OBJECTIVE: The authors discuss the relationship of impulsivity to psychiatric disorders and present selected hypotheses regarding the reasons for these relationships. METHOD: Previous research has shown significantly higher levels of impulsivity among patients with conduct disorder, personality disorders, substance use disorders, and bipolar disorder, compared to other psychiatric patients or healthy comparison subjects. A literature review of the theoretical bases of the relationship between these disorders and impulsivity is presented. Measurements of impulsivity and treatment options are discussed in relation to the physiology of impulsivity and the disorders in which it is a prominent feature. RESULTS: Impulsivity, as defined on the basis of a biopsychosocial approach, is a key feature of several psychiatric disorders. Behavioral and pharmacological interventions that are effective for treating impulsivity should be incorporated into treatment plans for these disorders. CONCLUSIONS: The high comorbidi...

Psychiatric aspects of impulsivity

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A User’s Guide

The etiology of alcoholism in women is no longer a question of nature or nurture. Most observers would agree that alcoholism, both male and female, is mediated by genetic factors. The question is how much of the variance is explained by genetic factors and to what degree is this genetically mediated disorder moderated by personal characteristics of the woman. Among the most salient personal characteristics moderating the genetic vulnerability may be factors such as age, ethnicity, and presence of psychiatric comorbidity. Cultural factors and familial environmental factors are most likely predictors as well. Therefore, the chapter will discuss the genetic epidemiology of alcoholism in women. Genetic heterogeneity will be discussed and evidence presented that suggests the existence of two forms of alcoholism in women: one more environmentally determined and one more influenced by genetic mediation. Evidence for the existence of a genetic diathesis in women will be presented, noting extant literature involving twin and adoption designs. Suggestions for what might be transmitted from generation to generation (e.g., neurobiological factors, temperament) with special reference to preadolescent and adolescent girls will also be discussed.

Recent Developments in Alcoholism

Objective: To determine the effectiveness of exercise as an intervention in the management of depression. Design: Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. Main outcome measures: Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. Results: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size −1.1 (95% confidence interval −1.5 to −0.6); weighted mean difference in Beck depression inventory −7.3 (−10.0 to −4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference −0.3 (95% confidence interval −0.7 to 0.1)). Conclusions: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up. What is already known on this topic Depression is common Management is often inadequate and many patients do not comply with antidepressant medication The effect of exercise on depression has been a subject of interest for many years What this study adds Most studies of the effect of exercise on depression are of poor quality, have brief follow up, and are undertaken on non-clinical volunteers Exercise may be efficacious in reducing symptoms of depression in the short term but its effectiveness in clinical populations is unknown A well designed, randomised controlled trial with long term follow up is needed

https://www.bmj.com/content/bmj/322/7289/763.full.pdf

The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

Diagnostic and Statistical Manual of Mental Disorders, 4th ed

Neuropsychological and cognitive psychophysiological substrates of impulsive aggression

This paper examines the relationship between childhood cruelty toward animals and aggressive behavior among criminals and noncriminals in adulthood.Data were derived from personal interviews with 152 criminals and noncriminals in Kansas and Connecticut. A standardized, closed, and open-ended interview, requiring approximately 1-2 hours to complete, was administered to all subjects. Aggressiveness was defined by behavioral criteria rather than by reason for incarceration.Childhood cruelty toward animals occurred to a significantly greater degree among aggressive criminals than among nonaggressive criminals or noncriminals. Additionally, the occurrence of more than 40 cases of extreme animal crielty facilitated the development of a preliminary classification of nine distinct motivations for animal cruelty. Finally, family violence, particularly paternal abuse and alcoholism, were significantly more common among aggressive criminals with a history of childhood cruelty toward animals.

Childhood Cruelty toward Animals among Criminals and Noncriminals

Studies of the effects of phenytoin on aggression have produced equivocal results primarily because of a lack of (1) common objective criterion measures of aggressive acts across studies; (2) rigorous inclusion and exclusion criteria for selecting subjects; and (3) a nosologic basis for classifying different types of aggression. The current study was designed to remedy these deficiencies. Aggression was defined using a nosology that defines three types of aggression: (1) medically related; (2) premeditated; and (3) impulsive. The purpose of this study was to test the hypothesis that phenytoin will decrease impulsive aggressive acts but not have a significant influence on premeditated aggressive acts. Sixty inmates were divided into two groups on the basis of committing primarily impulsive aggressive acts or premeditated aggressive acts while in prison. Medical aggression was ruled-out by subject selection. The study used a double-blind, placebo-controlled, crossover design. As hypothesized, phenytoin (200 mg a.m. and 100 mg p.m.) significantly reduced impulsive aggressive acts but not premeditated aggressive acts. Event-related potentials (ERPs) measured information processing in the cortex during drug/placebo conditions. The amplitudes of P300 ERP waveforms among impulsive aggressive subjects were increased significantly during the phenytoin condition but not during the placebo condition. There were no significant changes in P300 ERP waveforms between drug/placebo conditions among nonimpulsive aggressive subjects.

The effects of phenytoin on impulsive and premeditated aggression: a controlled study

Although the rate of combined homicide-suicides is low compared with that for suicide alone or homicide, homicide-suicides generate much public concern. In some cases, the homicide-suicide involves annihilation of an entire family or multiple non-family members. A difficult phenomenon to study--in part because the perpetrator is dead--it is, nonetheless, crucial to attempt to advance our understanding of this tragic phenomenon from a psychiatric view. This literature review then addresses demographic variables; proposes two classifications, one based on psychopathology, the other on the relationship between offender and victim; and suggests a three dimensional analytical approach to understanding homicide-suicide: 1) psychopathology and ego deficits of the perpetrator, 2) cumulative and precipitating stressors, and 3) motivation and vector of destructive urges against self and the other victim(s). Finally, some implications for mental health clinicians and forensic experts are offered. In attempting to understand acts of homicide-suicide, inquiry into the following dimensions should be useful: Ego Weakness. What type of mental disorder(s), psychopathology, or personality traits may have contributed to the homicidal-suicidal behavior? Stressors. What type of acute and chronic stressors did the individual experience leading up to this act? Vectors. Whom did the individual select to kill and why? Were some victims more clearly primary and others secondary or incidental?

Combined homicide-suicides: a review.

The existing literature on the relationship between childhood cruelty to animals and later violence against people appears to be inconsistent The authors review the controlled studies that did not support this relationship and those that did and identify several methodological factors that may have contributed to the contradictory findings Studies using direct interviews to examine subjects with multiple acts of violence point to an association between a pattern of childhood animal cruelty and later serious, recurrent aggression against people Identification of such a relationship could improve understanding of impulsive violence and facilitate early intervention and prevention

Alan R. Felthous

Papers

Neuropsychological and cognitive psychophysiological substrates of impulsive aggression

Childhood Cruelty toward Animals among Criminals and Noncriminals

The effects of phenytoin on impulsive and premeditated aggression: a controlled study

Combined homicide-suicides: a review.

Childhood cruelty to animals and later aggression against people: A review