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PubMed1998

[Impulse control disorders and other serotonin function disorders].

Disturbances of impulse control, classified in ICD-10 and/or DSM-IV, have a high risk of comorbidity with other disturbances of the serotonin system. These affective disturbances could be interpreted as symptoms of a related syndrome because they usually respond to antidepressive pharmacotherapy. Selective SSRIs in addition to their antidepressant activity are useful even for impulse control disturbances and for common multimorbid mixed disturbances by their polyvalent serotoninergic activity because they improve at least quality of life in these patients. Results are better in patients with episodically disturbed impulse control than in those constitutionally afflicted.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2003

[Pharmacological treatment of kleptomania--review].

According to most diagnostic manuals such as ICD-10 and DSM-IV, kleptomania is classified as an impulse-control disorder. With regard to comorbidity, kleptomania is related to the obsessive- compulsive disorder spectrum and to the broader spectrum of affective disorders. Accordingly a psychopharmacological intervention with anti-depressant drugs or mood stabilizers may be possible, even though there are to date no known results from controlled therapy studies. Nevertheless the successful administration of such medication has been reported in several cases. Assuming a disturbed central serotonin reuptake, the use of selective serotonin reuptake inhibitors (SSRI) seems to be indicated. But also naltrexone could be of use in kleptomania.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2006

Sexual orientation of men with pathological gambling: prevalence and psychiatric comorbidity in a treatment-seeking sample.

Although gay men represent a high-risk group for psychiatric illness and impairment, they are largely an understudied population. The purpose of the present study was to examine the sexual orientation and clinical correlates of men with pathological gambling (PG). Sexual orientation was assessed in 105 men presenting with PG. Gay and bisexual men with PG were compared with heterosexual men in terms of gambling symptoms, impairment, and co-occurring psychiatric disorders. Of 22 men (21.0%) with PG, 15 were gay (14.3%) and 7 were bisexual (6.7%). Gay and bisexual men vs heterosexual men were more likely to be single (81.8% vs 21.7%; chi(2)(2) = 28.2; P < .001), have a lifetime (81.8% vs 44.6%; chi(2)(1) = 9.7; P = .002) or current (68.2% vs 34.9%; chi(2)(1) = 7.9; P = .005) impulse control disorder, and have a lifetime substance use disorder (59.1% vs 31.3%; chi(2)(1) = 5.7; P < .05). Gay and bisexual men with PG also showed a trend toward greater impairment (P = .04). Psychiatric comorbidity and impairment are high in gay and bisexual men with PG. Research is needed to optimize patient care for gay and bisexual men with PG.

Adult↗

PubMed2003

Patterns of co-morbidity in male suicide completers.

BACKGROUND: Psychiatric co-morbidity is thought to be an important problem in suicide, but it has been little investigated. This study aims to investigate patterns of co-morbidity in a group of male suicide completers. METHOD: One hundred and fifteen male suicide completers from the Greater Montreal Area and 82 matched community controls were assessed using proxy-based diagnostic interviews. Patterns of co-morbidity were investigated using latent class analysis. RESULTS: Three subgroups of male suicide completers were identified (L2 = 171.62, df = 2012, P < 0.05). they differed significantly in the amount of co-morbidity (Kruskal-Wallis chi2 = 71.227, df = 2. P < 0.000) and exhibited different diagnostic profiles. Co-morbidity was particularly found in subjects with disorders characterized by impulsive and impulsive-aggressive traits, whereas subjects without those traits had levels of co-morbidity which were not significantly different from those of controls (chi2 = 8.17, df = 4, P = 0.086). CONCLUSIONS: Suicide completers can be divided into at least three subgroups according to co-morbidity: a low co-morbidity group, a substance-dependent group and a group exhibiting childhood onset of psychopathology.

Adult↗

PubMed2000

Suicide attempts and impulse control disorder are related to low cerebrospinal fluid 5-HIAA in mentally disordered violent offenders.

