THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH DISEASES.THIS PRESENTATION IS ABOUT DETAILS OF IMPULSE CONTROL DISORDER AND ITS MANAGEMENT.

1. MRS. AMRITA ROY
M.SC PSYCHIATRIC NURSING
NIMHANS,BANGALORE
IMPULSE CONTROL
DISORDERS

2. Core characteristics
(1) Repetitive engagement in a behavior despite adverse
consequences
(2) Diminished control over the problematic behavior
(3) An appetitive urge or craving state prior to engagement
in the problematic behavior; and
(4) A hedonic quality experienced during the performance
of the problematic behavior.

3. Risk Factors
 Verbal abuse and physical abuse
 Exposure to violence
 History of drug abuse
 Young age
 Family history of mood disorders
 Family history of substance abuse

4. (F63) HABIT AND IMPULSE DISORDERS
 F63.0 PATHOLOGICAL GAMBLING
 F63.1 PATHOLOGICAL FIRE-SETTING
[PYROMANIA]
 F63.2 PATHOLOGICAL STEALING
[KLEPTOMANIA]
 F63.3 TRICHOTILLOMANIA
 F63.8 OTHER HABIT AND IMPULSE
DISORDERS
 F63.9 HABIT AND IMPULSE DISORDER,
UNSPECIFIED

5. F63.0 PATHOLOGICAL GAMBLING
Persistent and recurrent maladaptive gambling
behavior as indicated by the following:
 Preoccupation
 Tolerance
 Loss of Control
 Withdrawal
 Escape
 Lying
 Illegal Activity
 Risked Relationships

6. Etiology
 Psychoanalytic theories(unconscious desire to lose,
unresolved Oedipial conflicts)
 Learning theories (monetary gain and excitement
acting as positive reinforcers)
 Cognitive theories (cognitive distortions such as
magnification of one’s gambling skills, superstitious
beliefs, interpretive biases) and
 Neurotransmitter theories (serotonin, noradrenaline
and dopamine dysfunction).

7. Comorbidity
 There appears to be a high co-occurrence
of substance use disorders, gambling
disorder, depressive and bipolar disorders, and
disruptive, impulse-control

8. Treatment
Psychological interventions-
 Behavioral treatments (include imaginal desensitisation,
imaginal relaxation, behavioural monitoring, and spousal
contingency contracting)
 Cognitive treatments (beliefs about randomness and
chance)
 Others - problem-solving skills, anger management,
communication skills, aggression replacement training
and long-term insight-oriented psychotherapy.

9. Treatment
Pharmacological interventions
 Opioid Antagonists - decrease dopamine
neurotransmission in the nucleus accumbens and
the motivational neurocircuitry, thus dampening
gambling-related excitement and cravings.
Eg:Naltrexone
 Antidepressants - The serotonin (5-hydroxyindole
or 5HT) system has long been associated with
impulse control.
Eg: Fluvoxamine, Paroxetine

10. F63.1 PATHOLOGICAL FIRE-SETTING
[PYROMANIA]
 The disorder is characterized by multiple acts of, or
attempts at, setting fire to property or other objects,
without apparent motive, and by a persistent
preoccupation with subjects related to fire and burning.
 There may also be an abnormal interest in fire-engines
and other fire-fighting equipment, in other associations
of fires, and in calling out the fire service.
 The population prevalence of pyromania is not known.

11. Development and course
 There are insufficient data to establish a typical age
at onset of pyromania.
 The relationship between fire setting in childhood
and pyromania in adulthood has not been
documented.
 Pyromania occurs much more often in males,
especially those with poorer social skills and learning
difficulties. (Lindberg et al. 2005).

12. Comorbidity
 Juvenile fire setting is usually associated
with conduct disorder, attention-
deficit/hyperactivity disorder, or an adjustment
disorder.
 There appears to be a high co-occurrence
of substance use disorders, gambling
disorder, depressive and bipolar disorders, and other
disruptive, impulse-control, and conduct
disorders with pyromania (Grant and Won Kim
2007).

