Impulse control disorders Flashcards
Definition of ICD
repeated inability to resist the impulse or urge to carry out a behaviour.
Kleptomania
Powerful impulse to steal.
tension and arousal before, excitement and relief after. not for monetary gain.
Pyromania
- Powerful impulse to set fires. tension before, pleasure after.
- any other fire stimuli is attractive
Gambling disorder
persistent gambling behaviour- impaired control, priority, despite negative consequences
K-SAS (kleptomania symptom assessment scale)
11 item, typically 0-5 “How strong were your urges to steal this past week”
Biological explanation
-To release Dopamine
-Reduce as behaviour becomes compulsive
-more engagemnet is called “reward deficiency syndrome”
-Klept could be side effect of parkinsons or other drugs
Positive reinforcemnet theory
-someones learned behaviour is a result of previous trials
-“schedules of reinforcement”
the anticipation that they could win one more time
Millers feeling state theory
Intense desire linked to intense postive experience results in feeling-state
- starting fire “I am powerful”
-feeling like a loser normally, winner during gambling, and loser again after messing up
Biological treatment
Opiate antagonists work by reducing reward centres in the brain .
These are group of drugs traditionally used to treat substance abuse
Grant et al 2008 AIM
identify clinical variables associated with treatment outcome in PG subjects receiving opiates
-positive results for family hsitory of alcoholics
-less severe PG will respond to placebo
GRANT design and procedure
- double blind placebo clinical trials
-16 and 18 weeks
-284 patients that had gambled in past 2 weeks - independent: placebo/25 mg/50/100
- PG YBOCS and semi structured interviews used
GRANT conclusion
- 35% reduction in PG YBOCS
-history of alcoholism treated
-higher dose=less urge
-placebo worked better for kids
GRANT evaluation
double blind, quantitative, deception, application to everyday life
Covert sensitisation
conditioning with an unpleasant stimulus like nausea or anxiety producing image.
Glover 1985
56 year old woman with 14 years of klept. started when her husband was arrested for theft.
- vomiting associated with stealing
- four sessions 2 week intervals.
first 2: muscle relaxation to help immese into visualisation
last 2: vomiting, sickness going away if she replaced
19 month checkup with 1 relapse only
Imaginal desensitization
use of images to help patients
Blasczynki and Nower 2003
- muscle relaxation
-visualise trigger
-think about acting
-visualise leaving
-voice recording works aswell
