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PubMed2001

Validation of the Interview Module for Intermittent Explosive Disorder (M-IED) in children and adolescents: a pilot study.

We identified a subset of impulsive, aggressive children as having symptoms that met criteria for Intermittent Explosive Disorder (IED) using the Interview Module for Intermittent Explosive Disorder (M-IED). The M-IED was administered to 34 children and adolescents between the ages of 10 and 17. These data provide initial evidence for the M-IED as a useful instrument in the diagnosis of IED in adolescents. The M-IED displayed a high level of inter-rater reliability and adequate test-retest reliability. Construct validity was supported by the fact that the subjects with IED symptomatology had significantly more lifetime aggression, oppositionality, inattention and hyperactivity/impulsivity compared to community controls. In addition, the subjects with IED symptomatology had a significantly greater number of episodes of lifetime physical aggression and documented episodes of aggression while in residential treatment compared to psychiatric controls. The subjects with IED symptomatology had a greater number of positive screening questions for DSM-IV diagnoses using the Swanson, Nolan and Pelham questionnaire (SNAP-IV), particularly those related to IED and posttraumatic stress disorder than psychiatric controls.

Adolescent↗

PubMed2005

Advancing treatment strategies for pathological gambling.

Experiences from treatment trials are described. The use of structured instruments for subject characterization and symptom change assessment is discussed and the challenges of treating specific groups (e.g., those with co-occurring alcohol use disorders) explored. Treatment for pathological gambling might be advanced most rapidly through collaborative multi-center efforts.

Behavior Therapy↗

PubMed1998

A review of behavioral and pharmacological treatments for habit disorders in individuals with mental retardation.

This paper reviews the prevalence and behavioral and pharmacological treatment-outcome studies for habit disorders exhibited by individuals with mental retardation. The treatment-outcome studies target the habit disorders identified previously by researchers including nervous habits (nail biting, bruxism, and trichotillomania), motor and vocal tics, and Tourette's disorder. The paucity of behavioral treatments and the lack of controlled pharmacological research warrants further experimental evaluation of treatments for habit disorders affecting individuals with mental retardation. Conclusions and recommendations for future research are made.

Behavior Therapy↗

PubMed1998

Characteristics of 34 adults with psychogenic excoriation.

BACKGROUND: Psychogenic excoriation, characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. The purpose of this study was to provide data regarding the demographics, phenomenology, course of illness, associated psychiatric comorbidity, and family history of subjects with psychogenic excoriation. METHOD: Thirty-four consecutive subjects were recruited from an outpatient dermatology practice and by advertisement. Subjects completed the Structured Clinical Interview for DSM-IV augmented with impulse control disorder modules, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview for family history, demographic data, and clinical features. RESULTS: Most subjects were women who described a mean age at onset of 38 years and a chronic course. Subjects excoriated multiple sites, most frequently the face. The behavior caused substantial distress and dysfunction. All 34 subjects met criteria for at least 1 comorbid psychiatric disorder, with a mood disorder the most common. Family histories were notable for depressive disorders and psychoactive substance use disorders. Most subjects experienced both mounting tension before excoriation and relief after excoriation as in impulse control disorders. A minority of subjects excoriated skin as part of obsessive-compulsive disorder. Body dysmorphic disorder with preoccupation about the skin's appearance precipitated excoriation in about a third of subjects. CONCLUSION: Psychogenic excoriation is chronic, involves multiple sites, and is associated with a high rate of psychiatric comorbidity. The behavior associated with the excoriation is heterogeneous and spans a compulsive-impulsive spectrum. Most subjects in this sample described features of an impulse control disorder.

Adult↗

PubMed1998

Psychopathological considerations on the relationship between bulimia and obsessive-compulsive disorder.

