The authors report four instances of significant, essentially unprovoked
aggressive behavior, including two homicides, following exposure to
cholinesterase inhibitors. No subject had a history of violent behavior,
antisocial personality, or major psychiatric or neurologic disorder. After
anticholinesterase exposure ceased, all showed sincere remorse for their
actions, and none has since engaged in aggressive or psychopathologic
behavior. Well-controlled experimentation in animals suggests that enhanced
activation of hypothalamic cholinergic receptors may underlie aggressive
behavior in humans exposed to cholinesterase inhibitors. A relationship
between cholinesterase inhibitors and aggression has important implications
for public health, raising the possibility of unappreciated neurotoxic
influences on behavior.Abstract Teaser