Treatment of impulse control disorders

Treatment of impulse control disorders

What are the pharmacotherapeutic options for impulse control disorders (ICDs)? 

ICDs include a broad range of disorders of similar but complex pathophysiologies involving systems that incorporate most of the major neurotransmitters.

Possible therapeutic options include mu opioid antagonists (to interrupt the reward reinforcement of ICD behaviors), SSRIs, atypical antipsychotics, beta-blockers, stimulants, anticonvulsants, and other agents.

Nearly half of patients with intermittent explosive disorder attained full (29%) or partial (17%) remission of criterion A (outbursts with dyscontrol of aggressive impulses) with fluoxetine treatment.

Reducing or discontinuing medications that may be contributing (e.g., dopaminergic treatments of parkinsonism) should also be considered.

Sources

  • Gerstenblith T, Kontos N: Somatic symptom disorders. In Stern TA, Fava M, Wilens TE, Rosenbaum JF (eds): Massachusetts General Hospital comprehensive clinical psychiatry. London: Elsevier, 2016, pp 255-264.
  • Thomas JJ, Mickley DW, Derenne JL, et al.: Eating disorders: evaluation and management. In Stern TA, Fava M, Wilens TE, Rosenbaum JF (eds): Massachusetts General Hospital comprehensive clinical psychiatry. London: Elsevier, 2016, pp 412-427.
  • Thomas JJ, Mickley DW, Derenne JL, et al.: Eating disorders: evaluation and management. In Stern TA, Fava M, Wilens TE, Rosenbaum JF (eds): Massachusetts General Hospital comprehensive clinical psychiatry. London: Elsevier, 2016, p 420.
  • McAllister TW, Arciniegas DB: Pharmacotherapy of behavioral disturbances. In Arciniegas DB, Anderson CA, Filley CM (eds): Behavioral neurology & neuropsychiatry. New York: Cambridge University Press, 2013, pp 571-575.
  • Coccaro EF: Intermittent explosive disorder. In Gabbard GO (ed): Gabbard’s treatments of psychiatric disorders. Washington, DC: American Psychiatric Publishing, 2014, p 734.
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