Impulse control

Another theory for the action of stimulant diugs in ADHD involves effects on nonstiiatal monoamine systems. Frontal cortical dopamine, norepinephrine, and serotonin are clearly important in cognitive functioning and impulse control. These neurotransmitters directly modulate reward-related behaviors associated with the striatal dopamine system. Moreover, the amygdala may be pharmacologically influenced leading to enhanced... 

Additionally, impulse-control and attention problems, hyperactivity, and even antisocial behavior could be caused by a prenatal exposure to psychoactive drugs that escaped detection. Research has linked these conditions with known prenatal toxicity, and the consequences of low levels of prenatal exposure to psychoactive substances can sometimes be missed. In these instances, the symptoms are more likely to be observed as behavioral and attributed to other causes (such as Attention-Deficit Disorder). Recent research also suggests that children of mothers who may have used substances during pregnancy also may be at risk for drug problems later in life (Baer, Sampson, Barr, Connor, Streissguth, 2003). 

Impulse Control Disorders. It can be challenging to distinguish the repetitious behaviors of certain impulse control disorders (e.g., kleptomania) from the compulsions of OCD. However, whereas the compulsive behaviors of OCD are ego-dystonic and driven by an obsessional fear, the behaviors associated with the impulse control disorders provide a transient ego-syntonic sense of gratification and are not motivated by an underlying fear. 

When these measures have failed and impulsivity and aggression remain a problem, additional strategies are available. First, reconsider the diagnosis. Does the patient have bipolar disorder rather than ADHD Is there another disruptive behavior disorder in addition to or instead of ADHD Does (s)he have an impulse control disorder In these more severe cases, other medications such as atypical antipsychot-ics or mood stabilizers are often helpful. 

Unlabeled Uses Eating disorders, generalized anxiety disorder (GAD), impulse control disorders... 

The differential diagnoses include several disorders with overlapping behaviors that have either a compulsive quality or impulse control deficits. The stereotypies and perseverative behavior of the pervasive develop-... 

Fluoxetine. An open fluoxetine trial in 17 patients with mild to profound MR showed improvement in 6 of eight children with impulse control problems and moodiness (Cook et al., 1992). 

Trichotillomania, listed in the DSM-IV under Impulse Control Disorders Not Elsewhere Classified ( 252), is characterized by impulses to pull out one s hair, often involving multiple sites (scalp, eyebrows, and eyelashes commonly pubic, axillary, chest, and rectal areas less commonly) ( 253). Some clinicians have proposed that this condition is a variant of OCD, based on similarities in phenomenology, family history, and response to treatment. Originally thought to occur more frequently in females, it has become evident that it may affect males just as often. Many victims of this disorder have histories beginning in childhood and refractoriness to all attempted remedies. Co-morbidity of trichotillomania with mood, anxiety, substance abuse, and eating disorders is also common (254). Others have noted that trichotillomania may also coexist with mental retardation and psychotic disorders (see Appendix Q). 

Patients with this disorder not only have a disturbed eating pattern but also problems with impulse control, often resulting in drug or alcohol abuse, self-mutilation, kleptomania, and sexual disinhibition. They also may have symptoms of obsessive-compulsive disorder or obsessive-compulsive personality disorder ( 498). In these individuals, manipulation of food is associated in varying degrees with alcohol and drug abuse. They are typically poor candidates for pharmacotherapy and, not surprisingly, have been unresponsive to a variety of psychotropics. 

Appendix Q. Impulse Control Disorders Not Elsewhere Classified. 

Confusion, hallucinations, delusions, and other psychiatric reactions are potential complications of dopaminergic treatment and are more common and severe with dopamine receptor agonists than with levodopa. Disorders of impulse control may lead to compulsive gambling, shopping, betting, sexual activity, and other behaviors. They clear on withdrawal of the offending medication. 

Potenza MN et al Drug insight Impulse control disorders and dopamine therapies in Parkinson s disease. Nat Clin Pract Neurol 2007 3 664. [PMID 18046439]... 

Specker, S. M., G. A. Carlson, G. A. Chistenson, and M. Marcotte. 1995. "Impulse Control Disorders and Attention Deficit Disorder in Pathological Gamblers. Annals of Clinical Psychiatry 7 175-79. 

To see the connection between impulse control and self-deception in... 

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