1
|
Fuss J, Keeley JW, Stein DJ, Rebello TJ, García JÁ, Briken P, Robles R, Matsumoto C, Abé C, Billieux J, Grant JE, Kraus SW, Lochner C, Potenza MN, Reed GM. Mental health professionals' use of the ICD-11 classification of impulse control disorders and behavioral addictions: An international field study. J Behav Addict 2024; 13:276-292. [PMID: 38217688 PMCID: PMC10988394 DOI: 10.1556/2006.2023.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024] Open
Abstract
Background and aims The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.
Collapse
Affiliation(s)
- Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Jared W. Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Tahilia J. Rebello
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatriy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebeca Robles
- Global Mental Health Research Center, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Switzerland
- Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Christine Lochner
- Department of Psychiatry, SA MRC Unit on Risk and Resilience in Mental Disorders, University of Stellenbosch, South Africa
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
2
|
Ciesinski NK, Drabick DAG, Berman ME, McCloskey MS. Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis. J Pers Disord 2024; 38:34-52. [PMID: 38324246 DOI: 10.1521/pedi.2024.38.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.
Collapse
Affiliation(s)
- Nicole K Ciesinski
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Deborah A G Drabick
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi
| | - Michael S McCloskey
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Ciesinski NK, Zajac MK, McCloskey MS. Predictors of treatment outcome in cognitive behavioral therapy for intermittent explosive disorder: A preliminary analysis. J Consult Clin Psychol 2024; 92:54-60. [PMID: 37856378 PMCID: PMC10843081 DOI: 10.1037/ccp0000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The present study examined potential treatment outcome predictors of a multicomponent cognitive behavioral intervention for intermittent explosive disorder (IED). METHOD The sample (n = 64; 22 female) consisted of individuals with a current diagnosis of IED that completed treatment across three study trials. Treatment outcome predictors assessed included demographic variables, psychiatric comorbidity, symptom severity, and treatment motivation/engagement. Treatment outcomes were (a) change in number of past-week aggressive acts from pretreatment to posttreatment and (b) presence of IED diagnosis at posttreatment. RESULTS Results indicated those who endorsed lower trait anger were more likely to remit from IED diagnosis at posttreatment. No other variables were found to significantly predict treatment outcome. CONCLUSIONS These findings support the notion that cognitive behavioral therapy can be effective for a wide range of individuals with IED, with little variation in efficaciousness based on presence of demographic characteristics, comorbid disorders, or treatment motivation/engagement. This seems to be particularly the case for individuals with lower levels of trait anger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
|
4
|
McCloskey MS, Chen EY, Olino TM, Coccaro EF. Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial. Behav Ther 2022; 53:1133-1146. [PMID: 36229112 DOI: 10.1016/j.beth.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20-55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale-Modified, which was conducted by an interviewer who was blind to the participant's study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.
Collapse
|
5
|
Krick LC, Berman ME, McCloskey MS, Coccaro EF, Fanning JR. Gender Moderates the Association Between Exposure to Interpersonal Violence and Intermittent Explosive Disorder Diagnosis. J Interpers Violence 2022; 37:NP14746-NP14771. [PMID: 33977809 DOI: 10.1177/08862605211013951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Exposure to interpersonal violence (EIV) is a prevalent risk-factor for aggressive behavior; however, it is unclear whether the effect of EIV on clinically significant aggressive behavior is similar across gender. We examined whether gender moderates the association between experiencing and witnessing interpersonal violence and the diagnosis of intermittent explosive disorder (IED). We also examined potential pathways that might differentially account for the association between EIV and IED in men and women, including emotion regulation and social information processing (SIP). Adult men and women (N = 582), who completed a semistructured clinical interview for syndromal and personality disorders, were classified as healthy controls (HC; n = 118), psychiatric controls (PC; n = 146) or participants with an IED diagnosis (n = 318). Participants also completed the life history of experienced aggression (LHEA) and life history of witnessed aggression (Lhwa) structured interview and self-report measures of emotion regulation and SIP. Men reported more EIV over the lifetime. In multiple logistic regression analysis, experiencing and witnessing aggression within the family and experiencing aggression outside the family were associated with lifetime IED diagnosis. We found that the relationship between EIV and IED was stronger in women than in men. Affective dysregulation mediated certain forms of EIV, and this relation was observed in both men and women. SIP biases did not mediate the relation between EIV and IED. EIV across the lifespan is a robust risk factor for recurrent, clinically significant aggressive behavior (i.e., IED). However, the relationship between EIV and IED appears to be stronger in women. Further, this relation appears partially mediated by affective dysregulation.
