RESUMO
BACKGROUND: Previous studies have described the association between dopamine replacement therapy in Parkinson's disease and impulse control disorders. METHODS: A case-control study was performed to establish the prevalence of four of these behaviors in Brazilian patients with Parkinson's disease on stable dopamine replacement therapy and the possible associated risk factors. We investigated 152 patients and 212 healthy controls for pathological gambling, compulsive sexual behavior and compulsive buying and eating. RESULTS: Overall, patients had more impulsive control disorders than controls (18.4% vs. 4.2%, P < 0.001). Impulse control disorders were more common in younger patients (P = 0.008) and in those taking dopamine agonist (P < 0.001) and levodopa (P = 0.02). Higher Unified Parkinson's Disease Rating Scale motor score (P = 0.03) and past smoking (P = 0.02) were also associated in the univariate analysis. Variables independently associated with impulse control disorders were history of smoking (odds ratio = 1.059 for each year of smoking, P = 0.010) and current use of pramipexole (odds ratio = 2.551 for each increase in 1 mg, P < 0.001). CONCLUSIONS: Dopaminergic stimulation and previous exposure to smoking are independently associated with impulse control disorders in a dose-dependent manner.
Assuntos
Agonistas de Dopamina/uso terapêutico , Comportamento Impulsivo/tratamento farmacológico , Comportamento Impulsivo/etiologia , Doença de Parkinson/complicações , Fumar/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/uso terapêutico , Estudos de Casos e Controles , Transtornos Disruptivos, de Controle do Impulso e da Conduta/complicações , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Índice de Gravidade de Doença , Fumar/epidemiologiaRESUMO
This article makes an initially tour of the definitions of violence, aggression and impulsiveness. Violence is a manifestation associated with various aspects of human behavior in different contexts of society and history. It can also be a clinical manifestation of a psychiatric disorder, the behavioral modality of some people with personality disorders, the expression of a somatic disorder, an action exercised by an individual under the influence of substances, as well as the expected reaction of an individual or a group to a specific trigger situation. Aggressiveness means "tendency to act or respond violently", using violent means to things or people and overcome their revulsion to do damage. After that, a brief overview of the different classifications of aggressive behaviour is made, to finish reviewing the bibliography published on the pharmacological treatment of emotional or impulsive aggression with the three main groups of drugs frequently used in clinical practice (antidepressants, mood stabilizers and antipsychotics), and a brief integration scheme is formulated.
Assuntos
Agressão , Comportamento Impulsivo/tratamento farmacológico , Antipsicóticos/uso terapêutico , Humanos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêuticoRESUMO
BACKGROUND: Disturbances in central serotonin function have been implicated in impulsive and aggressive behavior. A deletion/insertion polymorphism within the 5-HT transporter promoter gene (5-HTTLPR) is thought to be associated with disturbed impulse control, anxiety, and depression. The serotonin transporter (5-HTT) is the primary action site for selective serotonin reuptake inhibitors (SSRIs). Several studies of major depression have shown that the l allele of 5-HTTLPR is associated with better SSRI antidepressant effects than the s allele. METHODS: This study investigates the association between response of impulsivity to treatment with fluoxetine and 5-HTTLPR polymorphism in 49 personality disordered patients. Additionally, we studied TPH1, 5HT1B and 5HT2C receptor polymorphisms as predictors of response in this population. RESULTS: Results reveal that patients with the l/l genotype of 5-HTTLPR had a significantly better response to fluoxetine when compared to s allele carriers, as evaluated on the basis of total (P<0.05) and Aggression subscale (P<0.01) Overt Aggression Scale Modified-score percentage change. There were no significant associations between fluoxetine response and TPH1 (A218C) (-6525 A>G) (-5806 G>T), HTR1B (G861C) and HTR2C (G68C) genotype groups. CONCLUSION: This is the first study assessing the association between these polymorphisms and anti-impulsive response to fluoxetine in personality disorder. As the s genotype is associated with a poorer selective serotonin reuptake inhibitors response in major depression, bulimia nervosa and borderline personality disorder, it could represent a common biological background for SSRI response.
Assuntos
Agressão , Fluoxetina/uso terapêutico , Comportamento Impulsivo/genética , Transtornos da Personalidade/genética , Polimorfismo Genético/genética , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adolescente , Adulto , Idoso , Agressão/efeitos dos fármacos , Agressão/fisiologia , Alelos , Feminino , Genótipo , Humanos , Comportamento Impulsivo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/tratamento farmacológico , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
Impulsivity and aggressive behavior occur frequently in a variety of psychiatric disorders and neurological diseases. Two lines of treatment could be employed, the treatment of the disorder or disease in which these symptoms occur or the treatment of the impulsivity and aggressive behavior itself. This second approach considers that there are neurobiological similarities underlying these behaviors regardless of the 'primary' diagnoses with which they are associated. Imbalance between limbic bottom-up drives, exerted by structures like the amygdala, and prefrontal top-down control mechanisms could be the ultimate reason for an aggressive-impulsive behavior. The role of serotonin, noradrenaline and dopamine were comprehensively investigated with regards to impulsive and aggressive behavior and these neurochemical data were further integrated with the neuroanatomical model, providing the bases to the rational pharmacological approach of these behaviors.
