypothesis that the descending pathway from the medial hypothalamus to the dorsal periaqueductal gray (PAG) is critical for the expression of defensive rage behavior in the cat and utilizes excitatory amino acids as a neurotransmitter. In the first phase of the study, monopolar stimulating electrodes were implanted into the medial hypothalamus from which defensive rage behavior could be elicited by electrical stimulation. For the entire study, the hissing response was used as a measure of defensive rage behavior. Cannula electrodes were implanted into the PAG from which defensive rage sites could be identified and were later used for microinfusion of the NMDA receptor antagonist, DL-2-amino-7-phosphoheptanoic acid (AP-7), into behaviorally identified sites within the PAG. Initially, intracerbral microinjections of the NMDA receptor antagonist, AP-7 (0.2, 2.0 nmol), which were placed directly into sites within the PAG from which defensive rage had been elicited, blocked the occurrence of hypothalamic hissing. Microinjections of similar doses of AP-7 into the PAG also blocked the facilitatory effects of medial hypothalamic stimulation upon hissing behavior elicited from the PAG. However, microinjections of 2 nmol into the PAG had no effect upon hissing that was also elicited from the region of the injection site. This finding indicates that AP-7 selectively blocks hissing elicited from the medial hypothalamus and that the suppressive effects of AP-7 cannot be the result of anesthetic or other nonselective properties of the drug. The next phase of the study, which employed immunohistochemical, receptor autoradiographic techniques, identified NMDA receptors to be present in highest concentrations in the dorsolateral aspect of the PAG where defensive rage is typically elicited. The final phase of the study, which employed a combination of retrograde labeling procedures following microinjections of Fluoro-Gold into defensive rage sites in the dorsal PAG and the immunocytochemical labeling of glutamatergic neurons, identified large numbers of neurons in the medial hypothalamus that were labeled positively for both Fluoro-Gold and glutamate. The overall findings of this study support the hypothesis that descending fibers of the medial hypothalamus that supply the dorsal aspect of the PAG mediate defensive rage behavior and utilize excitatory amino acids that act upon NMDA receptors within the dorsal PAG.

Acute frontal lobe syndrome and dyscontrol associated with bilateral caudate nucleus infarctions

BACKGROUND

A 67-year-old man presented with acute onset of spatial and temporal disorientation, memory loss and associated episodic dyscontrol. Investigations showed infarctions of both caudate nuclei. This patient presented a unique opportunity to study the relationship between the lesions, his behaviour, and neuropsychological testing.

METHOD

Single case report. Investigations included interviews to determine cognitive impairment, i.e. WAIS-R, MMSE, and neurological examination.

RESULTS

Extensive neuropsychological testing revealed severe impairment on tasks requiring planning, memory or abstract thought. These findings are very similar to those seen in Huntington's disease.

CONCLUSIONS

A neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.

Neurobiological factors in aggressive behavior

OBJECTIVE

The author's aim was to review literature in the neurosciences and psychiatric clinical research reports about biological factors in aggression and the pathophysiological mechanisms that accompany aggression in neuropsychiatric syndromes.

METHOD

Studies were located through computer searches of relevant experimental reports and review articles mainly from the last 25 years.

RESULTS

Several studies using neuroimaging and neurophysiological and neuropathological research techniques have identified lesions in the limbic structures, temporal lobes, and frontal lobes of the brain in abnormally aggressive individuals. Several reports have associated deficiency or dysregulation of serotonin with homicidal, suicidal, and impulsive behavior. However, few studies have focused on polypeptides or second messenger systems, although abnormalities in these systems have been reported in patients with neuropsychiatric syndromes who have shown aggressive behavior. Even fewer studies focus on the correlation of brain structures and metabolic markers.

CONCLUSIONS

The understanding of aggressive behavior in psychiatric patients is fragmented. Some explanations are speculative and extrapolated to clinical psychiatric syndromes from experimental data on the neurophysiology of cats, rats, and other mammals. Identification of biochemical markers that can be used in predicting patients' response to pharmacological interventions may be the next step in developing more rational treatment of violent patients.

