Abstract
Firstly, the contribution that cerebro-spinal fluid (CSF) studies have made to our understanding of the pathophysiology of alcohol withdrawal is addressed. Secondly, the developing literature, from our own studies and those of others, on abnormal CSF measurements in alcoholics and violent offenders is reviewed, with particular regard to impulsive murderers and arsonists. It is concluded that there is CSF evidence for increased norepinephrine function in alcohol withdrawal and an underlying serotonin hypofunction in impulsive disorders including some forms of alcoholism. Finally we report that patients with Korsakoff's syndrome may have central serotonin dysfunction since they show memory improvements during treatment with the serotonin uptake blocker fluvoxamine. Furthermore, these improvements correlate with the magnitude of change that fluvoxamine produces in CSF concentrations of the serotonin metabolite 5-HIAA.
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Notes on contributors
David Nutt
Both authors formerly Public Health Officers, Eastern Sydney Area Public Health Unit Previously general practitioner, Orange NSW, Australia.