Assuntos
Agressão/efeitos dos fármacos , Comportamento Impulsivo/tratamento farmacológico , Psicotrópicos/uso terapêutico , HumanosRESUMO
A impulsividade aumentada e o comportamento agressivo ocorrem frequentemente em uma série de transtornos psiquiátricos e de doenças neurológicas. Duas abordagens de tratamento podem ser empregadas: o tratamento do transtorno ou da doença em que esses sintomas ocorrem ou o tratamento da impulsividade e do comportamento agressivo. Este segundo enfoque considera que há similaridades neurobiológicas subjacentes independentemente dos diagnósticos "primários" a que elas estejam associadas. O desequilíbrio entre os impulsos límbicos ascendentes, exercidos por estruturas como a amígdala, e os mecanismos de controle pré-frontais descendentes poderiam ser a razão última de um comportamento agressivo-impulsivo. Os papéis da serotonina, da noradrenalina e da dopamina foram amplamente investigados com relação ao comportamento impulsivo e agressivo e esses dados neuroquímicos foram ainda integrados ao modelo neuroanatômico, fornecendo as bases para a intervenção farmacológica sobre esses comportamentos.
Impulsivity and aggressive behavior occur frequently in a variety of psychiatric disorders and neurological diseases. Two lines of treatment could be employed, the treatment of the disorder or disease in which these symptoms occur or the treatment of the impulsivity and aggressive behavior itself. This second approach considers that there are neurobiological similarities underlying these behaviors regardless of the "primary" diagnoses with which they are associated. Imbalance between limbic bottom-up drives, exerted by structures like the amygdala, and prefrontal top-down control mechanisms could be the ultimate reason for an aggressive-impulsive behavior. The role of serotonin, noradrenalin and dopamine were comprehensively investigated with regards to impulsive and aggressive behavior and these neurochemical data were further integrated with the neuroanatomical model, providing the bases to the rational pharmacological approach of these behaviors.
Assuntos
Humanos , Agressão/efeitos dos fármacos , Comportamento Impulsivo/tratamento farmacológico , Psicotrópicos/uso terapêuticoRESUMO
Prefrontal cortex (PFC) dysfunction can lead to impairment in planning and behavioral inhibition, as well as personality changes. As ascending monoaminergic brainstem systems modulate PFC functioning, it is possible that lesions in the brainstem lead to symptoms similar to prefrontal dysfunction. A 29-year-old man developed several cognitive and behavioral symptoms after neurosurgery for resection of a pilocytic astrocytoma in the pontine-mesencephalic area. A careful analysis of symptoms indicated PFC dysfunction that could be attributed to lesions in the ascending monoaminergic brainstem systems. Interestingly, the cognitive symptoms improved after treatment with methylphenidate, which is a drug that modules catecholaminergic neurotransmission, thereby supporting this hypothesis. This is a unique case of PFC dysfunction that may be related to post-operative lesion of the catecholaminergic nuclei in the brainstem.
Assuntos
Astrocitoma/cirurgia , Neoplasias do Tronco Encefálico/cirurgia , Transtornos Cognitivos/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Adolescente , Adulto , Astrocitoma/diagnóstico , Atenção/efeitos dos fármacos , Atenção/fisiologia , Neoplasias do Tronco Encefálico/diagnóstico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/tratamento farmacológico , Escolaridade , Seguimentos , Humanos , Comportamento Impulsivo/diagnóstico , Comportamento Impulsivo/tratamento farmacológico , Comportamento Impulsivo/fisiopatologia , Inibição Psicológica , Relações Interpessoais , Deficiências da Aprendizagem/diagnóstico , Deficiências da Aprendizagem/tratamento farmacológico , Deficiências da Aprendizagem/fisiopatologia , Masculino , Metilfenidato/uso terapêutico , Testes Neuropsicológicos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Resolução de Problemas/efeitos dos fármacos , Resolução de Problemas/fisiologiaRESUMO
Severe impulsiveness in the absence of apparent neurological signs has rarely been reported as a clinical presentation of multiple sclerosis (MS). An 11-year-old female developed progressive and sustained personality disturbances including disinhibition, hypersexuality, drug abuse, aggressiveness and suicide attempts, without neurological signs. She was given several unsuccessful psychopharmacological and psychotherapeutic interventions. At age 21, a diagnosis of MS was made, confirmed by imaging, laboratory and neurophysiological studies. Although unusual, MS may produce pure neurobehavioral disturbances. In the present case, widespread demyelinization produced a complex behavioral disorder, with features compatible with orbitofrontal and Klüver-Bucy syndromes.
Assuntos
Comportamento Impulsivo/psicologia , Esclerose Múltipla/psicologia , Adolescente , Adulto , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Criança , Clozapina/uso terapêutico , Feminino , Homicídio/psicologia , Humanos , Comportamento Impulsivo/tratamento farmacológico , Comportamento Impulsivo/etiologia , Imageamento por Ressonância Magnética , Masturbação , Esclerose Múltipla/patologia , Personalidade , Psicotrópicos/uso terapêutico , Trabalho Sexual , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio/psicologia , Ácido Valproico/uso terapêuticoRESUMO
Se estudia un paciente esquizofrénico con conducta agresiva. En él se evalúan, doble ciego, cuatro esquemas terapéuticos utilizado trifuoperazina, carbamazepina, biperideno y placebo. Los resultados se aprecian en función de criterios experimentales y terapéuticos. Se utilizan la escala Breve de evaluación Psiquiátrica, la de Impresión Clínica Global y la de Agresividad. Se considera la agresividad como variables independientes en un diseño experimental de caso único. El control de la conducta agresiva se observa cuando la trifluoperazina es administrada sola. Se evidenciaron diferencias estadísticamente significativas en relación con los esquemas terapéuticos