Background: Impulse control behaviours are repetitive and excessive activities that may be subsyndromal and not fulfil the criteria for impulse control disorder. These activities have potential to negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence of impulse control behaviours and its associated features in Parkinson’s disease in our population. Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV. Eighty patients were enrolled and screened for impulse control behaviours using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse control behaviours among our cohort was 11.3%; the features significantly associated with it were higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage (p= 0.01). The commonest impulse control behaviour in our cohort was compulsive medication use (7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%). Conclusions: There is an association between impulse control behaviour and higher levodopa dosage in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of pathological gambling as compared to studies performed in the West.
Disruptive, Impulse Control, and Conduct Disorders ; Parkinson Disease

BACKGROUND AND PURPOSE: The aim of this study was to determine the changes in diffusion-tensor images associated with medication-related impulse control disorder (ICD) in Parkinson's disease (PD) patients undergoing chronic dopamine-replacement therapy. METHODS: Nineteen PD patients, comprising 10 with ICD (PD-ICD) and 9 without ICD (PD-nonICD), and 18 age-matched healthy controls (HCs) with no cognitive or other psychiatric disorders were analyzed. All subjects underwent 3-T magnetic resonance diffusion-tensor imaging. For all PD patients, clinical data on PD duration, antiparkinsonian medication dosages, Unified Parkinson's Disease Rating Scale and Mini-Mental State Examination were collected. Whole-brain voxel-based measures of fractional anisotropy (FA) and mean diffusivity (MD) were analyzed. RESULTS: In comparison with HCs, the PD-nonICD subjects had low FA at the bilateral orbitofrontal areas. While the PD-ICD subjects exhibited no such difference, their FA was significantly elevated at the anterior corpus callosum. Analysis of FA between the two PD groups revealed that FA in the anterior corpus callosum, right internal capsule posterior limbs, right posterior cingulum, and right thalamic radiations were significantly higher (corrected p<0.05) in the PD-ICD than in the PD-nonICD patients. MD did not differ between the PD-ICD and PD-nonICD groups in any brain regions. CONCLUSIONS: The PD-ICD patients appear to have relatively preserved white-matter integrity in the regions involved in reward-related behaviors compared to PD-nonICD patients. Further investigation is required to determine whether the difference in FA between PD-ICD and PD-nonICD patients reflects microstructural differences in the pathological progression of PD or is secondary to ICD.
Anisotropy ; Brain ; Corpus Callosum ; Extremities ; Humans ; Disruptive, Impulse Control, and Conduct Disorders* ; Internal Capsule ; Parkinson Disease

Kleptomania is a well-known impulse-control disorder. Although it is a rare disease, it exerts a greater influence on the social and economic. There are a variety of treatments for kleptomania, however case reports of its specific treatment techniques are extremely rare. In this case, covert sensitization was applied to a 44-year-old hospitalized patient with kleptomania, which can facilitate a specific treatment method through case presentation.
Adult ; Cognitive Therapy ; Humans ; Disruptive, Impulse Control, and Conduct Disorders* ; Rare Diseases

OBJECTIVES: Kleptomania is a disabling disorder, which results in intense personal shame, as well as familial, social, and legal problems. Despite its serious results, kleptomania remains poorly understood by the general public, clinicians, and the patients themselves. This study aimed to review the clinical characteristics, comorbidity, neurobiology, and treatment options of patients with kleptomania. METHODS: Domestic and international databases were searched using the keywords of "kleptomania" and "shoplifting". The search included articles published until May, 2010. RESULTS: The searches identified 252 articles. After excluding those which were overlapping in content or outside the scope of this study, a total of 65 articles remained for inclusion in this review. In general, the onset of kleptomania occurs in late adolescence or early adulthood, and the disorder is more common among women. Lifetime psychiatric comorbidity is frequent. Patients with kleptomania experience a significant decline in social and occupational functioning. Evidence suggests that kleptomania responds well to both pharmacological and psychosocial interventions. CONCLUSION: There is a need for mental health professionals to recognize and treat patients with kleptomania. More research into the etiology and treatment of this disorder, including studies involving double-blind, placebo-controlled trials, is required.
Adolescent ; Comorbidity ; Female ; Humans ; Disruptive, Impulse Control, and Conduct Disorders ; Mental Health ; Neurobiology ; Shame

