L’impulsivité dans le TDAH : prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l’attention/hyperactivité (TDA/H)

The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.

Prospective Follow-up Studies of ADHD: Helping Establish a Valid Diagnosis in Adults

Is Compulsive Buying a Real Disorder, and Is It Really Compulsive?

Impulse control disorders in eating disorders: clinical and therapeutic implications

Impulse control disorder comorbidity among patients with bipolar I disorder

Adults with ADHD have been found in prior studies to have a greater risk for various psychiatric disorders. Chief among these are oppositional defiant disorder (ODD) and conduct disorder (CD). Approximately 24–35% of clinic–referred adults diagnosed with ADHD have ODD and 17–25% have CD, either currently or over the course of their earlier development (Barkley, Murphy, & Kwasnik, 1996; Biederman, et al., 1993; Murphy & Barkley, 1996; Murphy, Barkley, & Bush, 2002; Spencer, 2004). These figures for clinic–referred adults are below those reported in studies of ADHD children, particularly studies of hyperactive children followed to adulthood, where levels of ODD and CD may be double or triple these rates reported for adults diagnosed with ADHD (see Barkley, 2006, for a review; Barkley, Fischer, Edelbrock, & Smallish, 1990; Fischer, Barkley, Smallish, & Fletcher, 2002; Weiss & Hechtman, 1993). Among parents of children having ADHD who also meet criteria for ADHD, disruptive behavior disorders are also significantly more common (McGough et al., 2005; Minde, et al., 2003). For instance, one study found that 53% have had ODD and 33% have had CD sometime in their lives (Biederman et al., 1993), figures closer to those seen in follow–up studies of hyperactive or ADHD children. Antisocial Personality Disorder is often an associated adult outcome in a large minority of those children or adolescents who have both ADHD and CD; thus it is not surprising to find that 7–44% of clinic–referred adults diagnosed with ADHD also qualify for a diagnosis of this personality disorder (Biederman et al., 1993; Shekim, Asarnow, Hess, Zaucha, & Wheeler, 1990; Torgersen, Gjervab, & Rasmussen, 2006). Even among those who do not qualify for this diagnosis, many receive higher than normal ratings on those personality traits associated with this personality disorder (Tzelepis, Schubiner, & Warbase, 1995). Substance dependence and abuse are known to occur to a more frequent degree among hyperactive or ADHD children who develop CD by adolescence or Antisocial Personality Disorder by adulthood (Barkley, 2006; Tercyak, Peshkin, Walker, & Stein, 2002). Arecent study of a large general population sample likewise found an association between ADHD and antisocial disorder (Kessler, et al., 2006). Adults clinically diagnosed with ADHD seem to be no exception to this rule linking ADHD, antisocial activities, and drug use disorders. Studies have found lifetime rates of alcohol dependence or abuse disorders ranging between 21% and 53% of adults diagnosed with ADHD, whereas 8–32% may manifest some other form of substance dependence or abuse disorder (Barkley,

The development of Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) is a recognised iatrogenic complication associated with the use of dopamine agonists. The prevalence of ICDs has been reported to be as high as 14% in studies conducted in Europe and North America. Early case reports and recent large-scale studies have shown that clinical features associated with the development of PD-related ICDs include novelty-seeking personality traits, early onset PD and a past history of psychiatric conditions. More recent studies have also suggested that ICDs may be associated with deep brain stimulation and dyskinesias. Moreover, there is heterogeneity in the clinical features associated with the range of ICDs, with studies pointing out that compulsive sexual behaviours and binge eating have fewer clinical features in common than compulsive buying and pathological gambling. The recent increase in the number of functional neuroimaging studies on patients with PD and ICDs, particularly those with pathological gambling, has provided a unique opportunity to understand the neurobiology of the disorder, and has indicated an abnormality in the meso-limbic dopaminergic pathways. Further studies directly comparing ICD sufferers with and without PD will provide valuable knowledge to aid in the management of both patient groups. This review will provide a clinical overview of impulse control behaviours in PD, including both commonly reported ICDs and other related impulsive-compulsive behaviours observed in PD. Keywords: Dopamine dysregulation syndrome, Binge eating, Compulsive buying, Compulsive sexual behaviour, Functional imaging, Impulse control disorder, Parkinson disease, Pathological gambling, Phenomenology, Compulsive Sexual Behaviour

Objective: To determine the prevalence of impulse control disorders (ICDs) among medical students and evaluate the related socio-demographic and clinical features. Methods: A total of 277 students in the fourth and fifth year of medical school were included in the study. The study was conducted between September 2011 and June 2012 in Cukurova University Medical School, Adana, Turkey. A demographic data form has been completed. The Structured Clinical Interview for DSM-IV (SCID-I) was used to determine axis I psychiatric disorders. The prevalence rates of ICDs were investigated by using the modified version of the Minnesota Impulse Disorders Interview. All patients completed Barratt Impulsiveness Scale Version 11 (BIS-11) and Symptom Check List-90. Results: The lifetime prevalence of at least one ICD in our sample was 11.2% (n=31). When the participants with the diagnosis of ICDs not otherwise specified were excluded the prevalence rate decreased to 7.9%. The most common ICD was intermittent explosive disorder (6.1%), followed by trichotillomania (2.5%). History of suicide attempts was significantly higher in the group with ICD. There was statistically significant difference between comorbidity of other Axis I psychiatric disorders and a significant difference was observed in terms of total impulsivity, non-planning activity, and motor impulsivity scores as determined by BIS-11 between groups with or without ICDs. Conclusion: ICDs might be underdiagnosed in young adult populations. ICDs affect the quality of life, the course and outcome of comorbid disorders so it is important to ask for these disorders in regular psychiatric interviews and treating them in an appropriate and specific way.

