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Subjects were 24 children with anxiety diagnoses (DSM\u2010IIIR) by structured interview, and 14 normal controls (ages 7 \u2013 14 years) matched for age and sex. All subjects were given a standard challenge dose of d,1\u2010fenfluramine (1 mg\/kg) followed by serial assessments of cardiovascular, neurohormonal, and mood parameters over a five hour period. In response to fenfluramine, controls demonstrated increases in subjective anxiety and systolic blood pressure relative to anxious subjects. Fenfluramine was safely tolerated and did not induce panic symptoms in any subject. Exaggerated prolactin response to fenfluramine differentiated an obsessive \u2013 compulsive disorder (OCD) subset from both controls and other anxiety disorders. Fenfluramine challenge differentiates anxious children from healthy controls by elevated anxiety ratings and systolic blood pressure in controls. Increased prolactin response to fenfluramine discriminates children with obsessive \u2013 compulsive disorder from both healthy children and children with other anxiety diagnoses. As adults with OCD appear to demonstrate a blunted prolactin response to fenfluramine challenge, the serotonin pathways involved may differ between \u2018early\u2019 and \u2018late\u2019 onset disorder, or the serotonin substrates tapped by this challenge may change over time. 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