OBJECTIVE: The aim of this study was to investigate the relationship between low cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) and aggressive acts in mentally disordered violent offenders. METHOD: CSF concentrations of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid and 4-hydroxy-3-methoxyphenyl glycol were measured in 35 drug-free men convicted of homicide and currently undergoing forensic psychiatric investigation in a high security hospital. RESULTS: The mean metabolite concentrations in the homicide offenders did not differ from those of age- and body-height matched male control subjects. One-third of the murderers had made one or several suicide attempts, and their mean concentration of spinal fluid 5-HIAA was significantly lower than that of the remaining murderers. Subjects with impulse control disorder also had lower mean CSF 5-HIAA. A consistent pattern of higher CSF 5-HIAA in subjects with more self-reported anxiety traits was observed. CONCLUSION: The association between serotonin and suicidal behaviour holds for yet another subject group. Determining CSF 5-HIAA might be worth while in the routine assessment of psychiatrically ill homicide offenders.

Adult↗

PubMed1994

[Kleptomania before and after spontaneous subarachnoid hemorrhage--a neuropsychodynamic case report].

Kleptomania is not supposed to be a nosologic entity, but represents a psychopathological symptom of variant neurological and psychiatric diseases. A 47-year-old woman had shown a kleptomanic impulse disorder on the basis of a phobic personality organisation, until she suffered a spontaneous subarachnoidal haemorrhage with a consecutive basal forebrain lesion five years ago. After this event the kleptomanic symptom worsened dramatically. This case suggests an integrated "neuropsychodynamic" approach to clinical findings, which are commonly to be interpreted neuropsychologically and psychodynamically. We discuss the many mutual overlappings of neurobiologically determined and biographically understandable psychic phenomena.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2003

Diagnosis and treatment of pathologic gambling.

Pathologic gambling (PG) is an impulse control disorder characterized by recurrent and maladaptive gambling behaviors that significantly disrupt the patient's functioning in the personal, familial, or vocational spheres. Pathologic gambling is estimated to currently affect 1% to 3.4% of the adult US population and is frequently comorbid with substance abuse or dependence, attention-deficit/hyperactivity disorder (ADHD), and affective disorders. Studies show evidence for the involvement of the serotonergic, noradrenergic, and dopaminergic systems in the etiology of PG. Medication treatment studies performed in PG patients demonstrated the short-term efficacy of various serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers in a subsample of adult pathologic gamblers who seek treatment. This review focuses on recent research examining the neurobiology and treatment of PG.

Adult↗

PubMed2004

Explosive-aggressive behavior related to bilateral subthalamic stimulation.

We describe a patient with Parkinson's Disease who underwent bilateral subthalamic nucleus deep brain stimulation and later presented with episodes of aggressive behavior disorder with disturbed impulse control and an inability to control anger likely related to the deep brain stimulation "switch-on stimulation". We hypothesize that increasing voltage intensity could influence neighboring passing fibers coming from basal limbic system that are involved in the regulation of affect and emotional behavior. We suggest investigating these neuropsychological disturbances considering their influence on quality of life after surgery.

Aggression↗

PubMed2005

The role of serotonin in impulsive and aggressive behaviors associated with epilepsy-like neuronal hyperexcitability in the amygdala.

Neuronal hyperexcitability in limbic areas, especially the amygdala, is a significant underlying mechanism associated with complex partial seizures (CPS). CPS may be comorbid with emotional disturbances, especially major mood disorders, anxiety, and aggression. Anticonvulsant medications such as phenytoin are also mood-stabilizing, and have been used for treatment of behavioral dyscontrol in impulsive aggressive individuals. Because the amygdala has important functional roles in epilepsy, emotion, and behavioral control, there may be common biological mechanisms involving neuronal excitability that contribute to both seizure activity and psychopathology. This review examines physiological mechanisms in the amygdala that regulate neuronal excitability and discusses how this may underlie, in part, disturbances in emotional behavior.

