Impulse control disorders due to cocaine and synthetic stimulants use: a systematic review

Abstract

The introduction of ICD-11 has opened up new horizons in understanding the impact of modern narcotic substances on mental health, in particular, it has increased the list of possible mental disorders associated with drug use. The purpose of the work is to conduct a systematic review of the literature and describe the features of the pathogenesis, clinical picture, and effectiveness of various types of therapy for impulse control disorders associated with use of cocaine and synthetic stimulants. A systematic analysis of scientific publications was performed in the eLibrary, PubMed, CNKI, and Google Scholar databases according to PRISMA recommendations. 41 publications were selected from the initially found 4,953 articles. The pathogenesis of induced impulse control disorders is associated with the direct effect of stimulant drugs on the brain and consists in the activation of D3 and 5‑HT1A receptors, as well as activation of limbic brain regions and a lack of inhibitory effects of the frontal lobe. Increased impulsivity in users of cocaine and synthetic stimulants has been proven in a large number of neurophysiological and neuroimaging studies. The frequency of occurrence, clinical features, and approaches to therapy of impulse control disorders resulting from the use of drugs with dopaminergic action (drugs for the treatment of Parkinson's disease and hyperprolactinemia, third-generation antipsychotics, and venlafaxine in high doses) have been described in details. At the same time, there is indirect evidence that cocaine and synthetic stimulants should cause impulse control disorders, since they have similar neurotransmitter activity. In addition, there are descriptions of the predominance of individual symptoms of impulse control disorders in this group of drug users. However, at the time of the review, no detailed description of these drug-induced disorders has been found. These are the prospects for further research. The use of fluoxetine and oxcarbazepine (for intermittent explosive disorder) and naltrexone (for kleptomania), as well as comprehensive prevention of drug use relapse and psychotherapy, has the highest degree of evidence as a therapy for impulse control disorders.