Collapse
Affiliation(s)
| | | | | | - Emil F Coccaro
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | |
Collapse
|
6
|
Nassif JB, Felthous AR. Mapping the neurocircuitry of impulsive aggression through the pharmacologic review of anti-impulsive aggressive agents. J Forensic Sci 2022; 67:844-853. [PMID: 35106768 DOI: 10.1111/1556-4029.15000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
Impulsive aggression, in contradistinction to premeditated aggression in humans or predatory aggression in animals, corresponds to defensive aggression in animal models. At the core of the neurocircuitry of impulsive aggression, from murine to feline to human species, it is the medial amygdala-mediobasal hypothalamus-dorsal periaqueductal gray pathway. Here, we update current knowledge on the neurocircuitry of impulsive aggression by placing the neurocircuitry and its neurophysiological substrates into the top-down/bottom-up hypothesis of impulsive aggression. We then reverse the neurotranslational approach, which applies neuroscience to developing therapeutic drugs, and apply current understanding of potential mechanisms of anti-impulsive aggression agents to further clarify, at least heuristically and hypothetically, the dynamic biochemical components of the neurocircuitry of impulsive aggression. To do this, we searched the medical literature for studies attempting to clarify the neurobiological and neurochemical effects of the five most widely studied anti-impulsive aggressive agents, particularly as they pertain to the top-down/bottom-up hypothesis. Multiple different mechanisms are discussed, all of which fitting in the hypothesis by way of either promoting the "top-down" part (i.e., enhancing inhibitory neurotransmitters), or suppressing the "bottom-up" part (i.e., decreasing excitatory neurotransmitters). The hypothesis appears consistent with the current psychopharmacological understanding of these agents, as well as to account for the likely multifactorial etiology of the condition. Limitations of the hypothesis and future directions are finally discussed.
Collapse
Affiliation(s)
- Joe Bou Nassif
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| |
Collapse
|
7
|
Abstract
BACKGROUND Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) intermittent explosive disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum. METHODS This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 disorders (n = 293), and adults without any DSM-5 disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies. RESULTS Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results. CONCLUSION These findings support the proposition that DSM-5 IED represents a distinct behavioral disorder rather than the severe end of an aggressive behavior continuum.
Collapse
Affiliation(s)
- Jennifer R Fanning
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Harvard Medical School, Belmont, MA02478, USA
| | - David K Marcus
- Department of Psychology, Washington State University, Pullman, WA99164, USA
| | - Jonathan R Preszler
- Department of Psychology, Washington State University, Pullman, WA99164, USA
| | - Emil F Coccaro
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL60637, USA
| |
Collapse
|
8
|
Seok JW, Cheong C. Gray Matter Deficits and Dysfunction in the Insula Among Individuals With Intermittent Explosive Disorder. Front Psychiatry 2020; 11:439. [PMID: 32508687 PMCID: PMC7251158 DOI: 10.3389/fpsyt.2020.00439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Although numerous neuroimaging studies have evaluated the characteristics of intermittent explosive disorder (IED), studies on the structural alterations and focal dysfunction in the brain in this condition are limited. This study aimed to identify gray matter deficits and functional alterations in individuals with IED using voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) analyses. Fifteen men with IED and 15 age- and sex-matched healthy controls participated in this study. Gray matter volume and brain activation while viewing the anger-inducing films were measured using 7T MRI. VBM results indicated that individuals with IED had significantly reduced gray matter volume in the insula, amygdala, and orbitofrontal area, relative to controls. Gray matter volume in the left insula was negatively correlated with composite aggression scores. fMRI results demonstrated that relative to healthy controls, individuals with IED showed greater activation in the insula, putamen, anterior cingulate cortex, and amygdala during anger processing. Left insular activity was positively correlated with composite aggression scores. Collectively, these findings suggest that structural and functional alterations in the left insula are linked to IED; this provides insight into the neural mechanisms underlying IED.
Collapse
Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Rehabilitation Counseling Psychology, Seoul Hanyoung University, Seoul, South Korea
| | - Chaejoon Cheong
- Bioimaging Research Team, Korean Basic Science Institute, Cheongju, South Korea
| |
Collapse
|
9
|
George DT, Ameli R, Koob GF. Periaqueductal Gray Sheds Light on Dark Areas of Psychopathology. Trends Neurosci 2019; 42:349-360. [PMID: 30955857 DOI: 10.1016/j.tins.2019.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 12/29/2022]
Abstract
Neurons in the periaqueductal gray (PAG) integrate negative emotions with the autonomic, neuroendocrine, and immune systems to facilitate responses to threat. Modern functional track tracing in animals and optogenetic and chemogenetic techniques show that the PAG is a rich substrate for the integration of active and passive responses to threat. In humans, the same regions of the PAG that give rise to adaptive anger/fight, fear/panic, depression/shutdown, pain, and predatory behaviors in response to challenging situations or overwhelming threats can become activated pathologically, resulting in symptoms that resemble those of psychiatric disorders. This review coalesces human and animal studies to link PAG neuropathways to specific elements of psychiatric diagnoses. The insights gained from this overview may eventually lead to new therapeutic interventions.
