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CP: 1.3 Impulse control disorders > 1.3.3 Treatment and management of impulse control disorders > Flashcards

1.3.3 Treatment and management of impulse control disorders Flashcards

1
Q

Biological treatments

Opiod antagonists

A

Opiates are a group of powerful drugs used as painkillers, they are considered high-risk, e.g. heroin is one of them.

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2
Q

Biological treatments

What has been used to treat ICDs, with the least success with gambling disorder?

A

SSRIs.

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3
Q

Biological treatments

What does some research suggest opiate antagonists may be successful in treating?

A

Gambling disorders.

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4
Q

GRANT ET AL. (2008)

What do endorphins bind to?

What does this allow?

A

Endorphins bind to opioid receptors, inhibit GABA and allow dopamine to increase.

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5
Q

GRANT ET AL. (2008)

What do opioid antagonists do?

A

Block opioid receptors and reduce euphoria.

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6
Q

GRANT ET AL. (2008)

What does a lack of reinforcement (euphoria) lead to?

A

The extinction of compulsive behaviours.

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7
Q

GRANT ET AL. (2008)

Aim & hypothesis

A

To investigate opiate antagonists as a treatment for gambling disorder.

Opiate antagonists are more effective in reducing gambling disorder in people with a family history of alcoholism, strong urges and euphoric response to alcohol compared to people who do not fit into these categories.

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8
Q

GRANT ET AL. (2008)

Method

A

Experiment/randomised control trials, independent measures, double-blind.

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9
Q

GRANT ET AL. (2008)

Participants

A
  • 284 pathological gamblers.
  • Had all gambled in the past 2 weeks.
  • Outpatients from 15 psychiatric centres.
  • Equal no. of males/females
  • From the USA.
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10
Q

GRANT ET AL. (2008)

What conditions were ppts assigned to?

A

Low, moderate or high dose of nalmefene, naltrexone or placebo.

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11
Q

GRANT ET AL. (2008)

What technique was used to assign ppts to their condition?

A

Random allocation.

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12
Q

GRANT ET AL. (2008)

How many trials took place?

What style were they?

How long did they last?

A

2 double-blind placebo clinical trials which lasted either 16 or 18 weeks.

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13
Q

GRANT ET AL. (2008)

How did Grant measure the severity of ppts’ gambling?

A

Yale-Brown obsessive compulsive scale modified for pathological gambling (PG-YBOCS).

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14
Q

GRANT ET AL. (2008)

Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS)

A

A clinician-administered scale to assess gambling severity by assessing symptoms over the previous 7 days, in terms of both gambling urges/thoughts and gambling behaviour.

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15
Q

GRANT ET AL. (2008)

Apart from using the PG-YBOCS, how was data gained from ppts?

What was the data about?

A

Semi-structured interviews were used to gather family history, particularly relating to first-degree relatives with alcoholism.

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16
Q

GRANT ET AL. (2008)

When were the measures taken?

A

After the 16 or 18 week long trials.

17
Q

GRANT ET AL. (2008)

What 3 factors were associated with positive treatment outcomes?

A
  • Family history of alcoholism
  • Stronger baseline urges
  • Aged (reduced placebo effect in older ppts)
18
Q

GRANT ET AL. (2008)

What was a treatment response operationalised as?

A

At least a 35% reduction in PG-YBOCS total score, for at least 1 month following treatment.

19
Q

GRANT ET AL. (2008)

Conclusions

A

Opiate antagonists have the greatest effect for gamblers who have a family history of alcoholism.

The stronger the urges, the higher the probability that these drugs will be effective.

Efficacy in younger gamblers may be due to placebo effects.

20
Q

GRANT ET AL. (2008)

Strengths

A
  • Double-blind = eliminated ppt/researcher bias and increased validity.
  • Quantitative data = objective measurement of symptoms through standardised Y-BOCS.
  • Informed consent = before the placebo trial, ppts were informed of the process.
  • Generalisable = ppts were diverse in age/ethnicity.
  • RWA = showed the effectiveness of opiate antagonists in treating gamblers, this can help impact treatment in the future.
21
Q

GRANT ET AL. (2008)

Criticisms

A

Unethical = ppts believed they might be receiving the real drug (deception), but did not get treatment which is a risk to their health.
Self-report = ppts may not have accurate knowledge regarding family history of alcoholism.
No follow-up = long-term efficacy is unknown, family history might predict short-term improvement only.

22
Q

Cognitive/behavioural treatments

Covert sensitisation

A

Imaginative punishment through visualisation of negative consequences.

Involves an aversive sitmuli in the form of anxiety producing imagery (feeling sick/being caught).

This is paired with undesirable behaviour in order to create an association to deter that behaviour.

23
Q

Cognitive/behavioural treatments

Overt sensitisation

A

Actual punishment through electric shocks, unpleasant smells, public shaming etc.

24
Q

Glover (1985, 2011) - Cognitive/behavioural treatments

How did Glover use covert sensitisation to solve a woman’s shoplifting problem?

A

A 56-year-old woman had been shoplifting everyday for 14 years, she would wake up with obsessive thoughts about stealing later in the day.

Glover made the woman imagine vomiting as she approached the item she planned to steal, attracting other shoppers’ attention.

The vomiting would stop when she replaced the item and left the shop.

19 months after this covert sensitisation course, she had not lapsed once into stealing.

25
Q

Blasznski and Nower (2003) - Cognitive/behavioural treatments

Imaginal desensitiation

A

Involves teaching progressive muscle relaxation and then the person visualises themselves being expose to the situation that triggers the drive to carry out the impulsive disorder.

The aim is to reduce to strength of the drive.

26
Q

Blasznski and Nower (2003) - Cognitive/behavioural treatments

What treatment plan did they follow to treat gamblers?

A
  • Initiating the urge
  • Planning to follow through on the urge
  • Arriving at the venue
  • Getting arousal/excitement
  • Having ‘second thoughts’
  • Decreasing the attractiveness of the behaviour
27
Q

Blasznski and Nower (2003) - Cognitive/behavioural treatments

Where did they carry out these treatment sessions?

What materials were used?

A

With a therapist, and later at home using a ‘home pack’ with a tape to listen to and 4 handouts to use.

28
Q

Issues and debates

Are all these treatments holistic or reductionist?

A

Reductionist, the biological one is more so than the cognitive.

This is good since they can be tested.

29
Q

Issues and debates

Which treatments are nurture-based vs nature?

A
  • Cognitive = nurture
  • Biological = nature
30
Q

Issues and debates

Are the biological treatments based on deterministic or free-will factors?

What about situational vs indvidual?

A

Biological treatments are based on determinism and individual factors.

CP: 1.3 Impulse control disorders (3 decks)

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