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PubMed2005

What do we know about relapse in pathological gambling?

The study of pathological gambling and its treatment is in a nascent stage. To date, no consistent definition of relapse to gambling exists, and only a few empirical studies have evaluated the phenomenon of relapse directly in this patient population. Perspectives on relapse to drug and alcohol use appear relevant to the study of pathological gambling, and relapse to gambling is reviewed within the larger context of addictive disorders. The application of psychological, biological, environmental, and treatment factors are described as they may relate to relapse among pathological gamblers.

Behavior, Addictive↗
PubMed1998

Opioid antagonists in the treatment of impulse-control disorders.

BACKGROUND: Symptoms of impulse-control disorders are generally refractory to psychotherapeutic or pharmacologic treatments. Recent study results suggest that opioid antagonists may reduce human urges, one of the core symptoms of impulse-control disorders. The author discusses the rationale for and the potential utility of the opioid antagonists in the treatment of impulse-control disorders. METHOD: Work by preclinical and clinical investigators on the subject of motivation and its contextually relevant behavior is reviewed. The review includes the pharmacologic modulation of the motivation or drive and subsequent changes in behavior in animals and humans. On the basis of these reviews, the author prescribed naltrexone for up to 9 months to 15 patients who had impulse-control disorder, and 3 select cases are reported. RESULTS: Naltrexone was generally well tolerated, and there were no hepatic side effects. Naltrexone appears to reduce urge-related symptoms and decreases the problematic behaviors such as pathological gambling. The effect appears to be sustained. In general, 50 mg/day of naltrexone was not effective. Most patients required higher doses. Results were similar in the 12 other cases not reported here. CONCLUSION: Naltrexone may be of use in select impulse-control disorder patients. Other opioid antagonists such as nalmefene also need to be tested. Until controlled study data become available, the present report should be viewed as preliminary.

Adult↗
PubMed1994

Low platelet monoamine oxidase activity in pathological gambling.

Decreased platelet monoamine oxidase (MAO) activity has been reported in association with sensation-seeking personality type and in some mental disorders associated with a lack of impulse control. Pathological gambling itself has been related with both sensation-seeking and reduced impulse control. Platelet MAO activity was investigated in 15 DSM-III-R pathological gamblers from our outpatient clinic. Gamblers had a significantly lower platelet MAO activity than a group of 25 healthy controls. The range of MAO levels in gamblers was also significantly shorter than in controls. In controls, platelet MAO levels showed the previously described negative correlations with sensation-seeking scores but not in gamblers. The findings are consistent with previous studies showing an association of low platelet MAO activity with impulse control disorders and raise some interesting therapeutic alternatives for pathological gambling.

Adult↗
PubMed1996

Mean genes and the biology of aggression: a critical review of recent animal and human research.

Recent genetic work has suggested that abnormalities in serotonin biochemistry are directly causally linked to aggressive behavior, and there appears to be a consensus in the psychiatric literature that low levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid are specifically associated with impulsive violent behavior. We review the limitations of the genetic studies and conduct a meta-analysis of 39 studies linking 5-HIAA to aggression in humans. No differences in mean 5-HIAA levels were found between groups of violent impulsive psychiatric patients and groups of subjects diagnosed with other psychiatric or medical conditions not considered to involve violence once these levels had been corrected for three nonpsychiatric sources of variation (age, sex and height). However, mean 5-HIAA levels in both of these groups were lower than the mean corrected level in groups of normal healthy volunteers. The results confirm an association between low 5-HIAA levels and psychiatric disorders, but fail to support any specific relationship between low 5-HIAA levels and impulsive aggression or criminality. It is premature and misleading to speak of "mean genes" (Hen 1996) or a specific neurochemistry of aggressive behavior.

Aggression↗
PubMed2004

[Kleptomania: clinical and legal aspects].