Collapse
Affiliation(s)
- David T George
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Rezvan Ameli
- National Institute of Mental Health and NIH Clinical Center, Pain and Palliative Care Service, Bethesda, MD, USA
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA; National Institute on Drug Abuse, Bethesda, MD, USA.
| |
Collapse
|
10
|
Abstract
Objective: Although several previous studies have focused on the mental health problems in detained juvenile offenders in China and found high levels of major psychiatric morbidity, the prevalence of intermittent explosive disorder (IED) in this group remains unknown. The purpose of this study is to discover the prevalence of IED among juvenile offenders in China as well as the difference in demographic characteristics and personality traits between IED offenders and the general population. Method: A total of 280 delinquent boys (Mean age 16.10 years) were interviewed by trained psychiatrists. The interview procedure included the recording of sociodemographic characteristics, criminal records, Composite International Diagnostic Interviews (CIDI), State-Trait Anger and Expression of Anger Inventory-2 (STAXI-2) and Modified Overt Aggression Scales (MOAS). Results: Of the 280 delinquent boys, 32 (11.4%) were diagnosed with IED, 129 (46.1%) were non-IED psychopathology controls (PC), and 119 (42.5%) were healthy controls (HC). Except for substance use disorder (SUD), no differences in psychiatric comorbidity were found between youths with IED and those with another psychiatric disorder. Compared with the PC and HC groups, those in the IED group were more likely to commit a violent crime such as rape, assault, or an affray but it is less likely that their motive can be explained by money or property. The IED group also had a higher rate of recidivism history than the HC group. The IED group displayed higher levels of state and trait anger and anger expression than the HC group and lower levels of anger control than both the PC and HC groups. MOAS also showed that those in the IED group were more aggressive than those in the PC and HC groups. Conclusion: The relationships between IED, anger and aggression reflect the need to develop and implement specific and individually tailored intervention approaches to correct IED juvenile offenders' behavior in order to prevent new crime.
Collapse
Affiliation(s)
- Yang Shao
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xie
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhou
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Jennings KM, Wildes JE, Coccaro EF. Intermittent explosive disorder and eating disorders: Analysis of national comorbidity and research samples. Compr Psychiatry 2017; 75:62-67. [PMID: 28324677 PMCID: PMC5410643 DOI: 10.1016/j.comppsych.2017.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED). METHODS Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,430) and a clinical research sample (n = 1,642). RESULTS Lifetime prevalence of Any ED was elevated in IED vs. non-IED for both the community and clinical research samples. Though anorexia nervosa displayed no relationship with IED in either sample, bulimia nervosa was associated with IED in the community sample and binge eating disorder was associated with IED in both the community and clinical research samples. Onset of IED preceded onset of Any ED in at least 70% of comorbid IED/ED cases in both community and clinical research samples. Associations of IED with Any ED and bulimia nervosa in the community sample, and associations of IED with binge eating disorder in the clinical research sample, remained significant after controlling for other psychiatric disorders. CONCLUSIONS Individuals with IED are more likely to report lifetime prevalence of ED, particularly bulimic spectrum disorders. This finding, and the observation that the onset of IED occurs prior to the onset of ED in the majority of individuals, suggests that longitudinal studies are needed to clarify this relationship and determine whether IED is a risk factor for the development of ED. Early identification of individuals with IED or impulsive aggression may provide clinically useful information to determine most effective treatment interventions.
Collapse
Affiliation(s)
- Karen M Jennings
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| |
Collapse
|
12
|
Scott KM, Lim CCW, Hwang I, Adamowski T, Al-Hamzawi A, Bromet E, Bunting B, Ferrand MP, Florescu S, Gureje O, Hinkov H, Hu C, Karam E, Lee S, Posada-Villa J, Stein D, Tachimori H, Viana MC, Xavier M, Kessler RC. The cross-national epidemiology of DSM-IV intermittent explosive disorder. Psychol Med 2016; 46:3161-3172. [PMID: 27572872 PMCID: PMC5206971 DOI: 10.1017/s0033291716001859] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is the first cross-national study of intermittent explosive disorder (IED). METHOD A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition. RESULTS Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13-23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset. CONCLUSIONS Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.
