ABSTRACTS - World Psychiatric Association

SS3.
THE ASSOCIATION BETWEEN IMPULSIVITY
AND ADDICTION: CAUSES, CONSEQUENCES
AND TREATMENT IMPLICATIONS
(organized by the WPA Section on Impulsivity
and Impulse Control Disorders)
SS3.1.
DIMINISHED SELF-REGULATION AS A PREDICTOR
OF RELAPSE IN PROBLEM GAMBLING: A FOCUS
ON IMPULSIVITY AND REWARD SENSITIVITY
R.J. van Holst, A.E. Goudriaan, J. Oosterlaan, E. de Beurs, W. van
den Brink
Academic Medical Centre, Department of Psychiatry, University
of Amsterdam; Department of Clinical Neuropsychology,
Vrije Universiteit, Amsterdam, the Netherlands
Diminished self-regulation plays an important role in the definition of
pathological gambling (PG), and diminished self-regulation is of
importance for the course and treatment of related addictive disorders.
However, only few empirical studies are available regarding neurocognitive
self-regulation in PG. This study therefore compared the performance
on several self-regulation tasks, comparing a PG group
(n=48) with an alcohol dependence (AD) group (n=46), a Tourette
syndrome (TS) group (n=47), and a normal control (NC) group
(n=49). Tasks relying on dorsolateral and orbital prefrontal brain circuitry
were included, such as response inhibition (Stop Signal Task),
planning (Tower of London), cognitive flexibility (Wisconsin Card
Sorting Task), and decision making (Iowa Gambling Task). Pathological
gamblers showed diminished performance on a range of self-regulatory
functions, such as response inhibition, cognitive flexibility, planning
and decision-making. Performance was not associated with subclinical
comorbidity levels. For the larger part, diminished performance
on these self-regulatory functions was also present in the AD
group. However, the TS group only displayed a diminished response
inhibition. Neurocognitive functions in PG should be addressed in
treatment and incorporated more explicitly in theoretical models of
PG, since they can influence the course of the disorder negatively.
SS3.2.
IMPULSE CONTROL DISORDERS AS ADDICTIVE
DISORDERS
F. Vocci
National Institute on Drug Abuse, National Institutes of Health,
Bethesda, MD, USA
Although substance dependence disorders can be conceptualized as
impulse control disorders, it does not necessarily follow that impulse
control disorders are addictive disorders. The current diagnostic
scheme of impulse control disorders contains the following conditions:
intermittent explosive disorder, kleptomania, pyromania,
pathological gambling, and tricotillomania. The diagnostic criteria for
pathological gambling most closely approximate a substance dependence
disorder. Pathological gamblers express preoccupation with
gambling, use larger amounts of money to get the desired affective
response, repeatedly fail to curb their gambling, and often suffer interpersonal,
legal, and job-related consequences similar to those addicted
to substances. Individuals with kleptomania, pyromania, and trichotillomania
have some features common to substance use: i.e.,
there is tension or affective arousal prior to the act and the act often
provides gratification or relief. However, with the exception of trichotillomania,
disturbances or impairments of social, occupational or
other important areas of function are usually not reported. Intermittent
explosive disorder seems to be the least like a substance dependence
disorder.
SS3.3.
IMPULSIVITY IN ADDICTION: UNDERLYING
NEUROBIOLOGY AND EFFECT ON TREATMENT
F.G. Moeller, J.M. Schmitz, J.L. Steinberg, C. Green, K.M. Hasan,
P.A. Narayana
Department of Psychiatry and Behavioral Sciences,
and Department of Diagnostic and Interventional Radiology,
University of Texas Health Science Center at Houston, TX, USA
The purpose of this paper is to present new findings on the neurobiology
of impulsivity and associated behavioral inhibition, decisionmaking,
and delayed reward in drug addiction, and also to provide
data that these behaviors have an impact on treatment outcome. Data
are presented showing higher impulsivity, lower behavioral inhibition,
and impaired decision-making in drug dependent subjects compared
to controls. Data are also presented from diffusion tensor imaging
(DTI) as well as functional magnetic resonance imaging (fMRI)
showing that these behavioral changes in drug users are associated
with functional and structural alterations in brain function. Specifically,
cocaine dependent subjects show lower fractional anisotropy
(FA), which is evidence of subtle white matter pathology, compared
to age and gender matched non-drug using controls. These differences
in brain structure are associated with measures of behavioral
inhibition. The treatment implications of these findings are significant:
in a recent treatment study of cocaine dependent subjects, those
subjects treated with citalopram showed significant reductions in
cocaine positive urines. A post-hoc analysis showed an interaction
between medication treatment and baseline Iowa Gambling Task
(IGT) performance. Specifically, those cocaine dependent subjects
who had intact decision-making on the IGT responded well to citalopram.
However, those subjects who showed poor decision-making on
the IGT did not show a reduction in cocaine positive urines after
treatment with citalopram. These results are discussed in light of similar
brain imaging and behavioral findings in some impulse control
disorders.
SS3.4.
IMPAIRED IMPULSE CONTROL AND DECISION
MAKING IN BULGARIAN HEROIN ADDICTS
J. Vassileva, P. Petkova, S. Georgiev, E.M. Martin, V. Velinov,
M. Raycheva, R. Tersiyski, P. Marinov
University of Illinois at Chicago, IL, USA; St. Naum University
Hospital, Sofia, Bulgaria; Alexandrovska Hospital, Sofia,
Bulgaria
Neurocognitive studies of substance-dependent individuals (SDIs)
are often hampered by two significant methodological challenges:
polysubstance dependence and comorbid psychiatric conditions,
which are independently associated with neurocognitive and impulse
control impairments. In order to avoid these methodological challenges,
we tested heroin addicts in Bulgaria, where heroin addiction
is highly prevalent but polysubstance dependence is rare. The goal of
the current study was to evaluate the potential contribution of psychopathy
to manifestations of impulsivity among a group of Bulgarian
heroin addicts. We tested 78 male currently abstinent heroin
addicts, classified as psychopathic or non-psychopathic using the
Hare Psychopathy Checklist, Revised (PCL-R). The Iowa Gambling
Task and the Delayed Reward Discounting Task were used as indices
76 World Psychiatry 8:S1 - February 2009