Kleptomania is characterized by repetitive and irresistible impulses to steal objects, with growing excitement before, and relief after the incidents. The thefts are not planned, carried out without confidants and regarded as illegal by the offenders who often feel guilty for it. The objects are stolen not for monetary gain or personal use, but are mostly discarded, given away or hoarded. Though there is a debate going on for more than 100 years, the nosological position of kleptomania remains unclear. On the one hand the clinical picture is observed as an isolated disorder in otherwise healthy persons, on the other hand it may also occur as an accompanying symptom of various other psychiatric disorders, e. g. impulse control disorders, acute psychoses, affective, or organic psychic disorders. The present article gives an overview of the most important aetiopathogenetic viewpoints about kleptomania and discusses their nosological, therapeutical and legal implications.

Crime↗
PubMed2006

Gambling problems and health functioning in individuals receiving disability.

PURPOSE: This study evaluated the rates and correlates of disordered gambling, with a focus on gambling behavior among participants receiving disability. METHOD: The sample consisted of 723 patients seeking free or reduced-cost dental care. Participants completed the South Oaks Gambling Screen (SOGS), Short Form-12 Health Survey, Second Edition (SF-12v2), and questions assessing demographic characteristics and frequency and intensity of current gambling behaviors. RESULTS: Results indicate a significantly higher prevalence of disordered gambling among participants receiving disability (26%) than in the remainder of the sample (14%; p < 0.001). Of the 135 individuals receiving disability, disordered gambling was associated with decreased physical and mental health functioning. CONCLUSIONS: These data indicate that individuals receiving disability have high rates of disordered gambling, and gambling behavior in this population is associated with poorer health functioning. Results suggest that disordered gamblers who receive disability have an increased need for interventions to reduce gambling and associated problems.

Adult↗
PubMed2006

Understanding and treating kleptomania: new models and new treatments.

Kleptomania, characterized by repetitive, uncontrollable stealing of items not needed for personal use, is a disabling disorder that often goes unrecognized in clinical practice. Although originally conceptualized as an obsessive compulsive spectrum disorder, emerging evidence (clinical characteristics, familial transmission, and treatment response) suggests that kleptomania may have important similarities to both addictive and mood disorders. In particular, kleptomania frequently co-occurs with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder. Additionally, there is some suggestion that selective serotonin reuptake inhibitors, the treatment of choice for obsessive compulsive disorder, may lack efficacy for kleptomania. Instead, other medications (lithium, anti-epileptics, and opioid antagonists) have shown early promise in treating kleptomania. Evidence suggests that there may be subtypes of kleptomania that are more like OCD, whereas others have more similarities to addictive and mood disorders. Subtyping of individuals with kleptomania may be a useful way to better understand this behavior and decide on effective treatment interventions.

Algorithms↗
PubMedDate not supplied

[Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results].

INTRODUCTION: Although in the pharmacological field topiramate has shown proved efficacy in impulsive behavioral disorders (IBD), this fact has not been demonstrated with the same evidence in children and adolescents. The aim of this study is to evaluate improvement of symptoms in different IBD in those ages after treatment with topiramate. CLINICAL CASE: Eleven cases of IBD (DSM-IV criteria) were evaluated with the Barrat Impulsivity Scale (BIS), obtaining scores at zero, one and three months after starting treatment with topiramate. RESULTS: We found significant differences in the cognitive impulsivity subscale (p=0.040) and total score of the BIS (p=0.043) when BIS scale was measured after one month of treatment; after three months of treatment, the motor impulsivity subscale also showed significant differences (p=0.015). CONCLUSIONS: The significant reductions at BIS scores in child and adolescents outpatients who have IBD make us consider topiramate as an effective pharmacological option for treatment of impulsivity in several psychiatric disorders, also in childhood and adolescence. More studies are needed to confirm these results, with bigger samples and control groups.

Adolescent↗
PubMed2005

The 5HTTLPR polymorphism, psychopathologic symptoms, and platelet [3H-] paroxetine binding in bulimic syndromes.

