Psychiatry and Clinical Psychopharmacology
Original Papers

Impulse control disorders in an inpatient psychiatry unit of a university hospital

1.

Cukurova University, School of Medicine, Department of Psychiatry, Adana - Turkey

2.

Cukurova University Faculty of Medicine Department of Psychiatry, Adana-Turkey

Psychiatry and Clinical Psychopharmacology 2008; 18: 153-161
Read: 736 Downloads: 482 Published: 04 March 2021

Objective: Like other comorbid disorders, comorbidity of impulse control disorders (ICDs) in various psychiatric disorders may complicate the diagnostic work-up of patients which might further influence the outcome and the treatment. As these disorders are not routinely screened for in regular psychiatric evaluations and several commonly used semi-structured interviews, it is highly probable that these disorders may go unrecognized and untreated. Despite the inclusion of ICD category under two widely used classification systems a long time ago, relatively little research has been done on this area. We conducted this study to find out the frequency of ICDs and search for relevant clinical and sociodemographic variables in a group of psychiatric inpatients. Method: One hundredandthree consecutive adult patients hospitalized in our psychiatric inpatient unit within 6 months period were included in the study. Axis I diagnoses were rendered using a Structured Clinical Interview for DSM-IV (SCID-I). ICDs were investigated with using the modified version of Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). Also all patients completed Zuckerman Sensation Seeking Scale Form V. Results: The prevalence rate for all comorbid ICD in this sample was 37.9% (n= 39). The most common ICD subtype was compulsive buying (CB) (n= 17, 16%) followed by intermittent explosive disorder (IED) (n= 15, 14%) and pathological gambling (n= 7, 7%). There were no cases meeting the criteria for kleptomania. There was no statistical difference between the characteristics of patients with and without ICDs with regards to age, sex, marital status, and number of hospitalizations. Some characteristics of the ICD(+) group (i.e. duration of education, primary admission diagnosis, and age of onset for primary diagnosis) were significantly different from ICD(-) patients. The duration of education in ICD(+) group was significantly longer than ICD(-) group. On the other hand, age at onset for primary psychiatric disorder in ICD(+) inpatients was lower than ICD(-) inpatients. Only patients with comorbid CB were significantly younger than ICD(-) group (31.5 vs 39.5 respectively). The comparison of sociodemographic and clinical variables among all other ICD subgroups did not show any significant differences. A significant difference was observed between ICD(+) and ICD(-) groups in terms of total impulsivity, nonplanning activity, and motor impulsivity scores as determined by BIS-11. Total impulsivity score was significantly higher in patients with IED and CB than ICD(-) group. Discussion: The results of this study revealed that about one third of patients admitted to our inpatient unit had at least one co-morbid impulse control disorder according to DSM-IV TR. Our findings are consistent with the results of two earlier French studies conducted among specific group of patients and another North American study searching for impulse control disorders in adult psychiaric inpatient units of two different hospitals.The high prevalence rate of impulse control disorders among psychiatric inpatients should alert mental health professionals to look for and treat these disorders in order to avoid any further complications.