Collapse
Affiliation(s)
- K. M. Scott
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - C. C. W. Lim
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - I. Hwang
- Department of Health Care Policy, Harvard University Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - T. Adamowski
- Medical University of Wroclaw, L. Pasteur Str. 10, 50-367 Wroclaw, Poland
| | - A. Al-Hamzawi
- Department of Psychiatry, College of Medicine, Qadisia University, Diwaniya 00964, Iraq
| | - E. Bromet
- Department of Psychiatry, State University of New York at Stony Brook, Putnam Hall – South Campus, Stony Brook, NY 11794-8790, USA
| | - B. Bunting
- University of Ulster, College Avenue, Londonderry BT48 7JL, UK
| | - M. P. Ferrand
- Universidad Peruana Cayetano Heredia, Facultad de Salud Pública y Administración, Honorio Delgado, Lima, Peru
| | - S. Florescu
- Health Services and Research Evaluation Center, National School of Public Health Management and Professional Development, 31 Vaselor Street, Bucharest, 021253, Romania
| | - O. Gureje
- Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria
| | - H. Hinkov
- National Center for Public Health Protection, 15 Acad. Ivan Ev. Geshov blvd, 1431 Sofia, Bulgaria
| | - C. Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, 13-15/F, Block B, No. 2019 Buxin Road, Luohu District, No. 1080 Cuizu Road, Luohu District, 518020, Guangdong Province, People's Republic of China
| | - E. Karam
- St. George Hospital University Medical Center, Balamand University, Faculty of Medicine, Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Medical Institute for Neuropsychological Disorders (MIND), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Institute for Development, Research Advocacy and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Ashrafieh 166378, Lebanon
| | - S. Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Flat 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - J. Posada-Villa
- Universidad Colegio Mayor de Cundinamarca, Cra 7 No. 119-14 Cons. 511, Bogotá D.C., Colombia
| | - D. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Private Bag X3, Rondebosch 7701, Cape Town, South Africa
| | - H. Tachimori
- National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Rua Dr Eurico de Aguiar 888/705, Vitoria, ES 29055-280, Brazil
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard University Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
13
|
Fanning JR, Lee R, Coccaro EF. Comorbid intermittent explosive disorder and posttraumatic stress disorder: Clinical correlates and relationship to suicidal behavior. Compr Psychiatry 2016; 70:125-33. [PMID: 27624432 PMCID: PMC5024714 DOI: 10.1016/j.comppsych.2016.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with both aggressive and suicidal behavior. Recent research suggests that the diagnosis of intermittent explosive disorder (IED), an impulse-control disorder characterized by repeated impulsive aggressive behavior, may help to identify individuals at risk for attempting suicide. Given the relationship between anger and PTSD, there is likely to be an increased prevalence of IED among individuals with PTSD; however, little is known about the overlap in these two disorders, including how individuals with comorbid IED and PTSD may differ from those with either disorder alone. The purpose of this study is to examine the clinical correlates of comorbid IED and PTSD and the contribution of these two disorders (among others) to lifetime suicide attempt and characteristics of suicidal behavior. METHOD In a large sample of community research volunteers (N=1460), we compared individuals with PTSD, IED, and comorbid PTSD and IED on measures of current mood, trait aggression, and trait impulsivity. We also examined the contributions of PTSD, IED, and other syndromal and personality disorders to the prediction of lifetime aggression and lifetime suicide attempt, and their relationship to characteristics of suicide attempts, including level of intent, use of violent versus non-violent means, and the medical seriousness of the attempt. RESULTS Comorbid PTSD and IED was associated with significantly elevated levels of depression, anxiety, anger, aggression, and impulsivity, as well as with high rates of comorbidity with other psychiatric disorders. IED (β=.56, p<.001), but not PTSD, significantly and uniquely predicted lifetime aggressive behavior. Both IED and PTSD were associated with lifetime suicide attempt in multivariate analysis (ORs: 1.6 and 1.6, ps<.05). The results show that IED, when comorbid with PTSD, identifies a subgroup of individuals with particularly high levels of aggressive behavior and a high rate of suicide attempt (41.4% in this sample). CONCLUSION These findings add support to the notion that the diagnosis of IED may aid in identifying individuals at risk for aggressive and suicidal behavior.
Collapse
|
14
|
Gan G, Preston-Campbell RN, Moeller SJ, Steinberg JL, Lane SD, Maloney T, Parvaz MA, Goldstein RZ, Alia-Klein N. Reward vs. Retaliation-the Role of the Mesocorticolimbic Salience Network in Human Reactive Aggression. Front Behav Neurosci 2016; 10:179. [PMID: 27729852 PMCID: PMC5037197 DOI: 10.3389/fnbeh.2016.00179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/09/2016] [Indexed: 11/22/2022] Open
Abstract
The propensity for reactive aggression (RA) which occurs in response to provocation has been linked to hyperresponsivity of the mesocorticolimbic reward network in healthy adults. Here, we aim to elucidate the role of the mesocorticolimbic network in clinically significant RA for two competing motivated behaviors, reward-seeking vs. retaliation. 18 male participants performed a variant of the Point-Subtraction Aggression Paradigm (PSAP) during functional magnetic resonance imaging (fMRI). We examined whether RA participants compared with non-aggressive controls would choose to obtain a monetary reward over the opportunity to retaliate against a fictitious opponent, who provoked the participant by randomly stealing money from his earnings. Across all fMRI-PSAP runs, RA individuals vs. controls chose to work harder to earn money but not to retaliate. When engaging in such reward-seeking behavior vs. retaliation in a single fMRI-PSAP run, RA individuals exhibited increased activation in the insular-striatal part of the mesocorticolimbic salience network, and decreased precuneus and ventromedial prefrontal cortex activation compared to controls. Enhanced overall reward-seeking behavior along with an up-regulation of the mesocorticolimbic salience network and a down-regulation of the default-mode network in RA individuals indicate that RA individuals are willing to work more for monetary reward than for retaliation when presented with a choice. Our findings may suggest that the use of positive reinforcement might represent an efficacious intervention approach for the potential reduction of retaliatory behavior in clinically significant RA.