Aggression↗

PubMed2006

Clinical features associated with impulse control disorders in Parkinson disease.

In patients with Parkinson disease (PD), impulse control disorders (ICDs) such as hypersexuality and pathologic gambling and shopping can be devastating complications of antiparkinsonian treatment. To improve their detection, we investigated clinical features associated with ICDs. Subjects were participants in a longitudinal study of PD. ICDs were associated with use of dopamine agonists and depressed mood, disinhibition, irritability, and appetite disturbance.

Adult↗

PubMed2007

Gambling behavior of student-athletes and a student cohort: what are the odds?

This study investigated the prevalence of gambling, gambling related NCAA violations, and disordered gambling in student-athletes (n = 736) with a comparison cohort of students (n = 1,071) at four universities. Student-athletes reported similar rates of gambling frequency, use of a bookmaker, and disordered gambling as students. After accounting for demographic differences, student-athletes were less likely to engage in sports wagering than students. Several risk factors for disordered gambling were identified, including being male and reporting at least one parent with a history of gambling problems. These findings suggest that problems associated with gambling are a university-wide issue with student-athletes meriting additional attention because of implications for the integrity of intercollegiate sports. Improved prevention and intervention efforts for collegiate gambling are recommended.

Adult↗

PubMedDate not supplied

Pathological gambling and substance misuse.

This paper first discusses the ways in which pathological gambling (a disorder of impulse control) and substance misuse are similar. It then examines research focusing on substance misuse among pathological gambles, and research on pathological gambling among substance misusers, focusing on a study examining gambling among 462 methadone patients from New York City. That study found that 21% of the sample were probable pathological gamblers, while an additional 9% were problem gamblers, i.e., they had some problem related to their gambling. The treatment implications of these findings and future research directions are also discussed.

Combined Modality Therapy↗

PubMedDate not supplied

The treatment of kleptomania with serotonin reuptake inhibitors.

Kleptomania is characterized by an irresistible impulse to steal objects not needed for personal use or for their monetary value. Several recent case reports have shown that Serotonin Specific Reuptake Inhibitors (SSRIs) could be effective in the treatment of kleptomania just as it is in other obsessive-compulsive spectrum disorders. We report five cases of kleptomania patients who were successfully treated with fluoxetine or paroxetine in combination with a psychotherapeutic intervention. In one case, the discontinuation of the medication repeatedly led to the resurgence of the kleptomanic behavior. Our case series illustrates the effectiveness of SSRIs in kleptomania. It thus supports the assumption that this syndrome involves a dysfunctional serotoninergic mechanism.

Adult↗

PubMed2005

Oniomania--successful treatment with fluvoxamine and cognitive-behavioral psychotherapy.

Compulsive buying (oniomania) is a disorder that has begun to receive attention from researchers in recent years. It has been estimated that disorder affects from 2 to 8% of the general adult population in the US (official data for Croatia are not available). About 90% of those affected are female. Onset occurs in the late teens or early twenties, and the disorder is generally chronic. Psychiatric comorbidity is frequent, particularly mood, anxiety, substance use, eating and personality disorders. Treatment has not been well delineated, but individual and group psychodynamic psychotherapy, cognitive-behavioural therapy and 12-step programmes may be helpful. Serotonin (5-hydroxytryptamine; 5-HT) re-uptake inhibitors may help some patients regulate their buying impulses. We have presented the case of a 32-year old woman with a history of excessive pathological buying treated successfully with combined therapy (fluvoxamine and cognitive-behavioral psychotherapy).

Adult↗

PubMed2001

Kleptomania: diagnosis and treatment options.