The relationship between eating disorders, impulse control disorders and obsessive-compulsive disorder as part of a so-called 'obsessive-compulsive spectrum' is discussed, with particular emphasis on the relationship between eating disorders (particularly bulimia) and obsessive-compulsive disorder. The empirical studies on comorbidity, personality and familiarity are briefly reviewed. Both similarities and differences found in personality, body image, mental rumination, fears, physical exercises, rituals, impulses (bulimic binging and obsessive impulses) and purging behaviors of these patients are discussed from a psychopathological point of view. In particular the importance of distinguishing between obsessive thoughts and prevalent (dominant) thoughts is underlined; the distinctions between repetitive weight controls, physical exercises and purging behaviors of eating disorder patients on the one hand and compulsions on the other, and the distinction between binge impulses and obsessive impulses, are also stressed.

Anorexia Nervosa↗

PubMed1994

Course of multi-impulsive bulimia.

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

Adult↗

PubMed2001

Suicide, impulsive aggression, and HTR1B genotype.

BACKGROUND: Suicidality and impulsive aggression are partially heritable, and postmortem brain studies suggest that abnormalities in serotonin 1B may be associated with suicide. Studies of serotonin 1B "knockout" mice show an increase in aggressive behavior relative to wild-type mice. METHODS: We assessed the relationship between genotype at the HTR1B locus and both suicide history and impulsive aggression in personality disorders. RESULTS: The "G" allele of a polymorphic gene at the HTR1B locus was associated with a history of suicide attempts in white patients with personality disorders [chi(2)(1) = 9.3, p =.01, n = 90]. No relationship was found between HTR1B genotype and self-reported impulsive aggression. CONCLUSIONS: This preliminary finding suggests that allelic variability at the HTR1B locus may be associated with the susceptibility to suicide attempts in patients with personality disorders.

Adult↗

PubMed2003

Treatment issues pertaining to pathological gamblers with a comorbid disorder.

Evidence of an increased risk for various psychiatric disorders among pathological gamblers far exceeds our understanding of the impact that this psychiatric comorbidity has on the outcome of treatment for pathological gambling. One major source of the problem is that treatment efficacy and effectiveness studies for pathological gambling typically have not addressed comorbidity's impact on outcome. This paper discusses epidemiological, clinical, health service delivery, and research issues pertaining to the intersection of pathological gambling treatment outcome and comorbid psychiatric disorders. It is argued that this topic suffers from major knowledge gaps in terms of the nature of comorbidity of pathological gambling and other psychiatric disorders and the role of client characteristics on treatment outcome for pathological gambling. Research priorities are identified.

Combined Modality Therapy↗

PubMedDate not supplied

Topiramate for the treatment of kleptomania: a case series and review of the literature.

Kleptomania--the inability to resist the impulse to steal objects, not for personal use or monetary gain--is currently classified in psychiatric nomenclature as an impulse control disorder. There is no standard pharmacologic therapy for this disorder. If kleptomania was considered a form of obsessive-compulsive disorder, treatments used for this spectrum, including serotonin reuptake inhibitors (SSRI), other antidepressants, opioid receptor antagonist medications, and mood stabilizers, could be logically tested. Topiramate is currently used for the treatment of patients with affective and compulsive eating disorders. This report documents three kleptomanic patients who responded well to topiramate given either alone or in combination with SSRIs.

Adolescent↗

PubMed2000

Predictive validity of bulimia nervosa as a diagnostic category.

OBJECTIVE: The authors sought to investigate the predictive validity of bulimia nervosa as a diagnostic category. METHOD: More than 10 years after they appeared as patients with bulimia nervosa, 177 women (participation rate=79.7%) completed follow-up assessments. RESULTS: Among the women with a current eating pathology, most engaged in recurrent binge eating and purging. Anorexia nervosa and binge eating disorder were relatively uncommon. Eating disorder outcome was significantly related to the presence of mood, substance use, and impulse control disorders but not to the presence of anxiety disorders. CONCLUSIONS: These results support the validity of bulimia nervosa as a diagnostic category that is distinct from anorexia nervosa. Furthermore, these results suggest that bulimic symptoms are associated with disorders involving distress and disinhibition.

