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PubMed2001

Demographic and clinical features of 131 adult pathological gamblers.

BACKGROUND: This study was constructed to detail the demographic and phenomenological features of pathological gamblers. METHOD: One hundred thirty-one subjects with DSM-IV pathological gambling were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, course, associated features, treatment history, and response to treatment of the disorder, followed by the Structured Clinical Interview for DSM-IV. RESULTS: Seventy-eight female (59.5%) and 53 male (40.5%) (mean +/- SD age = 47.7+/-11.0 years) pathological gamblers were studied. The majority of subjects (55.7%) were married. Subjects gambled a mean of 16 hours per week. Slot machines (65%), cards (33%), and blackjack (26%) were the most popular forms of gambling. The mean length of time between first gambling behavior and onset of pathological gambling was 6.3+/-8.9 years. Approximately one half (46%) of the subjects reported that television, radio, and billboard advertisements were a trigger to gamble. Most gamblers had severe financial, social, or legal problems. The majority of the subjects (58%) had at least 1 first-degree relative who also exhibited symptoms of problematic gambling behavior. CONCLUSION: Pathological gambling is a disabling disorder associated with high rates of social and legal difficulties.

Adult↗
PubMed2001

[Integral psychopathological model for impulse-control disorders in children, adolescents and young adults with schizophrenia].

Integral model for impulse-control disorders in schizophrenia is based on the data of examination of 200 patients who developed schizophrenia in childhood (14%) and adolescence (86%). The model comprises 4 components corresponding to the disorders variety. Phenomenological component (FC) reflects various pathological phenomena (sexual, eating, etc); typical psychopathological component (TPC) concerns mechanisms of their realization (impulsive, compulsive, obsessive, overvalued and transitional); processive component (PC) is represented by typical psychopathological traits comorbid with other psychopathological symptoms; evolutive component (EC) characterizes drive deviations, i.e. such manifestations that do not reach pathological level. FC stability allows considering it as a core in conventional space of the model, being surrounded by the other three components--TPC, PC, EC, thought to be marginal ones. Thus, impulse-control disorder dynamics in schizophrenia occurs due to change of its marginal components.

Adolescent↗
PubMed1989

[Impulse control disorders in adolescence].

This is an attempt of precise definition of the notion "drive disorders". An original definition is offered which differentiated these from related states. Based on the analysis of 76 clinical investigations, some general age-related features were found in the clinical pictures of the disorders, the systematics of their course was given, the criteria of expert evaluation derived. The relation of drive disorders to other adolescent psychopathology was stressed.

Adolescent↗
PubMed1997

[Psychopathology of alcohol abuse in schizophrenia].

Psychopathological study of primary and secondary alcohol abuse (PAA, SAA) was studied in 107 schizophrenic patients of 17-55 years old. Different types of PAA development was related to peculiarities of both schizophrenic syndromes and impulse control disorders. SAA development was the same as in chronic alcoholism.

Adolescent↗
PubMed2002

Serotonin 2a receptor T102C polymorphism and impaired impulse control.

Patients homozygous for the C allele of the T102C serotonin (5-HT) 2a receptor polymorphism have shown increased suicidal ideation or behavior in some reports, but not in others. We conducted a pilot investigation to determine whether this polymorphism might relate more specifically to a dimension of impaired impulse control, which may underlie only a portion of suicides. Rates of commission (impulsive) errors in a variant of the Continuous Performance Test (CPT) were compared across the genotypes of the T102C polymorphism in adults recruited from the community. The 102C/102C genotype was jointly associated with a greater incidence of past mood disorder or substance-use disorder, as well as significantly more commission errors compared to the 102T/102C and 102C/102C genotypes. These preliminary data suggest that the T102C 5-HT2a receptor polymorphism may be a marker for impaired behavior control-perhaps in the context of psychiatric disorder history.

Adult↗
PubMed2004

Impulsivity: a link between bipolar disorder and substance abuse.

BACKGROUND: Substance abuse is present in most patients with bipolar disorder and associated with poor treatment outcome and increased risk of suicide. Increased impulsivity may be a link between bipolar disorder and substance abuse. METHODS: First, we compared impulsivity as a stable trait (Barratt Impulsiveness Scale, BIS) and as state-dependent behavioral laboratory performance (Immediate Memory-Delayed Memory task, derived from the Continuous Performance Task) in interepisode bipolar and non-bipolar subjects with and without substance abuse. Secondly, we compared impulsivity in interepisode and manic bipolar subjects with and without substance abuse. RESULTS: The BIS scores were increased in interepisode bipolar disorder and in subjects with histories of substance abuse, and were increased further in interepisode bipolar subjects with substance abuse. Performance impulsivity was increased in subjects with substance abuse, regardless of whether they had bipolar disorder. Among subjects with bipolar disorder, after correction for age, BIS scores were increased in those with substance abuse. Performance impulsivity was increased in manic compared with interepisode subjects, regardless of substance abuse history, and was increased in interepisode subjects with substance abuse similarly to manic subjects without substance abuse. These differences could not be accounted for by age, gender, or course of illness. CONCLUSIONS: Trait impulsivity is increased additively in bipolar disorder and substance abuse. Performance impulsivity is increased in interepisode bipolar disorder only if a history of substance abuse is present. This increased predisposition to impulsivity when not manic may contribute to the decrement in treatment outcome and compliance, and increased risk for suicide and aggression, in bipolar disorder with substance abuse.

