Impulse-control disorders

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... 

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). 

Appendix Q. Impulse Control Disorders Not Elsewhere Classified. 

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. 

Physicians use benzodiazepines to treat many disorders, including a number of anxiety disorders. These include acute anxiety, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. In addition, benzodiazepines can be used to treat agitation or anxiety that is caused by other psychiatric conditions such as acute mania, psychotic illness, depression, impulse control disorders, and catatonia or mutism. 

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). 

Lidberg L, BeHrage H, Bertilsson L, Evenden MM, Asberg M (2000) Suicide attempts and impulse control disorder are related to low cerebrospinal fluid 5-HIAA in mentally disordered violent offenders. Acta Psychiatr Scand 101 395-402. 

The most prevalent past-year mental disease classes arc anxiety disorders (18%), mood disorders (10%), impulse-control disorders (9%), and substance abuse (15%). 

Kleptomania—An impulse-control disorder whereby patients have an uncontrollable urge to steal, along with recurrent failure to resist these urges. 

A word about prevalence mental illness is more common than many people imagine. The current prevalence estimates are that about half the U.S. population meets the criteria for at least one mental disorder during a lifetime, with about 25 percent of the population meeting the criteria for at least one mental disorder during any given year.1 Of these disorders, the most prevalent are apparently anxiety disorders, followed by mood disorders (for example, major depressive disorder), impulse-control disorders (for example, attention deficit hyperactivity disorder [ADHD]), and substance disorders (for example, alcohol abuse). In contrast, the prevalence of psychosis as I define it here is only 2—3 percent of the U.S. population, and the world prevalence is about the same. 

The effects of zonisamide in the treatment of impulse control disorders that occur in a subgroup of patients with Parkinson s disease have been studied in 15 patients [368 ]. The starting dosage was 25 mg/day titrated to 200 mg/day as tolerated. There was a marked reduction in the severity of impulsive behaviors and global impulsiveness. Four patients reported adverse reactions. The most common were difficulty in concentrating (n — 3) and fatigue (n=2). One patient complained of paresthesia and one withdrew because of difficulty in concentrating. 

Bermejo PE, Ruiz-Huete C, Anciones B. Zonisamide in managing impulse control disorders in Parkinson s disease. J Neurol 2010 257(10) 1682-5. 

Wingo TS, Evatt M, Scott B, Freeman A, Stacy M. Impulse control disorders arising... 

Callesen MB, Scheel-Kruger J, Kringelbach ML, MoUer A. A systematic review of impulse control disorders in parkinson s disease. J Parkinsons Dis 2013 3(2) 105-38. 

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