Bir üniversite psikiyatri kliniğinde dürtü kontrol bozukluğu sıklığı


Amaç: Di¤er ruhsal bozukluklarda oldu¤u gibi dürtü kontrol bozukluklar›n›n (DKB) da psikiyatrik bozukluklarla bir arada bulunmas›, hastalarda tan› konmas›n› güçlefltirir ve uygulanacak tedaviyi, hastal›¤›n gidiflini olumsuz etkiler. Bu bozukluklar rutin psikiyatrik muayene s›ras›nda ve yar› yap›land›r›lm›fl görüflmelerde sorgulanmad›¤› için, s›kl›kla tan› konmas› güçleflir ve tedavisinde gecikmeler olur. Dürtü kontrol bozukluklar› kategorisi uzun zamand›r yayg›n olarak kullan›lan iki s›n›fland›rma sisteminde de yer almas›na karfl›n, bu konu üzerinde az say›da çal›flma yap›lm›flt›r. Bu çal›flmada, konuya katk›da bulunmak amac›yla klinikte yatmakta olan bir psikiyatrik hasta grubunda dürtü kontrol bozukluklar›n›n s›kl›¤›n›n ve iliflkili klinik ve sosyodemografik de¤iflkenlerin de¤erlendirilmesi amaçlanm›flt›r. Yöntem:Psikiyatri klini¤imize 6 ayl›k bir süre içerisinde yatan 103 eriflkin hasta çal›flmaya dahil edilmifltir. Hastalar›n DSM-IV’e göre eksen I tan›lar›n› belirlemek için DSM-IV için yap›land›r›lm›fl klinik görüflme ölçe¤i kullan›ld›. Dürtü kontrol bozukluklar› saptamak için Minnesota Dürtü Kontrol Bozuklu¤u Görüflme Ölçe- ¤i’nin modifiye edilmifl flekli hastalara uyguland›. Dürtüsellik için Barratt Dürtüsellik Ölçe¤i-11(BDÖ-11) kullan›ld›. Ayr›ca tüm hastalar Zuckerman Heyecan Arama Ölçe¤ini de tamamlad›lar. Bulgular: Psikiyatrik yatan hasta örneklem grubunda en az bir dürtü kontrol bozuklu¤u efltan›s› alan hasta s›kl›¤› %37.9 (n= 39) idi. En s›k görülen dürtü kontrol bozuklu¤u kompulsif sat›n alma iken (n= 17, %16) bunu aral›kl› patlay›c› bozukluk (n= 15, %14) ve patolojik kumar bozuklu¤u (n= 7, %7) izlemekteydi. Kleptomani tan›s› konulan herhangi bir hasta yoktu. Dürtü kontrol bozuklu¤u efltan›s› konan ve konmayan hastalar aras›nda yafl, cinsiyet, medeni hal, hastaneye yat›fl say›s› yönünden anlaml› bir farkl›l›k yoktu. Bununla birlikte, e¤itim süresi, ilk hastaneye yat›flta konulan birincil tan› ve birincil tan›n›n bafllang›ç yafl› aç›s›ndan dürtü kontrol bozuklu¤u efltan›s› alan grup farkl›l›k gösteriyordu. E¤itim süresi dürtü kontrol bozuklu¤u efltan›s› alan grupta daha fazla iken, birincil hastal›¤›n bafllang›ç yafl› bu grupta daha düflüktü.Sadece kompulsif sat›n alma bozuklu- ¤u efltan›s› alan hastalar dürtü kontrol bozuklu¤u efltan›s› almayan hastalara gore daha gençti (31.5 y›la karfl›l›k 39.5 y›l). Di¤er tüm dürtü kontrol bozukluklar› efltan›lar› aras›nda demografik ve klinik özelliklere göre yap›lan karfl›laflt›rmalarda anlaml› bir farkl›l›k saptanmad›. BDÖ-11’de ölçüldü¤ü üzere, toplam dürtüsellik , plans›z eylem ve motor dürtüsellik skorlar› dürtü kontrol bozuklu¤u efltan›s› olan grupta olmayan gruba gore daha yüksekti. Aral›kl› patlay›c› bozuklu- ¤u ve kompulsif sat›n alma bozuklu¤u olan hastalar›n toplam dürtüsellik skorlar› dürtü kontrol bozuklu¤u olmayan hastalara k›yasla anlaml› olarak yüksekti. Tart›flma: Bu çal›flma sonuçlar› klini¤imize baflvuran hastalar›n ortalama üçte birinin DSM-IV’e göre en az bir dürtü kontrol bozuklu¤u efltan›s› ald›klar›n› göstermektedir. Bulgular›m›z daha önce özgül tan›l› hasta gruplar›nda yap›lm›fl iki Frans›z çal›flmas› ve iki farkl› hastanede eriflkin yatan psikiyatrik hasta grubunda dürtü kontrol bozuklu¤u s›kl›¤›n› araflt›ran bir Kuzey Amerika çal›flmas›n›n sonuçlar›yla uyumlu bulunmufltur. Dürtü kontrol bozukluklar›n oldukça s›k oranda görülmesi ve buna ba¤l› olarak psikiyatrik bozukluklar›n seyri s›ras›nda ortaya ç›kabilecek komplikasyonlardan kaç›nabilmek için, psikiyatristlerin bu bozukluklar›n fark›nda olmal› ve gerekli tedavi yaklafl›mlar›n› sergilemelidirler.

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EISSN 2475-0581