Antisocial personality disorder (ASPD) imposes a high societal burden given the repetitive reactive aggression that affected individuals perpetrate. Since the brain endocannabinoid system (ECS) has been implicated in ASPD and aggressive behavior, we utilized [¹¹C]CURB positron emission tomography to investigate fatty acid amide hydrolase (FAAH), an enzyme of the ECS that degrades anandamide, in 16 individuals with ASPD and 16 control participants. We hypothesized that FAAH density would be lower in the amygdala for several reasons. First, decreased FAAH expression is associated with increased cannabinoid receptor 1 stimulation, which may be responsible for amygdala hyper-reactivity in reactive aggression. Second, the amygdala is the seat of the neural circuit mediating reactive aggression. Third, other PET studies of externalizing populations show reduced brain FAAH density. Conversely, we hypothesized that FAAH expression would be greater in the orbitofrontal cortex. Consistent with our hypothesis, we found that amygdala FAAH density was lower in the amygdala of ASPD (p = 0.013). Cerebellar and striatal FAAH expression were inversely related with impulsivity (cerebellum: r = −0.60, p = 0.017; dorsal caudate: r = −0.58, p = 0.023; dorsal putamen: r = −0.55, p = 0.034), while cerebellar FAAH density was also negatively associated with assaultive aggression (r = −0.54, p = 0.035). ASPD presents high levels of disruptive behavior with few, if any, efficacious treatment options. Novel therapeutics that increase FAAH brain levels in a region-specific manner could hold promise for attenuating certain symptom clusters of ASPD, although our results require replication.

考虑到影响个人的反复反应性侵略，反社会人格障碍（ASPD）造成了很高的社会负担。由于脑内大麻素系统（ECS）与ASPD和攻击行为有关，因此我们利用了[ ¹¹C] CURB正电子发射断层扫描技术，用于研究16名患有ASPD的个体和16名对照参与者的脂肪酸酰胺水解酶（FAAH），它是ECS降解anandamide的一种酶。我们假设杏仁核中的FAAH密度会较低，这有几个原因。首先，FAAH表达降低与大麻素受体1刺激增加有关，这可能是反应性攻击中杏仁核反应过度的原因。其次，杏仁核是介导反应性攻击的神经回路的所在地。第三，其他将人群外部化的PET研究表明，大脑的FAAH密度降低。相反，我们假设FAAH在眶额皮质中的表达会更高。与我们的假设一致，我们发现ASPD的杏仁核中杏仁核FAAH密度较低（p = 0.013）。小脑和纹状体FAAH的表达与冲动呈负相关（小脑：r  = −0.60，p  = 0.017;尾状尾：r  = −0.58，p  = 0.023;背壳壳核：r  = −0.55，p  = 0.034），而小脑FAAH密度也与攻击性攻击负相关（r  = -0.54，p  = 0.035）。ASPD具有极高的破坏性行为，几乎没有有效的治疗选择。尽管我们的研究结果需要复制，但以特定区域方式增加FAAH脑水平的新型疗法有望缓解ASPD某些症状群。