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43 Cards in this Set
- Front
- Back
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What are the characteristics of impulse control disorders?
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- Predisposed inability to resist unplanned, rapid reactions toward internal or external stimuli - Without regard for negative consequences, may cause harm to oneself or to others - Not caused by another mental condition, medical condition, or substance use |
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What are the core qualities of impulse control disorders?
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- Repetitive or compulsive engagement in behavior despite adverse consequences - Little control over negative behavior - Anxiety or craving experienced prior to engagement in impulsive behavior - Relief or satisfaction during or after completion of behavior |
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Case: 27 yo married accountant who arrives to psych clinic complaining of difficulty in managing his temper since adolescence. Easily angered by small things. Reacts quickly and is volatile. Throws objects in fits of rage, made threatening statements to his wife and coworkers. One coworker has threatened to pursue legal action.
He describes these episodes as brief, only 10-15 min, and he feels embarrassed shortly after. Convinced he may lose his job. Denies hx of drug or alcohol abuse.
What is his most likely diagnosis? |
Intermittent Explosive Disorder - Impulsivity is a common characteristic of other axis I and II disorders - Must rule out other axis I and II disorders |
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Case: 27 yo married accountant who arrives to psych clinic complaining of difficulty in managing his temper since adolescence. Easily angered by small things. Reacts quickly and is volatile. Throws objects in fits of rage, made threatening statements to his wife and coworkers. One coworker has threatened to pursue legal action.
He describes these episodes as brief, only 10-15 min, and he feels embarrassed shortly after. Convinced he may lose his job. Denies hx of drug or alcohol abuse.
What is the recommended treatment? |
- Use of meds to treat impulsive aggression: SSRIs (fluoxetine), anticonvulsants, lithium, antipsychotics, propranolol - Individual psychotherapy is difficult and ineffective - Imaginal exposure therapy, relaxation training, and dialectical behavioral therapy are more effective - Group therapy and/or family therapy may be useful to create behavior plans to help manage episodes |
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What meds are good for treating impulsive aggression?
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- SSRIs (especially fluoxetine) - Anticonvulsants - Lithium - Anti-psychotics - Propranolol |
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What types of therapy are more effective for treating impulsive aggression?
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- Imaginal exposure therapy - Relaxation training - Dialectical behavioral therapy
- Group therapy and/or family therapy to create behavioral plans to help manage episodes |
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Case: 27 yo married accountant who arrives to psych clinic complaining of difficulty in managing his temper since adolescence. Easily angered by small things. Reacts quickly and is volatile. Throws objects in fits of rage, made threatening statements to his wife and coworkers. One coworker has threatened to pursue legal action.
He describes these episodes as brief, only 10-15 min, and he feels embarrassed shortly after. Convinced he may lose his job. Denies hx of drug or alcohol abuse.
What are the associated test findings? |
- Low mean 5-hydroxyindoleacetic acid (5-HIAA) in CSF - Non-specific EEG findings - Abnormalities on neuropsych testing |
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What are the DSM-IV criteria for Intermittent Explosive Disorder?
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- Recurrent outbursts of aggression that result in assault against people or property - Outbursts and aggression are out of proportion to the triggering event or stressor - Aggression is not better explained by another psychiatric diagnosis - Each episode of explosive behavior often remmits quickly and spontaneously, often leaving pts feeling remorseful and distressed |
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Who is more likely to get Intermittent Explosive Disorder? Typical age of onset?
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- Men > Women - Onset usually in late teens and may progress in severity until middle age |
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What factors play a role in the etiology of Intermittent Explosive Disorder?
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- Genetic - Perinatal - Environmental - Neurobiological - Hx of child abuse, head trauma, seizures |
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Low levels of what are associated with impulsiveness and aggression?
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Serotonin
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What meds can be used to treat Intermittent Explosive Disorder?
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- SSRIs - Anticonvulsants - Lithium - Propranolol |
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What are the DSM-IV criteria for kleptomania?
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- Inability to resist uncontrollable urges to steal objects that are not needeed for personal use or monetary reasons - Pleasure or relief is experienced while stealing; however, intense guilt and shame are often reported by those with the d/o - Objects stolen are typically given or thrown away, returned, or hoarded |
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In whom is kleptomania more likely?
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Women > Men, but severity of symptoms are not gender biased
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When do pts with kleptomania steal?
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During times of stress
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How common is kleptomania in shoplifters?
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5%
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Increased incidence of what disorders is associated with kleptomania?