OBJECTIVE: Impulse control disorders (ICDs) in Parkinson's disease (PD) are mostly related to dopamine replacement therapy (DRT); however, drug-naïve PD patients have also frequently experienced impulsivity. This phenomenon makes clinicians hesitate treating patients with DRT. In this study, we assessed the effect of impulsivity on quality of life (QOL) in drug-naïve PD patients. METHODS: Two hundred three newly diagnosed, nonmedicated PD patients were enrolled, and they received structured clinical interviews, physical examinations and validated questionnaires to evaluate motor and nonmotor symptoms and QOL. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). RESULTS: Thirty-eight patients (18.7%) had impulsivity with QUIP-RS scores ≥ 1 and 4 patients (2.0%) were diagnosed with combined ICDs. Motor and nonmotor symptoms were significantly correlated with the Parkinson's Disease Questionnaire-39 summary index. Female sex and QUIP-RS scores were also correlated with QOL in drug-naïve PD patients. CONCLUSION: The results of the present study showed that impulsivity negatively influences QOL in early drug-naïve PD patients. In addition, more severe motor and nonmotor symptoms were also associated with lower QOL. Such findings complicate treatment but provide valuable information for managing early PD.
Disruptive, Impulse Control, and Conduct Disorders ; Dopamine ; Female ; Humans ; Impulsive Behavior ; Parkinson Disease ; Physical Examination ; Quality of Life

OBJECT: This study was devised to examine the demographic characteristics, psychopathology and associated psychiatric disorder of the Kleptomania offenders. METHODS: Kleptomania offenders who was referred to the National Forensic Psychiatric Hospital was concerned. RESULTS: Most of the Kleptomania offenders were women(92.6%, N=25) and lived alone(71.4%, N=20). In their first stealing, 25(92.6%) reported stressful situation just before stealing behavior but at admission 14(51.9%) is reported. Kleptomania experienced physical and sexual abuse during childhood; 9(33.3%) in case of physical abuse and 12(44.4%) in case of sexual abuse. At admission, Most of them complains of depressive mood(88.9%, N=24) and anxiety(88.9%, M=24), and any disorders like delusion was rare(7.4%, M=2). Most of Kleptomania offenders were comorbid psychiatric disorder; mood disorder(48.1%, N=13), personality disorder(40.7%, N=11), psychotic disorder(25.9%, N=7), anxiety disorder(14.8%, N=4) and alcohol dependence(14.8%, N=4). 24(88.9%) responded to the psychiatric treatment and 16(59.2%) of them had good prognosis. CONCLUSION: Most of Kleptomania offenders were single women and were abused physically or sexually during childhood. They had comorbid psychiatric disorder that responded to the psychiatric treatment and had good prognosis.
Anxiety ; Criminals* ; Delusions ; Female ; Hospitals, Psychiatric ; Humans ; Disruptive, Impulse Control, and Conduct Disorders* ; Prognosis ; Psychopathology* ; Sex Offenses ; Theft

Impulse control disorders including hypersexuality occur occasionally in Parkinson's disease, especially when treated with dopamine agonist. A 62-year-old male with Parkinson's disease was initially treated with rasagiline monotherapy and presented hypersexuality. After 8 weeks of discontinuation of the drug, his hypersexual behavior was significantly improved. To our knowledge, this is the first reported Asian case of a hypersexuality caused by rasagiline. Our observation emphasizes that patients and caregivers need to be educated on the possibility of hypersexuality resulting from rasagiline.
Asian Continental Ancestry Group ; Caregivers ; Disruptive, Impulse Control, and Conduct Disorders ; Dopamine Agonists ; Humans ; Male ; Middle Aged ; Parkinson Disease*