Adult↗
PubMed2005

Reflective thinking and mental imagery: a perspective on the development of posttraumatic stress disorder.

Reflective thinking occurs when information stored in long-term memory (LTM) is not sufficient to allow one to respond "automatically" to an object or event. Instead, stored information must be entered into working memory and a novel response or solution produced. In this article I argue that mental imagery plays a central role in this process, and that over the course of normal cognitive development the process of reflective thinking "programs" LTM so that an increasingly large number of tasks can be performed without reflective thinking. Normal cognitive development thus results in a decreasing reliance on imagery. However, if highly emotional images are formed, additional retrieval cues can be entered into LTM, making such images more likely to occur in the future. Such images induce arousal, similar to that induced by the actual event. This line of thinking leads to a novel perspective on the neurocognitive deficits that underlie the development of posttraumatic stress disorder, and may also help to explain some symptoms seen in hyperactivity, impulsiveness, and difficulties in self-control.

Brain↗
PubMed2004

[Attention deficit hyperactivity disorder in adults. An overview].

Attention deficit hyperactivity disorder (ADHD), which is characterized by the inability to appropriately modulate attention and/or impulse control and hyperactivity, resulting in social, academic and occupational underachievement, is presently the topic of intensive discussion in German psychiatry. With a prevalence of 3-5%, ADHD is one of the most frequently seen disorders in child and adolescent psychiatry. With nearly 50% of childhood patients also affected during adulthood, this disorder is of much higher clinical significance for psychiatry than presumed thus far. The present review discusses current results of epidemiology, etiology, clinical symptoms and comorbidity, diagnostic assessment, pharmacotherapy, and psychological interventions for adults with ADHD.

Adolescent↗
PubMed2002

Citalopram treatment of compulsive shopping: an open-label study.

BACKGROUND: Compulsive shopping, a DSM-IV impulse-control disorder not otherwise specified, is characterized by preoccupation with shopping and inability to resist buying unneeded items, with resulting marked distress, social or occupational impairment, and financial and/or familial problems. Because an open-label trial suggested that fluovaxamine, a selective serotonin reuptake inhibitor (SSRI), is effective for this disorder, we tested the effectiveness of the SSRI citalopram. METHOD: We enrolled adults meeting formal diagnostic criteria (as defined by McElroy and colleagues) in a 12-week open-label trial. We excluded subjects with obsessive-compulsive disorder, bipolar disorder, substance abuse or dependence, or psychotic disorders. Citalopram treatment was begun at 20 mg/day and increased every 2 weeks by 20 mg/day, absent marked response and limiting side effects, to 60 mg/day. At endpoint, all subjects were asked to give written informed consent for follow-up telephone interviews at 3-month intervals for 12 months. RESULTS: We enrolled 24 subjects, 22 women and 2 men, whose mean +/- SD age was 43.7 +/- 8.1 years; most had been shopping compulsively for 2 decades or more. Citalopram (mean +/- SD endpoint dose = 35.4 +/- 21.4 mg/day) produced rapid, marked, sustained improvements on both the Yale-Brown Obsessive Compulsive Scale-Shopping Version and the Clinical Global Impressions-Improvement (CGI-I) scale in subjects with and without comorbid conditions. Seventeen subjects (71%) were responders, achieving ratings of much or very much improved on the CGI-I, including 2 of the 3 subjects who discontinued for adverse events (sedation or agitation). During a 6-month follow-up period, those continuing citalopram therapy were less likely to relapse than those discontinuing the medication. CONCLUSION: Citalopram appears to be a safe and effective treatment for compulsive shopping. Acute and long-term, double-blind, placebo-controlled trials of citalopram and other SSRIs for the treatment of this disorder are indicated.

Adult↗
PubMed2001

An open naltrexone treatment study in pathological gambling disorder.

The present study was designed to test the short-term efficacy and safety of naltrexone in the treatment of pathological gambling disorder. Seventeen subjects (seven men, 10 women) who fulfilled DSM-IV criteria for pathological gambling disorder, and were free from other Axis I diagnoses by Structured Clinical Interview for DSM-III-R screening, participated in a 6-week open naltrexone flexible dose trial. Gambling symptom change was assessed with the patient-rated Clinical Global Impression (CGI) Scale, the clinician-rated CGI and the Gambling Symptom Assessment Scale. Side-effects were monitored weekly and liver function tests biweekly. Naltrexone reduced urges to gamble and gambling behaviour. The mean change in gambling frequency per week was 1.40 +/- 0.28 episodes per week; the mean change in dollars lost per week was $66.95 +/- 13.77; and the mean change in clinician-rated CGI Improvement was 0.40 +/- 0.04. Of those who responded to the medication, the majority had done so by the end of the fourth week. Men responded to naltrexone as well as women. The average naltrexone dose required for effective symptom control was 157 mg/day. Nausea was common during the first week (47%). The present findings provide evidence that naltrexone may be effective in the treatment of pathological gambling disorder. The present report is preliminary and controlled trials are needed to confirm these findings.