Collapse
Affiliation(s)
- Gabriela Gan
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Rebecca N Preston-Campbell
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount SinaiNew York, NY, USA; Division of Social and Behavioral Sciences, Lindenwood University-BellevilleBelleville, IL, USA
| | - Scott J Moeller
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | | | - Scott D Lane
- Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston Houston, TX, USA
| | - Thomas Maloney
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Muhammad A Parvaz
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Rita Z Goldstein
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Nelly Alia-Klein
- Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY, USA
| |
Collapse
|
15
|
Alvarez-Alonso MJ, Morales-Muñoz I, Castaño-León AM, Lagares A, Rubio G, Jurado-Barba R. Single Case Study: Neuropsychological Functioning in a Patient Diagnosed with Intermittent Explosive Disorder Pre and Post Neurosurgery. Span J Psychol 2016; 19:E21. [PMID: 27161981 DOI: 10.1017/sjp.2016.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intermittent explosive disorder (IED) is characterized by a difficulty to resist the urge to carry out a recognized harmful behavior. The central symptom is aggressiveness, expressed in isolated episodes. Executive function impairments are habitually found in impulse control disorders. Neuropsychology of impulsivity is related to dysfunctions in the orbito-frontal cortex, dorsolateral cortex and anterior-cingulated regions, being consequently involved in cognitive mechanisms of inhibition. Lesions in those areas are common in IED. In the most severe cases of IED, surgical procedures are required for treatment. In this study, we examined JML; a patient suffering from a severe case of IED. He experienced frequent episodes of auto and heteroaggression and multiple psychiatric admissions, and thus stereotactic surgery was the recommended treatment. The procedure consisted of an electrode situated lateral to the lateral ventricle, targeting the projections between frontal and subcortical affected regions. We aimed to study the neuropsychological functioning of JML, before and after electrode implantation. Our results suggested that surgery in IED improves cognitive performance at some levels. JML significantly improved his cognitive flexibility, measured with WCST, and alternate attention assessed with CPT and TMT-B tests, after electrode implantation. Cognitive flexibility deficits may be also related to increased aggressiveness. Therefore, improvements at this level may involve a reduction of impulsivity and aggressive behavior.
Collapse
|
16
|
Keyes KM, McLaughlin KA, Vo T, Galbraith T, Heimberg RG. ANXIOUS AND AGGRESSIVE: THE CO-OCCURRENCE OF IED WITH ANXIETY DISORDERS. Depress Anxiety 2016; 33:101-11. [PMID: 26422701 PMCID: PMC4729594 DOI: 10.1002/da.22428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/27/2015] [Accepted: 08/29/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Evidence suggests that impulsive aggression and explosive anger are common among individuals with anxiety disorders; yet, the influence of intermittent explosive disorder (IED) on the onset, course, consequences, and patterns of comorbidity among those with anxiety disorders is unknown. METHODS Data were drawn from the National Comorbidity Survey Replication (N = 9,282) and Adolescent Supplement (N = 9,632), nationally representative surveys conducted between 2001 and 2004. Diagnoses were based on structured lay-administered interviews. Lifetime diagnoses were assessed with structured instruments. Outcomes included comorbidity, functional and role impairment, and treatment utilization. RESULTS Adolescents with a lifetime anxiety disorder had a higher prevalence of a lifetime anger attacks (68.5%) and IED (22.9%) than adolescents without a lifetime anxiety disorder (48.6 and 7.8%, respectively), especially social phobia and panic disorders. Similar elevation was found for adults. Age of onset and course of anxiety disorders did not differ by IED. Severe functional impairment associated with anxiety was higher among adolescents (39.3%) and adults (45.7%) with IED than those without IED (29.2 and 28.2%, respectively). Comorbidity for all other disorders was elevated. However, individuals with anxiety disorders and IED were no more likely to use treatment services than those with anxiety disorders without IED. CONCLUSIONS Individuals with IED concomitant to anxiety disorder, especially social phobia and panic, are at marked risk for worse functional impairment and a higher burden of comorbidity, but onset and course of anxiety disorder do not differ, and those with anxiety and IED are no more likely to utilize treatment services. Assessment, identification, and specialized treatment of anger in the context of anxiety disorders are critical to reducing burden.
Collapse
Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | | | - Thomas Vo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Todd Galbraith
- Department of Psychology, Temple University, 1701 N. 13 Street, Philadelphia, PA 19122-6085, USA
| | - Richard G. Heimberg
- Department of Psychology, Temple University, 1701 N. 13 Street, Philadelphia, PA 19122-6085, USA
| |
Collapse
|
17
|
Abstract
The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems.
