Explosive disorder

Episodic Dyscontrol Syndrome or Intermittent Explosive Disorder... 

This syndrome has similarities to the paradoxical reaction seen with barbiturates or BZDs, as well as epileptoid syndromes, including temporal lobe seizures and intermittent explosive disorder. Brain injury from trauma or encephalitis may also predispose some to an abnormally excessive response to even small amounts of alcohol. 

Valproate + fluoxetine II Intermittent explosive disorder + D62 NIMH... 

Selective serotonin reuptake inhibitors (SSRI s) like Prozac are used to treat many psychiatric disorders ranging from intermittent explosive disorder, to obsessive-compulsive disorder, to major depression and panic disorder (1), even though these disorders differ in their behavioral expression. How does one drug class treat these disparate disorders ... 

The treatment of intermittent explosive disorder, kleptomania, pyroma-nia, pathological gambling, trichotillomania, and impulse control disorder not otherwise specified is beyond the scope of this text, and we only briefly discuss some key aspects of impulse control disorders, about which the therapist should seek consultation with the psychiatrist. In particular, one must consider whether the person with intermittent problems of impulse control is manifesting a partial complex seizure (rare), or whether the person who habitually or rhythmically pulls his or her hair has a partial complex seizure instead of trichotillomania (unusual). 

When a therapist is evaluating a patient who demonstrates intermittent loss of impulse control, it is important to look for the sequence of events that kindled the condition. Sometimes, one discovers an obsessional antecedent to the loss of control, and this may respond very well to antiobsessional medication. The woman in the example that follows could have had an intermittent explosive disorder, a personality disorder, or other diagnoses but given her poverty and lack of health care insurance or access, she would probably have received no treatment. Had she been wealthy, she might have received psychotherapy, which may have helped, given time. However, medication management did result in prompt remission of her symptoms, and it may have saved her life and that of her son. In some cases, medication consultation for a patient with one of the impulse control disorders can be a life-saving collaboration between therapist and physician (see case example below). 

Dawson PM, Vander Zanden JA, Workman SL, Washington RL, Tyma TA. Cardiac dysrhythmia with the use of clonidine in explosive disorder. DICP 1989 23(6) 465-6. 

Antisocial Personality Disorder Borderline Personality Disorder Conduct Disorder Delirium Dementias Depression Explosive Disorder Medication-induced aggression Mania... 

The discussion below will focus on the relevance of some of the personality-type characteristics that have been linked to crash involvement. The personality concepts that have been studied in the context of driving include accident proneness, risk taking and sensation seeking, aggression, and perceptual style. Although each of these concepts is described separately, it is important to note that various specific personality characteristics are interrelated. For example, Malta et ol. (2005) demonstrated that aggressive drivers can be characterized by multiple distinct medical disorders such as Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. There are also other personality traits that have been linked to driving and will not be discussed here. These include extroversion (the tendency to attend to external events rather than focus internally) (Smith and Kirkham, 1981) and externally-oriented locus of control (the tendency not to assume responsibility for events that happen to a person) (Mayer and Treat, 1977). 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

Occupational health and safety in the rubber industry is discussed with reference to UK, US and European legislation. The review covers both natural and synthetic rubber industries. The first section outlines the laws affecting health and safety in the industry and the remainder presents specific health and safety issues of interest to employers and employees. Industrial safety is examined with reference to equipment, fire and explosions, solvents, epidemiology, NR latex allergy, skin irritations and dermatitis, dust and fume control, work-related musculoskeletal disorders, nitrosamines, 1,3-butadiene, and handling of rubber chemicals. 484 refs. 

Behaviorai probiems- For the treatment of behavioral problems in children with combative, explosive hyperexcitability that cannot be accounted for by immediate provocation. Reserve for use in these children only after failure to respond to psychotherapy or medications other than antipsychotics. Hyperactivity- For short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders consisting of... 

Donovan et al. (1996, 1997) completed an open study evaluating the use of valproic acid (Depakote) in adolescent outpatients with marijuana abuse or dependence and explosive mood disorder (mood symptoms were not classified using the DSM FV Diagnostic System). Eight subjects were prescribed 1000 mg of valproic acid (Depakote) for 5 weeks, in addition to regular therapy sessions, but did not receive any other psychotropic medications. All subjects showed a significant improvement in their marijuana use (p <0.007) and their affective symptoms (p < 0.001), although both outcomes were measured only by self-report. The most common adverse events were nausea and sedation. No subjects discontinued because of these side effects, nor were there any reported interactions between the valproic acid (Depakote) and substances of abuse. 

Budman, C., Brunn, R.D., Park, K.S., Lesser, M., and Olson, M. (2000) Explosive outbursts in children with Tourette s disorder./ Am Acad Child Adolesc Psychiatry 39 1270-1276. 

Horrigan, J.P., and Barnhill, L.J. (1997) Risperidone and explosive aggressive autism./ Autism Dev Disord 27 313-323. 

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