Anorexia Nervosa↗

PubMedDate not supplied

Low prolactin response to fenfluramine in impulsive aggression.

To examine the prolactin (prl) response to d,l-fenfluramine in a large sample of personality disorder patients with impulsive aggression. Patients were screened from clinics at the Bronx VAMC and the Mount Sinai Medical Center and from press releases. One hundred and forty-six personality disorder patients (90M;56F) and 23 normal controls (15M;8F) underwent oral d,l-fenfluramine challenge. The peak change in prolactin(deltapkprl) was calculated by subtracting baseline prolactin from peak response following fenfluramine administration (3 h). Analysis of variance and regression analysis were used to detect group differences in deltapkprl. Deltapkprl in impulsive aggressive men, but not women, with personality disorders was blunted compared with controls. Men with suicide histories also had a blunted deltapkprl compared with those without, which was not accounted for by depression. This study represents a replication of previous studies, in a much larger sample, showing a blunted PRL response to fenfluramine of male patients with personality disorder in relation to impulsive aggression and to suicide attempts.

Adult↗

PubMedDate not supplied

[On the psychiatric examination of fire-raisers].

By far not every fire-raiser suffers from so-called pyromania, i.e. a pathological urge to raise fire. It is indispensable to differentiate between extrinsic and intrinsic motivation, whenever a person is accused of arson. The former aims at external gain, such as the sum insured, while the latter tends towards manipulation of internal states. The leading motive may be frustration, fascination, or in rare cases even sexual arousal. The concept of pyromania, as established by French psychiatrist Esquirol, is not a validated one in all parts; today's diagnostic manuals take "pyromania" rather as a special form of a general disorder of impulse control. The author takes a case report to demonstrate the most important issues in evaluating and prognosticating fire raising behavior.

Adult↗

PubMedDate not supplied

Risk factors for suicide ideation and attempts among pathological gamblers.

The link between pathological gambling and suicide is poorly understood. The current study has two major goals: to provide descriptive information about suicide ideation and attempts among pathological gamblers trying to quit, and to identify predictors of suicidal ideation and attempts, with a particular emphasis on mood and substance use disorders. A community sample of 101 individuals with gambling problems who had made a recent quit attempt was assessed using structured instruments. Of these, 28.7% reported no history of suicide ideation or attempts, 38.6% reported having only thoughts of suicide, and 32.7% reported a suicide attempt. Ideation predated the onset of gambling problems by an average of greater than ten years. History of ideation was increasingly likely with a greater severity of gambling problem as determined by DSM criteria. Those experiencing ideation were also more likely to over gamble on gambling days and five times more likely to have a history of depression. Substance abuse history was the only factor that distinguished between individuals who had a history of suicide attempts versus ideation only. Having a drug history was related to a more than six times greater likelihood of having made a suicide attempt. Gambling-related suicide attempts were relatively rare-21.2% of attempters, or 7% of the total sample. These findings are consistent with the common factor model of etiology in which the suicidality of gambling is related to prior mental health disorders. More research on the relationship between alcohol and other drug disorders and their complex relationship to pathological gambling and suicide is crucial.

Adult↗

PubMed2005

Impulse control disorders in adult psychiatric inpatients.

OBJECTIVE: The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. METHOD: They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. RESULTS: Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. CONCLUSIONS: Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.

Adolescent↗

PubMed2003

An FMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers.

OBJECTIVE: Function of the ventromedial prefrontal cortex has been implicated in impulse control. The authors used the Stroop paradigm to test attention and response inhibition during the presentation of congruent and incongruent stimuli in male pathological gamblers and a group of comparison subjects. METHOD: Event-related functional magnetic resonance imaging was used to examine ventromedial prefrontal cortex function during Stroop performance. RESULTS: In response to infrequent incongruent stimuli, pathological gamblers demonstrated decreased activity in the left ventromedial prefrontal cortex relative to the comparison subjects. Both groups demonstrated similar activity changes in multiple brain regions, including activation of the dorsal anterior cingulate and dorsolateral frontal cortex. CONCLUSIONS: Pathological gamblers share many neural correlates of Stroop task performance with healthy subjects but differ in a brain region previously implicated in disorders characterized by poor impulse control.

