LO1: Impulse Control Disorders

Question 1

What defines an impulse control disorder?

Answer 1

The defining feature is the inability to control or inhibit acting on impulses that may be harmful to self or to others.

Question 2

What is the impulse response phases?

Answer 2

Impulse or desire ➡️ increased tension ➡️ increased arousal ➡️ commitment of the act ➡️ pleasure, gratification, and tension ➡️ regret, self-reproach, or guilt.

Question 3

What regions of the brain are involved with impulse control disorders and what are they in charge of?

Answer 3

Nucleus accumbens- involved in urges and impulses
Amygdala- involved in emotional responses
Frontal and prefrontal cortex- involved in risky/compulsive behaviour as well as planning and judgement

Question 4

What 2 pathways do impulse control disorders affect?

Answer 4

The mesocortical and mesolimbic pathways

Question 5

Kleptomania

Answer 5

1st clinical cases documented over two centuries ago
Term derived from Greek words meaning “to steal” and “insanity”
Majority of the cases are in females
Characterized by recurrent failures to resist impulses to steal objects
Objects are not desired for their monetary value or personal use
Pleasure or relief results from the act of stealing

Question 6

What are the three courses of kleptomania?

Answer 6

1. Sporadic with brief episode and long periods of remission
2. Episodic with prolonged periods of stealing remission
3. Chronic and fluctuating

Question 7

Kleptomania neurobiological influences

Answer 7

Serotonin and dopamine are the main neurotransmitters involved
Opioid and glutamatergic systems
Kleptomania can be a side effect of dopamine agonists used to treat Parkinson’s
Can result in legal problems
Associated with other impulse control disorders and impulse control-related problems, such as impulsive buying
Associated with mood disorders, such as mdd, anxiety disorders, eating disorders (mainly bulimia nervosa), and personality disorders.
SSRIs are first line agents

Question 8

Pyromania

Answer 8

Documented for at least two centuries
Term derived from Greek words for “fire” and “insanity”
Rare disorder (<1%)
No established age of onset
Majority of cases in males
Found more in those with poorly developed social skills and learning delays

Question 9

Pyromania

Answer 9

Failure to resist impulses to set fires on multiple occasions
No motivation other than relief of pleasure
Fire setting is episodic
Frequency waxes and wanes
Can result in legal issues
Effective pharmacology not well established

Question 10

Intermittent explosive disorder (IED)

Answer 10

Sparse epidemiological info available
Lifetime incidence is about 7%
More common in children, adolescents, and young adults
More common in males

Question 11

IED

Answer 11

Failure to resist aggressive impulses
Result in regular occurrences of verbal or physical aggression
Does or does not result in injury to others or property damage
Degree of outbursts is significantly out of proportion to the precipitating stressor
Revenge for minor injustice is motivation
In children may manifest as severe frequent temper tantrums

Question 12

Neurobiological influences of IED

Answer 12

Non-specific slowing on EEG
May see reflex asymmetries and delayed speech on exams
Serotonin metabolism may be altered
Treated with anticonvulsants, mood stabilizers, SSRIs, beta-blockers, alpha-2 agonists, and atypical antipsychotics

Question 13

Trichotillomania

Answer 13

1st described by French dermatologist >100 years ago
Similarities with obsessive-compulsive disorder and Tourette’s
Begins in childhood
Affects up to 3% of the population
More common in females

Question 14

Trichotillomania

Answer 14

Recurrent pulling out of hair
Results in noticeable hair loss
Continues despite repeated attempts to stop or decrease
Fear of discovery-delay in health care, forego reporting sexual assault
Treated with SSRIs
Two types- binge and sedentary

Question 15

Gambling Disorder

Answer 15

1-3% of the population
1/3 females and 2/3 males
More prevalent among those whose parents’ had gambling issues and those with deviant peer groups

Question 16

Gambling Disorder

Answer 16

Persistent and recurrent maladaptive gambling behaviour
Progression is insidious
Preoccupied with gambling
Urge is often stronger during stressful periods
Attempt to hide extent of behaviour
SSRIs, mood stabilizers, and opioid antagonists

Question 17

Gambling Disorder

Answer 17

Public health concern
It affects a person who gambles and their loved ones
Can result in: marital breakdown, bankruptcy or financial hardships, suicide, crime, reduced health, and increased use of alcohol and other substances

Question 18

Gambling disorder criteria

Answer 18

Persistent/recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the person experiencing 4+ of the criteria in a 12-month period
Mild: 4-5 criteria met
Moderate: 6-7 criteria met
Severe: 8-9 criteria met

Question 19

Non-Pharmacological tx for impulse control disorders

Answer 19

Cognitive restructuring, anger management, family therapy, support groups, coping skills training, relaxation techniques, and breathing techniques.

Question 20

Nursing dx for impulse control disorders

Answer 20

Risk of other-directed violence r/t antisocial characteristics
Risk of self-directed violence r/t rage reaction
Ineffective coping r/t situational crisis
Impaired social interaction r/t altered thought process