Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

Impulse control disorders (ICDs) are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment. This article presents a brief overview about the clinical characteristics of ICDs and pharmacological treatment options for individuals with ICDs

Neural and psychological underpinnings of gambling disorder: A review.

Gambling disorder affects 0.4 to 1.6% of adults worldwide, and is highly comorbid with other mental health disorders. This article provides a concise primer on the neural and psychological underpinnings of gambling disorder based on a selective review of the literature. Gambling disorder is associated with dysfunction across multiple cognitive domains which can be considered in terms of impulsivity and compulsivity. Neuroimaging data suggest structural and functional abnormalities of networks involved in reward processing and top-down control. Gambling disorder shows 50-60% heritability and it is likely that various neurochemical systems are implicated in the pathophysiology (including dopaminergic, glutamatergic, serotonergic, noradrenergic, and opioidergic). Elevated rates of certain personality traits (e.g. negative urgency, disinhibition), and personality disorders, are found. More research is required to evaluate whether cognitive dysfunction and personality aspects influence the longitudinal course and treatment outcome for gambling disorder. It is hoped that improved understanding of the biological and psychological components of gambling disorder, and their interactions, may lead to improved treatment approaches and raise the profile of this neglected condition.This research was supported by a Center for Excellence in Gambling Research grant by the National Center for Responsible Gaming to Dr. Grant, and a research grant from the Trichotillomania Learning Center to Mr. Odlaug, and by a research grant from the Academy of Medical Sciences (UK) to Dr. Chamberlain.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.pnpbp.2015.10.00

Reduced cortical thickness in gambling disorder: a morphometric MRI study.

Gambling disorder has recently been recognized as a prototype 'behavioral addiction' by virtue of its inclusion in the DSM-5 category of 'Substance-Related and Addictive Disorders.' Despite its newly acquired status and prevalence rate of 1-3 % globally, relatively little is known regarding the neurobiology of this disorder. The aim of this study was to explore cortical morphometry in untreated gambling disorder, for the first time. Subjects with gambling disorder (N = 16) free from current psychotropic medication or psychiatric comorbidities, and healthy controls (N = 17), were entered into the study and undertook magnetic resonance imaging (3T MRI). Cortical thickness was quantified using automated segmentation techniques (FreeSurfer), and group differences were identified using permutation cluster analysis, with stringent correction for multiple comparisons. Gambling disorder was associated with significant reductions (average 15.8-19.9 %) in cortical thickness, versus controls, predominantly in right frontal cortical regions. Pronounced right frontal morphometric brain abnormalities occur in gambling disorder, supporting neurobiological overlap with substance disorders and its recent reclassification as a behavioral addiction. Future work should explore the trait versus state nature of the findings and whether similarities exist with other not-yet-reclassified putative behavioral addictions.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant. The NCRG had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s00406-015-0592-

Adolescent stealing treated with motivational interviewing and imaginal desensitization — Case report

Background: Adolescent shoplifting occurs in an estimated 15% of the United States population. Although adolescent stealing is associated with significant psychosocial consequences there is limited research concerning efficacious treatments. Case study: A 17-year-old male with a history of compulsive stealing was treated using a six-session, individualized cognitive-behavioral therapy protocol which included motivational interviewing, psycho-education, behavioral modification, and an exposure script using imaginal desensitization. After the six-session therapy, the patient continued for eight further sessions of therapy to maintain treatment gains. His Yale-Brown Obsessive Compulsive Scale scores dropped from a 22 pre-treatment to a 3 at the end of the 14 sessions of therapy and he remained abstinent from stealing. Discussion: This case reports on the successful use of an individualized, cognitive behavioral therapy on an adolescent with compulsive shoplifting and other antisocial behaviors. This treatment provides a promising step towards the treatment of a relatively common adolescent behavior

The overlap between binge eating disorder and substance use disorders: Diagnosis and neurobiology

