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Results for “Disruptive, Impulse Control, and Conduct Disorders”

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PubMed2003

Alterations in brain activation in posttraumatic stress disorder patients with severe hyperarousal symptoms and impulsive aggressiveness.

OBJECTIVE: We wanted to assess possible alterations in brain activation in PTSD patients with severe hyperarousal symptoms and impulsive aggressiveness. METHOD: 25 Croatian War (1991-1995) veterans with combat-related PTSD with severe hyperarousal symptoms and impulsive aggressiveness were assessed for possible alterations in cerebral blood flow in single photon emission computed tomography brain scans. RESULTS: Increased regional cerebral blood flow in projection area of nucleus accumbens was found in 13 of 25 subjects, and for all in the dominant brain hemisphere. DISCUSSION: We believe that at least some of PTSD symptoms, and especially the impulsive aggression, can be associated with increased regional cerebral blood flow in the projection area of nucleus accumbens.

Aggression↗

PubMed1996

Medical approaches to gambling issues--I: The medical condition.

Gambling is a common human behavior. People who gamble encounter physicians. At times, gambling can produce adverse consequences for the player. Persistence of gambling despite adverse consequences can be called problem gambling. Roughly 1% of adults and 3% of adolescents exhibit signs of a medical disorder defined as pathological gambling. In many areas, including Wisconsin, gambling is increasing in legality, availability, and prevalence, and with it, pathological gambling is increasing in prevalence. This paper provides a descriptive review of gambling behaviors and the condition of pathological gambling, in the hope of increasing the awareness of practicing physicians, medical educators and researchers, and public policy makers, about what is known about these behaviors and the features of gambling illness that may present in a clinical setting. A companion paper focuses on the opportunities for constructive clinical activity by physicians regarding gambling problems.

Adult↗

PubMed1984

Satiation in the treatment of inappropriate fire setting.

This paper concerns the treatment of a 7-yr-old boy, who exhibited multiple behavioral disorders, and was treated in a residential setting for inappropriate fire setting by a satiation procedure. Throughout treatment the number of adult interventions at home to "correct him about fire" were recorded. Treatment consisted of 100 30-min sessions in the residential setting during which he was free to light as many matches as he wished. Contrary to earlier studies, the number of matches lit per therapy session did not decrease. However, the number of "corrections about fire" at home completely ceased midway through treatment, and did not recur through the 24-month follow-up period.

Behavior Therapy↗

PubMed2006

Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: To examine sex differences in DSM-IV subclinical and pathological gambling in nationally representative data of the US population. METHOD: Data come from a large (n = 43093) representative sample of the adult US population. RESULTS: The lifetime prevalence rate of DSM-IV pathological gambling was 0.64% (95% CI 0.50-0.78) for men and 0.23% (95% CI 0.17-0.29) for women, whereas the lifetime prevalence of subclinical pathological gambling was 6.79% (95% CI 6.32-7.26) for men and 3.26% (95% CI 2.93-3.59) for women. For subclinical pathological gambling, men were significantly (p < 0.01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and pathological gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to pathological gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report gambling to relieve depressed mood and to prefer casino gambling. Rates of treatment-seeking for DSM-IV pathological gambling were low for both men and women. CONCLUSIONS: There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and pathological gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling.

Adolescent↗

PubMed2003

Recent research on the comorbidity of alcoholism and pathological gambling.

This article summarizes a symposium held at the 2002 Annual Meeting of the Research Society on Alcoholism in San Francisco, CA, and was prepared on behalf of the symposium participants by the symposium co-organizers/co-chairs. Prior research with both clinical and nonclinical populations indicates a high comorbidity between alcohol-use disorders and pathological gambling. This symposium involved a set of papers in which exciting new research on this form of comorbidity was presented. The studies spanned populations of problem-gambling helpline callers, problem gamblers attempting to recover, and community-recruited gambler research volunteers. The studies used methodologies ranging from questionnaire and interview to laboratory-based paradigms (i.e., cognitive and alcohol challenge). Study designs ranged from cross-sectional to longitudinal and from correlation to experiment. The symposium highlighted novel approaches that researchers are using to enhance understanding of functional relations that may underlie this common comorbidity.

Alcoholism↗

PubMed2003

Impulsiveness as the intermediate link between the dopamine receptor D2 gene and alcohol dependence.