BACKGROUND: A short (s) allele in the promoter region of the 5-hydroxytryptamine (5-HT) transporter gene (5HTTLPR) has been associated with low transcription of the 5-HT transporter protein, and with clinical manifestations including impulsivity, affective disorder, and bulimia nervosa. METHODS: We studied implications of the 5HTTLPR s allele for eating symptoms, psychopathologic traits, and platelet [3H-] paroxetine binding in 59 women with bulimia spectrum syndromes. RESULTS: Compared with those without it, carriers of the s allele of 5HTTLPR showed significantly more affective instability, behavioral impulsivity, interpersonal insecurity, comorbid borderline personality disorder (BPD), and lower density (Bmax) of paroxetine-binding sites. CONCLUSIONS: Our results suggest that proneness to impulsivity, affective dysregulation, and reduced central 5-HT reuptake may (in part) be codetermined by the 5HTTLPR polymorphism. However, given inconsistent 5HTTLPR expression in different populations, we speculate that we may be observing a phenotype (i.e., eating disorder)-dependent manifestation.

Adolescent↗
PubMedDate not supplied

Kleptomania: clinical features and comorbidity in an Italian sample.

Kleptomania, listed in DSM-IV as an impulse control disorder not elsewhere classified, is a psychiatric condition still poorly understood and subject of only a few systematic studies. The aim of this research was, therefore, to evaluate the clinical features and comorbidity of Italian patients with a DSM-IV diagnosis of kleptomania. Twenty outpatients with a lifetime diagnosis of kleptomania by DSM-IV criteria, were included in the study and underwent a specially designed semistructured interview and the Family History Research Diagnostic Criteria. The majority of patients reported an early and abrupt onset and an episodic course of the disorder, with no gender preponderance. Lifetime comorbidity for other axis I disorders was high, in particular for mood, anxiety, and impulse control disorders. Family history also showed a high prevalence of psychiatric disorders. Our study indicates clear connections between kleptomania and different psychiatric disorders, the exact nature of which has yet to be clarified.

Adult↗
PubMed2006

Alcohol and suicide: neurobiological and clinical aspects.

Alcohol, primarily in the form of ethyl alcohol (ethanol), has occupied an important place in the history of humankind for at least 8,000 years. In most Western societies, at least 90% of people consume alcohol at some time during their lives, and 30% or more of drinkers develop alcohol-related problems. Severe alcohol-related life impairment, alcohol dependence (alcoholism), is observed at some time during their lives in about 10% of men and 3-5% of women. An additional 5-10% of each sex develops persistent, but less intense, problems that are diagnosed as alcohol abuse. It this review, neurobiological aspects of suicidal behavior in alcoholism is discussed. In individuals with comorbid depression and alcoholism, greater serotonergic impairment may be associated with higher risk of completed suicide. Dopaminergic dysfunction may play an important role in the pathophysiology of suicidal behavior in alcoholism. Brain damage and neurobehavioral deficits are associated with alcohol use disorders and may contribute to suicidal behavior in persons with alcohol dependence or abuse. Aggression/impulsivity and alcoholism severity affect risk for suicide among individuals with alcoholism. Major depressive episodes and stressful life events particularly, partner-relationship disruptions, may precipitate suicidal behavior in individuals with alcohol use disorders. Alcohol misuse and psychosocial adversity can combine to increase stress on the person, and, thereby, potentially, increase the risk for suicidal behavior. The management of suicidal patients with alcohol use disorders is also discussed. It is to be hoped that the efforts of clinicians will reduce morbidity and mortality associated with alcohol misuse.

Aggression↗
PubMed2005

Correlates of restraint use in an institutional population: a replication.

BACKGROUND: Reducing inappropriate restraint is an important mission of services for people with intellectual disabilities (IDs). METHODS: In this study, 52 clients who had been restrained were compared with 52 other clients, individually matched on age, gender and level of IDs. Participants were mostly adults with severe and profound IDs in an institutional setting. RESULTS: The two groups differed on six Diagnostic Assessment for the Severely Handicapped-II (DASH-II) and three Aberrant Behaviour Checklist (ABC) scales. However, discriminant functional analysis demonstrated that only DASH-II Impulse control disorder and ABC Irritability and Elimination disorder scores predicted group membership but only moderately. CONCLUSIONS: Individual differences in maladaptive behaviours were only moderately predictive of restraint use.

Adult↗
PubMed1998

Sexual addiction: many conceptions, minimal data.