Background and aims: Binge eating disorder (BED) is a relatively common condition, especially in young adult females, and is characterized by chronic over-consumption of food resulting in embarrassment, distress, and potential health problems. It is formally included as a disorder in DSM-5 for the first time, an acknowledgement to its debilitating nature. This article explores the overlap between binge eating disorder and substance use disorders (SUD). Methods: The bibliographic search was a computerized screen of PubMed databases from January 1990 to the present. Binge eating disorder, substance use disorder, binging, obesity, food addiction, comorbidity, dopamine, opioid, serotonin, glutamate, and pharmacological treatment were the keywords used in searching. Results: BED shares similar phenomenology to SUD, including significant urges to engage in binging episodes, resulting in distress and impairment. Similar neurobiological pathways are found in both BED and SUD and medications based on similar neurobiology have been examined for both disorders. A subset of individuals with BED may have a “food addiction”, but there is no clinical agreement on the meaning of “food addiction”. Exploring the relationship between BED and obesity may also shed light on the extent to which BED can be viewed as an addiction. Conclusions: Overall, nascent research regarding BED and SUD suggests an overlap between these disorders, but there are discrepancies between these two disorders that need further exploration

Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study.

BACKGROUND: Excoriation (skin-picking) disorder (SPD) is a relatively common psychiatric condition whose neurobiological basis is unknown. AIMS: To probe the function of fronto-striatal circuitry in SPD. METHOD: Eighteen participants with SPD and 15 matched healthy controls undertook an executive planning task (Tower of London) during functional magnetic resonance imaging (fMRI). Activation during planning was compared between groups using region of interest and whole-brain permutation cluster approaches. RESULTS: The SPD group exhibited significant functional underactivation in a cluster encompassing bilateral dorsal striatum (maximal in right caudate), bilateral anterior cingulate and right medial frontal regions. These abnormalities were, for the most part, outside the dorsal planning network typically activated by executive planning tasks. CONCLUSIONS: Abnormalities of neural regions involved in habit formation, action monitoring and inhibition appear involved in the pathophysiology of SPD. Implications exist for understanding the basis of excessive grooming and the relationship of SPD with putative obsessive-compulsive spectrum disorders.This is the accepted manuscript. The final version is available at http://dx.doi.org/10.1192/bjp.bp.114.15519

Impaired response inhibition and excess cortical thickness as candidate endophenotypes for trichotillomania.

This is the author accepted manuscript. the final version is available via Elsevier at http://www.sciencedirect.com/science/article/pii/S0022395614002465.Trichotillomania is characterized by repetitive pulling out of one's own hair. Impaired response inhibition has been identified in patients with trichotillomania, along with gray matter density changes in distributed neural regions including frontal cortex. The objective of this study was to evaluate impaired response inhibition and abnormal cortical morphology as candidate endophenotypes for the disorder. Subjects with trichotillomania (N = 12), unaffected first-degree relatives of these patients (N = 10), and healthy controls (N = 14), completed the Stop Signal Task (SST), a measure of response inhibition, and structural magnetic resonance imaging scans. Group differences in SST performance and cortical thickness were explored using permutation testing. Groups differed significantly in response inhibition, with patients demonstrating impaired performance versus controls, and relatives occupying an intermediate position. Permutation cluster analysis revealed significant excesses of cortical thickness in patients and their relatives compared to controls, in right inferior/middle frontal gyri (Brodmann Area, BA 47 & 11), right lingual gyrus (BA 18), left superior temporal cortex (BA 21), and left precuneus (BA 7). No significant differences emerged between groups for striatum or cerebellar volumes. Impaired response inhibition and an excess of cortical thickness in neural regions germane to inhibitory control, and action monitoring, represent vulnerability markers for trichotillomania. Future work should explore genetic and environmental associations with these biological markers.This research was supported by a grant from the Trichotillomania Learning Center, USA, to Mr. Odlaug; and by a grant from the Academy of Medical Sciences, UK, to Dr. Chamberlain. Neither of these entities had any further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication

Impulse control disorders in non-treatment seeking hair pullers

Background and aims: Hair pulling is a common body focused repetitive behavior. The purpose of this paper is to examine the prevalence of impulse control disorders (as defined in DSM-IV-TR) in a non-treatment seeking sample of hair pullers. Methods: 1,717 college students with (n = 44) and without (n = 1673) hair pulling completed a mental health survey. The college students were sent an online survey assessing hair pulling behavior and other impulse control disorders using the Minnesota Impulsive Disorders Interview. Results: Students with hair pulling were significantly more likely to have a co-occurring impulse control disorder (20.5% vs. 8.9%, p = 0.009, OR = 2.71, CI = 1.28–5.75) and were significantly more likely to meet criteria for compulsive buying, compulsive sexual behavior and intermittent explosive disorder than students without hair pulling. Differences seemed to be moderated by the male gender among students with hair pulling. Discussion and conclusions: Hair pulling is often comorbid with another impulse control disorder, which suggests that elements of impulsivity may be important in our understanding of hair pulling. Furthermore, gender may moderate impulse control comorbidity in hair pulling disorder

Racial-ethnic related clinical and neurocognitive differences in adults with gambling disorder.

Recent epidemiological data suggest that the lifetime prevalence of gambling problems differs depending on race-ethnicity. Understanding variations in disease presentation in blacks and whites, and relationships with biological and sociocultural factors, may have implications for selecting appropriate prevention strategies. 62 non-treatment seeking volunteers (18-29 years, n=18 [29.0%] female) with gambling disorder were recruited from the general community. Black (n=36) and White (n=26) participants were compared on demographic, clinical and cognitive measures. Young black adults with gambling disorder reported more symptoms of gambling disorder and greater scores on a measure of compulsivity. In addition they exhibited significantly higher total errors on a set-shifting task, less risk adjustment on a gambling task, greater delay aversion on a gambling task, and more total errors on a working memory task. These findings suggest that the clinical and neurocognitive presentation of gambling disorder different between racial-ethnic groups.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.psychres.2016.05.03

COMT genotype, gambling activity, and cognition.

Neuropsychological studies of adults with problem gambling indicate impairments across multiple cognitive domains. Catechol-O-methyltransferase (COMT) plays a unique role in the regulation of dopamine in the prefrontal cortex, and has been implicated in the cognitive dysfunction evident in problem gambling. This study examined adults with varying levels of gambling behavior to determine whether COMT genotype was associated with differences in gambling symptoms and cognitive functioning. 260 non-treatment-seeking adults aged 18-29 years with varying degrees of gambling behavior provided saliva samples for genotyping COMT val158met (rs4680). All subjects underwent clinical evaluations and neurocognitive assessment of decision-making, working memory, and impulsivity. The Val/Val COMT genotype was associated with the largest percentage of subjects with gambling disorder (31.8%), a rate significantly different from the Val/Met (13.2%) group (p = 0.001). The Val/Val COMT group was also associated with significantly more gambling disorder diagnostic criteria being met, greater frequency of gambling behavior, and significantly worse cognitive performance on the Cambridge Gamble Task (risk adjustment and delay aversion) and the Spatial Working Memory task (total errors). This study adds to the growing literature on the role of COMT in impulsive behaviors by showing that the Val/Val genotype was associated with specific clinical and cognitive elements among young adults who gamble, in the absence of differences on demographic measures and other cognitive domains. Future work should consider using genotyping to explore whether certain polymorphisms predict subsequent development of impulsive behaviors including gambling disorder, and treatment outcomes.This research was supported by a Center for Excellence in Gambling Research grant by the National Center for Responsible Gaming (Dr. Grant) and a research grant from the Trichotillomania Learning Center (to Mr. Odlaug).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org