OBJECTIVES: Reinforcement and reward processes have been proposed as being an intermediate link between the risk for alcohol dependence and the gene coding for the dopamine receptor D2 (DRD2). This hypothesis remains open to speculation, and personality traits such as impulsiveness, a core dimension in addictive disorders, should also be taken into account. For instance, recent evidence in rats showed that DRD2 antagonists might increase impulsivity in decreasing the value of delayed rewards. METHODS: Considering the pro-impulsiveness role of ethanol observed in clinical practice and epidemiological studies, we analysed the Barratt impulsiveness scores in a sample of 92 alcohol-dependent French patients (57 men and 35 women), according to the TaqI A polymorphism of the DRD2 gene. RESULTS: A2/A2 and A1/A2 genotypes were significantly associated with a higher global impulsiveness than A1/A1 genotype (P=0.02 and P=0.03, respectively). CONCLUSIONS: We propose that reward-related impulsiveness may constitute a risk factor for alcohol dependence, and that this core temperament could be partly mediated by the DRD2 gene.

Alcoholism↗

PubMed2003

Effect of a new casino on problem gambling in treatment-seeking substance abusers.

Problem gambling rates are frequently found to be higher in those who abuse substances than in the general population, and this group represents a well-established high-risk population for developing the disorder. In this study of 853 residential substance abusers, approximately 10% scored in the problem gambling range on the South Oaks Gambling Screen (SOGS). On most descriptive variables, these subjects appeared to be similar to substance abusers who do not have gambling problems. However, they tended to participate in more gambling behaviours and had more relationships with individuals who also gambled. There is some evidence that the introduction of a new casino in the community increased the SOGS scores for subjects who gambled most frequently on such casino-related gaming as slot machines, cards, and casino games.

Adult↗

PubMed2002

Intermittent explosive disorder: epidemiology, diagnosis and management.

Intermittent explosive disorder (IED) is characterised by discrete episodes of aggressive impulses that result in serious assaultive acts towards people or destruction of property. IED causes severe impairments in daily function. The diagnosis of IED should be made only after a thorough medical work-up. A structured or semi-structured diagnostic interview is helpful to ensure that comorbid and pre-existing conditions are considered. There is a lack of controlled trials of agents for the treatment of patients with IED, but there is evidence that mood stabilisers, antipsychotics, beta-blockers, alpha(2)-agonists, phenytoin and antidepressants may be useful. Behavioural interventions may be valuable as part of the overall treatment of IED.

Adrenergic Agents↗

PubMed2001

A case of kleptomania and compulsive sexual behavior treated with naltrexone.

Objective of this paper was to examine a possible treatment option for two disorders currently lacking agreed upon pharmacotherapeutic interventions. We report a patient fulfilling DSM-IV criteria for kleptomania with comorbid compulsive sexual behavior who failed to respond to fluoxetine, behavioral therapy, and psychotherapy, and who was therefore treated with naltrexone to reduce urges to steal and sexual urges. Treatment with high-dose naltrexone (150 mg/day) led to remission of both the patient's urges to steal and sexual urges. Discontinuation and rechallenge with the medication provides further support that improvement was due to naltrexone. Naltrexone in high doses show promise for the treatment of both kleptomania and compulsive sexual behavior.

Compulsive Behavior↗

PubMed2000

Conceptual issues in trichotillomania, a prototypical impulse control disorder.

Impulse control disorders (ICDs) are characterized by irresistible urges to perform acts that result in a reduction of tension and possibly gratification, but also have negative consequences. Trichotillomania, an ICD, is characterized by a recurrent failure to resist impulses to pull out one's hair, resulting in noticeable hair loss. Limited information is available about structural and neurochemical differences in individuals with trichotillomania. Cognitive behavioral techniques are promising treatments for trichotillomania. Pharmacologic treatments have focussed on clomipramine and venlafaxine as potentially effective for the short term control of symptoms in trichotillomania. Selective serotonin reuptake inhibitors, though promising in open trials, seem to be largely ineffective in reducing hair pulling in controlled studies. Durability of pharmacologic benefit for the symptoms of trichotillomania, both in a small trial and in clinical experience, appears to be poor.

Adult↗

PubMed1999

Altered emotional states in knockout mice lacking 5-HT1A or 5-HT1B receptors.