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. However, some of the principle features of the disorder, which include repetitive intrusion thoughts, inability to resist the compulsion to perform the thievery and the relief of tension following the act, suggest that kleptomania may constitute an obsessive-compulsive spectrum disorder. Kleptomania is commonly under-diagnosed and is often accompanied by other psychiatric conditions, most notably affective, anxiety and eating disorders, and alcohol and substance abuse. Individuals with the disorder are usually referred for treatment due to the comorbid psychiatric complaints rather than kleptomanic behaviour per se. Over the past century there has been a shift from psychotherapeutic to psychopharmacological interventions for kleptomania. Pharmacological management using selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) and other antidepressants, mood stabilisers and opioid receptor antagonists, as adjuvants to cognitive-behavioural therapy, has produced promising results.

Antidepressive Agents↗

PubMed1996

Pathological gambling in Louisiana: an epidemiological perspective.

A review of telephone interview data using the South Oaks Gambling Screen on a random sample of 1,818 Louisiana residents > 18 years indicated that 4.8% of adults > 21 years (approximately 122,500) have gambling disorders, compared to 14.4% of 18 to 21 year olds (approximately 21,000). Geographic distribution of gambling disorders shows equal statewide penetrance. Pathological gamblers are demographically distinct, more likely to be male, < 30 years, non-Caucasian, unmarried, and less likely to have graduated from high school than nonproblem gamblers. Two demographic clusters, males < 21 who primarily wager on video poker and those > 30 who primarily wager on horse racing, were noted. Data is needed on adolescent incidence and prevalence to plan prevention and early intervention programs in Louisiana.

Adolescent↗

PubMed1999

Relationships of plasma tryptophan availability to course of illness and clinical features of alcoholism: a preliminary study.

RATIONALE: Serotonergic (5-HT) mechanisms may be involved in impulse control (including antisocial behavior) across psychiatric syndromes. Age of onset may differentiate alcoholics on psychopathological characteristics associated with impulse control, especially mood disturbance, hostility, and a broad range of antisocial behaviors. Thus, there may be a predictable relationship between markers of 5-HT function and age of onset-related characteristics. OBJECTIVE: We tested the hypothesis that there would be a predictable relationship between the ratio of plasma tryptophan to large neutral amino acids (i.e. TRYP/LNAA ratio), a marker of 5-HT function, age of onset and related psychopathological characteristics associated with impulse control. METHODS: Fifty-eight male and female DSM-IV diagnosed alcoholics attending an outpatient treatment center completing a comprehensive psychopathological assessment, and from whom blood samples were obtained. RESULTS: Plasma TRYP/LNAA ratio was positively correlated with symptoms of dysphoria, and negatively associated with harm avoidance on Cloninger's Temperament and Character Inventory. Low tryptophan availability was associated with antisocial-type personality characteristics. Interestingly, the few (nine) subjects who had both early onset alcoholism and antisocial personality disorder had a higher plasma tryptophan but similar TRYP/LNAA ratio to the others. CONCLUSIONS: These data suggest that a low plasma TRYP/LNAA ratio is associated with susceptibility to anxiety, antisocial-type personality characteristics, and an early age of onset for alcoholism. In contrast, a high plasma TRYP/LNAA ratio is associated with a later onset of alcoholism and dysphoria.

Age of Onset↗

PubMed1990

Platelet serotonin decrease in alcoholic patients.

This study investigated the platelet 5-HT levels and their changes according to different physiological and pathological factors in 30 young alcoholic patients (16 alcohol abusers and 14 alcohol-dependent subjects) and 26 healthy controls. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. The mean platelet 5-HT levels obtained in patients during withdrawal and after 2 weeks of abstinence were significantly lower than in controls. Presence of positive history of impulse control disorders (ICD) influenced the mean platelet 5-HT levels in patients. These preliminary results suggest that the platelet 5-HT level decrease observed in alcohol-dependent patients mostly free from ICD and in alcohol abusers mostly affected by ICD might result from comparable neurobiological mechanisms. However, the age of onset of alcohol dependence might depend on psychological functioning features.

Adolescent↗