Collapse
|
18
|
Fettich KC, McCloskey MS, Look AE, Coccaro EF. Emotion regulation deficits in intermittent explosive disorder. Aggress Behav 2015; 41:25-33. [PMID: 27539871 DOI: 10.1002/ab.21566] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 11/05/2022]
Abstract
Intermittent explosive disorder (IED) is a psychiatric disorder characterized by repeated acts of affective aggression. Despite the diagnostic emphasis on the failure to control aggressive impulses, there is little research on affective processes and emotion regulation in IED; however, this research suggests possible dysfunctions in experiences of emotional intensity and lability. The hypothesis in the present study was that compared to individuals with other psychiatric disorders, and psychologically healthy individuals, individuals with IED experience greater negative affect intensity and emotional lability. Participants (N = 373) consisted of 202 individuals diagnosed with IED, 68 non-IED psychiatric controls (PC), and 103 healthy volunteers (HV). Emotion regulation was assessed using the General Behavior Inventory, the Affective Lability Scale, and the Affect Intensity Measure. Results showed that IED participants reported greater negative affect intensity and greater emotional lability across several emotion domains (e.g., anger, anxiety, depression) than PC and HV participants. These findings suggest that IED is characterized by more global emotion regulation deficits than those associated with anger alone. Aggr. Behav. 41:25-33 2015. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Karla C. Fettich
- Department of Psychology; Temple University; Philadelphia Pennsylvania
| | | | - Amy E. Look
- Department of Psychology; Temple University; Philadelphia Pennsylvania
| | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; Chicago Illinois
| |
Collapse
|
19
|
Hebbar S. Doing Psychiatry Right: A Case of Severe Avoidant Personality Disorder with Obsessive-compulsive Personality Disorder, Obsessive Compulsive Disorder, Intermittent Explosive Disorder and Sexual Paraphilias. Indian J Psychol Med 2014; 36:326-8. [PMID: 25035563 PMCID: PMC4100425 DOI: 10.4103/0253-7176.135392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over dependence on pharmacotherapy in psychiatry, known as biological imperialism, is a world-wide phenomenon. Some authors have opined that the inadequate and ineffective utilization of psychotherapeutic interventions and only dependence on pharmacotherapy amounts to institutional malpractice. Here is an example of such a case. A young male mainly received multiple psychotropic medicines, including clozapine (and also a failed psychotherapy) over a period of 4 years, without any benefit. His global assessment of function score remained at 30. However, with proper diagnosis and effectively conducted psychotherapy a significant improvement in Global assessment of functioning score of 70 was achieved, over a period of 1½ years.
Collapse
Affiliation(s)
- Sudhir Hebbar
- Department of Psychiatry, Rajarajeswari Medical College, Bengaluru, Karnataka, India
| |
Collapse
|
20
|
Okamoto H, Chino A, Hirasaki Y, Ueda K, Iyo M, Namiki T. Orengedoku-to augmentation in cases showing partial response to yokukan-san treatment: a case report and literature review of the evidence for use of these Kampo herbal formulae. Neuropsychiatr Dis Treat 2013; 9:151-5. [PMID: 23378767 PMCID: PMC3554226 DOI: 10.2147/ndt.s38318] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Yokukan-san, a Japanese traditional herbal (Kampo) prescription, has recently gathered increasing attention due to accumulating reports showing its remarkable efficacy in treating a wide variety of diseases refractory to conventional medicine as well as the behavioral and psychological symptoms of dementia. As yokukan-san has become broadly integrated with conventional medicine, augmentation therapy with other Kampo prescriptions has become necessary when the yokukan-san has been only partially efficacious. In this paper, we report three cases in which the addition of orengedoku-to, another Kampo formula, to yokukan-san was remarkably effective. CASES Case 1 was an 85-year-old man with Alzheimer-type dementia who had become aggressive during the past 2 years. Three milligrams of aripiprazole completely suppressed his problematic behaviors but had to be stopped because of extrapyramidal symptoms. In the second case, a 44-year-old man with methamphetamine-induced psychosis had suffered from serious tardive dystonia for 2 years. No conventional approach had improved his tardive dystonia. The third case was a 29-year-old engineer who often failed to resist aggressive impulses and was diagnosed with intermittent explosive disorder. He was prescribed 5 mg of olanzapine, which did not suppress his extraordinary anger and caused somnolence even though the dose was low. INTERVENTIONS AND OUTCOMES Yokukan-san was complementarily added to the patients' regular medication and exerted a definitive but partial effect in all cases. The addition of orengedoku-to to yokukan-san exerted the same efficacy as aripiprazole in controlling aggressiveness in Case 1, improved the tardive dystonia by 80% in Case 2, and was completely effective in controlling the patient's aggressive impulses in Case 3. CONCLUSION Together with empirical evidence demonstrating the effectiveness of both yokukansan and orengedoku-to in reducing irritability, impulsivity, and aggression, these three cases suggest that orengedoku-to augmentation can be an effective option in cases that are partially responsive to yokukan-san treatment.