Impulse control disorders in psychiatric inpatients

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.

The authors reviewed available studies of DSM-III-R impulse control disorders not elsewhere classified in order to determine the relationship of these disorders to one another and to other psychiatric disorders. The review focused on the demographic and clinical characteristics, phenomenology, family history, biology, and response to treatment of individuals with intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania. Analysis was restricted to reports which either indicated use of operational diagnostic criteria or provided descriptions of the impulsive behavior detailed enough that patients could be judged as probably meeting the DSM-III-R criteria. Although different impulse control disorders have different sex ratios, all have similar ages at onset and courses. Studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder). Biological studies indicate that intermittent explosive disorder and pyromania may share serotonergic abnormalities similar to those reported in mood disorders. The impulse control disorders not elsewhere classified appear to be related to one another and to mood, anxiety, and psychoactive substance use disorders. Thus, like major depression, obsessive-compulsive disorder, panic disorder, bulimia nervosa, and attention deficit hyperactivity disorder, they may represent forms of "affective spectrum disorder."

Parkinson's disease polygenic risk score is not associated with impulse control disorders: A longitudinal study

P.2.017 - ADHD and related aspects in a standardised investigation in Austrian prisons – incarcerated patients with substance use disorders

Objective: Psychiatric comorbidities are highly prevalent among individuals affected by substance use disorders and those with non-substance-related addictive disorders such as gambling disorder. More recently, the frequent co-occurrence of substance use disorders and attention-deficit hyperactivity disorder (ADHD) has received particular attention. The aim of our study was to identify patterns of psychiatric comorbidity and to examine associations between patient group and ADHD status with class membership. Methods: Participants were patients with opioid use disorder enrolled in opioid maintenance treatment (OMT), either recruited from the community (n = 142; M age = 35.8 years; 38.7% female) or prison (n = 133; M age = 35.7 years; 21.8% female), and patients undergoing treatment for problem gambling (PrG; n = 80; M age = 43.1 years; 20% female). To enable direct comparisons, the following instruments were applied: Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale, and European Addiction Severity Index. We used a latent class analysis (LCA) to identify psychiatric comorbidity patterns and a multinomial logistic regression to examine associations between patient group, ADHD status, age, and gender with class membership. Results: The LCA resulted in a three-class solution: (1) a class of individuals with a relatively low probability of current psychiatric comorbidities, except for a high probability of substance use disorders; (2) a class with markedly increased probabilities of current and recurrent psychiatric comorbidities, especially for major depression; and (3) a class with very low probabilities of psychiatric comorbidities, except for moderate probabilities of substance use disorders and antisocial personality disorder. Both OMT patients recruited from the community and those in prison were less likely than PrG patients to be assigned to the most burdened class with respect to psychiatric comorbidity (class 2). Further, both individuals with ADHD in childhood and those with adult ADHD were more likely members of class 2. Conclusions: PrG patients seem to be at an even higher risk for psychiatric comorbidities compared to OMT patients. Raising awareness among practitioners for the high prevalence of psychiatric comorbidities among patients with gambling disorder and individuals with ADHD is crucial to initiate adequate treatment and to improve response.

Pathological gambling (PG) is a prevalent public health problem associated with fronto-temporal dysfunction and maladaptive personality traits. To further test these associations, we assessed neuropsychological performance in pathological gamblers (PGs) and controls. We also examined selected personality characteristics and symptoms of attention deficit hyperactivity disorder (ADHD). Subjects were recruited from the community. All received a comprehensive neuropsychological battery, the ADHD Rating Scale, and personality measures including the Barratt Impulsiveness Scale and a version of the Temperament and Character Inventory. People with DSM-IV PG (n = 54) and controls (n = 65) were comparable in age, sex, and education level. PGs were more likely to have comorbid lifetime mood, anxiety, and substance use disorders; antisocial personality disorder; and other impulse control disorders. PGs performed significantly worse on the Wisconsin Card Sort Test-64 perseverative responses subscale and the Trails B test; they also had lower performance and full scale IQs. PGs had elevated levels of depression, ADHD symptoms, trait impulsivity, novelty seeking, and harm avoidance, but lower levels of reward dependence. High levels of self-reported impulsivity or ADHD symptoms in PGs did not predict worse neuropsychological performance. We conclude that PGs performed worse than controls on two measures of executive function and had lower IQs. They also had more psychiatric comorbidity, higher levels of trait impulsivity and ADHD symptoms, and both novelty seeking and harm-avoidance, but lower levels of reward-dependence. This study does not support the notion that there is a pattern of neuropsychological deficits associated with high levels of impulsivity or ADHD symptoms in PGs.