13. Treatment
 The treatment approaches for children and adolescents
involved with repeated fire setting include problem-
solving skills, anger management, communication skills,
aggression replacement training, and cognitive
restructuring.
 It is usually much more difficult to treat Pyromania in
adults because of the lack of cooperation and the most
common kind of treatment usually consists of a
combination of medication– usually one of the selective
serotonin reuptake inhibitors – and long-term insight-
oriented psychotherapy.

14. F63.2 PATHOLOGICAL STEALING
[KLEPTOMANIA]
 The disorder is characterized by repeated failure to
resist impulses to steal objects that are not acquired
for personal use or monetary gain.
 The Objects may instead be discarded, given away, or
hoarded. The disorder may cause legal, family,
career, and personal difficulties.

15. Prevalence
 Kleptomania occurs in about 4%–24% of individuals
arrested for shoplifting (Talih 2011).
 Its prevalence in the general population is very rare,
at approximately 0.3%–0.6% (Grant et al.
2010;Talih 2011).
 Females outnumber males at a ratio of 3:1(Talih
2011).

16. Treatment
 Covert sensitization (stealing and then facing
negative consequences, such as being caught)
 Aversion therapy (practice mildly painful techniques,
such as holding breath when there is an urge to steal)
 Systematic desensitization (practice relaxation
techniques and controlling urges to steal)

17. F63.3 TRICHOTILLOMANIA
 A disorder characterized by noticeable hair loss due
to a recurrent failure to resist impulses to pull out
hairs.
 The hair-pulling is usually preceded by mounting
tension and is followed by a sense of relief or
gratification.
 This diagnosis should not be made if there is a pre-
existing inflammation of the skin, or if the hair
pulling is in response to a delusion or a
hallucination.

18. Onset and Prevalence
 The prevalence has been estimated to be as high as
1.5% in males, and as high as 3.4% in females.
 The peak onset of this hair pulling disorder is
between the ages of 9 and 13

19. Etiology
 Abnormalities in the brain - emotional circuits
 Genetics - particular gene, inherited
 Lack of serotonin, the "feel-good" chemical in the
brain
 Changes in hormone levels - more common around
ages when hormone levels frequently change, such as
during puberty

20. Treatment
 Psychotherapy - CBT can help to address thoughts
about self, relationships with others and how one
relates to the world around.
 Relaxation strategies - Strategies include deep
breathing exercises or tensing and then relaxing
different muscles.
 Medication - (SSRIs) have demonstrated a degree of
effectiveness

21. F63.8 OTHER HABIT AND IMPULSE
DISORDERS
 This category should be used for other kinds of
persistently repeated maladaptive behaviour that are
not secondary to a recognized psychiatric syndrome,
and in which it appears that there is repeated failure
to resist impulses to carry out the behaviour.
 There is a prodromal period of tension with a feeling
of release at the time of the act.
 Includes: intermittent explosive (behaviour) disorder

22.  Impulse control disorders and related behaviours
(ICD-RBs) in Parkinson's disease patients:
Assessment using "Questionnaire for impulsive-
compulsive disorders in Parkinson's disease" (QUIP)
Ashish Sharma, Vinay Goyal, Madhuri Behari, Achal
Srivastva, Garima Shukla, Deepti Vibha
Department of Neurology, All India Institute of
Medical Sciences, New Delhi, India

23. Results
 Total of 299 patients participated in the study. At
least one ICD-RB was present in 128 (42.8%), at
least one Impulse control disorder (ICD) was
present in 74 (24.75%) and at least one Impulse
control related compulsive behaviour (ICRB) was
present in 93 (31.1%) patients. Punding was the most
frequent (12.4%) followed by hyper sexuality
(11.04%), compulsive hobbyism (9.4%), compulsive
shopping (8.4%), compulsive medication use (7.7%),
compulsive eating (5.35%), walkabout (4%) and
pathological gambling (3.3%). ≥ 2 ICD-RBs
were observed in 15.7% of patients.

24. Results
 After multivariate analysis, younger age of
onset, being unmarried were specifically
associated with presence of ICD. Longer
disease duration was specifically associated with
presence of ICRB.
 Whereas smoking and higher dopamine
levodopa equivalent daily doses (DA LEDD)
were associated with both presence of ICD
and ICRB. Higher LD LEDD was specifically
associated with presence of ICD-RB.