The authors reviewed the medical records and additional data of 460 mentally ill criminals who had referred to National Forensic Psychiatric Hospital, from January 1990 to December 1990 (60 cases) and from January 2000 and December 2000 (394 cases). The demographic factors, characteristics of crime, psychiatric diagnoses and psychiatric opinions and legal opinions , and legal opinions were analyzed and the results are as follows. 1) The frequency of crimes by female, high education level and single status increased. 2) As to the psychiatric diagnosis, schizophrenia decreased whereas substance- use disorder, mood disorder and personality disorder were increased and kleptomania and anxiety disorder were added. 3) As to the types and feature of crime, homicide and violence increased, whereas arson decreased and larcency, violation of harzadous substance and violation of narcotic drug were added. 4) As to victims of crime, the frequency of crimes committed to strangers increased whereas that of the family members and their lelatives were decreased. 5) As to motivation of crime, the frequency of impulsivity increased but psychotic symptoms such as delusion and hallucination significantly decreased. 6) More that half of psychiatric tests were referred from the court, but the agreement rate between the judge 's opinions and psychiatric opinions was decreased. In Conclusion, the changes of charateristics of mentally ill criminal were attributed to sociocultural changes for mentally ill criminals and implimeted in Social Protection Law. As the judges do not completely agree to the psychiatric opinions, the close cooperation between the judges and the psychiatrist as legal adviser should be necessory for mentally ill criminals.
Anxiety Disorders ; Crime ; Criminals* ; Delusions ; Demography ; Diagnosis ; Education ; Female ; Firesetting Behavior ; Hallucinations ; Homicide ; Hospitals, Psychiatric ; Humans ; Disruptive, Impulse Control, and Conduct Disorders ; Impulsive Behavior ; Jurisprudence ; Medical Records ; Mental Disorders ; Mentally Ill Persons* ; Mood Disorders ; Motivation ; Personality Disorders ; Psychiatry ; Public Policy ; Schizophrenia ; Violence

Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 2010 at the Institute of Mental Health, Singapore, we found three patients who were diagnosed with kleptomania. In this report, we describe the pertinent clinical and sociodemographic characteristics, as well as the diagnostic issues of kleptomania in relation to the three cases.
Alcoholism ; complications ; China ; ethnology ; Comorbidity ; Crime ; Depressive Disorder ; complications ; Disruptive, Impulse Control, and Conduct Disorders ; complications ; diagnosis ; psychology ; Female ; Forensic Psychiatry ; Humans ; India ; ethnology ; Male ; Middle Aged ; Retrospective Studies ; Singapore

The current study evaluated DSM-IV psychiatric diagnoses and investigated the psychological characteristics of sexual offenders by using the Hypersexual Behavior Inventory(HBI), Sexual Addiction Screening Test (SAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Fifty male sexual offenders and 36 male healthy controls completed the psychiatric diagnosis and 30 of the 50 male sexual offenders completed the psychological tests listed above. Thirty-two of the 50 sexual offenders were patients with paraphilias, these sexual offenders had been admitted by the Ministry of Justice to the Institute for Forensic Psychiatry in Gongjui-si due to sexual violence. Participants displayed high lifetime rates of psychiatric disorders: 32 (64%) had paraphilias, 16 (32%) had depressive disorders, 10 (20%) had anxiety disorders, 9 (18%) had impulse control disorders, 6 (12%) had schizophrenia, 2 (4%) had bipolar disorders, and 16 (32%) had personality disorders or some other Axis II disorder. Scores for the sexual offenders were significantly higher both on the HBI and the SAST than the comparison group. Scores for the sexual offenders were also higher for the BDI and the BAI as compared to the control group, but this difference was not statistically significant. Results indicate that sexual offenders may have sexual addictions and be hypersexual. In addition to depressive and anxious psychopathologies, they also seem to have sexual psychopathologies. These results suggested that the psychopathology of sexual offenders may be different than that of a control group.
Anxiety ; Anxiety Disorders ; Axis, Cervical Vertebra ; Bipolar Disorder ; Criminals ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Forensic Psychiatry ; Humans ; Disruptive, Impulse Control, and Conduct Disorders ; Male ; Mass Screening ; Mental Disorders ; Paraphilic Disorders ; Personality Disorders ; Psychological Tests ; Psychopathology ; Schizophrenia ; Sex Offenses ; Social Justice