Pharmacotherapy of impulse control disorders: A systematic review.

There are currently no evidence-based treatment recommendations for impulse control disorders, which include intermittent explosive disorder (IED), kleptomania and pyromania. Therefore, this systematic review sought to identify all randomized controlled trials (RCTs) that investigated pharmacological treatments for impulse control disorders, to evaluate their efficacy and tolerability. Searches were conducted within MEDLINE, PsychINFO, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Eight studies were included, six investigated pharmacotherapies for IED, while two investigated management for kleptomania. For the treatment of IED, oxcarbazepine and fluoxetine were the most efficacious. Importantly, divalproex was not superior to placebo in decreasing IED symptoms and was associated with significant adverse effects. In the treatment of kleptomania, only naltrexone was effective. The existing data suggest that the pharmacological treatment for impulse control disorders is an understudied area of psychiatry. Much of the current research on impulse control disorders focuses on management with anticonvulsants and antidepressants. Further studies conducted on these interventions in this population may yield promising results.

Comparing GBMI and non-GBMI Female Prisoners in Michigan.

The guilty but mentally ill (GBMI) verdict was first adopted in Michigan in part to provide treatment for offenders suffering from mental illness. Currently, little is known of its impact among women prisoners. Therefore, the primary aim of this study was to explore if GBMI women (n = 30) spent more time on acute and residential treatment program (RTP) units in prison and/or had a higher number of violence tickets, compared with matched guilty mentally ill prisoners (non-GBMI, n = 30). The secondary aim was to characterize Axis I and Axis II disorders in GBMI female prisoners. Finally, we analyzed the data to find which Axis I and II disorders, if any, were significantly associated with violence tickets in the first year of incarceration and time in acute and RTP settings. Results showed there were no significant differences in time on acute units or the number of violence tickets between groups. Across both groups, those diagnosed with Borderline Personality Disorder had a higher number of violence tickets in the first year of prison (p < .001). The results supported the arbitrariness of the GBMI verdict in the female population and advocated for Dialectical Behavioural Therapy (DBT) programs in prisons.