First Aid: Impulse Control Disorders

Question 1

With impulse control disorders, what is experienced prior to the impulse?

Answer 1

anxiety

Question 2

With impulse control disorders, what is experienced after the behavior is completed?

Answer 2

relief

Question 3

What is the DSM-IV criteria for intermittent explosive disorder?

Answer 3

• Failure to resist aggressive impulses that result in assault or property destruction
• Level of aggressiveness is out of proportion to any triggering events

Question 4

Do patients with intermittent explosive disorder usually feel remorse for their actions?

Answer 4

yes

Question 5

What neurochemical change has been shown to be associated with impulsiveness and aggression?

Answer 5

low levels of serotonin

Question 6

What is the gender difference in intermittent explosive disorder?

Answer 6

men > women

Question 7

What is the age of onset for intermittent explosive disorder?

Answer 7

typically in late teens or twenties

Question 8

What are common comorbidities for intermittent explosive disorder?

Answer 8

• H/o child abuse
• H/o head trauma
• H/o Seizures

Question 9

What is the prognosis for intermittent explosive disorder?

Answer 9

may progress in severity til middle age

Question 10

What is the treatment for intermittent explosive disorder?

Answer 10

SSRIs
Anticonvulsants
Lithium
Propranolol

Question 11

What is the role of therapy in intermittent explosive disorder?

Answer 11

Individual psychotherapy is difficult and ineffective

Question 12

What is the DSM-IV diagnostic criteria for kleptomania?

Answer 12

• Failure to resist urges to steal objects that are not needed for personal or monetary reasons
• Pleasure or relief is experienced while stealing
• Purpose of stealing is not to express anger and is not due to hallucination or delusion

Question 13

What is the gender difference for kleptomania?

Answer 13

women > men

Question 14

True or false: very few shoplifters have kleptomania?

Answer 14

true (under 5%)

Question 15

What are some comorbidities of kleptomania?

Answer 15

• Mood disorders
• Eating disorders (25% of bulimics)
• OCD

Question 16

What is the treatment for kleptomania?

Answer 16

• Insight-oriented psychotherapy
• Behavioral therapy (systematic desensitization and aversive conditioning)
• SSRIs

Question 17

What is the DSM-IV criteria for pyromania?

Answer 17

• More than 1 episode of intentional fire setting
• Tension present before the act and pleasure or relief experienced afterwards
• Fascination with or attraction to fire and its uses and consequences
• Purpose of fire setting is not for monetary gain, expression of anger, making a political statement and is not due to a hallucination or delusion

Question 18

What gender is more likely to have pyromania?

Answer 18

men

Question 19

What is a common comorbidity with pyromania?

Answer 19

mental retardation

Question 20

What is the prognosis for pyromania?

Answer 20

better in children than adults (children usually have complete recovery)

Question 21

What type of treatment is used for pyromania?

Answer 21

• Behavior therapy
• Supervision
• SSRIs

Question 22

What is the DSM-IV criteria for pathological gambling?

Answer 22

Recurrent maladaptive gambling behavior, as shown by 5 or more of the following:

• Preoccupation with gambling
• Need to gamble with increasing amount of $ to achieve pleasure
• Repeated and unsuccessful attempts to cut down on gambling
• Restlessness or irritability when attempting to stop gambling
• Gambling done to escape problems or relieve dysphoria
• Chasing losses
• Lying to therapist or family members about gambling
• Jeopardizing relationships or job because of gambling
• Relying on others to financially support gambling

Question 23

What is the most affective treatment for pathological gambling?

Answer 23

Gamblers Anonymous (12 step program)

Question 24

What is the DSM-IV criteria for trichotillomania?

Answer 24

• Recurrent pulling out of one’s hair, resulting in visible hair loss
• Usually involves scalp but can involve eyebrows, eyelashes, and facial and pubic hair
• Tension present before the behavior and pleasure or relief resulting afterwards
• Causes significant distress or impairment in daily functioning

Question 25

When does trichotillomania usually begin?

Answer 25

onset during childhood or adolescence (25% after stressful event)

Question 26

What are some common comorbidities of trichotillomania?

Answer 26

OCD OCPD Borderline Personality Disorder

Question 27

What is the treatment for trichotillomania?

Answer 27

- SSRIs, antipsychotics, lithium - Hypnosis, relaxation techniques - Behavioral therapy, substituting behaviors, positive reinforcement