Adolescent↗
PubMed2003

Asperger's disorder: a case report of repeated stealing and the collecting behaviours of an adolescent patient.

OBJECTIVE: To discuss special behavioural problems shown by a patient with Asperger's disorder from adolescence onward. METHOD: The case and treatment of a 21-year-old male patient is described. RESULTS: A 21-year-old male developed obstinate stealing behaviours when he was 17 years old. He was regarded as a schizophrenic at first, and was suspected of kleptomania later. Asperger's disorder was diagnosed after we reconsidered the relationship between the schizoid psychopathy in childhood and the stealing behaviours which occurred in adolescence. CONCLUSION: A wide variety of bizarre behaviours and so-called borderline behaviours occur in late adolescence and adult life of patients with Asperger's disorder. But classic schizophrenia is very rare. Psychiatrists unacquainted with the clinical diagnosis/context may find it difficult to evaluate 'concrete', 'childish', or 'bizarre' symptoms in patients with Asperger's disorder, and thus are prone to misdiagnose them as having schizophrenia disorders or other similar disorders.

Adult↗
PubMed2001

[Kleptomania in frontal lobe lesion].

A case of a kleptomaniac with frontal lobe dysfunction is presented. Kleptomania is related to the obsessive-compulsive spectrum disorders and the affective spectrum disorders. In obsessive-compulsive spectrum disorders neuroimaging and neuropsychological tasks have revealed abnormal functioning in the frontal brain which also could be related to kleptomania. Consolidated findings from animal and human studies have implied central serotonergic transmission in the genesis of obsessive-compulsive spectrum disorders and affective spectrum disorders. Altogether, these results suggest that kleptomania, like other disorders of the above mentioned spectrums, could have an abnormality in serotonergic transmission in common.

Brain Concussion↗
PubMed1997

Fluvoxamine in the treatment of obsessive-compulsive disorder and related conditions.

The mainstay of the pharmacologic treatment of obsessive-compulsive disorder (OCD) is a 10- to 12-week trial of a potent serotonin reuptake inhibitor (SRI) at an adequate dose. Double-blind, placebo-controlled trials have established the anti-obsessive-compulsive (OC) efficacy of five different SRIs. One of the most thoroughly studied of these SRIs is fluvoxamine, the focus of this article. Fluvoxamine's pharmacologic and pharmacokinetic properties, its efficacy, and guidelines for its clinical use in OCD and related disorders are briefly reviewed. Potential drug-drug interactions are discussed and placed in clinical perspective. The management of common SRI-induced side effects is also addressed. Recent comparative studies suggest that fluvoxamine may be equivalent in efficacy to clomipramine, yet better tolerated. Fluvoxamine shows promise in the treatment of several so-called OC-spectrum disorders, but additional controlled trials are needed.

Adolescent↗
PubMed2003

Comorbidity of impulse control disorders in pathological gamblers.

OBJECTIVE: To investigate the rate of impulse control disorders among pathological gamblers and examine the relationship of comorbidity to gambling severity. METHOD: Ninety-six adult pathological gamblers [mean age: 46.7 +/- 11.0 years; female: 44 (45.8%)] completed the following: Minnesota Impulsive Disorders Interview, Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, and Gambling Symptom Assessment Scale. RESULTS: Twenty-two subjects (22.9%) reported a comorbid impulse control disorder, most commonly compulsive sexual behaviour and compulsive buying. Subjects with comorbidity reported significantly greater intensity of urges (t = -2.021; df = 94; P = 0.046) and thoughts (t = -2.147; df = 42.3; P = 0.038) related to gambling, and greater interference (t = -3.913; df = 48.1; P < 0.001) and distress (t = -2.504; df = 52.7; P = 0.015) secondary to gambling urges and thoughts. CONCLUSION: Impulse control disorders appear common among pathological gamblers and are associated with more severe gambling symptoms.

Adult↗
PubMed2001

["Stealing madness"--kleptomania].

Kleptomania is one of the common less diagnosed impulse control disorders, which could be treated by the combination of psychological and pharmacological therapy. The most effective treatment regimens include cognitive behavioral therapy and interpersonal psychotherapy in the psychological field, and antidepressants and mood stabilizers as pharmacological treatment. Most of the patients with kleptomania are initially treated only for a comorbid psychiatric disorder, since kleptomaniac symptoms had not been raised in the anamnesis. The aim of our article is to inform the physicians about the possible diagnosis and treatment options for this disorder in order to prevent co-morbidity with other psychiatric disorders. Some specific cases are presented in order to explain symptomatology.

Antidepressive Agents↗