Collapse
Affiliation(s)
- Hideki Okamoto
- Department of Japanese-Oriental (Kampo) Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan
| | | | | | | | | | | |
Collapse
|
21
|
Perez-Rodriguez MM, Hazlett EA, Rich EL, Ripoll LH, Weiner DM, Spence N, Goodman M, Koenigsberg HW, Siever LJ, New AS. Striatal activity in borderline personality disorder with comorbid intermittent explosive disorder: sex differences. J Psychiatr Res 2012; 46:797-804. [PMID: 22464337 PMCID: PMC3645307 DOI: 10.1016/j.jpsychires.2012.02.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/17/2012] [Accepted: 02/23/2012] [Indexed: 11/20/2022]
Abstract
Borderline Personality Disorder (BPD) is associated with behavioral and emotional dysregulation, particularly in social contexts; however, the underlying pathophysiology at the level of brain function is not well understood. Previous studies found abnormalities in frontal cortical and limbic areas suggestive of poor frontal regulation of downstream brain regions. However, the striatum, which is closely connected with the medial frontal cortices and plays an important role in motivated behaviors and processing of rewarding stimuli, has been understudied in BPD. Here we hypothesized that, in addition to frontal dysfunction, BPD patients may show abnormal striatal function. In this study, 38 BPD patients with intermittent explosive disorder (BPD-IED) and 36 healthy controls (HC) participated in the Point Subtraction Aggression Paradigm (PSAP), a computer game played with a fictitious other player. (18)Fluoro-deoxyglucose positron emission tomography (FDG-PET) measured relative glucose metabolism (rGMR) within caudate and putamen in response to aggression-provoking and non-provoking versions of the PSAP. Male BPD-IED patients had significantly lower striatal rGMR than all other groups during both conditions, although male and female BPD-IED patients did not differ in clinical or behavioral measures. These sex differences suggest differential involvement of frontal-striatal circuits in BPD-IED, and are discussed in relation to striatal involvement in affective learning and social decision-making.
Collapse
Affiliation(s)
- M. Mercedes Perez-Rodriguez
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Erin A. Hazlett
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Erin L. Rich
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA
| | - Luis H. Ripoll
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Daniel M. Weiner
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Nicole Spence
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Marianne Goodman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Harold W. Koenigsberg
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Larry J. Siever
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Antonia S. New
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| |
Collapse
|
22
|
Yoshimasu K, Kawakami N. Epidemiological aspects of intermittent explosive disorder in Japan; prevalence and psychosocial comorbidity: findings from the World Mental Health Japan Survey 2002-2006. Psychiatry Res 2011; 186:384-9. [PMID: 20709410 PMCID: PMC3012136 DOI: 10.1016/j.psychres.2010.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
Abstract
The purpose of the present study is to evaluate the prevalence of intermittent explosive disorder (IED) as well as its comorbidity with other mental disorders in a Japanese community sample. Subjects were 4,134 residents in selected sites in Japan. Diagnoses of mental disorders are based on the World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview. Lifetime and 12-month prevalence of IED were 2.1% and 0.7%, respectively, whereas those of narrow IED were 1.2% and 0.6%, respectively. Male gender and young age were positively associated with an increased prevalence of IED. Mood and anxiety disorders as well as suicidal ideation were shown to be associated with IED in both genders. The overall association between anxiety disorders and IED was stronger in women than in men. Positive association of substance use problems with IED was also observed. Similar findings were observed between those psychosocial factors and narrow IED. These results suggest that people having those mixed complications might have a high suicidal risk. Further research using psychological measures for anger suppression will lead to more thorough understanding of the effects of IED on psychosocial comorbidity and suicidal risk.
Collapse
Affiliation(s)
- Kouichi Yoshimasu
- Department of Hygiene, School of Medicine, Wakayama Medical University, Kimiidera, Wakayama 641-0012, Japan.
| | - Norito Kawakami
- Department of Mental Health, School of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | |
Collapse
|
23
|
Rosell DR, Thompson JL, Slifstein M, Xu X, Frankle WG, New AS, Goodman M, Weinstein SR, Laruelle M, Dargham AA, Siever LJ. Increased serotonin 2A receptor availability in the orbitofrontal cortex of physically aggressive personality disordered patients. Biol Psychiatry 2010; 67:1154-62. [PMID: 20434136 PMCID: PMC3091264 DOI: 10.1016/j.biopsych.2010.03.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/29/2010] [Accepted: 03/02/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impulsive physical aggression is a common and problematic feature of many personality disorders. The serotonergic system is known to be involved in the pathophysiology of aggression, and multiple lines of evidence have implicated the serotonin 2A receptor (5-HT(2A)R). We sought to examine the role of the 5-HT(2A)R in impulsive aggression specifically in the orbitofrontal cortex (OFC), given that our own studies and an extensive literature indicate that serotonergic disturbances in the OFC are linked to aggression. We have previously hypothesized that increased 5-HT(2A)R function in the OFC is a state phenomenon that promotes impulsive aggression. METHODS Serotonin 2A receptor availability was measured with positron emission tomography and the selective 5-HT(2A)R antagonist radioligand [(11)C]MDL100907 in two groups of impulsively aggressive personality disordered patients-14 with current physical aggression, and 15 without current physical aggression-and 25 healthy control subjects. Clinical ratings of various symptom dimensions were also obtained. RESULTS Orbitofrontal 5-HT(2A)R availability was greater in patients with current physical aggression compared with patients without current physical aggression and healthy control subjects; no differences in OFC 5-HT(2A)R availability were observed between patients without current physical aggression and healthy control subjects. No significant differences in 5-HT(2A)R availability were observed in other brain regions examined. Among both groups of impulsively aggressive personality disordered patients combined, OFC 5-HT(2A)R availability was correlated, specifically, with a state measure of impulsive aggression. CONCLUSIONS These findings are consistent with our previously described model in which impulsive aggression is related to dynamic changes in 5-HT(2A)R function in the OFC.