Sexual addiction has received increasing attention in the past decade. We review existing literature on (a) competing conceptualizations of this syndrome as constituting an addictive, obsessive-compulsive, or impulse control disorder; (b) symptomatology and progression; (c) etiological models; and (d) treatment approaches. Based on this review, we conclude by identifying questions requiring resolution via empirical investigation.

Behavior, Addictive↗
PubMed2004

The efficacy of ECT in adults with mental retardation experiencing psychiatric disorders.

There is a paucity of empirical data establishing the efficacy of electroconvulsive therapy (ECT) in patients with mental retardation and psychiatric disorders. This study examines the efficacy of ECT on specific symptoms and between psychiatric diagnoses in patients with mental retardation who are psychiatrically ill. A chart review was performed on 20 inpatients who had received ECT on a dedicated Mental Retardation-Dual Diagnosis Unit and were divided into 3 categories: mood disorders (n = 12), psychotic disorders (n = 6), and intermittent explosive disorder (n = 2). Ratings were performed 1 week before ECT treatment and 1-week after its termination using the Aberrant Behavior Checklist and the Clinical Global Impressions Severity Scale. A repeated-measures analysis of variance comparing Aberrant Behavior Checklist scale scores revealed a significant time-by-treatment interaction (F = 75.43, df = 1,9, P = 0.000, 2 t). The mood disorder and psychotic disorder groups had significantly lower irritability and hyperactivity scores after treatment compared with the intermittent explosive disorder group. The Clinical Global Impressions Severity Scale rating scores showed significant improvement in the mood disorders group (67%), in contrast to the intermittent explosive disorder group (0%). Our data suggests the utility of ECT for patients with mental retardation who also have treatment-resistant mood disorders and psychotic disorders, particularly with symptoms of hyperactivity and irritability. The data are sufficiently encouraging to justify prospective research of this question.

Adult↗
PubMed2006

A comment on the utility of prevalence estimates of pathological gambling.

The case is presented that researchers interested in policy aimed at treating the pathological gambler need to shift focus to improving the utility of prevalence estimates. It is argued that researchers supplement prevalence estimates with practical and well-defined measures of severity and other predictors and correlates of help-seeking. The dimension of severity is emphasized as one means of providing estimates that are relevant to policy makers when placed in the context of additional measures that improve their meaning and utility. Estimates may then be partitioned along these dimensions to ascertain the proportion of gamblers most likely to need or seek treatment for gambling-related disorders. The recommendations provided are subject to a number of possible objections and are presented in the interest of stimulating further discussion such as the distinction between symptom assessment and the measurement of severity.

Disruptive, Impulse Control, and Conduct Disorders↗
PubMed1999

Clinical correlates of self-mutilation in a sample of general psychiatric patients.

The aims of this study were to examine whether certain axis I disorders characterized by impulsive aggression were associated with self-mutilative behavior and to evaluate the clinical correlates of self-mutilation in a sample of general psychiatric outpatients. Two hundred fifty-six outpatients were administered diagnostic interviews for axis I and axis II disorders. In addition, questionnaires that measured self-mutilative acts within the last 3 months, dissociation, and childhood abuse were completed. This study found that axis I disorders of substance abuse, posttraumatic stress disorder, and intermittent explosive disorder were significantly related to self-mutilative behavior, independent of borderline personality disorder and antisocial personality disorder. Also, a higher level of dissociation was related to self-mutilation, controlling for borderline personality disorder and childhood abuse. Outpatients with certain axis I disorders and those who dissociate may represent a sizable group of patients who are at risk for self-mutilative behavior.

Adult↗
PubMed1990

Hot-headed or impulsive?

A sample of men in prison was interviewed and rated for the presence of six behaviours commonly thought to be impulsive: alcohol abuse (CAGE positive), sedative dependence, other drug abuse, pathological gambling, repeated aggression and self-harm. They were also asked to complete the EPQ and 15 questionnaires. Out of 61 men on a 'special protection, wing, 51 agreed to take part. We found that the score on the Impulsiveness scale of the 15 correlated with the number of disorders present in individuals, even when corrected for age. Pathological gambling and self-harm did not correlate with the presence of any of the other behaviours.

Adult↗