Impulse Control Disorders Flashcards
measure for kleptomania
Measures - The Kleptomania Symptom Assessment Scale (K-SAS)
11- item self-report scale
requires the respondent to consider their thoughts, feelings and actions over the past week.
each item is scored from 0-4
The maximum score is 44;
a score over 31 = severe symptoms
a score of over 21 = moderate.
Most people with this disorder score between 22 and 37.
used to assess changes in severity of symptoms over time for ex, following treatment
ten minutes to complete
Biological explanation
Imbalance of dopamine is associated with schizophrenia, and also with impulse control disorders.
Dopamine receptors exist in very high numbers in the neural pathways related to reward/reinforcement.
Reward Deficiency Syndrome:
Impulse control disorders may result from low levels of dopamine in brain regions like the striatum → thought to result from an interaction between specific genes and environmental factors →they seek out opportunities that lead to a dopamine rush.
Carrying allele 1, which codes for D2 dopamine receptors has been associated with reduced density or sensitivity of dopamine receptors → may lead to altered dopamine signalling in the brain, which could potentially influence impulsive behaviours.
Behavioural Explanation: Positive Reinforcement and Partial Reinforcement Schedules
Variable ratio
the ratio of rewards to responses is unpredictable → gives the steadiest and highest rate of responding
Fixed ratio
rewarded every nth response
Why the losses, which far outweigh the wins when gambling, do not stop the behaviour?
Skinner’s research with rats:
The schedule that led to the highest response rate was a variable ratio schedule →
The anticipation of a win experience can also become rewarding in itself.
it fails to acknowledge the role of negative reinforcement →
The alleviation of a negative feeling is negatively reinforcing and the person is more likely to exhibit this behaviour in future.
Cognitive Explanation: Miller’s Feeling-State Theory
State Dependent Memory - when we are in a certain emotional state, we begin to retrieve memories from the last time we were in that state
Addictive memory (AM) - memories from past experiences relating to the problem behaviour in people with impulse control disorders (such as fire-starting, gambling or stealing)
intense desire (starting fire) + intense positive experience (feeling of euphoria) = feeling state
If a person’s feeling-state about starting a fire is: ‘I am a powerful human being’ combined with the positive emotions, psychological arousal and memory of setting the fire then this could create a compulsion for fire-setting behaviour
Biological Treatment and Management of Impulse Control Disorder
Opiates - The molecules bind to opioid receptors throughout the nervous system. Antagonists reduce the effects of neurochemicals by occupying receptors without activating them.
Opiate antagonists block opiate receptors
and lessen the ability to experience euphoria.
Endorphins - The body creates its own morphine, better known as endorphins. Endorphins are released in response to exercise, sex and eating, but also as a reaction to pain and stress.
They have two main effects:
to increase pleasure
to decrease pain
When opioid receptors are activated, they inhibit the release of a neurotransmitter called GABA → GABA regulates dopamine → while opioid receptors are occupied, dopamine activity increases
Key Study - Grant et Al
Aim and hypostheses
AIM:
To investigate factors that predict the effectiveness of opiate antagonists in the treatment of gambling disorder
Hypotheses
Opiate antagonists would be more effective for people with a family history of alcoholism, stronger urges to gamble and euphoria in response to alcohol compared with people with no —
People with less severe gambling urges may experience a placebo effect
Grant et al
methodology
The study combined the results of two randomised control trials
Both RCTs were double-blind, placebo-controlled experiments with independent measures.
Data gathering techniques included structured and semi-structured interviews, questionnaires and psychometric tests:
- Severity of gambling disorder symptoms was assessed before and after treatment using a modified version of the Yale-Brown Obsessive-Compulsive Scale.
- Comorbid diagnosis were identified using a structured interview
- Daily functioning, anxiety and depression were assessed using questionnaires
- a semi-structured interview was used to collect information about family history of psychiatric diagnoses, including alcoholism in first-degree relatives.
grant et al
sample
284 american participants
Diagnosed with pathological gambling using DSM-IV and scored five or more on the South Oaks Gambling
Screen (SOGS)
48% female, none pregnant nor breastfeeding, all used regular contraception.
207 outpatients from 15 psychiatric centres who participated in a 16-week trial of nalmefene (an opiate antagonist)
The remaining 77 participated in an 18-week trial of naltrexone
All had gambled in the past 2 weeks and gambled more than once a week
None had used either of the trial drugs before
Participants were randomly assigned to either the placebo group or the low, medium or higher dose in the drug group.
covert sensitisation
Psychological treatment
Involves conditioning
unpleasant stimulus (nausea/an anxiety-producing image) is paired with an undesirable behaviour → thoughts of the target behaviour will now trigger negative feelings that override the urge to enact the behaviour.
example study Glover:
muscle-relaxing medication + self hypnosis + imagery of vomiting + shopping list + leave stealing bag at home
Imaginal desensitisation
Psychological treatment
a personalised script + relaxation-based imagery to reduce the strength of the urges to engage in behaviours by reducing excitement and physiological arousal
Progressive muscle relaxation (PMR)
tensing different muscle groups while breathing in and relaxing the muscles while breathing out
Guided imagery:
Reverse physiological arousal to the point where the stimulus no longer leads to the same bodily response, making way for alternative, more adaptive responses.
The therapist will then break the sequence of events into 4-6 scenes that lead up to the target behaviour:
awareness of urge
collecting required items for the behaviour
travelling to the venue where the behaviour will take place
starting the behaviour
Homework
Clients are asked to:
participate in guided imagery 2-3 times a day for 5-7 days
record their progress on specially prepared handouts provided by the therapist.
Clients may only have 2-3 face-to-face sessions with the therapist:
one to inform the design of the script
another to practise the relaxation strategies and run through the script (+details of how to practise at home)
one further session to check on the client’s progress and to see whether the script needs modifying
