Impulsivity and Its Treatment

Yıl 2012, Cilt: 4 Sayı: 3, 293 - 314, 01.09.2012

Pınar Güzel Özdemir Yavuz Selvi Adem Aydın

https://doi.org/10.5455/cap.20120418

Öz

Identification, description and therapeutic management of impulsivity, which underlies the mechanism and coexistence of many neurological and psychiatric diseases, are considered to be very crucial. Treatment can be applied in two ways; either for the disorder that occurs with impulsivity or for the treatment of the impulsive behavior itself. Disorders associated with or accompanied by impulsivity can be classified as borderline and antisocial personality disorders, schizophrenia, bipolar disorder, attention deficit and hyperactivity disorder, eating disorders, substance use disorders. In addition, impulsivity can manifest itself within the context of diagnostic criteria implicated in the impulse control disorders which include pathological gambling, intermittent explosive disorder, pyromania, kleptomania and trichotillomania. Behavioral and pharmacological interventions that are effective in treatment plans for these disorders should be integrated. These can be listed as insight-oriented psychotherapy and cognitive-behavioral psychotherapies, contingency management, and pharmacotherapy. The aim of the current review is to understand impulsivity and discuss its relation to other psychiatric disorders and to focus on the treatment of impulsivity.

Anahtar Kelimeler

Impulsivity, treatment, psychiatric disorder

Dürtüsellik ve Tedavisi

Öz

BBirçok nörolojik ve psikiyatrik hastalığın temelinde yer alan ya da beraberinde seyreden dürtüselliğin tanımlanması ve tedavisinin düzenlenmesi oldukça önemlidir. Tedavide ya dürtüsellik ile ortaya çıkan hastalığın tedavisi ya da dürtüsel davranışın kendisinin tedavi edilmesi şeklinde iki yola başvurulabilir. Dürtüselliğin eşlik ettiği bozukluklar arasında antisosyal ve borderline kişilik bozuklukları, şizofreni, bipolar bozukluk, dikkat eksikliği hiperaktivite bozukluğu, yeme bozuklukları, madde kullanım bozuklukları sayılabilir. Ayrıca dürtü kontrol bozuklukları olan patolojik kumar oynama, aralıklı patlayıcı bozukluk, piromani, kleptomani ve trikotillomani tanı ölçütleri içerisinde bir ölçüt olarak bulunur. Bu bozuklukların tedavi planında etkin olan davranışsal ve farmakolojik müdahalelerin bütünleştirilmesi gerekir. Bunlar içgörü yönelimli ve bilişsel-davranışçı psikoterapiler, beklenmedik olayların yönetimi ve farmakoterapi olarak sıralanabilir. Bu yazıda, dürtüselliğin tanımı, diğer psikiyatrik bozukluklarla birlikteliği ve tedavisi aktarılmıştır.