Collapse
Affiliation(s)
- Daniel R. Rosell
- James J. Peters Veterans Affairs Medical Center, Bronx, NY; Mount Sinai School of Medicine, New York, NY
| | - Judy L. Thompson
- Columbia University Medical Center, New York, NY; The New York State Psychiatric Institute, New York, NY
| | - Mark Slifstein
- Columbia University Medical Center, New York, NY; The New York State Psychiatric Institute, New York, NY
| | - Xiaoyan Xu
- Columbia University Medical Center, New York, NY; The New York State Psychiatric Institute, New York, NY
| | - W. Gordon Frankle
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA
| | - Antonia S. New
- James J. Peters Veterans Affairs Medical Center, Bronx, NY; Mount Sinai School of Medicine, New York, NY
| | - Marianne Goodman
- James J. Peters Veterans Affairs Medical Center, Bronx, NY; Mount Sinai School of Medicine, New York, NY
| | - Shauna R. Weinstein
- James J. Peters Veterans Affairs Medical Center, Bronx, NY; Mount Sinai School of Medicine, New York, NY
| | | | - Anissa Abi Dargham
- Columbia University Medical Center, New York, NY; The New York State Psychiatric Institute, New York, NY
| | - Larry J. Siever
- James J. Peters Veterans Affairs Medical Center, Bronx, NY; Mount Sinai School of Medicine, New York, NY
- Corresponding Author: Larry J. Siever, M.D., James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Room 6A-44, Bronx, New York 10468, Phone: (718) 584-9000 ext 5227 or x5225,
| |
Collapse
|
24
|
Abstract
Objective. Recent observations in Iraq during the period of sanction suggest the existence of benzhexol prescribing linked to its calming effects on explosive behaviours. This inspired our group to research the existence of this practice and the characteristics of those involved in it. Method. All patients from the psychiatric service in Merjan Hospital, Al Hilla City, Babylon Governate, Iraq, who had a prescription for benzhexol between January 1991 and December 2000, were identified. All participants received their diagnosis based on the clinical criteria of the DSM-IV, after taking a comprehensive medical and psychiatric history, mental state examination and collateral information from family members. The patients were evaluated by the same qualified consultant psychiatrist at the initial assessment and all through the period of follow-up. Results. In the 10-year period under study, 354 patients were prescribed benzhexol. A total of 190 patients diagnosed as intermittent explosive disorder (IED) and 164 suffering from severe mental disorders or personality disorders were excluded from the study. The average age of the IED group was 29.5 years. On direct questioning, the main reason patients gave most frequently for using benzhexol was to control the aggressive outbursts (N=92, 48.4), to get high (N=49, 25.8), to relax (N=26, 13.7), to get rid of boredom (N=23, 12.1). In total, the whole group were prescribed benzhexol, at an average dose of 12.5 mg/day (range 2-20 mg/day). At the time of final assessment the mean dose of prescribed benzhexol had fallen slightly to 12 mg/day (2-20 mg/day), with 10 patients being benzhexol free. Of the 190, three patients had a diagnosis of obsessive compulsive disorders, 36 patients had a diagnosis of benzodiazepines dependence, and a further five had a diagnosis of alcohol dependency syndrome. Eighty percent felt satisfied with the effect of the drug and 95 were not motivated to stop it. Conclusions. There are a significant number of patients who are routinely prescribed benzhexol as a replacement therapy. The main original reason for starting it is to control outbursts and improves their reaction to stress situations. This growing issue raises the need for awareness, by both public and medical practitioners, of the potential adverse effects of benzhexol and its untoward consequences.
Collapse
|
25
|
McCloskey MS, Ben-Zeev D, Lee R, Coccaro EF. Prevalence of suicidal and self-injurious behavior among subjects with intermittent explosive disorder. Psychiatry Res 2008; 158:248-50. [PMID: 18221794 DOI: 10.1016/j.psychres.2007.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 05/23/2007] [Accepted: 09/29/2007] [Indexed: 11/21/2022]
Abstract
The prevalence of suicidal attempts and self-injurious behavior among 376 subjects diagnosed with Intermittent Explosive Disorder (IED) was assessed via structured interviews. Results showed 16% of IED subjects reported self-aggression, with 12.5% reporting suicide attempts and 7.4% reporting non-lethal self-injurious behaviors. Additional risk factors were identified.
Collapse
|
26
|
Changulani M, Avasthi A. Impulse control disorders : nosology and concept. Indian J Psychiatry 2001; 43:206-12. [PMID: 21407856 PMCID: PMC2956143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Impulse control disoders have long been recognized. Although included in nosological systems since two decades, their diagnostic validity individually, as well as a category remains in question. Conceptually, these have been linked to variety of other psychiatric or medical disorder viz. OCD, affective disorders, addictive disorders, organic mental conditions etc, but systematic studies have not been done. The present review focuses on the nosological and conceptual evolution of these disorders and highlights the overlap and boundaries with other psychiatric disorders.
Collapse
Affiliation(s)
- M Changulani
- MUKESH CHANGULANI, MD., Senior Resident, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012
| | | |
Collapse
|