Psychiatry lectures. Terminology

Size: px

Start display at page:

Download "Psychiatry lectures. Terminology"

Virgil Ray
5 years ago
Views:

- Essential feature a failure to resist an impulse, drive, or temptation to perform an act that is harmful

1 Psychiatry lectures Prof. János J KálmK lmán Terminology Impulse control disorders (ICDs) are group of psychiatric disorders in DSM-5 - Essential feature a failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others ICDs increasingly accepted as term for major disorders reported to occur in PD (also behavioural addictions ) 1. Gambling 2. Buying 3. Sexual behaviors 4. Eating 2

2 ICD Frequencies At least one ICD identified in 13.6% of patients % of ICD patients had 2 ICDs Frequencies of individual ICDs were: - Problem/pathological gambling = 5.0% Compulsive sexual behavior = 3.5% Compulsive buying = 5.7% Binge-eating disorder = 4.3% 3 Impulsive Aggression Symptom Syndrome Behavioral Dimension 4

3 Impulse Control Disorders Subtypes Excessive anger (Intermittent explosive disorder) Antisocial personality disorder Compulsive stealing (Kleptomania) Compulsive buying (Oniomania) Compulsive fire-starting (Piromania) Self injury (Cutting yourself with a sharp object) Compulsive sexual behavior (OCD) Trichotillomania (OCD) 5 Impulsive-Aggressive Spectrum Cluster B Personality Disorders Borderline Personality Disorders Bipolar Spectrum Sexual Compulsions Substance Use Disorder ADHD Spectrum Tourette s/ OCD Impulsivity & Aggression PTSD Impulse Control Disorders Developmental Disorders Autism Spectrum Disorders 6

4 Some DSM-IV IV-TR Disorders Associated with Aggression Mental retardation Attention-deficit/hyperactivity disorder Conduct disorder Cognitive disorders Delirium Dementia Psychotic disorders Schizophrenia Psychotic disorder not otherwise specified Mood disorders Mood disorder because of a general medical condition Substance-induced mood disorder Intermittent explosive disorder Adjustment disorder with disturbance of conduct Personality disorders Paranoid personality disorder Antisocial personality disorder Borderline personality disorder Narcissistic personality disorder Axis V conditions Childhood, adolescent, or adult Kálmán antisocial - Psychiatry behavior 7 Impulse Control Disorder Lifetime Prevalence Trichotillomania 3.91% Trichotillomania without tension/gratification 1.39% Compulsive Sexual Behavior 3.66% Sub-clinical Compulsive Sexual Behavior 7.82% Compulsive Buying 1.89% Sub-clinical Compulsive Buying 10.59% Pathological Gambling 1.13% Problem gambling 1.39% Pyromania 1.01% Sub-clinical Pyromania 1.26% Intermittent Explosive Disorder 0.50% Sub-clinical Intermittent Explosive Disorder 3.53% Kleptomania 0.38% Sub-clinical Kleptomania 0.50% 8

IMPULSE-CONTROL DISORDERS These disorders involve disturbances in the ability to regulate specific impulses not attributable to other DSM-5 diagnoses.

5 IMPULSE-CONTROL DISORDERS These disorders involve disturbances in the ability to regulate specific impulses not attributable to other DSM-5 diagnoses. 9 Regulation problems of Impulse Control Failure to resist impulse, drive, or temptation to perform act that is harmful to self/others. Relief of mounting tension or arousal with act. 10

6 Core Features of Impulse Control Disorders Repetitive or compulsive engagement in a behavior despite adverse consequences Diminished control over the problematic behavior An appetitive urge or craving state prior to engagement in the problematic behavior A hedonic quality during the performance of the problematic behavior. 11 Common Core Features of Impulse Control Disorders Tolerance Withdrawal Repeated unsuccessful attempts to cut back or stop Impairment in major areas of life functioning 12

7 Kleptomania An impulse-control disorder that involves the persistent urge to steal. The act of stealing excites them. The object stolen is not particularly desired. Stealing releases tension, although the urge feels unpleasant, senseless. 13 Kleptomania The lack of interest in the stolen item is the main feature that differentiates a kleptomaniac from a typical shoplifter or burglar. 14

Piromania Urge to prepare, set, watch fires for fun Unlike arsonists motivated by greed or revenge An impulse-control disorder involving the persistent and compelling urge to start fires.