Anahtar Kelimeler

Dürtüsellik, tedavi, psikiyatrik bozukluk

Kaynakça

• Yazıcı K, Yazıcı AE. Dürtüselliğin nöroanatomik ve nörokimyasal temelleri. Psikiyat- ride Güncel Yaklaşımlar 2010; 2:254-280.
• Hollander E, Evers M. New developments in impulsivity. Lancet 2001; 358(9286):949-950.
• Eysenck SB, Eysenck HJ. The place of impulsiveness in a dimensional system of personality description. Br J Soc Clin Psychol 1977; 16:57-68.
• Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 1995; 51:768-774.
• Ainslie G. Specious reward: a behavioral theory of impulsiveness and impulse control. Psychol Bull 1975; 82:463-498.
• L’Abate L. A family theory of impulsivity. In The Impulsive Client (Eds WG McCown, JL Johnson, MB Shure):93-117. Washington DC, American Psychological Association, 1993.
• Moeller G, Barratt E, Dougherty D, Schmitz M, Swann A. Psychiatric aspects of impulsivity. Am J Psychiatry 2001; 158:1783-1793.
• Rachlin H. The Science of Self Control. Cambridge, Mass, Harvard University Press, 2000.
• Hollander E, Stein D. Clinical Manual of Impulse-control Disorders. Arlington, American Psychiatric Publishing, 2005.
• Hollander E, Rosen J. Impulsivity. J Psychopharmacol 2000; 4(suppl 1):39-44.
• Barratt ES, Stanford MS, Kent TA, Felthous A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry 1997; 41:1045-1061.
• Coccaro EF, Siever LJ, Klar HM, Maurer G, Cochrane K, Cooper TB et al. Serotonergic studies in patients with affective and personality disorders: correlates with suicidal and impulsive aggressive behavior. Arch Gen Psychiatry 1989; 46:587- 599.
• Blair RJ, Cipolotti L. Impaired social response reversal: a case of “acquired sociopathy”. Brain 2000; 123:1122-1141.
• Bechara A, Damasio H, Tranel D, Damasio AR. Deciding advantageously before knowing the advantageous strategy. Science 1997; 275:1293-1295.
• Links PS, Heslegrave R, van Reekum R. Impulsivity: core aspect of borderline personality disorder. J Pers Disord 1999; 13:1-9.
• Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Risk factors for suicidal behavior in borderline personality disorder. Am J Psychiatry 1994; 151:1316-1323.
• Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999; 156:181-189.
• Swann AC, Janicak PL, Calabrese JR, Bowden CL, Dilsaver SC, Morris DD et al. Structure of mania: subgroups with distinct clinical characteristics and course of illness in randomized clinical trial participants. J Affect Disord 2001; 67:123-132.
• Güleç H, Tamam L, Usta H, Saygılı İ, Güleç MY, Zengin M et al. Bipolar bozukluk- ta dürtüsellik. Anadolu Psikiyatri Dergisi 2009; 10:198-203.
• Swann AC, Koslow SH, Katz MM, Maas JW, Javaid J, Secunda SK, et al. Lithium carbonate treatment of mania: cerebrospinal fluid and urinary monoamine metabolites and treatment outcome. Arch Gen Psychiatry 1987; 44:345-354.
• Jentsch JD, Taylor JR. Impulsivity resulting from frontostriatal dysfunction in drug abuse: implications for the control of behavior by reward-related stimuli. Psychopharmacology (Berl) 1999; 146:373-390.
• Brady KT, Myrick H, McElroy S. The relationship between substance use disorders, impulse control disorders, and pathological aggression. Am J Addict 1998; 7:221- 230.
• Willcutt EG, Pennington BF, Chhabildas NA, Friedman MC, Alexander J. Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. J Am Acad Child Adolesc Psychiatry 1999; 38:1355-1362.
• Smalley SL, Bailey JN, Palmer CG, Cantwell DP, McGough JJ, Del’Homme MA et al. Evidence that the dopamine D4 receptor is a susceptibility gene in attention deficit hyperactivity disorder. Mol Psychiatry 1998; 3:427-430.
• Hoptman MJ, Ardekani BA, Butler PD, Nierenberg J, Javitt DC, Lim KO. DTI and impulsivity in schizophrenia: a first voxelwise correlational analysis. Neuroreport 2004; 15:2467-2470.
• Enticott PG, Ogloff JRP, Bradshaw JL, Fitzgerald PB. Cognitive inhibitory control and self reported imulsivity among violent offendes with schizophrenia. J Clin Exp Neuropsychol 2008; 30:157-162.