Neuroanatomy and neurotransmitter regulation of defensive behaviors and related emotions in mammals

1. There is suggestive evidence that the septo-hippocampal system and the amygdala are involved in risk assessment behavior, a response to potential threat possibly related to anxiety. In addition, experimental results have been reported implicating the medial hypothalamus in coordinated escape, while the periaqueductal gray matter (PAG) and the median raphe nucleus serotonergic projection to the hippocampus seem to mediate freezing. The latter defensive behaviors are evoked by distal danger stimuli and may be viewed as manifestations of fear. Finally, there is a sound body of evidence indicating that the PAG commands primitive fight or flight reactions elicited by proximal threat, acute pain or asphyxia. These defense reactions may be related to rage and panic, respectively. In contrast, the lateral septal area and the bed nucleus of the stria terminalis have been shown to exert tonic inhibitory influence on defense. 2. Experimental evidence indicates that gamma-aminobutyric acid (GABA) tonically inhibits defensive behavior in the amygdala, hypothalamus and the PAG, an effect opposed by excitatory amino acids. Among monoamines, serotonin (5-HT) has been suggested to facilitate anxiety in the amygdala while inhibiting panic in the PAG. The role of noradrenaline in defense is less clear, although hypotheses implicating the locus coeruleus in anxiety and panic have been suggested. Among peptides, corticotropin-releasing factor (CRF) acting as a central neurotransmitter is thought to mediate behavioral and physiological effects of acute stress, while opioid peptides have been shown to inhibit defense in the amygdala and in the dorsal PAG. Finally, acetylcholine seems to facilitate defensive behavior in the hypothalamus and the PAG.

Basal amygdaloid facilitation of midbrain periaqueductal gray elicited defensive rage behavior in the cat is mediated through NMDA receptors

The present study tested the hypotheses that: (1) defensive rage behavior elicited from the midbrain periaqueductal gray (PAG) in the cat is facilitated from the basal complex of amygdala; and (2) such facilitation from this region of amygdala is mediated via a pathway in which excitatory amino acids acting upon NMDA receptors within the PAG are utilized as a neurotransmitter. In the first phase of this study, cannula electrodes were implanted into PAG sites for the elicitation of defensive rage behavior as well as for drug delivery. Then, a second monopolar electrode was implanted into the basal nucleus of amygdala from which facilitation of defensive rage could be obtained. As a result of dual stimulation of the basal amygdala and PAG, response latencies for defensive rage were significantly lowered relative to PAG stimulation alone (P < 0.01). In the second phase of this experiment, 3 doses of a selective NMDA receptor antagonist, AP-7 (0.1, 0.5, 1.0 mg/kg), were peripherally (i.p.) administered in 5 animals. The results indicated a significant decrease in the facilitatory effects of amygdaloid stimulation in a dose and time dependent manner (P < 0.001). In the third phase, AP-7 was administered intracerebrally into PAG defensive rage sites in doses of 0.2 and 2.0 nmol. It was noted that intracerebral microinjections of AP-7 at the higher dose (2.0 nmol) also significantly suppressed the facilitatory effects of amygdaloid stimulation (P < 0.01); however, these effects were somewhat less potent then those observed following peripheral drug administration. A fourth phase of the study was conducted at the completion of the pharmacological experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence that substance P is utilized in medial amygdaloid facilitation of defensive rage behavior in the cat

The present study was designed to test the hypothesis that a major excitatory mechanism for the expression of feline defensive rage behavior involves the medial nucleus of the amygdala which utilizes substance P as a neurotransmitter in a direct output pathway that supplies the medial hypothalamus. In phase I of the experiment, stimulating electrodes were implanted into the medial amygdala and cannula electrodes were implanted into the medial and lateral hypothalamus from which defensive rage and predatory attack behavior could be elicited by electrical stimulation, respectively. Response latencies for defensive rage were significantly lowered after dual stimulation of the medial amygdala and medial hypothalamus relative to single stimulation of the medial hypothalamus alone. In phase II, dose- and time-dependent decreases in medial amygdaloid-induced facilitation of defensive rage were observed after the i.p. administration of the NK1 antagonist, CP-96,345 (0.05, 2 and 4 mg/kg). In phase III of the study, the effects of microinjections of CP-96,345 placed directly into defensive rage sites within the medial hypothalamus (0.05, 0.5 and 2.5 nmol) upon medial amygdaloid modulation of this response were assessed. Again, intracerebral administration of this antagonist blocked the facilitatory effects of medial amygdaloid-induced facilitation of defensive rage in a manner parallel to that observed with peripheral administration of the NK1 antagonist. The results suggest that the medial amygdala facilitates defensive rage by acting through a substance P mechanism at the level of the medial hypothalamus. Other experiments revealed that peripheral administration of the NK1 antagonist: (1) had little upon the latency or threshold for elicitation of defensive rage, suggesting that the medial amygdaloid-substance P facilitatory mechanism acts in a phasic rather than tonic manner; and (2) also blocks the suppressive effects of medial amygdaloid stimulation upon predatory attack behavior elicited from the lateral hypothalamus. The latter finding suggest that similar neurochemical mechanisms regulate medial amygdaloid modulation of both forms of hypothalamically elicited aggression. The final aspect of this study utilized the combination of retrograde-tracing of amygdaloid neurons into the medial hypothalamus after microinjections of Fluoro-Gold into defensive rage sites, and the immunocytochemical analysis of substance P neurons within the amygdala. The data indicated that large numbers of retrogradely and immunocytochemically positive labeled cells were identified in the medial nucleus, including many that were double-labeled.(ABSTRACT TRUNCATED AT 400 WORDS)