Adolescent↗

PubMed2005

Personality and problem gambling: a prospective study of a birth cohort of young adults.

CONTEXT: Individual differences in dimensions of personality may play an important role in explaining risk for disordered gambling behavior as well as the comorbidity between disordered gambling behavior and other substance-related addictive disorders. OBJECTIVES: To identify the personality correlates of problem gambling in a representative non-treatment-seeking sample, as well as to determine whether these are similar to the personality correlates of other substance-related addictive disorders and whether individual differences in personality might account for the comorbidity between disordered gambling behavior and other substance-related addictive disorders. DESIGN: Longitudinal population-based study. PARTICIPANTS: A complete birth cohort of young adults born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973 (N = 939; 475 men, 464 women). MAIN OUTCOME MEASURES: Multidimensional Personality Questionnaire assessments of personality were obtained at age 18 years; structured interview-based diagnoses of past-year problem gambling and alcohol, cannabis, and nicotine dependence were obtained at age 21 years. RESULTS: Problem gambling at age 21 years was associated with higher scores on the higher-order personality dimension of negative emotionality (d = 0.90) and with lower scores on the personality dimension of constraint (d = -0.72) measured at age 18 years compared with control subjects who did not have a past-year addictive disorder at age 21 years. Problem gambling was also associated with Multidimensional Personality Questionnaire indicators of risk-taking (d = 0.50) and impulsivity (d = 0.56). The personality profile associated with problem gambling was similar to the profiles associated with alcohol, cannabis, and nicotine dependence. The relations between problem gambling and the substance-related addictive disorders (odds ratios = 3.32-3.61) were reduced after controlling for individual differences in personality (odds ratios = 1.90-2.32). CONCLUSIONS: From the perspective of personality, problem gambling has much in common with the addictive disorders, as well as with the larger class of "externalizing" or "disinhibitory" disorders. Knowledge gained from the study of common personality underpinnings may be helpful in determining where disordered gambling behavior should reside in our diagnostic classification system.

Adult↗

PubMedDate not supplied

[Heteroaggressiveness' assessment].

In this article we describe topics associated with violence and aggressiveness. We review the psychological, social and neurobiological bases of aggressiveness according to different theoretical views. Different ideas about dangerousness are listed, and at the same time we try to delimit this term within the forensic psychiatric field. We classify different types of dangerousness and their relation with related psychiatric disorders. Finally, we locate dangerousness in the Civil and the Criminal Code and we supply scales for its assessment.

Aggression↗

PubMed2006

Estimated prevalence of compulsive buying behavior in the United States.

OBJECTIVE: Compulsive buying (uncontrolled urges to buy, with resulting significant adverse consequences) has been estimated to affect from 1.8% to 16% of the adult U.S. population. To the authors' knowledge, no study has used a large general population sample to estimate its prevalence. METHOD: The authors conducted a random sample, national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults. The interviews addressed buying attitudes and behaviors, their consequences, and the respondents' financial and demographic data. The authors used a clinically validated screening instrument, the Compulsive Buying Scale, to classify respondents as either compulsive buyers or not. RESULTS: The rate of response was 56.3%, which compares favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people ages 55 and older than the U.S. adult population. The estimated point prevalence of compulsive buying among respondents was 5.8% (by gender: 6.0% for women, 5.5% for men). The gender-adjusted prevalence rate was 5.8%. Compared with other respondents, compulsive buyers were younger, and a greater proportion reported incomes under 50,000 US dollars. They exhibited more maladaptive responses on most consumer behavior measures and were more than four times less likely to pay off credit card balances in full. CONCLUSIONS: A study using clinically valid interviews is needed to evaluate these results. The emotional and functional toll of compulsive buying and the frequency of comorbid psychiatric disorders suggests that studies of treatments and social interventions are warranted.

Adult↗