Dysfunctions of the serotonergic system have been implicated in a number of psychiatric disorders including depression, anxiety and disorders of impulse control. To model these disorders we have generated mice with altered serotonergic systems. Specifically, we have created mice that lack or express reduced levels of two serotonin receptors: 5-HT1A and 5-HT1B receptors. These receptors are localized both on serotonergic neurons where they act as autoreceptors and on non-serotonergic neurons. As a result, the 5-HT1A and 5-HT1B receptors control the tone of the serotonergic system and mediate some of the postsynaptic effects of serotonin. Agonists of these receptors are currently used in the treatment of migraine and anxiety disorders. Mice lacking these receptors develop, feed, and breed normally and do not display any obvious abnormalities. However, when analyzed in a number of behavioral paradigms, the 5-HT1A and 5-HT1B knockout mice display a number of contrasting phenotypes. While the 5-HT1B knockout mice are more aggressive, more reactive, and less anxious than the wild-types, the 5-HT1A knockouts are less reactive, more anxious, and possibly less aggressive than the wild-types. We are currently investigating with tissue-specific knockout mice which neural circuits are responsible for these phenotypes.

Animals↗

PubMed2001

Case series: amantadine open-label treatment of impulsive and aggressive behavior in hospitalized children with developmental disabilities.

OBJECTIVE: A growing body of literature implicates interactions between glutamatergic and neostriatal dopaminergic neurotransmitter systems in the development and expression of impulsivity, hyperactivity, and stereotypy. Amantadine hydrochloride, a drug used in young children for influenza prophylaxis, acts both as an indirect dopamine agonist as well as an N-methyl-D-aspartate (NMDA) receptor antagonist. Thus an open clinical trial of this medication for the treatment of symptoms of impulse control disorders in children was performed. METHOD: A total of eight children (seven with neurodevelopmental disorders and all inpatients) with target behaviors refractory to other treatments were selected after parental informed consent. All patients were male and ranged in age from 4 to 12 years. Outcome was based on subjective consensus clinical ratings by the multidisciplinary treatment team. RESULTS: For four of the children, amantadine was associated with marked clinical improvement. In the remainder, improvement was also observed. Amantadine was well tolerated. CONCLUSIONS: On the basis of this experience, it appears that amantadine hydrochloride or related NMDA antagonists may warrant additional study in this and related populations.

Aggression↗

PubMedDate not supplied

Addicted women: when your patient can't stop drinking, smoking, shopping, eating.

While they do not necessarily present the same health risk, such other problems as compulsive shopping and eating have similarly serious implications for both physical and emotional health. All of these behaviors share a common theme reflecting difficulty with impulse control. In some cases, identifying patients with impulse control problems is straightforward; the pack of cigarettes or nicotine stains are easily visible, or the patient's weight can be measured in the office. Other problems, such as alcohol abuse or compulsive shopping, are less observable. To further compound the difficulty with identification is the fact that physicians may not ask routinely about the existence of such problems. Whether a practitioner inquires about the existence of these or other impulse control problems may be related to the difficulty one faces when the problem is finally identified. Addictive behaviors and impulse control disorders are notoriously difficult to treat. High relapse rates and the frustration of both patient and health care provider when efforts to change fail are a testimonial to the tenacity of these behaviors. Recent research highlighting how to meet patients at their level of readiness to change a risk-related behavior offers a perspective on what clinicians can do to assist their patients in approaching and ultimately changing these behaviors. The stages of change model will be described as a method for conceptualizing how behavior change can be facilitated in patients with these various problems. In addition, issues relevant to making a referral will be discussed.

Behavior Therapy↗

PubMed2004

Awareness promotion about excessive gambling among video lottery retailers.

This paper describes and evaluates "As luck would have it," an awareness program completed by retailers in Quebec Province. This program, which is presented as a two-hour awareness promotion workshop, aimed to inform retailers about excessive gambling. More specifically, it provided answers to the following questions: (1) What is chance and randomness? (2) Is there a link between misunderstanding the concept of chance and excessive gambling? (3) How does one recognise the symptoms of this disorder? (4) How should retailers intervene if they decide to do so? Results showed that retailers developed a better understanding of problem gambling, could recognise its main symptoms, felt more capable of coping with excessive gamblers, and of choosing the most appropriate moment to do so. In the follow-up phase, retailers who had attended the workshop reported that they approached a problem gambler significantly more often than the retailers who had not attended the workshop, and had discussed how to help problem gamblers significantly more often. The practical implications of these results are briefly discussed.