Amygdalo-hippocampectomy for pathological aggression

Two patients are reported, one with severe brain damage and epilepsy, and the other with limbic epilepsy, who were treated with unilateral microsurgical amygdalo-hippocampectomy for the control of rage and aggression. Both had significant improvement in their aggressiveness, and the second patient also improved in the frequency of his seizures and psychotic episodes. The significance of these observations for our understanding of the morphophysiological basis of rage and aggression is discussed.

Role of NMDA receptors in hypothalamic facilitation of feline defensive rage elicited from the midbrain periaqueductal gray

The present study tested the hypothesis that the pathway from the medial hypothalamus to the midbrain periaqueductal gray (PAG) subserving defensive rage behavior in the cat facilitates the occurrence of this response when elicited from the PAG by utilizing excitatory amino acids as a neurotransmitter or neuromodulator. Cannula electrodes were implanted into the PAG for the elicitation of defensive rage behavior as well as for microinjections of excitatory amino acid antagonists and N-methyl-D-aspartic acid (NMDA). Monopolar stimulating electrodes were also implanted into the medial hypothalamus from which this response could also be elicited and, when stimulated at subthreshold levels for elicitation of behavior, could also facilitate the occurrence of PAG elicited defensive rage. Initially, dual stimulation of the PAG and medial hypothalamus facilitated the occurrence of defensive rage elicited from the PAG. Then, the identical dual stimulation paradigm was repeated with the same current parameters following the infusion of various antagonists for different receptors into the PAG defensive rage sites. The results indicate that infusion of either kynurenic acid [(0.1-2.0 nmol), a non-selective excitatory amino acid receptor antagonist] or D-2-amino-7-phosphonoheptanoic acid (AP7) [(0.1-2.0 nmol), a specific NMDA receptor antagonist], produced a dose and time dependent blockade of the facilitatory effects of medial hypothalamic stimulation. In contrast, microinjections of relatively larger doses of 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) [(4 nmol), a non-NMDA receptor (quisqualate and kainate) antagonist] or atropine [(4.4 nmol), a muscarinic receptor antagonist] had little effect upon medial hypothalamically elicited facilitation of the PAG response. In a second experiment, NMDA [0.1-1.0 nmol] was microinjected directly into PAG defensive rage sites in the absence of medial hypothalamic stimulation. In these animals, drug infusion mimicked the effects of dual stimulation by producing a dose and time dependent decrease in response latencies. A third experiment was designed to further test the hypothesis by neuroanatomical methods. Here, the retrograde label, Fluoro-Gold, was microinjected into defensive rage sites within the PAG and following a survival time of 5-6 days, the animals were sacrificed. The brains were then processed for immunocytochemical analysis of cells that immunoreact positively for aspartate and glutamate. The results indicated the presence of many retrogradely labelled and immunocytochemically positive cells within the rostro-caudal extent of the medial hypothalamus as well as others that were double labelled.(ABSTRACT TRUNCATED AT 400 WORDS)

Posteromedial hypothalamotomy in the treatment of violent, aggressive behaviour

Although emotion in the human is largely modified by the frontal association areas (software) and may better be called affect, it is still very much influenced by the balance of the ergotropic and the trophotropic circuits in the prosencephalon (hardware) especially in patients with organic brain lesions. Violent, aggressive, restless behaviours or rage can be regarded as an unbalanced state of these two circuits with dominance of the ergotropic circuit. In order to restore the balance of these two circuits, small stereotactic lesions were made in the ergotropic portion of the posterior hypothalamus (posteromedial hypothalamotomy) with good results in the follow-up of 10-25 years. Postoperatively there was no disturbance in endocrine activities and growth.

