Impulse Control Disorders-Zuchowski Flashcards Preview

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Flashcards in Impulse Control Disorders-Zuchowski Deck (47):

What are the 5 Impulse Control Disorders?

-Intermittent Explosive Disorder


mpulses such as hunger originate in the (blank)
This impulse can be put off, but its drive will increase with time.

satiety center of the hypothalamus


Impulses to fear and reactions to anger occur in the (blank). If you see anger being physically manifested how does this affect your amygdala?


even more so!! (i.e seeing an angry face doesnt light up your amygdala as much as seeing an angry person grabbing someone)


The (blank) structure such as the hypothalamus is the main region where impulses arise. These impulses are then modulated by specific areas of the (blank, blank and blank) typically resulting in (blank).

mid brain structure

cortex; the prefrontal cortex and the orbital frontal cortex

processing and suppression


The mid brain structure such as the hypothalamus is the main region where impulses arise. These impulses are then modulated by specific areas of the cortex; the prefrontal cortex and the orbital frontal cortex. When it gets here, what happens to the impulse?

information is sent for cognitive appraisal where the impulse can either be stopped or driven.


Sensory processing can be affected by many factors such as ....?

sensory deficits or distortions, cultural/social factors and level of cognition or cognitive impairment.


(blank) function in the suppression and regulation of impulse (acts as the breaks)

The Orbital Frontal (and anterior cingulate gyrus)


The (blank and blank) are the "bottom up" signals and work to drive the impulse.

amygdala and insula


What are brain disorders with secondary impulse control problems?

a. Trauma to the frontal lobes
b. Presence of epidural hematomas
c. Dementia's, particularly Frontal Temporal Dementia
d. Vascular dementia can also show signs of impulse control dysregulation depending on what areas are affected.


T or F
Levels of neuromodulators effect impulse control



Low (blank) and enhanced (blank) are associated with poor impulse control and aggressive behavior.

dopamine (and norepinephrine)


Low serotonin and enhanced dopamine (and norepinephrine) are associated with poor impulse control and aggressive behaviors. These neuromodulators have their effects primarily on the (blank) brain circuitry and abnormal levels of these neuromodulators are associated with conditions such as (blank......)


-cortical lesion (trauma, tumor),
-decreased cortical volume
-orbitalfrontal/cingulate cortex processing inefficiency


(blank) GABA, (blank) glutamate and (blank) acetylcholine are also associated with poor impulse control
These neurotransmitters have their effects primarily on the (blank) and can cause what?


limbic system

-hyperactivity of the amygdala and limbic system
-reduced amaygdalar volume
-emotional hypersensitivity


Low CSF serotonin levels are correlated with what?

-more violent forms of aggression
-loss of impulse control
-greater risk taking
-more physical wounds


(blank) is associated with low social rank, and higher dysfunctional aggression

Low serotonin


"appropriate" aggression used to maintain social dominance was not associated with (blank) in monkeys

low serotonin levels


What is reactive aggression?
What happens if you have poor impulse control?
What is an example of this?

response to a perceived threat or provocation

-lower threshold to perceive provocation and/or lower threshold to repond aggressively



What is proactive aggression?
Is it associated with poor impulse control?

a behavior that anticipates reward such as attention, esteem of peers, money and drugs and is associated with a thought process that aggression will result with a "positive outcome" i.e bullying

It is not associated with impulse control.


If you commit a murder in the context of a sex crime, what are your serotonin levels like?
What about a murderer without a sex crime?
What about for people who commit suicide?

Very low serotonin
Normal serotonin
Low serotonin


What are serotonin levels like in patients with intermittent explosive disorder?

less serotonergic innervation in the anterior cingulate cortex AND pnts have fewer platelet serotonin binding sites


What do physiological disorders do you use dopamine agonists for and what are some dopamine agonists?

Parkinsons and restless leg syndrome
Ropinirole (requip) and Pramipexole (mirapex)


Research has shown that certain impulse control problems can result from the use of dopamine agonists, what are these?
How did we figure this out?