• Kısa C, Yıldırım SG, Göka E. Ataklık ve ruhsal bozukluklar. Turk Psikiyatri Derg 2005; 16:46-54.
• Fahy T, Eisler I. Impulsivity and eating disorders. Br J Psychiatry 1993; 162:193-197.
• Steiger H, Young SN, Kin NM, Koerner N, Israel M, Lageix P, et al. Implications of impulsive and affective symptoms for serotonin function in bulimia nervosa. Psychol Med 2001; 31:85-95.
• Fenichel O. The Psychoanalytic Theory of Neurosis. New York, WW Norton, 1945.
• Aronson TA. A critical review of psychotherapeutic treatments of borderline personality. J Nerv Ment Dis 1989; 177:511-528.
• Platt JJ, Taube DO, Metzger D, Duome MAJ. Training in interpersonal problem solving (TIPS). J Cogn Psychother 1988; 2:5-34.
• Linehan MM: Dialectical behavioral therapy in groups: treating borderline personality disorders and suicidal behavior. In Women’s Therapy Groups: Paradigms of Feminist Treatment (Ed CM Brody):145-162. New York, Springer, 1987.
• Baer RA, Nietzel MT. Cognitive and behavioral treatment of impulsivity in children: a meta-analytic review of the outcome literature. J Clin Child Psychol 1991; 20:400- 412.
• Higgins ST, Wong CJ, Badger GJ, Ogden DE, Dantrona RL. Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. J Consult Clin Psychol 2000; 68:64-72.
• Pelham WE, Carlson C, Sams SE, Vallano G, Dixon MJ, Hoza B. Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit hyperactivity disorder in the classroom. J Consult Clin Psychol 1993; 61:506-515.
• Sheard MH. Effect of lithium in human aggression. Nature 1971; 230:113-114.
• Goodwin FK, Fireman B, Simon GE, Hunkelel EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003; 290:1467-1473.
• Bierbrauer J, Nilsson A, Müller-Oerlinghausen B, Bauer M. Therapeutic and prophylatic effects of lithium on pathological aggression. In Lithium in Neuropsychiatry (Eds M Bauer, P Grog, B Müller-Oerlinghausen):227-236. Abingdon, Informa, 2006.
• Olvera RL. Intermitant expolsive disorder: epidemiology, diagnosis and management. CNS Drugs 2002; 16:517-526.
• Citrome L, Casey DE, Daniel DG, Wozniak P, Kochan LD, Tracy KA. Adjunctive divalproex and hostility among patients with schizophrenia receiving olanzapine or risperidone. Psychiatr Serv 2004; 55:290-294.
• Gobbi G, Gaudreau PO, Leblanc N. Efficacy of topiramate, valproate, and their combination on aggression/agitation behavior in patients with psychosis. J Clin Psychopharmacol 2006; 26:467-473.
• Hollander E, Tracy KA, Swann AC, Coccaro EF, McElroy SL, Wozniak P et al. Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology 2003; 28:1186-1197.
• Hollander E, Swann AC, Coccaro EF, Jiang P, Smith TB. Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder. Am J Psychiatry 2005; 162:621-624.
• Cowdry RW, Gardner DL. Pharmacotherapy of borderline personality disorder: alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry 1988; 45:111-119.
• Tariot PN, Erb R, Podgorski CA, Cox C, Patel S, Jakimovich L et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155:54-61.
• Stanford MS, Helfritz LE, Conklin SM, Villemarette-Pittman NR, Grve KW, Adams D et al. A comparison of anticonvulsants in the treatment of impulsive aggression. Exp Clin Psychopharmacol 2005; 13:72-77.
• Mattes JA. Oxcarbazepine in patients with impulsive aggression: a double-blind, placebo controlled trial. J Clin Psychopharmacol 2005; 25:575-579.
• Nickel MK, Nickel C, Mitterlehner FO, Tritt K, Lahmann C, Leiberich PK et al. Topiramate treatment of aggression in female borderline personality disorder: a double blind, placebo-controlled study. J Clin Psychiatry 2004; 65:1515-1519.
• Nickel MK, Nickel C, Kaplan P, Lahmann C, Mühlbacher M, Tritt K et al. Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study. Biol Psychiatry 2005; 57:495-499.
• do Prado-Lima PA, Kristensen CH, Bacaltchuck J. Can childhood trauma predict response to topiramate in borderline personality disorder? J Clin Pharm Ther 2006; 31:193-196.