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- Mood disorders - Eating disorders (1/4 of pts with bulimia nervosa) - OCD |
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What is the course of kleptomania?
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Chronic
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How do you treat kleptomania?
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- Insight-oriented psychotherapy - Behavior therapy such as systematic desensitization and aversive conditioning - SSRIs - Some anecdotal evidence for naltrexone use |
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What are the DSM-IV criteria for pathological gambling?
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Persistent and recurrent maladaptive gambling behavior, as evidenced by 5 or more of following: 1. Preoccupation with gambling 2. Need to gamble with increasing amounts of money to achieve pleasure 3. Repeated and unsuccessful attempts to cut down on gambling 4. Restlessness or irritability when attempting to stop gambling 5. Gambling done to escape problems or relieve dysphoria 6. Returning to reclaim losses after gambling 7. Lying to therapist or family members to hide level of gambling 8. Committing illegal acts to finance gambling 9. Jeopardizing relationships or job because of gambling 10. Relying on others to financially support gambling |
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How common is pathological gambling? Men vs women?
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1-3% of adults in US; men are 2/3 of cases
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Who has high rates of pathological gambling?
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- Men are approx 2/3 of cases - High rates in adolescents and young adults - Lower rates in older adults, marked by periods of abstinence and relapse |
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There are increased incidence of what disorders with pathological gambling?
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- Mood disorders - Anxiety disorders - OCD |
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What are predisposing factors for pathological gambling?
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- Loss of a parent during childhood
- Inappropriate parental discipline during childhood - ADHD - Lack of family emphasis on budgeting or saving money |
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What is the prognosis for pathological gambling if no treatment is given?
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1/3 will achieve recovery without treatment
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How should pathological gambling be treated?
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- Participate in Gamblers Anonymous (12-step program) - most effective treatment
- After 3 months of abstinence from gambling, insight-oriented psychotherapy may be attempted - Important to treat comorbid mood disorders, anxiety disorders, and substance abuse problems with SSRIs, mood stabilizers, or opioid antagonsits |
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What is the disorder that is characterized by recurrent, repetitive, intentional pulling out of one's hair?
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Trichotillomania
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What are the DSM-IV criteria for Trichotillomania?
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- Recurrent, repetitive, intentional pulling out of one's hair causing visible hair loss
- Usually involves the scalp, though can include eyebrows, eyelashes, and facial and pubic hair - Tension is experienced immediately before the pulling behavior, and pleasure or relief occurs afterward - Causes significant distress or impairment in daily functioning |
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How common is Trichotillomania? Men vs women?
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1-3%
Women > Men |
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When is the typical onset of Trichotillomania?
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Usually during childhood or adolescence, and is associated with a stressful event in 25% of patients
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What is the trigger for Trichotillomania behavior?
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The texture of the hair
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What sort of dysfunction does Trichotillomania cause?
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Occupational and social dysfunction
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What can predispose to the development of Trichotillomania?
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- Problems in relationship with parent
- Recent loss of an important object or figure |
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There is increased incidence of what comorbid disorders with Trichotillomania?
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- OCD
- Obsessive Compulsive Personality Disorder - Mood disorders - Borderline personality disorder |
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What is the course of Trichotillomania?
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Chronic or remitting
Adult onset is generally more difficult to treat |
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How should you treat Trichotillomania?
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- Meds: SSRIs, anti-psychotics, or lithium
- Behavioral interventions such as hypnosis, relaxation techniques, substituting another behavior, or positive reinforcement may have some therapeutic benefit |
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What is pyromania?
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The impulse to start fires to relieve tension, typically with feelings of gratification or relief afterward
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What are the DSM-IV criteria for Pyromania?
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- At least one episode of deliberate fire setting
- Tension or arousal experienced before the act, and pleasure, gratification, or relief experienced when setting fires and subsequent consequences - Fascination with, interest in, curiosity about, or attraction to fire and consequences - Purpose of fire setting is not for monetary gain, expression of anger, or making a political statement, and it is not due to a hallucination or delusion |
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How many deliberate fire setting episodes need to occur to make the diagnosis of Pyromania?
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Only 1
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When is the mean age of onset of Pyromania?
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Late adolescence
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Who has a better prognosis with Pyromania?
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Better in children than adults; children often recover completely
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What is the course of Pyromania?
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Can be chronic of untreated
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How do you treat Pyromania?
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- Behavior therapy
- Supervision - SSRIs |