-pathological gambling
-compulsive shopping

We compared parkinsons patients behavior on dopamine agonists with parkinsons patients not on dopamine.
(PD itself does not appear to increase risk of impulse control problems)


Using the “gas” and “brake” analogy for impulse control, which statement is most accurate?
A) Dopamine is the brake, serotonin the gas
B) GABA is the gas, serotonin the brake
C) Dopamine is the gas, glutamate is the brake
D) Dopamine is the gas, serotonin the brake

D) Dopamine is the gas, serotonin the brake


What is this:
-Recurrent verbal or physical aggression
(grossly out of proportion to provocation)
-Not premeditated
-No tangible objective
-Intermittency leads to potential for escalating meds doses and/or irrational polypharmacy
-Patients frequently report memory lapse or a "graying out" during outburst

Intermittent Explosive Disorder


What is the differential diagnosis of intermittent episodes?

Bipolar disorder
Major depression
Panic disorder
Conduct disorder
Antisocial personality disorder
Borderline personality disorder


Which type of aggression is most consistent with intermittent explosive disorder?
A) Reactive aggression
B) Proactive aggression
C) Both
D) Neither

A) Reactive aggression


What are the essential featuers of kleptomania and pyromania?

How do kleptomaniacs and pyromaniacs feel before they commit the act?

-Failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others

-The individual feels an increasing sense of tension or arousal


How do kleptomaniacs and pyromaniacs feel at the time of commiting the act?

How do they feel after the act?

-the individual experience pleasure, gratification, or relief

-the individual experiences a sense of relief from the urge, the individual may or may not feel regret, self-reproach, or guilt


What is this:
Deliberate fire setting on multiple occasions
Fascination about fire
Tension/relief cycle

Is it common?

rare, only 3% of those jailed for setting fires


A man says he has kleptomania. Which of the following is most consistent with that dx?
A) Stealing money
B) Stealing drugs from a dealer
C) Purse snatching
D) Stealing salt and pepper shakers from restaurants

D) Stealing salt and pepper shakers from restaurants


What is this:
-failure to resist impulses to steal
-not desired for value or use
-tension/relief cycle
-aware that act is wrong/senseless



What is this:
-patients are aware that act is wrong/senseless
-feel depressed and anxious about actions
-rare in general population but up to 25% of shoplifters

Who is it more common in?


More common in females (3:1)


WHen do you typically see the first onet of symptoms for impulse control disorders? What must your rule out? What should you identify and what should you advise these individuals to avoid?

age 40

general medical cause (infectious, structural, metabolic, hormonal) or a rational motive for behavior
-avoid intoxication


Midbrain (amygdala and insula) and deeper brain structures (Blank) impulses and the cortex and anterior cingulate gyrus (blank) impulses



What would be good drugs to lessen aggregration induced by impulsivity?

SSRIs cuz they can increase serotonin or anytipsychotics cuz they are D2 antagonists


What seizure disorder is mistaken for impulse control disorder?

temporal lobe seizure


Do we like benzos? Why not? when can you use them?
HOw do you overcome the disinhibition paradoxical effect?

no, cuz they can cause paradoxical inhibition due to a time lag and their ability to inhibit the inhibitiory centers of the brain leading to excitation.
-for acute management of agitation in ER setting
-Give them more IV benzos and they will fall asleep


When people with impulse control disorder take benzos how do they subjectively think they feel? what do other people see?

decreased PERCEIVED anxiety and hostility
-significant increase in impulsivity and aggression were observed


A woman presents with recurrent impulsive violence following a traumatic brain injury. Which of the following is the best first line treatment?
A) Antipsychotic like haloperidol
B) Benzodiazepine like alprazolam
C) Antidepressant like bupropion
D) Beta blocker like propranolol

D) beta blocker like propranolol


What are the three types of CBT for klepto/pyromania?

-Covert sensitization
-Aversion therapy
-Systematic desensitization


What is this an example of:
(picture stealing or setting a fire and then facing negative consequences, such as getting caught)

covert sensitization


What is this an example of:
(practice mildly painful techniques, such as breath holding until uncomfortable, when having urge to steal)

Aversion therapy


What is this an example of:
(using relaxation techniques while picturing CONTROLLING urges to steal)

systematic desensitization


Anatomically, the (blank) seems to be a driving force and the (blank) and (blank) seem to be inhibitory


orbital frontal
prefrontal cortices


Impulsivity itself is (blank)



T or F
Vast majority of shoplifters, fire setters and assaultive people will have “ordinary” motives
AND not have disorders



T or F
Except in acute management (ER or inpatient setting) avoid benzodiazepines