• Knutson B, Wolkowitz OM, Cole SW, Chan T, Moore EA, Johnson RC et al. Selective alteration of personality and social behavior by serotonergic intervention. Am J Psychiatry 1998; 155:373-379.
• Krakowski MI, Czobor P, Citrome L, Bark N, Cooper TB. Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry 2006; 63:622-629.
• Citrome L, Volavka J, Czobor P, Sheitman B, Lindenmayer JP, McEvoy J et al. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr Serv 2001; 52:1510-1514.
• Volavka J, Czobor P, Nolan K, Sheitman B, Lindenmayer JP, Citrome L et al. Overt aggression on psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. J Clin Psychopharmacol 2004; 24:225-228.
• Swanson JW, Swartz MS, Elbogen EB, Van Dorn RA. Reducing violence risk in persons with schizophrenia: olanzapine versus risperidone. J Clin Psychiatry 2004; 65:1666-1673.
• Schulz SC, Camlin KL, Berry SA, Jesberger JA, Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Biol Psychiatry 1999; 46:1429-1435.
• Soler J, Pascual JC, Campins J, Barrachina J, Puigdemont D, Alvarez E et al. Double- blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder. Am J Psychiatry 2005; 162:1221-1224.
• Connor DF, McLaughlin TJ, Jeffers-Terry M. Randomized controlled pilot study of quetiapine in the treatment of adolescent conduct disorder. J Child Adolesc Psychopharmacol 2008; 18:140-156.
• Greendyke RM, Kanter DR, Schuster DB, Verstreate S, Wootton J. Propanolol treatment of assaultive patients with organic brain disease: a double-blind crossover, placebo controlled study. J Nerv Ment Dis 1986; 174:290-294.
• Greendyke RM, Kanter DR. Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study. J Clin Psychiatry 1986; 47:423-426.
• Pappadopulos E, Woolston S, Chait A, Perkins M, Connor DF, Jensen PS. Pharmacotherapy of aggression in children and adolescents: efficacy and effect size. J Can Acad Child Adolesc Psychiatry 2006; 15:27-39.
• Petry NM. Pathological Gambling: Etiology, Comorbidities, and Treatment. Washington D.C., American Psychological Association, 2005.
• Reist C, Nakamura K, Sagart E, Sokolski KN, Fujimoto KA. Impulsive aggressive behavior: open-label treatment with citalopram. J ClinPsychiatry 2003, 64:81-85.
• Tamam L. Piromani (Patolojik Yangın Çıkarma). Turkiye Klinikleri J Psychiatry- Special Topics 2009; 2(1):20-28.
• Swedo SE, Leonard HL, Rapopart JL. A double-blind comparison of clomipramine and desimipramine in the treatment of tricotillomania. N Eng J Med 1989; 321:497- 501.
• Christenson GA, Pophin MK, Machenzie TB, Realmuto GM. Lithium treatment of chronic hair pulling. J Clin Psychiatry 1991; 52:116-120.
• De Sousa A. An open-label pilot study of naltrexone in childhood trichotillomania. J Child Adolesc Psychopharmacol 2008; 18:30-33.
• McElroy SL, Pope HG, Jr. Hudson JI, Keck PE, Jr. White KL. Kleptomania: a report of 20 cases. Am J Psychiatry 1991; 148:652-657.
• Kim SW. Opioid antagonists in the treatment of impulse control disorders. J Clin Psychiatry 1998; 59:159-164.
• Tamam L. Dürtü kontrol bozukluklarında ilaç tedavisi. In Temel Psikofarmakoloji, 1. Baskı (Ed N Yüksel) :1089-1099. Ankara, Türkiye Psikiyatri Derneği, 2010.
• Annagür BB, Tamam L. Depresyon hastalarında dürtü kontrol bozuklukları eş tanıla- rı. Nöropsikiyatri Arşivi 2011; 48:22-30.
• Güleç H. Ayaktan başvuruda bulunan alkol kötüye kullanan erkek hastalarda impulsivite: bir ön çalışma. Yeni Symposium 2010; 48:102-109.
• Selvi Y, Aydin A, Atli A, Boysan M, Selvi F, Besiroglu L. Chronotype differences in suicidal behavior and impulsivity among suicide attempters. Chronobiol Int 2011; 28:170-175.
• Pınar Güzel Özdemir, Uzm.Dr., Yüzüncü Yıl Üniv. Tıp Fakültesi Psikiyatri ABD, Van; Yavuz Selvi,
• Yrd.Doç.Dr., Yüzüncü Yıl Üniv. Tıp Fakültesi Psikiyatri ABD, Van; Adem Kaya, Yrd. Doç. Dr., Yüzüncü Yıl Üniv.
• Tıp Fakültesi Psikiyatri ABD, Van