Adult↗

PubMed2005

Fracture of subthalamic nucleus deep brain stimulation hardware as a result of compulsive manipulation: case report.

OBJECTIVE AND IMPORTANCE: Trichotillomania (TTM) is an impulse control disorder characterized by the recurrent pulling of one's hair resulting in noticeable hair loss. There has been no definite association drawn between Parkinson's disease (PD) and TTM, although there is a suggestion that obsessive-compulsive symptomatology may be more prevalent in left-side predominant PD. We believe that it is important to be aware of psychiatric comorbidities in the surgical treatment of PD, as they may significantly impact the postoperative course. CLINICAL PRESENTATION: We describe the case of a 58-year-old woman with an eleven-year history of left-side predominant PD who also suffered from TTM. She underwent subthalamic nucleus deep brain stimulation (STN-DBS) and subsequently developed significant wound complications of her left-sided deep brain stimulation leads. It was noted during the postoperative period that the patient was picking her left-sided, but not right-sided, incision-a behavior that was felt to be a part of this patient's impulse control disorder. INTERVENTION: Multiple wound revisions and eventual replacement of her left-sided deep brain stimulation lead was performed as a result of hardware malfunction secondary to wound manipulation by the patient. CONCLUSION: Before surgery, this patient's TTM was right-sided, but after subthalamic nucleus deep brain stimulation, her wound picking was only left-sided. This case suggests that subthalamic nucleus deep brain stimulation may have a role in unleashing the symptomatology of TTM through an as yet poorly understood mechanism. Furthermore, there is also an implication that the pathophysiology of PD and TTM may be intertwined.

Deep Brain Stimulation↗

PubMed2006

Self-reported and neuropsychological measures of impulsivity in pathological gambling.

Pathological Gambling is an impulse control disorder. Impulsivity has been investigated separately by neuropsychological tests and self-report scales. Although some studies have tried to correlate these approaches, their interaction has not been sufficiently explored among pathological gamblers (PG). In this study, we have compared 214 PG (162 with comorbidity and 52 with no comorbidity) to 82 healthy volunteers regarding the reaction time and number of errors at Go/No-go tasks, and scores on the Barratt Impulsiveness Scale (BIS). PG have committed more errors at the Go/No-go tasks and presented higher scores on the self-report scale. The neuropsychological tests and BIS composed a multinomial logistic model that discriminated PG from non-gamblers better than models having one or another type of measure. Impulsivity seems to be a multi-dimensional phenomenon, and PG a heterogeneous population in which different types of impulsivity are present.

Adult↗

PubMed2002

Psychological characteristics of aggressive drivers with and without intermittent explosive disorder.

We compared two groups of aggressive drivers, those who met criteria for Intermittent Explosive Disorder (IED) (n=10) and comparable aggressive drivers who did not meet IED criteria (n=20), to a group of non-aggressive driving controls (n=20) on measures of psychological distress, anger, hostility, and Type A behavior as well as measures of aggressive driving and driving anger and their driving records. There were few differences between the aggressive drivers with IED and those without IED. The IED positive aggressive drivers endorsed more assaultiveness and resentment as well as more impatience and showed trends to have more hostility and angry temperament. When all aggressive drivers were compared to controls, differences emerged on anxiety, hostility, and anger as well as on measure specific to aggressive driving (competitiveness) and driving anger (at slow drivers and traffic obstructions).

Adolescent↗

PubMed2001

The genetics of alcoholism and alcohol abuse.

Twin studies have established that there are substantial genetic influences on alcoholism (0.5-0.6) in both men and women. Our knowledge of behaviors predisposing to alcoholism, including anxiety and impulsivity, is advancing rapidly through animal and human studies. Although alcoholism is often comorbid with other substance abuse and psychiatric disorders, recent studies have shown that, with the exception of nicotine, the heritability of alcoholism is largely substance-specific. Increasing understanding of the neurobiology of addiction has identified neural pathways in which genetic variation at candidate genes could influence vulnerability. Some functional variants of these genes have been identified. Recent linkage analyses in humans and rodents have pointed to genomic regions harboring genes that influence alcoholism. Refinement of clinical phenotypes and use of intermediate phenotypes will improve chances of gene identification. All these advances in the understanding of the genetics of alcoholism should facilitate the development of more accurately targeted therapies using molecular diagnostic approaches.

Alcoholism↗