EEG and brainstem auditory evoked potentials in brain-injured patients with rage attacks and self-injurious behavior

Attacks of rage and self-injurious behavior are often encountered in brain-injured individuals. Clinical and experimental evidence suggests that brainstem centers may be involved in such behavior. We compared brainstem auditory evoked potentials in 10 normal controls, 10 patients with rage attacks, and 10 individuals with self-injurious behavior. The two patient groups had significantly longer group means for I-V and III-V interpeak latencies than controls. EEGs showed no specific features within or between the two groups. The findings suggest that the EEG may add little to the evaluation of such patients, except of course evidence of epilepsy or encephalopathy, while BAEPs may be a useful tool in the study of rage or self-injurious behaviors, in which brainstem centers may play an important role, possibly through abnormal or diminished reticular formation output.

Aggression

Pathologic aggression can be evaluated in terms of its psychosocial provocations, but it also must be recognized as a physiologically generated behavior and that disruptions of those controlling physiologic mechanisms can lead to pathologic states of aggression. Laboratory and clinical evidence indicates that the phylogenetically older limbic system is the anatomic core and that serotonin is the major neurotransmitter linked to that behavior. Hormonal factors influence aggression but are, to a large extent, altered by the aggressive acts themselves. There are a number of recognizable clinical syndromes which, by producing abnormal activity in limbic structures, by interfering with higher cortical control, or by causing neuroendocrine dysfunction, lead to states of pathologic aggression.

Effects of substantia nigra stimulation on hypothalamic rage reaction in cats

The effects of substantia nigra (SN) (pars compacta) stimulation on the rage reaction elicited by ventromedial hypothalamic nucleus (VMH) were investigated in the cat. The studied parameters of the rage reaction were: the current and the frequency threshold for the appearance of the hissing and the hissing latency. A facilitatory effect induced by the SN on the hypothalamic rage reaction was observed in the form of a decrease in the hypothalamic stimulus threshold for the hissing appearance and a decrease in the hissing latency. Moreover, when the VMH was stimulated with parameters below the threshold for the hissing display, simultaneous nigral activation determined its appearance. The excitatory influence exerted by the SN on the affective component of the aggressive behavior is discussed.

The role of the substantia nigra on the rage reaction elicited by hypothalamic stimulation, in the cat

The effects of substantia nigra stimulation on the rage reaction evoked by hypothalamic activation were studied. The reference value of the rage reaction was the latency of the hissing, which was constant in all animals when hypothalamic stimulation was performed with the same parameters. Simultaneous activation of substantia nigra and hypothalamus determined a significant decrease in hissing latency. The influence of the substantia nigra on the affective components of the aggressive behavior is underlined.

[Effects of stimulation of the substantia nigra on the rage reaction evoked in the cat by hypothalamic stimulation]

The effects of substantia nigra stimulation on the rage reaction evoked by hypothalamic activation were studied. The reference value of the rage reaction was the latency of the hissing, which was constant in all animals when hypothalamic stimulation was performed with the same parameters. Simultaneous activation of substantia nigra and hypothalamus determined a significant decrease of the hissing latency. The influence of the substantia nigra on the affective components of the aggressive behaviour in underlined.

Influence of environmental rearing history and postsurgical environmental change on the septal rage syndrome in mice

Reactivity to handling was examined in Binghamton Heterogeneous (HET) mice given septal lesions or control surgery following 5 weeks of postweaning rearing in enriched or restricted environments. Three housing conditions were employed: continuous enrichment, continuous restriction (both pre- and postsurgically), and a group switched from environmental enrichment to restriction 24 hours after surgery. The restricted mice were more reactive to handling than the enriched mice presurgically (60 days old), and interactions of housing conditions and surgery were found over the seven day postsurgical handling and testing period. The restricted mice given septal lesions greatly increased in reactivity postsurgically, while the intact controls declined in reactivity over the postsurgical week. The enriched septals were only moderately increased over the low presurgical reactivity baseline, and were much less reactive than the restricted septals. Perhaps the most remarkable finding was the dramatic and immediate increase in reactivity in the septals switched from enrichment to restriction, while intact controls showed no effect of the switch. These results emphasize the importance of experience in determining the effects of septal damage, and may be useful in examining other correlates of septal rage.