F63 HABIT AND IMPULSE DISORDERS F63.0 Pathological gambling A.

A. Repeated (two or more) episodes of gambling over a period of at least one year. B. These episodes do not have a profitable outcome for the person, but are continued despite personal distress and interference with personal functioning in daily living. C. The person describes an intense urge to gamble which is difficult to control, and reports that he or she is unable to stop gambling by an effort of will. D. The person is preoccupied with thoughts or mental images of the act of gambling or the circumstances surrounding the act.

 F63.1 Pathological fire-setting [pyromania] A. Repeated (two or more) acts of, fire-setting without apparent motive. B. The person describes an intense urge to set fire to objects, with a feeling of tension before the act and relief afterwards. C. The person is pre-occupied with thoughts or mental images of fire-setting or of the circumstances surrounding the act (e.g. with fire engines, or with calling out the fire brigade).

 F63.2 Pathological stealing [kleptomania] A. Repeated (two or more) acts in which the person steals without any apparent motive of gain to the individual or another person. B. The person describes an intense urge to steal with a feeling of tension before the act with relief afterwards.

Kleptomania
Mean age of onset is 20 years old. Prevalence estimated at 0.6% of the population and only 8% of shoplifters Women 4x more than men Very different from premeditated stealing or robbery (where money or personal use is the goal). Usually not fun.

 F63.3 Trichotillomania A. Noticeable hair-loss due to a persistent and recurrent failure to resist impulses to pull out hairs. B. The person describes an intense urge to pull out hairs with a mounting tension before and a sense of relief afterwards. C. Absence of a pre-existing inflammation of the skin; not in response to a delusion or hallucination.

Trichotillomania
Women more than men Prevalence somewhere between 0.6-3% of population Children more frequent than adults and oftentimes starts in teenage years

 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.

 F63.9 Habit and impulse disorder, unspecified

Impulsivity is present in : Personality Disorders (EUPD) ADHD Substance Abuse Mania Neurological Syndromes Impulse Control Disorders Dementia

Common features of Impulse Control Disorders

Failure to resist impulses, urges to perform an act; no brakes in the brain Rise in tension or arousal before committing the act and relief/pleasure after Most start in adolescence and are chronic Almost never is just one problem - comorbid psychiatric condtiions (depression, anxiety, OCD) and other impulsive conditions

Neurobiology of ICD (Neuroanatomy)

Decreased activity in (fMRI)
Left ventromedial PFC (Decision-making) Orbitofrontal cortex (processing of rewards, dealing with uncertainty, inhibiting responses) Anterior Cingulate (Decision-making) Ventral striatum (NA, Limbic system)

Lesions in the Amygdala

Impaired decision making Increased impulsive choice

Lesions in Nucleus Accumbens(reward)

Induces hyperactivity

Psychological
Impulsivity Harm Minimization, underestimation Pleasure Seeking Sensitive to reward, insensitive to punishment Acts too quickly

Intermittent Explosive Disorder

Characterized by:
Failure to resist aggressive impulses that result in destroying stuff or assaultive acts Degree of aggressiveness is out of proportion to the triggering event All other Axis I/ II ruled out Recurrent Tends to be more ego dystonic,

Treatment
What are the goals of medications?
To treat comorbid disorders like depression or anxiety disorders Can help with sleep, appetite and concentration May reduce urges and cravings Lays the groundwork for psychosocial treatments NO MAGIC PILLS