Men with low CNS serotonin turnover, as measured by cerebrospinal fluid 5-hydroxyindoleacetic acid : Sleep, serotonin, impulsivity, primate, aggression Psychiatric research suggests that a reduced turnover rate of serotonin in the central nervous system (CNS), as measured by cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA), is a risk factor for impaired impulse control, violent behavior, and premature mortality from suicide and violence (Faustman et al. 1990;Kruesi et al. 1990;Lidberg et al. 1985;Linnoila et al. Received February 12, 1999; revised June 16, 1999; accepted August 20, 1999. Dr. P.T. Mehlman and Dr. G.C. Westergaard are to be considered as co-first authors whose names are interchangeable. Dr. Mehlman was the Principal Investigator when the study was designed, the data were collected and analyzed, and was the first author when this manuscript was originally submitted. Dr. Westergaard was the Principal Investigator when the manuscript was revised and resubmitted for publication in this journal. Virkkunen et al. 1994). Research using nonhuman primates has replicated and extended many of these findings (Higley et al. 1996a;Higley et al. 1992a;Higley et al. 1996b;Kaplan et al. 1994;Mehlman et al. 1995;Mehlman et al. 1994;Mehlman et al. 1997;Raleigh 1987;Raleigh et al. 1983a;Raleigh et al. 1983b;Raleigh et al. 1980;Raleigh and McGuire 1994). Further, this research has demonstrated that inter-individual differences in CSF 5-HIAA concentrations are stable across time and experimental settings and can be attributed to genetic and early environmental influences that produce lasting modifications in the CNS serotonin response (Higley et al. 1996b;Higley et al. 1994;Higley et al. 1996a).Serotonin-mediated behavioral deficits are thought to result in part from an inability to maintain a homeostatic response in a number of physiological systems (Virkkunen et al. 1989a;Virkkunen and Narvanen 1987;Virkkunen et al. 1994). Various lines of evidence indicate that central serotonin neurotransmission contributes to regulation of sleep-wake cycles and circadian activity patterns. For example, several decades of research has shown that the sleep-wake cycle is partially modulated by serotonin release from projections of the ralphe nuclei (Jacobs 1991;Jouvet 1974;Jouvet 1967;Koella 1985;Koella and Czicman 1966;Maeda et al. 1989;Puizillout et al. 1981). Further, administration of p-chlorophenylalanine (PCPA), which inhibits the synthesis of serotonin, causes a reduction in total sleep in the cat (Jouvet 1974), rat (Torda 1967), and monkey (Weitzman et al. 1968). Finally, experimentally induced lesions of the ralphe system lead to nerve terminal decreases in 5-HT and 5-HIAA which are directly proportional to the degree of insomnia produced by the lesions (Jouvet 1974). These findings support the view that increases in CNS serotonin turnover rate promote sleep, in particular NREM sleep, and that deficits in serotonergic transmission are associated with insomnia, high levels of nighttime activity and/or...