8 Piromania Urge to prepare, set, watch fires for fun Unlike arsonists motivated by greed or revenge An impulse-control disorder involving the persistent and compelling urge to start fires. 15 Compulsive sexual behavior Driven to engage in frequent, indiscriminate sex. Often feel bad after they engage in sex. May extend into violent deviance, like rape, rape/murders, serial killing. Usually also have substance abuse disorder and depression; some may have dissociative symptoms. 16

9 Intermittent explosive disorder inability to hold back urges to express strong angry feelings and associated violent behaviors. Over 90 percent have co-occurring occurring mood disorder. Other co-occurring occurring disorders include substance problems and anxiety. 17 Intermittent Explosive Disorder Verbal aggression 2x weekly for 3 months Destruction or assault: 3x in 12 months 6 6 years + 18

10 Disruptive, Impulse-Control, and Conduct Disorders Oppositional Defiant Disorder Criteria exhibited with at least one individual who is not a sibling Spiteful or vindictive twice in 6 months Severity: Mild, moderate, severe <5years most days for 6 months; >5 years, weekly 19 Conduct Disorder Adds specifier With limited prosocial emotions Persistently in 12 months (2 of 4) Lack of Remorse/ guilt Callous lack lack of empathy Unconcerned about performance Shallow or deficient affect 20

Conduct disorder before age 15 21 CNS Mechanisms in Impulsivity Motivation: generation of behavior Attention/arousal Overstimulation

11 A A pervasive pattern of disregard for and violation of the rights of others. Repeated acts that are grounds for arrest Antisocial PD Deceitful, impulsive, irritable and aggressive Reckless Irresponsible Lack remorse Conduct disorder before age CNS Mechanisms in Impulsivity Motivation: generation of behavior Attention/arousal Overstimulation Efficient screening of environment Filter: matching to context Screening relevant memories Moll et al. NATURE REVIEWS NEUROSCIENCE VOLUME Kálmán 6 -OCTOBER Psychiatry Barratt & Patton, 1983; Moeller et al, 2001

12 Brain maturation is not complete until about age 24 Amygdala Judgment Emotion Prefrontal Cortex Motivation Physical coordination Nucleus Accumbens Cerebellum Judgment is last to develop! Judgment Emotion Motivation Physical coordination, sensory processing Balance

13 The 20 items listed in the Psychopathy Checklist-Revised (PCL-R) Anderson and Kiehl

14 References An Overview of the DSM-5, Timothy C. Thomason, ad=rja&uact=8&ved=0ccqqfjaa&url=http%3a%2f%2fworks. bepress.com%2fcontext%2ftimothy_thomason%2farticle%2f1175%2ftype%2fnative%2fviewcontent&ei=fog9vnw0pkpgyqptxyh4d %2Fnative%2Fviewcontent&ei=fog9VNW0PKPgyQPTxYH4D Q&usg=AFQjCNFmjTo4Rz9xfp-- --PTlImfDQiAL21A&sig2=ZhRHF9gc_GPMWVy8Yr892A Conduct Disorder, Dr. Aubrey H. Fine, der.ppt Conduct Disorder and Oppositional Defiant Disorder,, Carolyn R. Fallahi, %20Oppositional%20Defiant%20Disorder.pdf Development of Disruptive Behavior Disorders: Implications for Prevention P & Treatment, Marcia Jensen, _HandoutsDevelopment%20of%20DBD.ppt Diagnostic and Statistical Manual Of Mental Disorders, Changing from DSM-IV to DSM-5, Steve Franklin, Shelly Justison, Kathleen McMullan, Disruptive Behaviour Disorders, Donna Dowling, DGPtalk.ppt Disruptive Behavior Disorders, Renee Fitzpatrick, r_disorders.pdf Disruptive Behavior: A Process for Preventing and Containing Unacceptable Behavior, Kendall L. Stewart, Firesetting, Arson, Pyromania, and the Forensic Mental Health Expert. Paul R. S. Burton, MD, Dale E. McNiel, and Renee L. Binder,, J Am Acad Psychiatry Law 40:355 65, 2012, Impulse-Control Disorders, M. Marsh, impulse-control control-disorders disorders-ppt-pdf-d d Intermittent Explosive Disorder as a Disorder of Impulse Control Disorder, Greg Sheffield, Geoffrey Miller, Michael Grant, Stefani Bjorck, Tim Sullivan, lse+control+disorder.ppt Impulsive Aggression for DSM-5, Coccaro, E. F. (Am J Psychiatry 2012; 169: ) 588) Mood & Disruptive Behavior Disorders in Children & Adolescents, Bruce Michael Cappo, assoc.com/presentation- handouts-on on-vario/mood%20%20disruptive%20behavior%20disorders%20in%20childre vario/mood%20%20disruptive%20behavior%20disorders%20in%20children%20%20adolescents%20 n%20%20adolescents%20-%20final.pdf %20final.pdf Neurodevelopmental Disorders, Disruptive, Impulse Conduct Disorder (DSM 5), Matthew Soulier, Paula Wadell, Scott Summers, Reconceptualizing Disorders of Conduct, Barbara M. Stillwell, Matthew R. Galvin, Y2M0N/Reconceptualizing_Disorders_of_Conduct_powerpoint_ppt_presentation entation 27 Self-Injurious Behaviors, Gender And Cultural Issues, Abid Nazeer, werpoint-slides/sib.ppt

Other Disorders Myers for AP Module 69

Other Disorders Myers for AP Module 69 1 Other s Myers for AP Module 69 Describe the general characteristics of somatic symptom disorders. How does culture influence people s expression of physical complaints? Compare the symptoms of conversion